Hypertension Drugs

Front 1

normal HTN?

PreHTN?

what is stage 1 hypertension?

what is stage 2 HTN?

Back 1

normal: <120 and <80

PreHTN: SBP 120-139 or DBP< 80-89

stage 1: SBP >140-159 or DBP 90-99

stage 2: SBP >160 or DBP >100

Front 2

CV Mortality Risk ______ w/ each _____/____ mmHg BP increment

Back 2

doubles; 20/10

Front 3

how do you measure BP?

Back 3

BP= CO x TPR (total peripheral resistance)

Front 4

patients may experience what kind of signs and symptoms assoc. w/ HTN?

Back 4

HA

dizziness

fatigue

+/- chest pain

Front 5

what is the cause of Essential (Primary) HTN?

Back 5

idiopathic

Front 6

what affects cardiac output? peripheral resistance?

Back 6

CO: HR + contractility + filling pressure (which is affected by bld volume and venous tone)

Peripheral Resistance: arteriolar tone

Front 7

what are the 2 ways TPR can be increased?

Back 7

1. structural wall thickening from atherosclerotic plaques

2. increased neural or humoral constrictor activity (sympathetic stim. of catehcolamines)

Front 8

what is the domino effect of HTN?

Back 8

uncontrolled HTN→ LVH→ diastolic impairment→ HF→ kidney failure→ CVA→MI→arrhythmia→ death

Front 9

what are non-pharmacologic management of HTN?

Back 9

-healthy diet- low Na+, high K+, ↓ fat intake, ↑ fiber

-weight loss

-exercise

-smoking cessation

-reduced alcohol intake

-CPR training

-ASA therapy

-cholesterol-lowering therapy

Front 10

if the pt is >60 YO, the BP goal is _______

Back 10

SBP <150

DBP <90

Front 11

anybody w/ CKD of any race should be on _______

Back 11

ACEI or ARB either alone or in combo w/ other drugs

Front 12

Black pts or diabetic pts who are black should be on _____

Back 12

thiazide-type diuretic or CCB, alone or in combo

Front 13

Nonblack pts or diabetic pts who are non-black should be on _____

Back 13

thiazide-type diuretic or ACEI/ARB or CCB, alone or in combo

Front 14

drug tx titration strategy:

Back 14

1. you should maximize 1st HTN med before adding a second

2. add the 2nd med before reaching maximize dose of 1st med

3. start w/ 2 meds classes separately or as fixed-dose combo

Front 15

1st line of HTN is _____

Back 15

lifestyle modifications

Front 16

if lifestyle modifications doesn't work, your initial drug choice depends on whether it's stage 1 HTN or 2nd HTN. in stage 1 HTN, you give_____. in stage 2 HTN, you give ______.

Back 16

stage 1 HTN: thiazide diuretic for most

consider ACEI, ARB, BB, CCB, or combo

stage 2 HTN: 2 drug combo for most (usually diuretic and ACEI/ARB, or BB or CCB)

Front 17

increase dose if no improvement after _____months and then change drug

Back 17

one slide says 3 months and another says 1 month

Front 18

if >___ drugs needed, refer to HTN specialist

Back 18

3

Front 19

don't use _____ and ARB together

Back 19

ACEI

Front 20

what are the types of diuretics?

Back 20

Thiazides (HCTZ, Indapamide, Chlorothiazide)

Loop (Bumetanide, Furosemide)

Potassium-sparing (Amiloride, Eperenone, Spironolactone, Tiriametrene)

Carbonic Anhydrase Inhibitors (Diamox)

Osomotic- (Mannitol, Urea)

Front 21

what's the MOA of thiazide diuretics?

Back 21

1. ↓ sodium, water retention

2. ↓ peripheral resistance

Front 22

Name a carbonic anhydrase inhibitor. MOA? strong or weak diuretic properties?

Back 22

Acetazolamide

MOA: inhibits reabsorption of HCO3- in the PROXMIAL CONVOLUTED TUBULE

weak diuretic properties

Front 23

acetazolamide increases urinary excretion of what?

Back 23

Na, K, HCO3-

Front 24

name 4 loop diuretics

Back 24

bumetanide (Bumex)

furosemide (Lasix)

torsemide (Demadex)

ethacrynic acid (Edecrin)

Front 25

what's the MOA of loop diuretics?

Back 25

inhibit Na/K/Cl cotransport in the ASCENDING LOOP OF HENLE

Front 26

what drugs are the most effcacious of diuretics?

