Term
| goal BP for uncomplicated HTN |
|
Definition
|
|
Term
|
Definition
|
|
Term
| goal BP for HTN + chronic renal disease |
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Definition
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|
Term
| stage 1 HTN: initial drug choices for pts without compelling indications |
|
Definition
thiazide-type diuretics for most
may consider ACE inhibitor, ARB, BB, CCB, or combo |
|
|
Term
|
Definition
systolic 140-159
diastolic 90-99 |
|
|
Term
|
Definition
systolic 160 or higher
diastolic 100 or higher |
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Term
| stage 2 HTN: initial drug choices for pts without compelling indications |
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Definition
| 2-drug combo for most (usually thiazide-type diuretic and ACE inhibitor, ARB, BB, or CCB) |
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|
Term
| initial drug choices for HTN pts with compelling indications (past MI, etc.) |
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Definition
| other antiHTN drugs as needed |
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Term
| general approach based on JNC-7 |
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Definition
1. thiazides
2. ACE inhibitor
3. ARB
4. beta blocker
5. calcium channel blocker
6. alpha blocker
7. vasodilator |
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|
Term
| mechanism of action of diuretics in HTN |
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Definition
acute effects: Na+ and H20 loss-->decreased blood volume-->decreased CO-->decreased BP
chronic effects: Na+ loss causes decreased responsiveness of arterioles to NE-->decreased arteriolar resistance |
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|
Term
| When do you not choose a thiazide first for HTN? |
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Definition
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|
Term
| Use _________ diuretics for HTN in renal insufficiency pts. |
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Definition
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Term
| Thiazides are very effective in what populations? |
|
Definition
| elderly and African Americans |
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|
Term
| common side effects of thiazides |
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Definition
|
|
Term
| less common side effects of thiazides |
|
Definition
high serum uric acid
hypertriglyceridemia
DM exacerbation |
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Term
| ACE inhibitors mechanism of action |
|
Definition
| block conversion of angiotensin I to angiotensin II |
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Term
| effects of ACE inhibitors |
|
Definition
decrease preload (venous dilation)
decrease afterload (arteriole dilation)
decrease BP |
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Term
| ACE inhibitors do/do not have effect on heart rate. |
|
Definition
|
|
Term
|
Definition
|
|
Term
| Angiotensin I comes from... |
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Definition
|
|
Term
| ACE inhibitors are preferred for... |
|
Definition
high plasma renin
diabetes mellitus (reduces proteinuria)
CHF (decreases mortality) |
|
|
Term
| In addition to being antihypertensive, these drugs slow changes in cardiac shape that is a key problem in CHF. |
|
Definition
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|
Term
| advantages of ACE inhibitors |
|
Definition
-predictable, typically mild, dose-related side effects
-blunt hypokalemia caused by diuretics
-little orthostatic hypotension or SNS activation
-no effect on TGs or cholesterol |
|
|
Term
| ACE inhibitors side effects |
|
Definition
| cough, initial dose hypotension, skin rashes, neutropenia, acute renal failure in renal artery stenosis, angioedema, AAs and elderly may not respond well, hyperkalemia possible |
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|
Term
| Why do ACE inhibitors cause cough? |
|
Definition
| elevated bradykinin in the lungs |
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|
Term
| ACE inhibitors contradindications |
|
Definition
| pregnancy (2nd and 3rd trimester) |
|
|
Term
|
Definition
| block AT1 subtype of the angiotensin II receptors |
|
|
Term
| ARBs have a greater/lesser chance of causing angioedema. |
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Definition
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|
Term
|
Definition
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|
Term
|
Definition
|
|
Term
| beta 1 stimulation causes |
|
Definition
increased HR
increased contractility
increased AV conduction
increased electrical excitability
