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113 Cards in this Set

  • Front
  • Back
What are some identifiable causes of hypertension
Chronic kidney disease, sleep apnea, drug induced, primary aldosteronism, renovascular disease, chronic steroid therapy and cushing's syndrome, tumor (pheochromocytoma), coarctation of the aorta, thyroid or parathyroid disease
What are some culprits of drug-induced hypertension
Oral contraceptives, NSAIDS, sympathomimetics, corticosteriods, FK506, erythropoietin, cyclosporine, cocaine, amphetamines, sympathomimetics, nicotine, alcohol
Risk factors for hypertension
smoking, obesity, inactivity, dyslipidemia, diabetes, microalbuminuria, age (>55 for men, >65 for women), family history
3 main things hypertensive patients die from
stroke, cardiovascular events, kidney failure
target BP for general patients
<140/90
target BP for patients with HTN, DM, or renal disease
<130/80
What organs are targeted by prolonged hypertension?
Eye (retinal hemorrhages & infarcts), brain (cerebral infarcts or encephalopathy), heart (MI, CHF), Kidneys (failure)
What should be used as a starting medication for HTN?
A thiazide diuretic unless preexisting contraindication.
When should pharmacologic methods be stated on a patient with HTN?
after 1-2 months with no changes with lifestyle modification
What are the 4 classes of diuretics?
loop, potassium sparing, aldosterone receptor antagonists, thiazide
Name 3 loop diuretics?
The ide's: Bumetanide (Bumex), Furosemide (Lasix), Torsemide (Demadex)
Name 2 potassium sparing diuretics
Amiloride (Midamor), Triamterene (Dyrenium)
How are potassium sparing diuretics given?
In combo with thiazides to minimize hypokalemia
Name 2 aldosterone receptor antagonists
The one's: Eplerenone (Inspra), Spironolactone (Aldactone)
List some thiazide diuretics
Chlorothiazide (Diuril), Chlorthalidone, Hydrochlorothiazide (HydroDiuril), polythiazide (Renese), Indapamide (Lozol), Metolazone (Mykrox or Zaroxolyn)
MOA of thiazide diuretics
Inhibit Na and water resorption from renal tubules to decreasing circulating volume (decreasing volume therefore decreasing BP)
What are some side effects of diuretics?
ELECTROLYTE IMBALANCE, photosensitivity, ototoxicity with high doses, increased insulin resistance (HCTZ), hyperuricemia causing gout
What are some drug interactions with diuretics?
Lithium, aminoglycosides, NSAIDS
Important monitoring facts for diuretics
caution with renal dysfunction, give in AM to avoid nocturnal diuresis, thiazides are more effective than loops for antiHTN (except in severely decreased creatinine clearance), HCTZ preferred
What drug is an absolute contraindication with renal failure and diabetic microalbuminemia?
Eplerenone (Inspra)
Why should spironolactone be avoided in patients with kidney failure?
May cause hyperkalemia
List some ACE inhibitors
prils: brands include Lotensin, Capoten, Vasotec, Monopril, Prinivil or Zestril, univasc, aceon, accupril, altace, mavik
What is the MOA of ace inhibitors?
prevents conversion of angiotensin I to angiotensin II (which prevents vasoconstriction), increases renin and decreases aldosterone production (which decreases intravascular volume), increases adrenergic outflow from CNA, increases breakdown of vasoactive kallikreins
When should ACE inhibitors not be used?
Renal dysfunction, pregnancy, or renal artery stenosis
What are some side effects of ACE inhibitors?
COUGH, angioedema, rash, hyperkalemia, ha, dizziness
What are some drug interactions with ACE inhibitors?
KCL, NSAIDS, K-sparing diuretics, Lithium
What should be monitored when taking ACE inhibitors?
SCr, K, BP
List some other benefits of ACE inhibitors
nephroprotection, prevents remodeling post-MI and decreases mortality in patients with CHF
List some Angiotensin II receptor blockers
(sartan's) brands: Atacand, Teveten, avapro, cozaar, benicar, micardis, diovan
What is the mechanism of action of ARBS?
Inhibit binding on Angiotensin II to receptors causing less vasoconstriction and less aldosterone production
What are some SE's of ARB's?
