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Pharmacology > HTN > Flashcards

HTN Flashcards

1
Q

JNC Joint National Committee

A

sets standards of treatment

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2
Q

Diuretics

A

Ions drive the action
Increase osmolality of filtrate
Requires good blood flow to Kidney
GFR> 30

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3
Q

Thiazide Diuretics

African American Male (good response)

A

Works at Distal convuluted tubule
Blocks Na+ channels–no reabsorption of Na+/ Cl.-filtrate stays in kidney for excretion.
Contraindicated with Gout DX’
NO Na+ in and NO uric acid out—> risk
Gout.

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4
Q

Thiazide Diuretics

Contraindicated in DX
Gout, Renal Insuffiency

A 
Chlorothiazide 250 mg -1gm/day
Hydrochlorothiazide ** most common
  12.5-100mg/day
Metolazone 2.5-5mg/day
Chlorthalidone -more potent/ longer half life
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5
Q

Loop Diuretics

A

Blocks Na+ at loop of Henle
Blocks Cl binding at NA+/K+/Cl transporter
increased risk of K+ loss
increased effectiveness due to increased Na+ absorption in loop of Henle.

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6
Q

Loop Diuretics

Standard of treatment in Renal Disease

A

Furosemide 20-80 mg/day
Bumetidine (Bumex) 0.5-2mg/day

Monitor K+, NaCl, Ca+, and renal fx
K+ supplementation

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7
Q

K+ Sparing Diruetics

A

Monitor for hypercalemia
esp with combinations of K= sparing meds (prils and birth contorl Yaz/yasman)
Blocks Na+/K+ pump–blocks Na+ reabsorption to body–increases Na+ in filtrate–K+ reabsorbs into body- no loss of K+.

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8
Q

K+ sparing Diuretics

A

Spironolactone 25-100mg/day
Amiloride 5-20mf/day
Triamterene 100-200mg/day

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9
Q

K+ sparing Diuretics

Aldosterone Receptor Antagonist

Used with liver failure/heart failure
Used in PCOS (block of androgen effect)

A

Spironolactone.
Blocks action of aldosterone at the collecting duct. Na= stays out/K= stays in
caution K+ levels with other K+ sparing meds.

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10
Q

MI compelling indication for

A

Beta Blocker

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11
Q

Beta blockers

A

Categories
Non selective with alpha blocking
Non selective Beta - blocks Beta1/Beta2
Selective blocks only Beta1

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12
Q

Non selective Beta Blocker

Beta 1 & Beta 2 antagonist

***Contraindicated with DX lung Disease

A

Propranolol (Inderal)
Nadolol
Timolol

Uses hyperthyroidism, tremor, migraine prevention

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13
Q

Non selective Beta Blocker

Effects

A 
decreased HR (-chronotrope)
decreased contraction (-inotrope)
decreased Renin secretion
Bronchoconstriction
increased GI distress
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14
Q

Selective Beta Blocker

Beta 1 Antagonist

A 
Atenolol (Tenormin)
Metroprolol
   tartate -regular
   succinate-ER  (Toprol XL)
Uses Cardiac
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15
Q

Selective Beta blocker
Effects

**Can lose selectivity at higher doses (MAX DOSE)

A 
decreased HR (-chronotrope)
decreased contraction (-inotrope)
decreased Renin secretion
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16
Q

Nebivolol- Bystolic

Selective Beta blocker Beta 1

A

Very cardio selective
good safety record in RAD (reactive Airway Disease)
increases release of NO (Nitrous Oxide)= vasodilation=decrease BP

17
Q

Labetolol
Carvedilol (coreg)

Non selective Beta blocker +
Beta 1, Beta 2, Alpha 1
1st line drug for HF
carefully watch lung fx. (trial low dose )

A 
Alpha 1 antagonist effects---
  Vasodilation=decreased vascular resistance.
Beta 1 antagonist effects--
  decreased HR (-chronotrope)
  decreased contraction (-inotrope)
  decreased Renin secretion
Beta 2 antagonist effects---
18
Q

Beta blockers & Prescribing indications HTN

Compelling indications
S/P MI, HF, DM2 combined DM/HF
other uses HF migraine prevention

A

Start low-titrate slowely
Hold if HR <60
Consider dx lung disease

**note blunting SNS response masks s/s of hypoglycemia

19
Q

Beta Blocker SE

A 
<HR                           Dizziness
depression                  GI upset
sexual dysfunction       **fatigue
malaise
Rebound HTN with sudden withdrawl
20
Q

Beta Blocker Contraindications

A

> 1st degree heart block
Bradycardia
RAD (Reactive Airway Disease)

Common interaction– Separate dosing time
Antacids
Anti-cholinergics-increase absorption

21
Q

Alpha Blockers for HTN

Never 1st line tx

A

3rd or 4th line drug

Good to treat stress component of HTN etiology.
Vasodilation

22
Q

Selective alpha 1 blocker
***do not combine with Nitrates= unsafe drop in BP
Use in conjunction with a diuretic.
Commonly used for prostate