increased renin release |
|
|
Term
| beta 2 stimulation causes |
|
Definition
bronchodilation
arteriole dilation
relaxation of the uterus
insulin release
increased glycogenolysis |
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|
Term
| beta blockers mechanism of action |
|
Definition
-decreases heart contractility (negative inotrope) reducing O2 requirements of myocardial cells
-decreases SA node firing rate (negative chronotrope) |
|
|
Term
| beta blockers therapeutic effects |
|
Definition
-decreased HR
-decreased myocardial oxygen demand
-decreased angina
-fewer rhythm disturbances
-decreased renin release |
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|
Term
| How do beta blockers decreased total peripheral resistance? |
|
Definition
| block of renin release through block of beta 1 receptors |
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|
Term
|
Definition
non-selective beta blocker
cheap, efficacious, extensive history |
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|
Term
| propranolol contraindication |
|
Definition
| asthma, acute CHF, AV conduction problems |
|
|
Term
|
Definition
impotence
impairs recovery from hypoglycemia
masks symptoms of hypoglycemia |
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|
Term
| Beta blockers used to treat hypertension have been suggested to _________________________ in pateints with essential hypertension wihtout known CAD and CHF. |
|
Definition
| increase the risk of cardiovascular events and death |
|
|
Term
| beta 1 selective blockers (metoprolol, atenolol) are preferred in individuals who also have... |
|
Definition
| peripheral vascular disease |
|
|
Term
|
Definition
| beta 1 selective blocker that is also a vasodilator by the endothelial L-arginine/NO pathway |
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|
Term
| drug that has the highest cardioselectivity of any currently available beta blocker |
|
Definition
|
|
Term
| Which drug has fewer respiratory effects and less bradycardia than other beta blockers? |
|
Definition
|
|
Term
| beta blocker side effects |
|
Definition
| AV block, severe bradycardia, bronchospasm, respiratory distress, exacerbation of CHF and pulmonary edema, delay of recovery from hypoglycemia, hypertriglyceridemia, decreased HDL |
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|
Term
| alpha blocker side effect |
|
Definition
|
|
Term
|
Definition
|
|
Term
| calcium channel blocker mechanism of action |
|
Definition
| decreased calcium influx results in smooth muscle relaxation which causes vasodilation |
|
|
Term
| Calcium channel blockers are relatively selective for... |
|
Definition
| vascular smooth muscle Ca channels |
|
|
Term
|
Definition
nifedipine
felodipine
amlodipine
nicardipine |
|
|
Term
| What is the only calcium channel blocker that is okay to use in CHF pts? |
|
Definition
|
|
Term
| Why are calcium channel blockers less preferred than ACE inhibitors or ARBs? |
|
Definition
| higher profile of side effects related to vasodilation |
|
|
Term
| What is a specific use for calcium channel blockers? |
|
Definition
|
|
Term
| calcium channel blocker side effects |
|
Definition
| headache, flushing, orthostatic problems, peripheral edema |
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|
Term
|
Definition
central adrenergic agonist
alpha 2 agonist |
|
|
Term
|
Definition
| drowsiness, dry mouth, depression, rebound hypertension (can elicit HTN crisis) |
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|
Term
| first line HTN drug during pregnancy |
|
Definition
|
|
Term
|
Definition
| dry mouth, sedation, fatigue, depression, nightmares, sexual dysfunction, hemolytic anemia, hepatitis (rare) |
|
|
Term
| antiHTN for coronary heart disease |
|
Definition
beta blockers
ACE inhibitors |
|
|
Term
|
Definition
ACE inhibitors
beta blockers
ARBs
spiranolactone |
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|
Term
|
Definition
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|
Term
| antiHTN for renal insufficiency |
|
Definition
|
|
Term
|
Definition
end-organ damage is present or progressive
BP control should be achieved within 1 hr |
|
|
Term
|
Definition
no obvious end-organ damage
BP control should be achieved within 24 hrs |
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|
Term
| treatment of hypertensive crisis |
|
Definition
-get diastolic down to 100-110, then move to normal over the next few days
-avoid excessive and rapid decrease in BP |
|
|
Term
|
Definition
nitroprusside
labetalol
fenoldopam |
|
|
Term
| precautions with vasodilator therapy |
|
Definition
-overly aggressive therapy is associate with severe hypotensive problems, including insufficient circulation to the CNS