Back 26

LOOP DIURETICS

Front 27

what drug inhibit reabsorption of Na and Cl in the DISTAL CONVOLUTED TUBULE resulting in retention of water in the tubule?

Back 27

thiazides and thiazide-like

Front 28

thiazides increase urinary excretion secreting _______, ______, _______, and ecreased urinary excretion in _______.

Back 28

increased excretion: Na, K, urine volume

decreased excretion: Ca

Front 29

what is the most commonly used diuretic for tx of HTN?

Back 29

THIAZIDE AND THIAZIDE-LIKE

Front 30

Name 3 potassium sparing drugs

where does this drugs work?

Back 30

spironolacotne

amiloride

triameterene

prevent loss of K+

works on COLLECTING TUBULE AND DUCT

Front 31

what's the MOA of Spironoalactone?

Back 31

ALDOSTERONE ANTAGONIST

inhibits aldosterone-mediated reabsorption of Na and secretion of K+

Front 32

what's the MOA of Amiloride?

Back 32

block Na+ channels

Front 33

potassium sparing diuretics increase what urinary excretion? and decreased what urinary excretion?

Back 33

increase: Na

decrease: K+ so watch for hyperkalemia

Front 34

secretion of organic acids occurs in the ____ ____ and _______.

Back 34

proximal tubule and collecting tubule and duct

Front 35

what 2 drugs acts on the collecting duct?

Back 35

aldosterone and antidiuretic hormone

Front 36

loop diuretics increased urinary excretion of ____, _____, ____, ____, and decreased urinary excretion of _______

Back 36

Na, K, Ca, volume of urine

nothing.

Front 37

Loop diuretics can be administered ____, ___, or ___

Back 37

IM, IV, or PO dosing

Front 38

what are loop diuretics better use for than HTN?

Back 38

edema/CHF

Front 39

what is often supplemented w/ loop diuretics?

Back 39

potassium

Front 40

What must you educate your patient about when taking loop diuretics? what is the high ceiling affect?

Back 40

must take w/ food or milk to avoid GI upset

high ceiling- i have no idea? any help?

Front 41

what are SE of loop diuretics?

Back 41

ototoxicity

hyperuricema

hypotension

hypokalemia

hypomagenesemia

KNOW THIS!

Front 42

name alpha blockers for HTN

Back 42

Doxazosin (Cardura)

Prazosin (Minipress)

Terazosin (Hytrin)

end in -ZOSIN

Front 43

what do you have to watch out for when using alpha blockers?

Back 43

1st dose effect (hypotension)

Front 44

when should you take alpha blockers?

Back 44

dose initially at bedtime in small doses

Front 45

alpha blockers can also be used in adjunct for ____

Back 45

BPH

Front 46

what are the "OTHER" anti-HTN drugs?

Back 46

Clonidine (Catapres, Duraclon)

Fenoldopam (Corlopam)

Hydralazine (Apresoline)

Methyldopa (Aldomet)

Minoxidil (Loniten)

Nitroprusside (Nitropress)

Front 47

which drug can be used for HTN and itching?

Back 47

Hydralazine

Front 48

what is the MOA of Hydralazine? CI?

Back 48

MOA: peripheral vasodilator through relaxation of vascular smooth muscles

CI: valvular rheumatic heart disease

Front 49

which drug can cause hair growth (Rogaine)?

Back 49

Minoxidil

Front 50

what is a BLACK BOX WARNING for Minoxidil?

Back 50

pericardial effusion progressing to tamponade

Front 51

what does Minoxidil require?

Back 51

loop diuretic, not thiazide

Front 52

which is the DOC for treating HTN in pregnant women?

Back 52

Methyldopa

Front 53

CI of Methyldopa and SE?

Back 53

SE: CNs, GI, bradycardia, may cause a positive Coomb's test or rarely hemolytic anemia

CI: active hepatic dz

Front 54

which drug do you have watch out for rebound HTN w/ abrupt withdrawal?

Back 54

Clonidine

Front 55

what are indications for Clonidine?

Back 55

ETOH withdrawal

HTN EMERGENCY

Opiod detox

ADHD

fast onset and given transdermal or PO**

Front 56

Aliskiren (Tekturna) is what type of drug?

Back 56

Renin Inhibitors

Front 57

T or F: it has been to improve outcome in HF

Back 57

False. ACEI and ARB has been proven to improve HF but not Tekturna.

Front 58

what are SE of Tekturna?

Back 58

rash

diarrhea

head and neck angioedema

LUPUS LIKE RXNS

Front 59

what is the black box warning assoc. w/ Tekturna?

