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2010-10-13 13:24:20
Pharm Exam Hypertension

Pharm exam 2 part 3
Show Answers:

  1. Define blood pressure using an equation
    BP = CO x PR
  2. Factors that increase morbidity and mortality of HTN
    • smoking
    • dyslipidemia
    • DM
    • age >60
    • male
    • postmenopausal women
    • family hx of CVD (<65 in mom, <55 in dad)
    • chronic kidney disease
  3. Define cardiac output using an equation.
    CO = SV x HR
  4. Non-drug therapy for HTN
    • high fiber, low-fat diet
    • weight loss
    • reduce sodium intake
    • decrease alcohol intake
    • no tobacco
    • excercise
    • adequate K, Ca, Mg intake
  5. Thiazide duretics
    • hydrochlorothiazide
    • chlorthalidone
  6. loop diuretics
  7. nonselective beta blockers
  8. beta 1 blockers
    • atenolol
    • metoprolol
  9. alpha 1 blockers
  10. alpha 2 agonists
  11. direct acting vasodilators
    • hydralazine
    • minoxidil
  12. ACE inhibitors
  13. angiotensin II blockers
  14. calcium channel blockers
    • diltiazem
    • nifedipine
    • verapamil
  15. drug classes used to treat HTN
    beta blockers, diuretics, alpha 1 blockers, alpha 2 agonists, vasodilators, ACEIs, ARBs, Ca channel blockers
  16. If pt has asthma/COPD what drug class should be used/avoided with HTN?
    • use: diuretics, CCB
    • avoid: beta blockers
  17. If pt has BPH what drugs should be used for HTN?
    prazosin, terazosin
  18. If pt has DM what drug classes should be used/avoided with HTN?
    • use: ACEI and ARBs
    • avoid: beta blockers
  19. thiazide diuretics and HTN
    • block resoption of Na
    • more effective than loop diuretics except in pts with renal probs (can still use metolazone and indapamide)
    • DECREASE excretion of Ca
    • used in all pts with HTN
  20. loop diuretics and HTN
    • block sodium and chloride resorption
    • INCREASE renal elimination of Ca
  21. diuretics and HTN
    • should be used in all pts with HTN
    • can take 2-4 wks to see effects
    • toxicities: hypokalemia (treat with KCl), hyperuricemia, hyperglycemia, increased cholesterol and trigs, hypomagnesemia
    • (K sparing diuretics are also Mg sparing diuretics)
    • pt related variable: digoxin therapy (hypokalemia will increase toxicity), renal dysfunction (treat with loops or metolazone)
    • interact with NSAIDS, antagonize antihypertensive effects
  22. beta blockers and HTN
    • decrease CO and decrease release of renin from kidneys
    • best if used with other antihypertensives
    • abrupt d/c can increase anginal attacks, taper dose over 2 wks
    • toxicity: bronchoconstriction in asthmatics, HF, peripheral vascular insufficiency, prolonation of hypoglycemia, beta blocker blues
    • DO NOT administer immediately after d/c clonodine
  23. alpha 1 blockers and HTN
    • not good antihypertensive
    • decreases PR
    • used with pts who have BPH
    • may cause first dose syncope, reflex tachycardia, orthostatic hypotension
  24. alpha 2 agonists and HTN
    • decreases sympathetic response
    • rebound HTN may occur after d/c of drug
    • oral or patch (do not cut patch)
    • toxicity: rebound HTN, orthostatic hypotension, sedation, impotence
  25. direct acting vasodilators and HTN
    • reduce PR by directly dilating arterioles
    • reflex tachycardia and aldosterone secretion are common
    • use beta blocker to decrease reflex tachycardia and diuretic to prevent edema
    • take same time each day with meal
    • toxicity: edema, hypertrichosis (increased hair growth), reversible SLE (with hydralazine)
  26. ACEIs and ARBs and HTN
    • avoide ACEIs if serum K is >5 or Cr is >3 (indicates renal probs)
    • toxicity: precipitous BP drop after first dose, dry cough, angioedema (of face)
    • containdications: pregnancy, bilateral renal artery stenosis, h/o angioedema
    • renal protective in DM
  27. Ca channel blockers and HTN
    • cause arterial dilation (decrease afterload)
    • verapamil and diltiazem decrease inotropic state of heart
    • nifedipine increases vasodilation more than V or D
    • always use SR of these drugs for HTN
    • toxicity: reflex tachycardia, aggrevation of GERD
    • pt related variables: preexisting heart block, concurrent used of beta blockers (V and D), HF, hypovolemia, will interact with grapefruit juice (nifedipine)
  28. Aldosterone antagonists
  29. spironolactone
    • aldosterone antagonist
    • causes increased absorption of Na, H2O, and K
    • toxicity: hyperkalemia
  30. hypertensive emergency
    • severly elevated BP with end organ damage
    • lower BP up to 25% (to range of 160/100) in minutes to hours
    • use IV agents (NTG, hydralazine, labetalol)
  31. hypertensive urgency
    • severely elevated BP without end organ damage
    • lower BP over hours
    • use PO agents (clonodine, labetalol, captopril)