-insufficient therapy is associated with end-organ damage, including stroke |
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|
Term
| vasodilator mechanism of action |
|
Definition
| decrease BP by decreasing systemic vascular resistance |
|
|
Term
|
Definition
hypertensive emergencies
surgery (controlled hypotension) |
|
|
Term
| nitroprusside side effects |
|
Definition
excessive hypotension
cyanide/thiocyanate toxicity |
|
|
Term
| Which vasodilator is a D1 agonist? |
|
Definition
|
|
Term
|
Definition
in-hospital, short-term (up to 48 hrs) management of severe hypertension when rapid, but quickly reversible, emergency reduction of BP is clinically indicated
ex: malignant HTN with deteriorating end-organ function |
|
|
Term
| What vasodilator is a beta blocker with intrinsic activity? |
|
Definition
|
|
Term
|
Definition
hypertensive crises
pre-eclampsia
pheochromocytoma |
|
|
Term
| major risk factors that modify LDL goals |
|
Definition
cigarette smoking
HTN
low HDL
family history of premature CHD
age |
|
|
Term
|
Definition
| CHD or CHD risk equivalents |
|
|
Term
|
Definition
2+ risk factors
10 year risk 10-20% |
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|
Term
|
Definition
2+ risk factors
10 year risk <10% |
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|
Term
|
Definition
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|
Term
|
Definition
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|
Term
| goal LDL for moderately high risk and moderate risk |
|
Definition
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|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| High levels of VLDL increase risk of... |
|
Definition
|
|
Term
| Which cholesterol makes the greatest contribution to coronary atherosclerosis? |
|
Definition
|
|
Term
| Which cholesterol promotes cholesterol removal? |
|
Definition
|
|
Term
| statins derived from fungi |
|
Definition
lovastatin
pravastatin
simvastatin |
|
|
Term
| statin mechanism of action |
|
Definition
| inhibition of HMG-CoA reductase |
|
|
Term
|
Definition
| elevated cholesterol of all types (particularly effective in lowering LDL) |
|
|
Term
| Statins increase/decrease LDL receptors in the liver. |
|
Definition
|
|
Term
| What do you often see with statins in addition to lowered LDL? |
|
Definition
| small decrease in TGs and small increase in HDL |
|
|
Term
| "optional" goal for LDL in pts with 2 risks |
|
Definition
|
|
Term
|
Definition
| hepatic damage, peripheral neuropathies |
|
|
Term
| What do you have to watch for with statins? |
|
Definition
| myalgia, myopathy, and rhabdomyolysis (esp. when combining with niacin, fibrate drugs, or erythromycin) |
|
|
Term
|
Definition
|
|
Term
| Which statins cross the BBB and therefore may cause sleep disturbances? |
|
Definition
|
|
Term
| Why can't you drink grapefruit juice when taking a statin? |
|
Definition
| furanocoumarins bind to and deactivet the CYP3A4 enzyme causing possible increased drug effects due to decreased metabolism |
|
|
Term
| Which statin does the grapefruit juice stipulation not apply to? |
|
Definition
|
|
Term
| niacin mechanism of action |
|
Definition
| inhibits VLDL secretion which leads to decreased VLDL, decreased LDL, and increased HDL |
|
|
Term
|
Definition
any lipoprotein disorder, particularly mixed hyperlipidemia with elevated TGs
DOC for decreasing TG levels in pts at risk for pancreatitis |
|
|
Term
|
Definition
| itching, flushing, unpleasant sensation of being warm, GI distress, hyperuricemia, hepatotoxicity, carb intolerance |
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|
Term
|
Definition
|
|
Term
| fibrate derivatives mechanism of action |
|
Definition
| increased activity of lipoprotein lipase |
|
|
Term
| fibrate derivatives therapeutic effects |
|
Definition
decrease VLDL formation in the liver leading to decreased TGs
modest reduction in LDL, more impressive rise ind HDL |
|
|
Term
| fibrate derivative indications |
|
Definition
reduction of TGs when VLDL is very high or when IDL is elevated
do NOT use if VLDL is not elevated! |
|
|
Term
| gemfibrozil contraindication |
|
Definition
| pt with gall bladder problems (causes lithiasis) |
|
|
Term
| bile acid binders mechanism of action |
|
Definition
enhanced excretion of bile acids, leading to increased conversion of cholesterol to bile acids in the liver
loss of cholesterol triggers up regulation of LDL receptors in the liver; therefore, decreased LDL |
|
|
Term
| ezetimibe mechanism of action |
|
Definition
| inhibits absorption of phytosterols and cholesterol |
|
|
Term
| omega-3-fatty acids mechanism of action |
|
Definition
| reduce TG and VLDL synthesis in the liver |
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