Hyperkalemia, angioedema, cough (but less than with ACE) SIMILAR SE'S WITH ACE
What are some drug interactions with ARBs?
NSAIDS, KCL, K-sparing diuretics, lithium
What should be monitored when using ARBs?
SCr, K, and BP
When should ARBs be avoided?
pregnancy, renal insufficiency, renal artery stenosis
List some beta blockers
the olol's, brands: TERNORMIN, kerlone, zebeta, lopressor, corgard, INDERAL, blocarden
Which BB is nonselective (blocking both B1 and B2)?
Propanolol (inderal)
List some BB's with intrinsic sympathomimetic activity (a surge of norepinephrine with stimulates the heart)
sectal, levatol, pindolol
Which BB's have combined alpha?
Coreg, Normodyne or Trandate
MOA of BB's
decreases CO by locking B 1 stimulation of the heart
When should BB's not be used?
in asthmatics, DM, AV conduction abnormalities, inadequate heart function
What are some SE of BB's?
BRADYCARDIA, MASKED HYPOGLYCEMIA, BRONCHOSPASM, depression, constipation, Raynaud's phenomenon
List some adverse effects of BB's
abrupt discontinuation may cause rebound hypertension (must wean), BB mixed with alpha blockers may cause orthostatic hypotension
When are BB's with intrinsic sympathomimetic activity beneficial?
In patients with bradycardia
List some alpha 1 blockers
(sin's) Cardura, Minipress, Hytrin
MOA of Alpha 1 blockers
block alpha 1 adrenergic receptors to cause vasodilation and decrease peripheral vascular reisistance
SE's of Alpha 1 blockers
fatigue, sexual dysfunction, polyuria, dyspnea, orthostatic hypotension
List 2 warning for alpha 1 blockers
first dose should be given at bedtime, rise slowly to avoid orthostatic hypotension
what additional benefits does an alpha 1 blocker provide?
men with BPH
List direct arterial vasodilators
Hydralazine (apresoline) and minoxidil (loniten)
List a side effect of minoxidil (loniten)
Hair growth
MOA of DAV's
Direct arteriolar smooth muscle relaxation (cause little to no venous vasodilation)
What are some SE's of hydralazine?
lupus like syndrome, dermatitis, drug fever, peripheral neuropathy
When in hydralazine used in combination therapy?
With nitrate to treat heart failure
What is the difference between Hydralazine and Minoxidil
Minoxidil is a more potent vasodilator than hydralazine, causing a compensatory increase in HR, CO, renin release and water retenion (which may exacerbate heart failure)
List some centra alpha 2 agonists
Clonidine (catapres), Methyldopa (aldomet)
When is Methyldopa preferred over clonidine?
in the hypertensive pregnant patient
MOA of central alpha 2 agonists
stimulates central alpha 2 receptors to increase sympathetic outflow, decreases vasomotor tone and heart rate
When should central alpha 2 agonists be avoided
in cerebral vascular disease
SE's of CA2A
dizziness, xerostomia, bradycardia, ha, loss of libido, and syncope
When is CA2A most effective?
when used with a diuretic to diminish fluid retention
2 take home facts about CA2A
abrupt d/c may cause rebound hypertension, clonidine patch is replaced once per week
DI's with CA2A
TCA, CNS depressants, cyclosporine, FK506
What should be monitored when taking CA2A
BP, HR, mental status
List some Calcium channel blockers (non dihydrophyridines)
Diltiazem (tiazac, dilacor, or cardizem), verapamil (calan, isoptin, covera, verelan)
List some Calcium channel blockers (dihydropyridines)
(pine's) amiodipine (norvasc), felodipine (plendil), isradipine (dynacirc), nicardipine (cardene), nifedipine (aldat or procardia both removed from the market), nisoldipine (sular)
MOA of CCB's
block calcium influx in myocardial cells to decrease AV conduction and heart rate, causes coronary and peripheral vasodilation
When are CCB's contraindicated
3rd degree heart block, pulmonary congestion
SE's of CCB's
Bradycardia, heart block, pedal edema, arrhythmias, gingival hyperplasia
What is the difference b/t dihydrophyridines and non dihydropyridines in terms of peripheral vasodilation?
