Hypertension

Front 1

1st dose effect - what it is & what causes it

Back 1

postural hypotension & syncope; alpha antagonists

Front 2

labetolol effects

Back 2

the β2 stimulation (vasodilation) enhances the α1 block; the β1 block (↓HR & BP) prevents reflex stimulation of HR caused by vasodilation; the α1 block prevents ↑ in peripheral resistance in response to ↓ BP

Front 3

beta blocker side effects

Back 3

bradycardia; fatigue (related to ↓ in muscle K+ (β stim. usually drives K+ into tissues); ↑ plasma lipids

Front 4

causes bradykinin cough

Back 4

ACE inhibitors

Front 5

hydralazine MOA

Back 5

vasodilator -
↓ IP3-mediated release of Ca from the SR
opens ATP-dependent K+ channels --> hyperpolarization

Front 6

Blood-borne vasoactive substances

Back 6

ACh, vasopressin, bradykinin, serotonin, ADP & ATP

Front 7

3 stimuli for renin secretion

Back 7

1. increased renal symp. nerve impulses 2. decreased pressure in renal afferent arterioles 3. decreased sodium ions to macula densa of kidney nephrons

Front 8

Loop diuretics MOA

Back 8

block the Cl site of the Na-K-2Cl symporter in the ascending loop

Front 9

Thiazide diuretics MOA

Back 9

block the Cl site of the Na-Cl symporter (NCC1) in the distal convoluted tubule

Front 10

1st step in HTN tx algorithim

Back 10

Lifestyle modifications

Front 11

Tx algorithim: initial drug choices without compelling indications (e.g. comorbidities)

Back 11

Stage 1: thiazides for most (can consider ACEI, ARB, BB, CCB or combo)
Stage 2: 2 drug combo, usually thiazide + ACEI/ARB, or BB or CCB

Front 12

recommended Rxs to tx HTN in pts w/ chronic kidney dz

Back 12

ACEI and ARB

Front 13

recommended Rxs to tx HTN in pts w/ HF

Back 13

all but CCB

Front 14

recommended Rxs to tx HTN in pts w/ DM

Back 14

all but aldosterone antagonist

Front 15

sequence of Rxs for pts w/ BP >130/80 in DM or kidney dz w/ any level of albuminuria

Back 15

1. ACEI or ARB, then if not at goal 2. add thiazide or CCB/BB, then 3. add CCB (add other subgroup if already using CCB), then 4. add vasodilator

Front 16

hypertensive urgency vs. emergency

Back 16

urgency: very high BP w/o end organ damage, must be lowered within hours
emergency: very high BP with end organ damage, must be lowered in minutes

Front 17

first treatment priority in hypertensive emergency

Back 17

lower blood pressure (e.g. organic nitrates)

Front 18

beta-blocker with intrinsic sympathetic activity

Back 18

Pindolol - useful for HTN pts w/ bradycardia

Front 19

nitroprusside complication from chronic infusion or in pts with decreased renal function

Back 19

toxicity from accumulation of cyanide or thiocyanate
normal metabolism: NO--> cyanide --> thiocyanate

Front 20

minoxidil effects on arteries & veins

Back 20

dilates arteriolar vessels without significant effect on venous vessels
causes strong baroreflex increase in CO --> renin release & fluid retention

Front 21

minoxidil MOA

Back 21

activates K+ channels --> K efflux --> hyperpolarization & relaxation of vasc. smooth muscle

Front 22

indications to look for secondary causes for HTN

Back 22

age <30 or >55, refractory (uncontrolled on 3 or more meds), caucasian males, abrupt onset or escalation, lab values/exam consistent w/ secondary cause