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Fuchs > Antihypertensives > Flashcards

Antihypertensives Flashcards

1
Q

BP =

A

BP = CO x PR

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2
Q

Furosemide

A

loop diuretic, at ascending loop

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3
Q

Hydrochlorothiazide

A

thiazide, at distal tubule

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4
Q

Sprionolactone

A

K+ sparing, at distal tubule and collecting duct

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5
Q

Mannitol

A

osmotic diuretic; at proximal tubule and descending loop

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6
Q

acetazolamide

A

carbonic anhydrase inhibitor; at proximal convoluted tubule

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7
Q

___ produces angiotensinogen

A

liver

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8
Q

renin produced in ____

A

juxtaglomerular cells in kidney

*renin is rate limiting factor

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9
Q

ACE produced in ___

A

capillary endothelium cells in lungs

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10
Q

angiotensin II binds to ___

A

AT1 receptors

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11
Q

ACE converts ___ to ___

A

angiotensin I –> angiotensin II

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12
Q

renin converts ___ to ___

A

angiotensinogen –> angiotensin I

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13
Q

ACE inhibitor MOA

A

Block production of angiotensin-II; decrease vascular resistance.
Sympathetic reflex not activated  cardiac output and HR are NOT significantly changed

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14
Q

captopril

A

active drug, ACEi

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15
Q

lisinopril

A

active drug, ACEi

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16
Q

ACEi uses

A

HTN (low and high renin forms); particularly indicated for CKD, DM, heart failure post MI

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17
Q

ACEi SEs

A 
Renal failure in presence of renal artery stenosis 
Hyperkalemia 
Cough (bradykinin action)
Angioedema 
*contraindicated w/ pregnancy
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18
Q

ARBs MOA

A

Block activation of angiotensin receptor by angiotensin-II;

No effect on bradykinin

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19
Q

losartan

A

ARB

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20
Q

valsartan

A

ARB

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21
Q

ARB SEs

A

Similar to ACE inhibitors, but less cough and angioedema;

Same precautions for pregnancy

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22
Q

Aliskiren MOA

A

renin inhibitor, inhibits renin enzymatic activity

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23
Q

Aliskiren SEs

A

Hypotension, hyperkalemia (from aldosterone effect), diarrhea, cough, rash.
Injury or death to developing fetus

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24
Q

hydralazine class

A

vasodilator

oral

25
Q

minoxidil class

A

vasodilator, oral

26
Q

nitroprusside class

A

vasodilator, IV

27
Q

fenoldopam class

A

vasodilator, IV

28
Q

hydralazine use

A

long-term use
Preeclampsia
w/ nitrates for heart failure resistant to ACEi

29
Q

minoxidil use

A

long-term use

HTN refractory to other treatments

30
Q

nitroprusside use

A 
HTN emergencies (>180/120)
Immediate reduction in BP, reduce bleeding during surgery, treatment of acute CHF
31
Q

fenoldopam use

A

postop HTN, HTN emergencies

32
Q

minoxidil MOA

A

dilates arteries, NOT veins

open K+ channels in smooth muscle cells, stabilizes resting membrane potential –> contractions less likely

33
Q

hydralazine SEs

A

Sympathetic reflex, Na+/fluid retention, HA, nausea, anorexia, palpitation, sweating, flushing, angina, ischemic arrhythmia.
Arthralgia, myalgia, rash, fever (lupus erythematous like)

34
Q

minoxidil SEs

A
  • Extreme caution in patients with renal failure
  • tachycardia, palpitations, angina, edema, HA, sweating, hypertrichosis
  • activation of sympathetic reaction and Na+/fluid retention –> use with b-blocker and loop diuretic
35
Q

Nitroprusside MOA

A

more active on veins than arteries

NO –> activation of guanylyl cyclase –> vasodilation

36
Q

Fenoldopam MOA

A

fast acting peripheral arteriolar dilator

  • Selective postsynaptic D1 agonist
  • binds w/ moderate affinity to a2-adrenoceptors
  • decreasing peripheral resistance, increasing renal blood flow, diuresis, natriuresis
37
Q

