Pharm Test Ii

Front 1

prevalence of htn is ____ million people in US
____% of pts are aware that they have the disease
____% are treated
____-___% are controlled

Back 1

70; 80; 70; 50; 60

Front 2

htn is termed the "_____ _____" as most pts are asymptomatic

Back 2

silent killer

Front 3

sequelae of htn

Back 3

end organ damage (kidneys etc), MI, stroke, sudden death

Front 4

advantages to at home or self-measured BP

Back 4

indentifies "White-coat htn"
assesses response to meds
improves adherence to tx
potentially reduces cost

Front 5

follow up recommendations based on initial BP measurements
<120 <80 recheck ___ years
120-139 80-89 _____ changes
140-159 90-99 start ___ med
>160 >100 start ___ meds

Back 5

2; lifestyle; one; two

Front 6

evaluation components of htn pt

Back 6

medical hx; physical exam; routine labs (renal fxn, electrolyte levels); optional tests (plasma renin activite 24 hour urnine for catacholemines)

Front 7

examples of indentifiable causes of htn

Back 7

renovascular dz, renal parenchymal dz, polycystic kidney, aortic coarctation, pheo, primary aldosteronism, cushing sydrome, hyperparathyroidism, exogenous causes (smoking, coke, meth, stress

Front 8

cardiovascular risk in pts with htn

Back 8

smoking, dyslipidemia, DM, age > 60, men, post-meno. women, fmhx, obesity

Front 9

blood pressure determinants

BP is effected by ___ and ___
CO is effected by ___ and ___
SV is effected by ___ and ___

Back 9

cardiac output and systemic vascular resistance
heart rate adn stroke volume
contractilit and volume

Front 10

algorithum for tx htn
1. ____ changes
2. use of 2 drugs such as _____, _____, _____, _____, ____

Back 10

lifestyle
diuretics, B-blockers, ace, arb, CCB

Front 11

with initial drug choice there was no response or troublesome side effects you ______ another drug from a ____ class

Back 11

sustitute; different

Front 12

if there was an inadequate repsonse, but well tolerated you add _____ agent from _____ class

Back 12

second; different

Front 13

if htn still not controlled you continue ____ agents from ____ classes and consider _____ (if failing ___ meds)

Back 13

adding; different; referral; three

Front 14

MOA of diuretics

Back 14

reduce volume
prevent Na reabsorption

Front 15

areas where diuretics work

Back 15

proximal tubule, loop of henle, distal tubule

Front 16

meds that work in proximal tubule

Back 16

carbonic anhydrase inhibitors

Front 17

examples of carbonic anhydrase inhibitors are

Back 17

acetazolamide (oral, IV)(glaucoma, altitude sickness)
dorzolamide (Trusopt) (ophtatlmic soln)

Front 18

carbonic anhydrase inhibitors are ______ diuretics

Back 18

weak

Front 19

acetazolamide is excreted ____

Back 19

renally

Front 20

clinical uses for acetazolamide

Back 20

glaucoma; urinary alkalinization, metabolic acidosis, altitude sickness

Front 21

caution use of acetazolamide in pts with _____ allergy (anaphylaxis)

Back 21

sulfa

Front 22

group of diuretics that work in the loop of henle

Back 22

loop diuretics

Front 23

loop diuretics MOA

Back 23

inhibit Na reabsorption in LOH and some in proximal tubule

Front 24

loop diuretics are well and ______ absorbed

Back 24

rapidly

Front 25

examples of loop diuretics

Back 25

Furosemide (Lasix)
Ethacrynic acid (Edecrin)
Bumetanide (Bumex)
Toresemide (Demedex)

Front 26

all loop diuretics are sulfa based except

Back 26

Ethancrynic acid (Edecrin)

Front 27

adverse effects of loop diuretics

Back 27

hypovolemia, metabolic acidosis, hypomagnesemia,
hypokalemia, hypocalcemia, ototoxicity, hyperuricemia

Front 28

clincal uses of loop diuretics

Back 28

acute pulmonary edema
hypercalcemia (bone malign)
maintenance in CHF

Front 29

tx of htn with loop diuretics only if they have

Back 29

acute pulmonary edema
hypercalcemia
CHF

Front 30

Thiazides are _____ than loop diuretics

Back 30

weaker

Front 31

MOA of thiazide diuretics

require normal _____ fxn to be effective

Back 31

block Na reabsorption in distal tube

renal

Front 32

adverse effect of thiazides

Back 32

hypokalemia, hypomagnesemia, HYPERcalcemia, hypertriglyceridemia, hyperglycemia, hyperuicemia

Front 33

examples of thiazides

Back 33

HCTZ, chlorthalidone (Hygroton), chlorothiazide (Diuril){injectable}, methyclohiazide (enduron), Indapamide (Lozol), metolazone (Zaroxolyn)

Front 34

Max dose for thiazides is

if dose is >50mg/d efficacy is ____ increased, but ___ are

Back 34

25mg q d

not; SE

Front 35

clinical uses of thiazides

Back 35

hypertension; CHF in combo with loop; nephrolithiasis

Front 36

examples of K+ sparing diuretics

Back 36

spironolactone (Aldactone)
triamterene
amiloride

Front 37

Aldactone is a _____ antangonsit of ______

Back 37

competative; aldosterone

Front 38

Amiloride decreases activity of ___-___ antiport

Back 38

Na-H

Front 39

K+ sparing diuretics decrease the loss of ____

Back 39

K+

Front 40

adverse effects of PSD

Back 40

HYPERkalemia
metabolic acidosis
antiandrogenic effects (esp. renal dysfxn_)