Back 59

injury or death to a fetus

Front 60

T or F: you do not need K+ w/ Tekturna.

Back 60

True.

Front 61

CCB ends in _____

Back 61

-pine

Front 62

what are short acting CCB

Back 62

Dihydropyridines:

isradipine

nicardipine

nifedipine

nimodipine

nitrendipine

Front 63

what are long-acting CCB

Back 63

Dihydropyridines:

amlodipine

felodipine

isradipine (controlled release)

nicardipine (sustained release)

nifedipine (extended release)

nisoldipine (extended release)

Front 64

CCB can also be Dilitiazem or Verapamil

Back 64

just extra info

Front 65

MOA of CCB?

Back 65

dilation of coronary vessels

Nifedipine and Dilitiazem have the strongest action. Verapamil has the weakest action.

Front 66

which CCB decreases AV conduction the most? least?

Back 66

most: verapamil

least: Nifedipine

Front 67

which CCB has the most SE? least?

Back 67

most: Nifedipine

least: Diltiazem

Front 68

what are SE of CCB?

Back 68

flushing

dizziness

HA

Hypotension

peripheral edema

Front 69

name some beta blockers

Back 69

•Atenolol (Tenormin)•Carvedilol (Coreg)•Labetalol (Normodyne)•Metoprolol (Lopressor, Toprol –XL)•Nadolol (Corgard)•Nebivolol (Bystolic)•Propranolol (Inderal)

•Timolol (Timoptic)

Front 70

what are the 4 reasons BB is called the "anti-effect?"

Back 70

1. preventative effect of remodeling

2. anti-ischemic (atherosclerosis)

3. anti-arrhythmic

4. anti-HTN

Front 71

SE of BB

Back 71

Hypotension

bradycardia

fatigue

INSOMNIA

SEXUAL DYSFXN

Front 72

What kind of drugs are these:

benazepril (Lotensin)

Captopril (Capoten)

Enalapril (Vasotec)

Fosinopril (Monopril)

Lisinopril (Prinivil, Zestril)

Moexipril (Univasc)

Quinapril (Accupril)

Ramipril (Altace)

Back 72

ACE inhibitors

Front 73

what is the MOA of ACEI?

Back 73

block Angiotensin I from become angiotensin II

Front 74

SE of ACEI?

Back 74

dry, hacking cough b/c of liberation of bradykinin

hyperkalemia (check CrCl levels)

skin rash - angioedema (blacks)

hypotension

class effect- not one superior than the other*

Front 75

•Azilsartan medoxomil (Edarbi)•Candesartan (Atacand)•Eprosartan (Teveten)•Ibesartan (Avapro)•Losartan (Cozaar)•Olmesartan (Benicar)•Telmisartan (Micardis)

•Valsartan (Diovan)

Back 75

these are ARBs

-SARTAN

TX: HTN and HF

Front 76

which class of drugs has a risk of lithium toxicity and potentiate gout?

Back 76

Thiazides

Front 77

name some thiazides

Back 77

Chlorothiazide (Diuril)

Chlorthalidone (Hygroton)

HCTZ (Hydrochlorothiazide)

Indapamide (Lozol)

Metolazone (Zaroxolyn)

Front 78

what are SE of thiazides?

Back 78

Hypokalemia

Hyperuricemia

Hypotension

Hyponatremia

Hypercalcemia

Front 79

how long do you have to take thiazide diuretics for before it reaches it's max effect? where is it absorbed?

Back 79

4 weeks

absorbed in SI

Front 80

what is its' plateau range?

it can lower the effectiveness of _______ and cause an increase of ______ and _____.

Back 80

25 mg

lower effectiveness of NSAIDs and increase mild glucose and mild LDL

Front 81

Potassium sparing diuretics are:

Back 81

Amiloride

Eplerenone

Spironolactone

Triameterene

Front 82

which potassium sparing diuretic can decrease mortality in HF pts?

Back 82

Spironolactone

Front 83

what drug has limited usefulness b/c of systemic acidosis?

Back 83

Acetazolamide

Front 84

Acetazolamide is what type of drug again? what's its MOA?

Back 84

carbonic anhydrase inhibitors

MOA: prevents the enzyme, carbonic anhydrase, from converting carbonic acid to water and CO2 and vice versa.

Front 85

what are indications for Acetazolamide?

Back 85

glaucoma

acute mountain sickness

adjunct to CHF tx

NOT INDICATED FOR HTN!

Front 86

Mannitol and Urea are what type of diuretics?

Back 86

osmotic diuretics