Nitroprusside SEs

A
  • Hypotension, metabolic acidosis, arrhythmias, death.
  • release of cyanide –> weakness, disorientation, psychosis, muscle spasm, convulsions.
    Antidotes: thiosulfate and hydroxocobalamin
38
Q

CCB MOA

verapamil, diltiazem, nifedipine

A

Blocks L-type Ca2+ channel –> Ca2+ can’t enter –> –> no phosphorylation of myosin light chain –> no contraction = relaxation of arterial smooth muscle
(not much effect on venous)
- reduction in afterload (but not preload)

39
Q

Methyldopa MOA

A 
centrally acting sympathoplegic agent 
*a2 agonist in brain
Reduces sympathetic tone --> reduces vascular resistance (including in kidney) 
- NO direct effect on heart
- renin activity reduced
40
Q

Methyldopa SEs

A
  • sedation (at onset)
  • nightmares, depression, vertigo
  • lactation (increased prolactin)
  • positive Coomb’s test (hemolytic anemia)
  • rarely orthostatic hypotension
  • safe to use during pregnancy
  • does NOT reduce blood flow or GFR
41
Q

Clonidine MOA

A

centrally acting sympathoplegic agent
*a2 agonist in brain
decease HR and peripheral resistance

  • high doses –> stimulates vascular a2b and may reduce effect
    IV: initial increase in BP (stimulates a2b –> constriction)
42
Q

Guanabenz & Guanfacine MOA

A

a2 agonists in brain, similar to clonidine

43
Q

B-blocker MOA

A

negative chronotropic (slows HR) and inotropic (decrease stroke volume and CO)
o Decrease vasomotor tone via reduction of angiotensin-II
o Decrease renin (B1 receptor blockade on juxtaglomerular cells)

44
Q

a1 antagonists MOA

A

decrease peripheral vasomotor tone, relaxation of vessels

BP more reduced in upright position –> bedtime administration

45
Q

propranolol

A

non-selective

46
Q

propranolol contraindications

A

asthma/COPD

47
Q

cardioselective b-blockers

A

metoprolol and atenolol

ok for pt’s w/ asthma/COPD
advantageous for patients with asthma, DM, or peripheral vascular disease

48
Q

pindolol

A

partial agonist, b-blocker w/ some sympathomimetic activity

for pt with bradyarrhythmia or peripheral vascular disease

49
Q

acebutolol

A

partial agonist, b-blocker w/ some sympathomimetic activity

for pt with bradyarrhythmia or peripheral vascular disease

50
Q

Labetalol

A

Racemic mixture with B-blocking and a-blocking properties; b-blocking and vasodilating effects

51
Q

Carvedilol

A

Racemic mixture with B-blocking and a-blocking properties; b-blocking and vasodilating effects

52
Q

Nebivolol

A

b-blocking and vasodilating effects
Vasodilating effects due to increase nitric oxide (not a-blocking effect) –> strong decrease in peripheral vascular resistance

53
Q

Esmolol

A

b1 selective blocker

  • Perioperative hypertension
  • hypertensive emergencies associated with tachycardia
54
Q

Prazosin

A

selective a1 antagonist in arterioles and venules –> relaxation of vessels

55
Q

Terazosin

A

selective a1 antagonist in arterioles and venules –> relaxation of vessels

56
Q

Doxazosin

A

selective a1 antagonist in arterioles and venules –> relaxation of vessels

57
Q

a1 antagonist uses

A

Hypertensive patients w/ prostatic hyperplasia and bladder obstruction symptoms

(end with -zosin)

58
Q

a1 antagonist SEs

A

Salt/water retention – use in combo with b-blocker or diuretic
- dizziness, palpitations, HA, lassitude, orthostatic hypotension

Fuchs (3 decks)

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