A 
Doxazosin mesylate (Cardura)
Prazosin HCl (minipress)
Terazosin HCl (hytrin)
23
Q

alpha blockers SE

A 
***Severe orthostatic hypotension (biggest)
fatigue
Na+/H2O retension=edema
HA, N/V
educate prostate pts--get up slowly
24
Q

alpha 1 blockers contraindications

A

hepatic dysfunction

drug interactions NSAIDS attenuate antihypertensive effect

25
Q

Alpha 2 agonist

Labs decrease urine catecholamines and vanillylmandelic acid (+for DX of phenochromacytoma- tumor causing very high BP)

A

Alpha 2 receptors put breaks on SNS.
decrease SNS activity in peripheral vessels
increases vagus activity para SNS
vasodilation
decreased CO cardiac output
decreased catecholamine& renin release

26
Q

Alpha 2 agonist

Uses
drug withdrawl, tourettes,anger management and menopause (calming)

A

Methyldpoa (Aldomet) oldest BP med
pregnancy approved
Clonidine weekly patch or po.

27
Q

alpha 2 agonist effects
Caution in recent MI& depression
drug reaction with TCA Tricyclic antidepressants

A

CNS depression/sedation in addition of alpha 1 responses
Severe orthostatic hypotension, fatigue
Na+/H2O retension=edema, HA, N/V

28
Q

CCB Calcium Channel Blockers

A 
3 channels for calcium to enter cells. 
l type, N type and T type.
focus on
 L type long lasting--contractile muscle
      Heart and smooth muscle
 T type - found only in pace making cells
29
Q

CCB Calcium Channel Blockers

Non-dihydropyridines

A

Diltiazem (Cardizem) A FIB
Verapamil (calan SR) A FIB
Greater effect on T-type channels Pacing cells but modest impact on HTN

30
Q

CCB Calcium Channel Blockers
Dihydropyridines
1st pril then ipine

Used for HTN
other uses HF and esophageal spasm

A 
Nifidipine (Procardia XL)
Amlodipine  (Norvasc)
Cleridipine  emergency use
 drugs ending in     IPINE
Greater effect on L type channels 
  decreased contractility heart and arterial smooth muscle---HTN tx
31
Q

CCB- Adverse reactions
CCB contraindications

2nd/3rd degree heart block SBP< 90
Sick Sinus Syndrome Aortic stenosis
Severe CHF

A

***Flushing
Dizziness/HA/Dry mouth/nausea and constipation (decreased in smooth muscle contraction).
Peripheral edema (give in combo with ACE/pril to decrease edema)
heart dysrhythmias
photosensitivity

32
Q

Direct acting Vasodilators

A 
Cause direct relaxation and dilation of arteriolar smooth muscle-decrease vascular resistance
Hydralazine (Apresoline)
   slow IV admin
   \+ reflex tachycardia& HTN
Minoxidil (Loniten)
  Used primarily for side effect of hair 
     growth--not used much for HTN
Nitroprusside (Nitropress)
  *****Emergency only
          keep away from light
33
Q

Endothelial Dysfunction

Players

A

Nitric Oxide–Vasodilation
RAAS– Angiotension II (called AT1 receptor)–vasoconstriction
Thromboxane A2

34
Q 
ACE  Inhibitors
Pregnancy class D

Decreased BP, stroke, and MI

A

ACE blocks angiotension I from changing to angiotension II by blocking angiotension converting enzyme—vascular changes (AT1) & decreased aldosterone activity (AT2)–increased Na+ & H2O excretion, increased K+ retension
PO/IV administration
.

35
Q

ACE SE

Dry cough–AT2 breaks down Bradykinin in lungs. Blocking AT2=increased Bradykinin in lungs

A

r/t antihypertensive effects (HA,dizziness, tachycardia, cough, Maculopapular rash, neutropenia/agranulocytosis, angioedema (swelling lips and rash, incidence increasing)

36
Q

ARBS Angiotension II receptor blockers

End in sartan

A

Blocks angiotension II at receptor site in tissue–decreased vascular resistance
Benicar
Diovan

37
Q

ARBS SE

A

FEW No cough
K+ sparing -careful in combo with other K= sparing meds >K+
? same Benefits as ACE
?use in renal impairment

38
Q

Renin Inhibitors
Newest class of antihypertensives
Aliskiren

A

Direct Renin inhibitor–, conversion of angiotensinogen to angiotension I.
effects RAAS without increasing the plasma renin activity
Dosage 150-300mg daily

39
Q

ReninInhibitors Adverse Effects

Drug interactions

A

Angioedema, diarrhea, cough

Substrate of P450 3A4
reduced loop diuretic activity
Do not combine with ACE/ARB
?safety/efficacy in renal disease

Pharmacology (10 decks)

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