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HTN Lectures (4 PowerPoints)
Terms in this set (97)
Which diuretics can cause hyperkalemia + gynecomastia?
What is another name for Aldosterone Antagonist?
Thiazide diuretics can cause electrolyte abnormality, such as:
Increased uric acid, increase Ca2+, decreased Na+, decreased K+
Which diuretics have a rare risk of hyperglycemia/ new onset of diabetes?
Thiazide + Thiazide type diuretics
Which diuretics have the risk of ototoxicity?
(T/F) The risk of hyperkalemia increases with concomitant use with ACE-I and Calcium Channel Blockers (CCB)
With concomitant use with ACE-I + ARB
(T/F) Epleronone (used for HTN) is contraindicated with Type 2 Diabetes
1) Type 2 Diabetes
2) CrCl > 50 ml/min
3) Scr > 2mg/dL (MALES) and 1.8 mg/dL (female)
Patients with renal insufficiencies should not take which kind of diuretics?
All except loop diuretics
Thiazide diuretics and loop diuretics are contraindicated in pts with:
Sulfa allergy- in both. In loop diuretics (all sulfa but ethacrynic acid)
Adopting a DASH eating diet can reduce BP by:
8-14 mm Hg
(T/F) We should not initiate thiazide-type diuretics in Black pts
We can initiate thiazide + CCB. Can NOT use ACE-I or ARB (unless they have CKD)
A patient (with HTN) greater or equal to 60 years of age with NO history of diabetes or CKD should have a BP goal of:
SBP <150 mm Hg + DBP <90 mm HG
Making modifications such as weight reduction can reduce BP in patients with HTN by:
5-20 mm Hg/ 10 kg
Aldosterone antagonists work on:
The collecting tubule
Loop diuretics work on:
Ascending limb of Loop of Henle
Thiazide diuretics work on:
Distal convoluted tubule
We should discontinue pts off Potassium-sparing diuretics when:
K > 5.5 mEq/L
ACE-I have pregnancy category:
In numerous studies, the use has shown damage to the fetus
(T/F) ACE-I are LESS effective in Black pts
What is angioedema?
A rapid swelling in the nose, throat, mouth, glottis, larynx, lips and/or tongue--It can happen even after a long term treatment with RAAS inhibitor
(T/F) All ACE-I end in -PRIL
Potassium-sparing diuretics + ACE-I + ARB + Direct Renin Inhibitor all can cause which electrolyte imbalance?
Avoid use of ACE-I in: (3 instances)
2) Concomitant use with drugs that cause hyperkalemia
3) Bilateral renal artery stenosis
(T/F) ARBs may cause a dry cough
Alpha-1 blockers are beneficial in: (2 things)
2) Resistant HTN
(T/F) Alpha-1 blockers can cause orthostatic hypotension
Can also cause CNS adverse effects
Alpha-1 blockers all end in:
Cardura XL- Osmotic controlled-Release Oral delivery system (OROS) formulation - can leave a ghost tablet (empty shell) in the stool. What CLASS of drugs does Cardura XL belong?
Alpha-1 blocker; can also cause:
2) Floppy iris syndrome
Which class of HTN medications is NOT the first line agents for uncomplicated hypertension?
UNLESS presented with comorbidities such as
(T/F) Using Beta Blockers (BB) will mask symptoms of hypoglycemia
Should have patient check their own blood glucose levels
Which Beta Blockers should be used in patient populations with reactive airway disease? Why?
Beta-1 Selective Blocker
Because Non-selective Beta-1 and Beta-2 Blockers can cause exacerbation of reactive airway disease
(T/F) Beta Blockers does not cause sexual dysfunction
Contraindications of Beta Blockers: (2 things)
1) Severe bradycardia
2) Heart blocks (2nd and 3rd degree)
Which medications can be used for resistant HTN?
Alpha-1 Blocker (all 3), Central-2 Alpha Agonist (ONLY Clonidine)
(T/F) ARBs and Alpha-1 Blockers do NOT have any medications in injection form.
Which Beta-1 selective blocker is contraindicated in pts with severe liver impairment?
