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Naplex
HTN clinical pearls
| Question | Answer |
|---|---|
| Contraindication if Asthma | Nonselective beta-blockers |
| Amlodipine SEs | • Headache • Flushing • Peripheral edema • Reflex tachycardia/palpitations |
| Cause bradycardia | • Non-DHP - CCBs • Beta-blockers • Centrally-acting alpha-2 agonists |
| Drug-induced lupus (Malar ("butterfly") rash, Fever, fatigue, weight loss & anorexia, photosensitivity, Myalgia & arthralgia) | Hydralazine, methyldopa |
| Beta-1 selective | Atenolol, Metoprolol, Esmolol, Nebivolol, Betaxolol, Bisoprolol |
| Nonselective beta blockers | Nadolol, Propranolol, Pindolol (with ISA), Timolol |
| Nonselective beta-blocker + alpha-1 blocker | Carvedilol, Labetalol |
| spironolactone | breasts to feel tender / Gynecomastia |
| ACE / ARBs | BBW to avoid in pregnancy |
| Nifedipine IR | NOT used for chronic hypertension |
| Gingival hyperplasia | CCBs |
| Metoprolol tartrate IV:PO conversion | 1 : 2.5 |
| Clevidipine | Contraindicated with soy, soybean, or egg allergy |
| Empty tablet shell in stool (ghost table) | Procardia XL (nifedipine extended-release) |
| ER formulations that can be safely cut in half | Toprol XL (Metoprolol succinate) |
| Beta blocker SEs | Bradycardia, Fatigue, Impotence, hypoglycemia, CNS (fatigue, dizziness, depression), cold extremities (exacerbate Raynaud') |
| Cl w sulfa allergy | - Thiazide - Loop (EXCEPT: ethacrynic acid / Edecrin) |
| Constipation | verapamil >> diltiazem, Clonidine, Guanfacine, Methyldopa |
| Anticholinergic side effects: dry mouth, somnolence, fatigue, constipation | Clonidine, Guanfacine, Methyldopa |
| Vasodilatory side effects: headache, flushing, peripheral edema, reflex tachycardia, palpitations | Hydralazine, Minoxidil, DHP CCBs |
| Do not discontinue abruptly | Beta blocker, Clonidine, Guanfacine, Methyldopa |
| Minoxidil box warning | - Angina exacerbations, Pericardial effusion. - Manage with B Blocker, diuretics |
| Beta blocker w intrinsic sympathomimetic activity (ISA) | (less effect on HR reduction vs selective beta 1 blocker) - Acebutolol (beta 1) - Pindolol (non selective) |
| Impotence (B-T-C-S = Bad To Cause Sex dysfunction) | Beta blocker, thiazide, Clonidine, Spirinolactone guanfacine |
| Photosensitive | Thiazide, Loop |
| IV DHP CCBs | Nicardipine, Clevidipine |
| IV ACE inhibitor | Enalaprilat |
| IV Vasodilators | Hydralazine, Nitroglycerin, Nitroprusside |
| increase LITHIUM serum concentrations | Thiazide, ACE / ARBs, NSAIDs |
| Drug-induced hemolytic anemia (Positive direct Coombs test, Fatigue, dyspnea, pallor, jaundice, dark urine) | Methyldopa, hydrazaline |
| Conditions can be exacerbated by a thiazide | (1) Diabetes mellitus, (2) Dyslipidemia, (3) Erectile dysfunction, (4) Gout |
| Depression | Beta blocker |
| nifedipine IR SEs | - Hypotension - Reflex tachycardia which may exacerbate ischemia (eg, MI) |
| Portal HTN | Nadolol (Corgard), propranolol |
| Catapres-TTS counseling points | Replace the patch every 7 days, Remove the patch before magnetic resonance imaging (MRI), Localized skin reactions, The patch should not be abruptly discontinued |
| Spironolactone SEs | Hyperkalemia, Gynecomastia, Impotence, Renal impairment |
| Drug-induced hemolytic anemia | Methyldopa, Levodopa, Penicillins, Cephalosporins, Sulfonamides, Isoniazid, Rifampin, Quinidine, Quinine |
