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Hypertension
Drugs etc
50
Pharmacology
Professional
03/28/2012

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Cards

Term
What is primary hypertension calculated by and caused by?
Definition
BP = CO * PR
CO - increased preload due to fluid volume
PR - constriction due to RAAS
Term
What are the secondary identifiable causes of HTN?
Definition
- Sleep apnea due to metabolic syndrome
- CKD
- Aldosteronism
- Renovascular disease
- Chronic Steroid/Cushing syndrome
Term
What drugs can induce secondary hypertension?
Definition
- Any adrenal steroid (Prednisone, fludricortisone)
- Amphetamine/phentermine
- VEGF agents for cancer
- Estrogens in oral contraceptives
- Calcineurins for transplant patients (Tacrolimus, cyclosporin)
- Decongestants
- Epogen - increases BV
- NSAIDS and CoxII inhibitors
- Venlafaxine, Reglan, and Wellbutrin
- Street drugs and withdrawal, licorice
Term
What target organ damage is possible if HTN goes untreated?
Definition
retinopathy in the eyes, risk of stroke/TIA, LVH, CHD, and heart failure, ESRD, and peripheral artery disease
Term
What calculates are taken with blood pressure?
Definition
Pressure pulse = Systolic - Diastolic
Mean Arterial Pressure = 1/3(systolic) + 2/3(diastolic)
Term
What are some tenants of good BP technique?
Definition
- Refrain from stimulants for 30 min and rest for 5 min. Take reading w/ good posture at heart level.
- Use an appropriate sized cuff
- ablate radial pulse first! and palpate for artery. Curvature forward on stethescope
- Release pressure slowly, deflate 10/20 mmHg after last sound
- Avg 2 measurements 5 min apart, no talking
Term
Why would home BP monitoring not be useful?
Definition
Complex, not how studies were completed, and values can be fabricated
Term
How does BP increase affect mortality?
Definition
For every 20 mmHg systolic or 10 mmHg diastolic increase in BP, there is a doubling of mortality from both ischemic heart disease and stroke.
Term
What drugs are thiazide diuretics?
Definition
Chlorthalidone/Hygroton, HCTZ/Microzide, Indapamide/Lozol, and Metolazone/Zaroxolyn
Term
In what case do Thiazides not work?
Definition
CrCL <25ml/min
Term
What are adverse effects of thiazides? What do they interact with?
Definition
Hypokalemia, photosensitivity, hyperglycemia and uric acid levels.
Increased lithium levels, Bile acid sequestrants
Term
What are the main monitoring parameters and counseling points for thiazides?
Definition
Monitor BP and baseline SrCr
Dose in the morning
Doses greater than 25 ineffective
Term
What drugs are loop diuretics? When would you use these over thiazides?
Definition
Furosemide/Lasix, Bumetanide/Bumex, Torsemide/Demadex. Can use in decreased CrCl
Term
What is the main side effect and monitoring parameters of loop diuretics? When are they dosed?
Definition
WILL cause hypokalemia, must monitor K+ along with electrolytes, glucose, uric acid, and fluid status. Dose at least BID, avoid sulfa allergy.
Term
Which drugs are K-sparing diuretics? What are their monitoring parameters?
Definition
Amiloride/Midamor, Triamterene/Dyrenium
Mainly K+, then BP, SrCr, BUN, Na, Glu
Term
What is the contraindication for using potassium sparing diuretics?
Definition
K+ > 5.5 mEq/L
Increased Hyperkalemia risk with trimethoprim, AceI, ARBs, and aldosterone inhibitors.
Term
What drugs are aldosterone inhibitors?
What are their side effects and monitoring?
Definition
Eplerenone/Inspra and Spironolactone/Aldactone
Both cause hyperkalemia, Inspra causes high triglycerides, Aldacone causes gynecomastia. Monitor K+ prior to, within first week of, and after 1 month of therapy
Term
What drug interaction risks exist with aldosterone antagonists?
Definition
Any drug that also causes hyperkalemia
Eplerenone Contraindicated with potent Cyp3A4 inhibitors - itraconazole and ketaconazole
Eplerenone cautioned with moderate cyp3A4 inhibitors - erythromycin, fluconazole, saquinavir, verapamil - use lower starting dose.
Term
What are contraindications for using aldosterone antagonists?
Definition
K+ > 5.5
Eplerenone: CrCl < 50 mL/min or SrCr > 1.8 in women or 2 in men, DM2 w/ microalbuminuria, Potent Cyp3A4 use, other drugs that increase K+
Term
What drugs are Ace inhibitors?
Definition
Benazepril/Lotensin, Captopril/Capoten, Enalopril/Vasotec, Lisinopril/Prinivil, Quinipril/Accupril, Ramipril/Altace, Trandolapril/Mavik
Term
What adverse effects are seen in Ace inhibitors? How are these drugs monitored?
Definition
- HYPERkalemia, transiently increased SrCr, COUGH, ANGIOEDEMA
- Monitor BP, HR, K+
- Monitor dry cough and angioedema, use lower doses in renal dysfunction
Term
What are absolute contraindications for having an AceI?
Definition
-Bilateral renal artery stenosis
- PREGNANCY
- History of angioedema
Term
What are the two main side effects of AceI and their causes?