Which Beta-1 Selective Blockers are useful in lowering BP in urgent situations? (2 meds)
2) Metoprolol tartrate
Which Beta-1 and Beta 2 Non- Selective Blockers has high lipid solubility and crosses the BBB, and therefore is useful in managing migraines?
When using Carvedilol, which receptors are blocked? (3 things)
(T/F) Carvedilol CR has less bioavailability than IR
Should also take Carvedilol CR with food
(T/F) All Beta Blockers (BB) (Beta-1 Selective Blockers, Beta-1 and Beta-2 Non-selective Blockers, Nonselective BB and Alpha 1 Blockers) have AT LEAST 1 medication in injection form.
Beta-1 + Beta-2 Non-selective Blockers DO NOT have a medication in injection form
Beta-1 Selective Blocker: Esmolol + Metoprolol Tartrate
Nonselective BB + Alpha 1 Blocker: Labetolol
Which BBs can be used in hypertensive crisis?
2) Metoprolol tartrate
(T/F) Both Metoprolol tartrate and Metoprolol succinate are available in injection form, and therefore can be used in hypertensive crisis.
Only Metoprolol tartrate is available in injection form.
Is Nebivolol a Beta-1 selective blocker or Beta-1 + Beta 2 Nonselective blocker?
Beta-1 selective blocker
Is Nadolol a selective or nonselective blocker? And can it be used in pts with reactive airway disease?
B1 +B2 Nonselective blocker
Therefore, it CAN NOT be used in pts with reactive airway disease
Which HTN drug classes can cause rebound HTN if discontinued abruptly? (2 classes)
1) Beta blockers
2) Central Alpha-2 Agonist
Which drug class for HTN is efficacious is special populations (resistant HTN and/or pre-eclampsia/eclampsia)
Central Alpha-2 Agonist
(T/F) Central Alpha-2 Agonists do not have any medications in injection form
(T/F) Clonidine is available as an ophthalmic solution
It is available as a patch
Timolol (B1+B2 Non-selective blocker) is available as ophthalmic sln
Guanfacine IR and Guanfacine ER are available. Which one is used for HTN and which one for ADHD?
Guanfacine IR: HTN
Guanfacine ER: ADHD
Which direct vasodilator is efficacious in pts with severe renal insufficiency?
Which medication is an alternative for the ACE-I intolerant population?
Which medication can cause cyanide toxicity, and is therefore only used in hypertensive crisis?
Which Direct Vasodilator can have side effects of fluid retention, tachycardia, hair growth?
Which classes of medication have Pregnancy Category X? (3 classes)
3) Direct Renin Inhibitor
Which medication can cause Lupus-like syndrome?
Which medication is the last line option used for HTN?
Direct Renin Inhibitor (Aliskiren)
AB is 62 y/o patient with HTN, who has a history of CKD (chronic kidney disease) but no history of diabetes. What would be the BP goal for AB?
SBP: < 140 mmHg
DBP: < 90 mmHg
Patients of all ages, all races (even Blacks) with history of CKD (with or without diabetes) will have a BP goal of <140/90 mmHg
CD is a 61 y/o patient with HTN, who has no history of diabetes or CKD. What would be the BP goal for CD?
SBP: < 150 mmHg
DBP: < 90 mmHg
Elderly have a more lenient BP goal UNLESS they have a history of CKD (where the SBP goal is <140 mmHg)
EF is a 59 y/o Black patient with HTN, who has a history of diabetes but no CKD. What would be the BP goal for EF?
SBP: < 140 mmHg
DBP: < 90 mmHg
GH is a 63 y/o patient with HTN, who has a history of diabetes but no history of CKD. What would be the BP goal for GH?
SBP: < 140 mmHg
DBP: < 90 mmHg
For CCB, are non-DHP or DHP preferred?
(all end in -PINE: such as NNN CAF)
(T/F) We should never use ACE-I or ARBs in Black patients.
We would not use it as a first line agent in patients with diabetes or no condition BUT we can use either ACE-I or ARB as first-line agent for patients with CKD (regardless of age or race)
(T/F) Ganglionic blockers are no longer used for HTN
Drugs that reduce release/synthesis of NE are called:
Methyldopa gets converted to 1) _________and 2)________ and replaces 3)________ in nerve endings.