| Medication should be avoided because it can exacerbate HF | non-DHP CCBs (diltiazem and verapamil) |
| BP med causes diarrhea | Olmesartan (Benicar) |
| Adverse effects of clonidine & guanfacine | Bradycardia, hypotension, Dry mouth, constipation, Somnolence, fatigue, dizziness, Impotence |
| CNS-related effects • Fatigue, dizziness, depression • Risk with lipophilic beta-blockers (eg, propranolol) | beta-blockers |
| BP meds causes both hyperkalemia and renal dysfunction | ACE , ARBs & ARNIs |
| short-acting oral antihypertensives for HTN urgency (PO) | captopril, clonidine, hydralazine |
| What is the next step for HTN stage 1 | - Calculate Prevent-CVD risk estimator. - If < 7.5%: lifestyle changes, reassessment 3-6 mos. - If > = 7.5%: lifestyle changes, antihypertensive med, f/u 1mo |
| Normal BP | SBP (mmHg)< 120 AND DBP (mmHg) < 80 |
| Elevated BP | SBP (mmHg) 120-129 AND DBP (mmHg) < 80 |
| Stage 1 Hypertension | SBP (mmHg) 130-139 OR DBP (mmHg) 80-89 |
| Stage 2 Hypertension | SBP (mmHg) ≥ 140 OR DBP (mmHg) ≥ 90 |
| What pt population that loop is preferable over thiazide | - Heart failure with fluid overload - CrCl < 30 mL/min - High calcium level |
| What is beta-blockers taken with food? | - Carvedilol - Metoprolol: with or immediately following food |
| What is more potent: Chlorthalidone or HCT | Chlorthalidone (longer duration of action) |
| Does SSRI increase BP | - S S RI = S table BP - S N RI = N orepinephrine → increase BP |
| What are possible features of hypertensive emergency? | - Elevated systolic and diastolic blood pressure - Chest pain - Blurry vision - Headache |
| Med for Raynaud's disease | - It is a spasm of the smooth muscle of digital arterioles (digits means fingers), leading to blockage of the blood supply to the distal end of fingers - DHP CCB (NOT non-DHP) |
| Meds can WORSEN Raynaud's and subsequently cause necrosis of digits. (BET) | - Beta-blockers - Ergots - Triptans (eg. Sumatriptan / Imitrex) |
| What antihypertensive meds cause hyPERlipidemia | Beta-blockers, thiazides (& PI for HIV), Loop (TGs) |
| DASH diet vs Mediterranean diet | - DASH diet: HTN - Mediterranean diet: DM |
| ACE which is a capsule that may be opened, sprinkled on applesauce, and administered via NG tube? | Ramipril (Altace) |
| Does nifedipine (or DHP CCB) causes unilateral peripheral edema | - No - It causes lateral peripheral edema |
| What CCB causes the LEAST headache, flushing, and edema? | Verapamil |
| Captopril and Moexipril are taken food | - NO - They are taken on an EMPTY STOMACH |
| When initiate 2 antihypertensive medications for new diagnosis HTN | - Baseline is > 20/10 mmHg above goal (eg. 150/90) - Stage 2 |
| What antihypertensive to select if Urine Analysis shows "Protein: +2" | - ACEi or ARB |
| What antihypertensive to select if Urine Analysis shows " 3+ Albuminuria" | - ACEi or ARB |
| Zaroxylyn (Metolazone, a thiazide-like diuretic): ISN'T effective in patients with impaired renal function. | FALSE |
| What meds are used to counter hyPOkalemia caused by diuretics? | - Potassium-sparing: amiloride (Midamor) and triamterene (Dyrenium) |
| Antihypertensive agents are recommended for gestational hypertension? | Methyldopa, hydralazine, nifedipine ER, and labetalol |
| What is the maximum daily dose of HCTZ . | 50 mg |
| TRUE or FALSE "For pt HTN: Avoid using SNRI or SSRI with St. John's wort due to the risk of serotonin syndrome." | TRUE, serotonin syndrome may cause BP increasing |
