anti HTN Flashcards Preview

Pharm Unit 4 by Hans Kim > anti HTN > Flashcards

Flashcards in anti HTN Deck (65)
Loading flashcards...
1

what are the 4 basic types of anti HTN meds?

1. diuretics --> decrease intravascular volume
2. angiotensin blockers --> inhibit production or action of angiotensin II (potent vasoconstrictor) thereby reducing peripheral vascular resistance
3. direct vasodilators
4. sympathoplegic agents (beta blockers, alpha blockers)

2

what is the mech of high potency loop diuretics?

competitively inhibit Na+K+Cl- transporter in the proximal ascending tubule

3

what it the low medium potency diuretics?

thiazide diuretics --> inhibits Na+/Cl- in the distal ascending loop

4

what is the low potency diuretics?

potassium sparing diuretics --> inhibit Na+ reabsorption in the distal tubule

5

what is the most appropriate for most mild moderate hypertensive?

thiazide

6

what is the clinical application of loop diuretics?

1. necessary for severe HTN
2. in the setting of CHF or Cirrhosis, and with renal insufficiency GFR < 30-40

7

when is appropriate to use potassium sparing diuretics?

appropriate in combination with above 2 to help prevent hypokalemia

8

what do you need to be cautious of when using loop and thiazide diuretics?

1. hypokalemia & hypomagnesemia (both can contribute to cardiac arrythmias)
2. impaired glucose tolerance
3. increased lipids
4. increased uric acid
5. erectile dysfunction
6. volume depletion

9

side effects of potassium sparing diuretics?

1. gynecomastia (spironolactone)
2. menstrual irregularities, menorrhagia and nipple tenderness
3. hyperkalemia
4. especially in setting of ...
1) renal failure
2) diabetes
3) use of ACE inhibitors or ARB's

10

two major biologic effects of diuretics?

1. volume depletion by enhanced excretion of sodium and water --> initially causes BP drop and a drop in cardiac output
2. over time CO returns to normal

11

name of loop diuretics?

furosemide

12

names of thiazides?

hydrochlorothiazide, chlorthalidone, indapamide, metolazone (in order of increasing potency)

13

names of potassium sparing diuretics?

1. spironolactone
2. triamterene
3. amiloride

14

what are the 4 major causes of secondary HTN?

1. renal --> chronic kidney dz (due to high volume and high renin states)
2. drugs --> ETOH, oral contraceptive, NSAIDs
3. endocrine --> pheochromocytoma, Cushing
4. pulmonary --> obstructive sleep apnea

15

what is a common 2nd cause of HTN which is due to endocrine problem?

hypo/hyperthyroidism

16

what are the two important parameters that result in end organ dz?

1. extent of BP
2. duration of HTN

17

what are the unique side effects of thiazide diuretics?

1. hyperuricemia --> can develop to Gout
2. hyperglycemia
3. hyperlipidemia
4. hypercalcemia

18

what are the unique side effects of loop diuretics?

1. hypokalemia and acidosis
2. hypocalcemia (loop lose Ca2+)
3. ototoxicity with aminoglycoside

19

what is the advantage is of using K+ sparing?

b/c both loop (high potency) and thiazide (medium potency) lead to hypokalemia, thus you may want to add K+ sparing, when pt is too hypokalemic

20

when is thiazides most appropriate to use?

mild to moderate hypertensive

21

when is loop diuretics necessary?

for severe HTN in setting of CHF or cirrhosis, and with renal insufficiency GFR < 30-40 (normal GFR is about 100)

22

when your GFR goes down from 100 (normal) to 30, what needs to be done?

thiazide (medium potency) does not work any more, thus need to change it to loop

23

K+ sparing diuretics are appropriate in

combination with thiazides and loop to help prevent hypokalemia

24

what are the side effects of loop and thiazide?

1. hypokalemia, hypomagnesemia (both can contriube to cardiac arrythmias)
2. impaired glucose tolerance
3. increased lipids
4. increased uric acid
5. erectile dysfunction
6. volume depletion

25

what is the mech of ACE inhibitors?

Mechanism is blocking endothelial ACE from
converting Angiotensin I to Angiotensin II. Also
inhibits the breakdown of bradykinin which is a
potent vasodilator.

26

spironolactone is a competitive antagonist for

aldosterone

27

mech for Angiotensin Receptor Blockers?

competitive receptor binding of angiotensin II to vascular endothelium (angiotensin II is very potent vasoconstrictor)

28

what is the name of the short acting ACEI?

captopril

29

what are the 4 names of the longer acting ACEI?

1. lisinopril
2. benazepril
3. quinapril
4. ramipril

30

what is unique about enalapril?

Enalapril is ACEI that is converted to enalaprilat which is a more active metabolie