Methyldopa's central actions include (all decreased):
1) decrease PVR
2) decreased renal vascular resistance
3) decreased CO
4) decreased HR
Clonidine central actions include:
1) Decreasing sympathetic outflow
2) Increasing PS outflow
Leads to decreased PVR, CO, HR
(T/F) Clonidine has a short t1/2
Patch 7 day
Clonidine should not be taken with which type of drugs because it can cause mental depression?
Which agents that alter sympathetic nervous system function PREVENT the release of NE?
Adrenergic neuron blocking agents
Guanethidine + Reserpine
(T/F) Atenolol has shown to be more effective than metoprolol
The other way around
(T/F) Reduced doses of Betaxolol and Bisprolol can be used in renal insufficiency.
Which Beta Blockers (3) act as PARTIAL AGONISTS and are preferable in people with bradyarrhythmias and peripheral
vascular disease because they cause a lesser decrease in CO and HR than others?
Labetolol has 1) __:__ beta:alpha blocking action, while Carvedilol has 2) __:__ beta:alpha blocking action.
Which drug classes (3) alter sympathetic nervous system function?
1) Alpha-1 Blocker
3) Central Alpha-2 Agonist
Alpha-1 Blockers are more useful with used with: (2 things)
Beta-blocker + diuretic
Hydralazine is not a first-choice agent but it has proven efficacious in 2 situations:
1) Pts who are ACE-I intolerant
2) Pts who have severe renal insufficiency
Name the 3 drug classes that are classified as sympathoplegic agents:
1) Alpha-1 Blockers
2) Beta Blockers
3) Central Alpha-2 Agonists
Name the 2 drug classes that are classified as vasodilators:
1) Calcium Channel Blockers
2) Direct Vasodilators
Name the 3 drug classes that are classified as agents that block the production or action of angiotensin:
3) Direct Renin Inhibitors
Name the 4 types of diuretics and the locations they work on the renal tubule:
1) Carbonic anhydrase inhibitor (proximal convoluted tubule + proximal straight tubule)
2) Loop diuretic (Ascending limb of the Loop of Henle)
3) Thiazide + thiazide-type diuretic (distal convoluted tubule)
4) Aldosterone antagonist (collecting tubule)
Name the 3 different classifications of beta blockers:
1) Beta-1 selective blockers
2) Beta-1 + Beta-2 nonselective blockers
3) B1+B2 Nonselective + A1 blocker
Which drugs must be used with a B-blocker and Diuretic because they can cause salt and water retention?
1) Alpha-1 Blockers (drugs that end in -zosin)
2) Minoxidil (a vasodilator)
A dry, persistent cough can occur with ACE-Is, but not ARBs. This cough is due to accumulations of 1)___, 2)____, and/or 3)___
2) substance P
What are the 7 adverse events of ACE-Is?
Hypotension, hyperkalemia, cough, angioedema, acute renal failure, fetopathic potential, skin rash
(T/F) ACE-Is have minimal effects on baroreflexes
What are the three pathways that regulate renin secretion?
1) Macula densa pathway
2) Intrarenal baroreceptor pathway
3) B1-adrenergic receptor pathway
Increased NaCl flux across the macula densa 1) ____ (inhibits/stimulates) renin release, while decreased NaCl flux 2)____ (inhibits/stimulates) renin release.
When there is decreased NaCl flux across the macula densa and renin release is stimulated, this process is mediated by:
prostaglandins PGE2 + PGI2
When there is increased NaCl flux across the macula densa and renin release is inhibited, this process is mediated by:
increased adenosine + ATP
Decreased in blood pressure and renal perfusion pressure _____(stimulates/inhibits) renin release:
What are 2 things that can help with cough caused by ACE-Is?
Aspirin + Iron supplements
Thiazide diuretics and loop diuretics both can cause 1)____(hypo/hyper)kalemic metabolic 2)___(acid/alkal)osis
(T/F) Thiazide diuretics cause more severe dehydration than loop diuretics
(T/F) Loop diuretics cause an increase in uric acid and calcium levels
Only increase in uric acid
Causes a decrease in NaCl as well as K+, Ca2+, Mg2+
(T/F) Thiazide diuretics cause an increase in uric acid and calcium levels
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