dihydropyridines are more potent peripheral vasodilators than non dihydropyridines
why is nifedipine no longer on the market?
it causes a baroreceptor reflex tachcardia b/c of their potent peripheral vasodialting effects (not good for supraventricular tacharrhythmias)
How do nondihydropyridines affect supraventricular tachyarrhythmias?
they decrease HR and slow AV nodal conduction (good for supraventricular tachyarrhythmias)
List some parenteral drugs for treatment of hypertensive emergencies
nitroprusside, nicardipine, fenoldopam, nitroglycerin, enalaprilat, hydralazine, diazoxide, labetolol, esmolol, phentolamine
S/E's of nitroprusside (nipride)
n/v, muscle twitching, sweating, thiocyanate and cyanide intoxication
When should you be cautious using cardene?
acute heart failure, coronary ischemia
when should you be cautious using nipride?
with high intracranial pressure or azotemia
what are the S/E's of nicardipine (cardene)
tachycardia, ha, flushing, local phlebitis
S/E's of fenolodopam (corlopam)
tachycardia, ha, nausea, flushing
when should you be cautious using corlopam
glaucoma
S/E's of nitroglycerin (Tridil)
ha, vomiting, methemoglobinemia, tolerance with prolonged use
when should you be cautious using tridil?
coronary ischemia
S/E's of Enalaprilat (Vasotec)
precipitious fall in pressure in high renin states
When should you be cautious using vasotec?
acute left ventricular failure, MI
S/E of hydralazine (apresoline)
tachycardia, flushing, ha, vomiting, aggravation of angina
When should you be cautious using apresoline?
eclampsia
S/E's of diazoxide
nausea, flushing, tachycardia, chest pain
special indications of diazoxide
now obsolete, when no intesive monitoring is available
S/e's of Labetalol (normodyne)
vomiting, scalp tingling, burning in throat, nausea, heart block, orthostatic hypotension
when should you be cautious using normodyne?
actue heart failure
S/e's of esmolol (brevibloc)
hypotension, nausea
when should you be cautious using brevibloc?
aortic dissection perioperative
s/e's of phentolamine (regitine)
tachycardia, flushing, ha
when should you be cautious using regitine?
catecholamine excess
What is the drug of choice for pregnancy
Methyldopa
what drug class is contraindicated for pregnancy
ACE inhibitors (acute renal failure)
s/s of preeclampsia
increase in bp, proteinuria, edema
which drugs are preferred in the elderly if isolated SBP
diuretics
what is the dose adjustment of hypertensive drugs for the elderly
1/2 dose used in younger patients
which 2 drugs have high response rates in african americans?
diuretics and CCB's
what is the BP goal for a diabetic patient
<130/80
how can BB's affect a diabetic patient
they can mask hypoglycemia (except sweating)
what 2 drug classes offer renal protection in diabetic patients?
ACE inhibitors and ARBs (esp in type 2)
what 2 types of drug classes should be avoided in hyperlipidemia
BB's and diuretics (they increase lipids)
how do alpha adrenergic antagonists affect cholesterol?
decrease LDL and increase HDL
what is the j-curve phenomenon?
patients with ischemic heart disease are more at risk of events in BSP lowered to less than 85
what is the drug class of choice for coronary artery disease?
BB's
which drug can exacerbate asthma?
BB's
what 2 drugs classes are safe in patients with asthma
ACE and ARB
which drug class can increase uric acid levels in gout?
diuretics
what are some important facts to remember during hypertensive emergency
BP sould be reduced in 3 hrs, reduce mean arterial bp by no more than 25% in first 2 hrs then 160/100 in 2-6 hrs, avoid excessive falls in bp, SL NIFEDIPINE IS UNACCEPTABLE
what are some causes of resistant hypertension
improper BP management, volume overload and pseudotolerance, drug-induced, inappropriate use of bp meds/noncompliance, obesity, etoh
what is the risk for developing hypertension in a normotensive pt at 55
90% risk
what SBP and DSP levels are considered pre-hypertensive?
SBP 120-139, DBP 80-89
2 or more drugs are needed to control HTN and HTN with diabetes and chronic kidney disease. what are the goal levels with this therapy?
HTN <140/90, HTN with diabetes or kidney disease < 130/80