Definition
- dry, unproductive cough - within the first few months, due to bradykinin, Pgs, or substance P. D/c therapy, switch to ARB
- Angioedema - swelling of mucous membranes most common in lips and tongue, life threatening. Stop drug and go to the hospital
Term
What drugs are ARBs?
Definition
Candesartan/Atacand, Irbesartan/Avapro, Losartan/Cozaar, Valsartan/Diovan
Term
What are side effects and contraindications of ARBs?
Definition
Do not use in pregnancy, BRAS. Causes hyperkalemia
Term
What drugs are DHP CC blockers?
Definition
Amlodipine/Norvasc, Felodipine/Plendil, Nifedipine ER/Adalat or Procardia. Never use IR Nifedipine
Term
What are the main side effects and cautions of DHP CC blockers?
Definition
Peripheral edema (Norvasc) and reflex tachycardia, caution in angina. Monitor dizziness and edema. Treat constipation w/ bulk forming laxatives
Term
What drugs are non-DHP CCB?
Definition
Diltiazem SR or ER/ Cardizem
Verapamil/Calan or Isoptin or Verelan
Term
What are the main side effects and contraindications in Non-DHP CCBs?
Definition
- Side effects: Bradycardia and constipation
- Contraindications - 2nd/3rd AV block, SSS, acute MI, pulmonary congestion, heart failure
Term
What are guidelines to be used when counseling on non-DHB CCBs?
Definition
Do not give with BBs, do not crush/chew, monitor bradycardia.
Term
What drug interactions are seen with non-DHP CCBs?
Definition
Diltiazem and Verapamil are major 3A4 substrates, avoid Cyp3A4 inducers (which use up drug quickly): Rifampin, Phenytoin, Barbituates, Epitol
Also 3A4 inhibitors, increases concentrations of drugs metabolized by 3A4. Diltiazem > Verapamil in interactions
Term
Which beta blockers are non-selective?
Definition
Nadalol/Coragard, Propanalol/Inderal
At higher strengths, all non-selective
Term
Which beta-blockers are cardioselective for B1?
Definition
Atenolol/Tenormin, Metoprolol/Lopressor/Toprol
Term
Which beta blockers have ISA characteristics?
Definition
Acebutolol/Sectral, Pindolol/Visken
Cannot use in coronary artery disease/post-MI
Term
What drugs are mixed alpha and beta blockers?
Definition
Carvedilol/Coreg, Labetalol/Normodyne
No reflex tachycardia
Term
What are the main adverse effects and contraindications of beta blockers?
Definition
Sinus bradycardia, 2nd/3rd AV block, decompensated HF, shock, pregnancy
Causes bradycardia and fatigue. Interacts with non-DHP which also cause bradycardia
Blunts signs of hypoglycemia
Term
What is the only sign of hypoglycemia not block by beta blockers?
Definition
Sweating
Term
What drugs are alpha blockers?
Definition
Doxazosin/Cardura, Prazosin/Minipress, Terazosin/Hytrin
Term
How are alpha blockers monitored and counseled on?
Definition
Cause postural hypotension, measure sitting and standing BP. Do not use w/ PDE-5 inhibitors. Take at bedtime and rise slowly, use in BPH
Term
How does the direct renin inhibitor work and what are it's cautions?
Definition
Aliskiren/Tekturna. Same as AceI - monitor BP, SCR, and K+, no pregnancy and watch hyperkalemia
Term
What drugs are alpha agonists?
What are they used for, their side effects?
Definition
Clonodine/Catapres - available in patch
Methyldopa/Aldomet
Used for resistant HTN. Always causes dry mouth, sedation. Rebound HTN if abruptly discontinued
Term
Which drugs are arterial vasodilators?
What must be monitored and side effects?
Definition
Minoxidil/Loniten, Hydralazine/Apresoline
Monitor BP for tachycardia, minoxidil causes fluid retention so I/O. Caution in renal disease, stroke, or CAD. Take w/ food and rise slowly. Used in severe HTN. Hydralazine causes lupus-like symptoms
Term
What lifestyle modifications should be counseled on?
Definition
- Stop smoking
- Exercise 30 min/day most days -- at least 60-90 min/week
- DASH diet, limit sodium to 2.4 g
- Limit alcohol to 2 drinks/day - 12 oz beer/5 oz wine/1.5 oz liquer
- Weight loss of at least 10 lb
Term
What are the HTN goals according to JNC7?
Definition
Less than 140/90 unless DM2 or ESRD, then less than 130/80
Term
What is the initial choice for most HTN patients?
Definition
HCTZ 25 mg po daily unless there is a compelling indication
Term
In african americans, which drugs have proven less effective?
Definition
AceI, ARBs, and beta blockers. Good response to Na restriction and diuretics
Term
What considerations are there in the elderly?
Definition
Use lower doses and avoid alpha blockers/agonists and labetalol
Term
What considerations are there in pregnant patients?
Definition
Do not use AceI and ARBs.
Use Labetalol or Methydopa
Term
When do you substitute drugs from a different class?
Definition
When there is little response and no compelling indication, or bad side effects.
Term
What is the difference between hypertenion urgency and emergency?
Definition
BP >180/120 in both. Emergency - signs of target organ damage, requires IV therapy.
IV drugs - Labetalol, hydralazine, Enalaprilat
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