Flashcards in Lecture Deck (76)
What is a NORMAL BP
What is pre-HTN?
What is stage I HTN?
What is stage II HTN?
Greater than 160 systolic
Greater than 100 diastolic
What classifies a blood pressure as a hypertensive emergency?
DBP greater than 120mmHg
What are the 4 types of diuretics?
What is the site of action of diuretics?
Increases urinary Na+ and H2O excretion, decreases extracellular fluid and/or plasma volume which causes a decrease in TPR
Method of action of diuretics
What is the most commonly used medication for mild to moderate hypertension?
How do you dose diuretics?
Start with low potency, monitor for tolerance
What kind of diet do you recommend to a person on diuretics?
Low in Na+, high in K+
What should you warn your patient about when they take a diuretic?
Hypovalemia - low blood plasma
What do beta blockers do?
Decrease heart rate, decrease stroke volume, decrease TPR via decreasing renin and angiotensin II
What is the site of action of beta blockers?
Heart and kidney
Who should you caution use of beta blockers in?
Patients with pulmonary disease
What is the benefit of beta blockers post MI?
What are some other uses for beta blockers?
What should you monitor in a patient with renal insufficiency if they are taking an ACEI?
Monitor creatinine closely
If your patient is receiving hemodialysis and you want to start them on an ACEI, what should you do?
Communicate with nephrologist because increased incidence of negative effects
If your patient on an ACEI experiences edema, what should you do?
Take them off medication and do not try again! Once experienced they are always at risk and it can be life threatening
What vitamin should you keep an eye on if your patient is taking an ACEI?
What is the site of action for an ACEI?
Renal (Renin-angiotensin system)
What do ACEIs do?
Inhibit conversion of Angiotensin I to angiotensin II
ACEIs _____ arteriolar resistance, _____ venous capacity, _____ cardiac output, and _______ vascular volume, and ______ renovascular resistance
Site of action of ARBs?
Smooth muscle of blood vessels
What do ARBs do?
Block angiotensin from binding to angiotensin receptors
Relaxes and dilates blood vessels
Site of action of direct renin inhibitor?
What do direct renin inhibitors do?
Inhibit renin which diminishes production of angiotensin
Dilates vessels, lowers TPR, lowers BP
Site of action of DCCB and NDCCB?
Vascular smooth muscle, SA and AV nodal conduction, myocardium
What may cause a positive ANA and a direct Coombs test?
Why should a patient not take a CCB with grapefruit juice or grapefruit?
Could increase serum concentration of CCB
What type of health maintenance should you include in your patient education when your patient is on a beta blocker?
Dental - gingival hypertrophy and inflammation may occur
Site of action of Hydralazine?
Vascular smooth muscle
What drug can cause Lupus?
Which drug may caused increased hair production?
What is the drug of choice for treatment of a hypertensive emergency in women?
What is the site of action of alpha blockers?
Peripheral arterioles, veins, and smooth muscle
What drug should patients taking an alpha blocker avoid?
Cialis - hypotension
What is the site of action of a centrally acting A2 agonist?
What does prolonged use of a centrally acting A2 agonist cause?
What can occur to BP in response to starting a patient on a centrally acting A2 agonist?
Rebound increase in BP
What is commonly used in detox protocols for ETOH withdrawal?
Centrally acting A2 agonist
What is one mood altering affect of centrally acting A2 agonists?
How do antihypertensives work to control BP?
They all reduce cardiac output and/or TPR to lower BP!
What is the rule about prescribing multiple hypertensives ?
Don't combine two drugs from the same class
What drug regimen is recommended for patients with heart failure?
What drug regimen is recommended for patients with diabetes?
Avoid Beta blockers!! use an ACEI
What drug regimen is recommended for patients with myocardial infarction?
Beta blocker, ACEI
What drug regimen is recommended for patients with renal insufficiency?
What drug regimen is recommended for patients with angina?
Beta blocker, CCB
What drug regimen is recommended for patients with asthma?
Avoid non selective beta blocker
What drug regimen is recommended for patients with isolated systolic HTN (older patients)?
Which anti-arrhythmics are in Class 1a
Which anti-arrhythmic is in class 1B
Which anti-arrhythmic is in class 1C
Which anti-arrhythmic is in class 2
Which anti-arrhythmic is in class 3
Which anti-arrhythmic is in class 4
Which anti-arrhythmic is in the "miscellaneous category"?
Prolongs APD, intermediate dissociation kinetics
Shortens APD ion selective tissues, rapid dissociation kinetics
Minimal APD impact, slow dissociation kinetics
Prolongation of APD
Blockade of calcium current
What is primary prevention of hyperlipidemia?
High LDL levels with family history or diabetes
High global risk score (over 7.5%)
What is secondary prevention of hyperlipidemia?
History of heart disease or stroke
What are the guidelines for treating a patient for hyperlipidemia?
Don't treat to target LDL but use intensity of statin therapy as rubric
High intensity statins reduce LDL by ?
Moderate intensity statins reduce LDL by?
Which HMG-CoA reductase drug should you avoid in patients with decreased renal function (GFR under 30)
Which HMG-CoA reductase drug should you use w patients who have hepatic dysfunction because it is not CYP450 metabolized?
Which HMG-CoA reductase drug should you avoid in patients with renal or hepatic dysfunction because it is the second most potent combination for LDL/Trig reduction?
Which HMG-CoA reductase drug should you avoid in patents with renal dysfunction?
What are the thresholds for treatment for HTN?
SBP greater than 140mmHg in patients less than 60
SBP greater than 150mmHg in patients older than 60