| What renal condition in which ACEi is a contraindicated? | - Hx of renal artery stenosis (ARB is also CI) |
| Common SEs of NON-DHP CCBs | - Constipation (V>D) - Gingival hyperplasia - Edema (D > V) - Headache, dizziness - Cutaneous hypersensitive reactions (D) |
| Non DHP CCB monitoring | BP, HR, ECG, LFTs |
| Why IV diltiazem in most crash carts | - Control ventricular rate in Afib/A.flutter - Cardioversion of paroxysmal supraventricular tachycardia (PSVT) |
| Beta-blocker + non-dihydropyridines CCB | This combinations is generally NOT used together: - Severe bradycardia - AV block - Hypotension - HF exacerbation |
| Verapamil is effective in preventing angina attacks and in prolonging exercise duration. | TRUE |
| Meds with AV blocking properties (ABCD) | Amiodarone, BB, CCBs nonDHPs, and Digoxin |
| Reflex tachycardia | It is a compensatory increase in heart rate due to a sudden drop in blood pressure. |
| What DHP CCB has ER tablet | - Nisoldipine (Plendil) - Felodipine (Sular) - Nifedipine (Procardia XL) |
| Loop site of Action | Works on the thick ascending limb of the loop of Henle |
| What antihypertensive agent has ototoxicity warning? | - Loop (Hearing loss, tinnitus and vertigo) - Increasing risk w Ethacrynic acid or rapid IV administration |
| Loop dose convertion | - Furo PO:IV = 2:1 - Bume / Ethracrynic PO:IV = 1:1 - 50 : 40 : 20 : 1 = E:F:T:B |
| List of Loop | - Ethracrynic acid (Edecrin) - Furosemide (Laxis, Furoscix): PO tab / sol, IM, IV - Torsemide (Soaanz) - Bumetanide (Bumex) |
| What alpha-blockers generally don't require titrate (first dose phenomenon) | - Afluzosin: 10 mg (Ext Release = Uroxatral) - Silodosin (Rapaflo): 8 mg - Tamsulosin (Flomax): 0.4mg (inadequate response after 2 - 4 weeks: 0.8mg) |
| Terazosin standard titration(appropriate for most patients): | - Days 1 - 3: 1 mg/day - Days 4 - 14: 2 mg/day - Weeks 2 - 6: 5 mg/day - Week 7 and thereafter: 10 mg/day |
| What alpha-1-adrenergic antagonists is NOT used for patients with ВРН? | Prazosin (Minipress): HTN |
| List of alpha-1-adrenergic antagonists | - Alfuzosin (Uroxatral) - Doxazosin (Cardura) - Tamsulosin (Flomax) - Prazosin (Minipress) - Silodosin (Rapaflo) - Terazosin (Hytrin) |
| 5-alpha-reductase inhibitors | - Finasteride - Dutasteride |
| Carvedilol dose convertion | - IR 3.125 mg BID = CR 10 mg PO QD |
| Hypertensive emergency: BP goal for treatment | Reduce BP not more than 15-25% daily, mostly within the first few hours |
| Useful antihypertensive agent in patients with renal hypertensive emergencies? | Fenoldopam (Corlpam) |
| Clevidipine | - Soy allergy - Egg allergy - Lipid emulsion for IV infusion |
| IV beta-blockers: | Metoprolol, Propranolol, Labetalol, Esmolol, Sotalol. |
| Atenolol | - Negative chronotrope - Depresses conduction through the atrioventricular node |
| Nitroprusside | - Stable in D5W (preferred) - Be protected from light (use a foil). - Cyanide toxicity - Causes rapid BP lowering, continuous BP monitoring - Arterial + venous dilator |
| Catapres-TTS strengths | - Catapres-TTS-1: 0.1 mg/24 hr (4 ea) - Catapres-TTS-2: 0.2 mg/24 hr (4 ea) - Catapres-TTS-3: 0.3 mg/24 hr (4 ea) |
| Initial starting dose of PO clonidine for hypertension | 0.1 mg |
| Clonidine available formulation | - Tablet - Patch |
| Indications for using clonidine | - Hypertension - ADHD |
Created by:
dao.vo11017