Front 41

only osmotic diuretic used in US

it's used in the reduction of ______ and ______ pressure

Back 41

mannitol

intraocular adn intracranial

Front 42

osmotic diuretics work in the

Back 42

proximal tubule

Front 43

examples of combo diuretics
(thiazides and PSD)

Back 43

triamterene (Diazide, Maxzide)
spironolactone (Aldactizide)

Front 44

diuretics work well in ____ groups of pts

they are ______ ($)

Back 44

all; cheap

Front 45

problems with diuretics

Back 45

limitied dosing; fluid/elect. imbalance, decreased glucose control, hypertriglyceridemia (thiazides only)

Front 46

BB reduce BP by have an negative ______ and _____ effect

Back 46

chronotropy; inotropy

Front 47

examples of BB

Back 47

propranolol(Inderal)
atenolol(Tenormin)
Metroprolol(Lopressor)

Front 48

problems with BB

Back 48

asthma
DM
CHF (- chronotropic)

Front 49

angiotensinogen is converted into angiotensin I by

Back 49

Renin (kidney)
(has no other physiological effect)

Front 50

angiotensin I is coverted into angiotensin II (involved in vasoconstriction, cardiac fxn, inotropy) by

which then leads to ______ and release of _______ which then loops back to ______

Back 50

ACE; vasoconstriction; aldosterone; renin

Front 51

ACE inhibitors are an effective _____ line therapy; has less effect in ______

Back 51

first; black

Front 52

problems with ACEs are

Back 52

cough; renal dysfxn (limited decreased glomerulo filtration); HYPERkalemia

Front 53

examples of ACES

Back 53

captopril (Capoten) [only ACE dosed BID for htn)
Enalapril (Vasotec), Lisinopril (Prinivil)[dual elimination], Benazepril (Lotensin), Quinapril (Acupril), Ramipril (Altace), Fosinopril (Monopril), Trandolapril (Mavik)

Front 54

ARBS (angiotensin II blockers)

similar to ACES except no _____

Back 54

cough

Front 55

examples of ARBS

Back 55

Losartan (Cozaar), Valsartan (diovan), Irbesartan (Avapro), Candesartain (Atacand), Telminsartan (Micardis), Olmesartan (Benicar)

Front 56

Direct Renin Inhibitors inhibit ______ production, decreaes ______, improves _____ suppression

Back 56

renin; PRA; RAS

Front 57

example of direct renin inhibitor

Back 57

ALiskiren

Front 58

alpha-1 antagonists work on _________, are a good _____ line agent, beneficial to persons with ________

Back 58

vasodilation; second; hyperlipidemia

Front 59

problems with alpha-1 antangonists

Back 59

first dose hypotension, syncope, relfex tachycardia

Front 60

examples of alpha 1 blockers

Back 60

prazosin (Minipress)
terazosin (Hytrin)
doxazosin (Cardura)

Front 61

Alpha-Beta blockers, at higher doses alpha blocking effects ___________, use same precautions as _______

Back 61

dominate; BB

Front 62

examples of ABB

Back 62

Labetolol (Trandate)

Front 63

Alpha 2 agonist are an effective ________ line therapy

Back 63

second

Front 64

Problems with A2A are

Back 64

depression, sedation, sexual dysfxn, rebound effects with abrupt discontinuation

Front 65

examples of A2A

Back 65

clonidine (Catapress) (po IV, topical)
methyldopa (Aldomet) (PO, IV)[only one safe in pregnancy]

Front 66

examples of direct vasodilators
dilates __________ and _________ as well

Back 66

hydralazine (Apresoline)
Minoxidil (PO only)
arterioles; veniole

Front 67

direct vasodilators are used as _______ or ________ line

Back 67

3rd or 4th

Front 68

Problems with vasodilators

Back 68

water retention (LLE)
reflex tachy

Front 69

examples of CCB

Back 69

Verapamil (Calan)
Diltiazem (Cardizem)
Dihydropyridines

Front 70

CCB work in ______ channels in _______ muscle and have a negative ________ effect

Back 70

calcium; cardiac; ionotropic

Front 71

verapamil and diltiazem are not commonly used in htn unless ________

Back 71

other cardiac problems exist

Front 72

SE CCB

Back 72

constipation

Front 73

dihydropyridines are ___ and ___ acting. _______ acting prep work well in htn

Back 73

long; short; long

Front 74

problems with dihydropyridines are

Back 74

relfex tachy
peripheral edema

Front 75

examples of dihydropyridines are

Back 75

nifedipine (procardia, adalat) (sutained release)
felodipine (Plendyl)
Nicardipine (Cardene)
Isradipine (Dyancirc)
Amlodipine (Norvasc)
Nisoldipine (Sular)

Front 76

examples of combo therapies

Back 76

BB and Diur (tenoretic)
ACE diur
ARB and Diur(diovan/hct)
CCB and ACE (Lotrel)

Front 77

first line for DM

Back 77

ace or ARB (delay nephropathy)

Front 78

time frame for switch of meds

Back 78

6 weeks

Front 79

htn emergency require ________ BP reduction to prevent _______ ____ damage

Back 79

immediate, end organ

Front 80

HTN urgencies benefit from reducing BP within ______

Back 80

hours

Front 81

drugs used for HTN emergency

Back 81

vasodilators(nitroprusside, nicardipine, nitro, enalaprilat), adrenergic inhibitors (labetalol, atenolol, phentolamine)

Front 82

starting doses in elderly persons should be _____ than those used in younger adults

SBP is _______predictor of events than DBP

Back 82

lower; better