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