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Anti-Hypertensive Agents Flashcards

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1
Q

What is the pre-hypertensive state?

A

Systolic < 120 AND Diastolic < 80

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2
Q

What is considered pre hypertension?

A

Systolic 120-129 AND Diastolic < 80

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3
Q

What is Stage I HTN?

A

Systolic of 130-139 or Diastolic of 80-89

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4
Q

What is Stage II HTN?

A

Systolic ≥ 140 OR Diastolic ≥ 90

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5
Q

What Blood Pressure is considered a Hypertensive Crisis

A

Systolic > 180 AND/OR Diastolic > 120

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6
Q

What are the 4 sites of action for HTN drugs?

A
  1. Arterial resistance
  2. Venule capacitance
  3. Kidney volume
  4. Cardiac output
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7
Q

What drugs alter arteriole resistance?

A 
Diuretics
Calcium Channel Blockers (CCBs)
Alpha Adrenergic Blockers 
Beta Adrenergic Blockers (BBs) 
Vasodilators
Angiotensin Receptor Blockers (ARBs)
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8
Q

What drugs alter venous capacitance?

A

Vasodilators

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9
Q

What drugs alter cardiac output?

A

Beta-blockers

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10
Q

What drugs alter the volume excreted by the kidneys?

A

Diuretics
ACE Inhibitors
Beta-blockers (inhibit renin)

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11
Q

What are the drugs of choice for uncomplicated HTN?

A

Diuretics

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12
Q

Thiazide MOA

A

Inhibits Na+/Cl co-transporter

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13
Q

Thiazide SE

A

Hyponatremia
Hyperglycemia
Increased LDL/HDL
Hypokalemia

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14
Q

How do thiazides stimulate hypokalemia?

A

Low Na stimulate aldosterone which causes increased delivery of Na+ to collecting duct cells increases Na+ diffusion.

K+ loss from principal cells and H+ loss from intercalated cells due to resulting neg. charge on lumen side following Na reuptake.

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15
Q

What are the 4 first line drugs for HTN?

A
  • Diuretics
  • Calcium Channel Blockers (CCBs)
  • Angiotensin Converting Enzyme inhibitors (ACEIs) *Angiotensin Receptor Blockers (ARBs)
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16
Q

What are the interactions of thiazides with NSAIDs and beta blockers?

A

NSAIDs – inhibits prostaglandin production, reduces efficacy

ß-blockers – enhances hyperlipidemia and hyperglycemia

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17
Q

Thiazide Contraindications

A

Hypokalemia

Pregnancy (starting after pregnant)

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18
Q

Loop Diuretic MOA

A

Blocks Na+/K+/Cl co-transporter, causes venous dilation via prostaglandins

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19
Q

Loop Diuretic SE

A 
Dehydration/hyponatremia 
Hypokalemia
Increased LDL/HDL
Impaired diabetes control
Ototoxicity
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20
Q

What are the drug interactions of the loop diuretics?

A

NSAIDS - inhibit prostaglandins which are required for efficacy

Aminoglycosides – enhance ototoxicity and nephrotoxicity

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21
Q

K+ Sparing Diuretics MOA

A

Aldosterone receptor blocker – combine with diuretics, not used for monotherapy of HT

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22
Q

K+ Sparing Diuretics SE

A

Hyperkalemia

Gynecomastia (spironolactone)

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23
Q

K+ Sparing Diuretics Contraindications

A

Renin System Inhibitors (they will inhibit aldosterone which will further contribute to hyperkalemia)

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24
Q

Ca Channel Blockers MOA

A

All reduce vascular resistance by reducing calcium influx in VSM Non-dihydropyridines also reduce pacemaker potentials, AV node conduction, and contractility

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25
CCB - Nifedipine Action and SE
Nifedipine – dihydropyridine, limited effect on pacemaker or conduction SE: acute tachycardia, peripheral edema (arteriolar dilation > venodilation)
26
CCB - Diltiazem Action and SE
Diltiazem – non-dihydropyridine, reduces pacemaker and conduction currents SE: bradycardia
27
CCB - Verapamil Action and SE
Verapamil – non-dihydropyridine, more pronounced reduction of currents SE: constipation, bradycardia
28
CCB - non-dihydropyridine Contraindications
Non-dihydropyridines are contraindicated in pts with conduction disturbances. - Use with care in patients on beta blockers
29
Clonidine MOA
Alpha-2 agonist that causes peripheral vasoconstriction but decreases sympathetic outflow from CNS resulting in vasodilation
30
Clonidine SE
Sedation Dry Mouth Dermatitis Rebound HTN with withdrawal of the drug
31
What is the analog of clonidine that has less chance of rebound?
Guanfacine
32
Methyldopa MOA
It is converted to methylnorepinephrine and is a α2-adrenergic receptor agonist
33
Methyldopa SE
Sedation
34
Methyldopa Drug Interactions
L-DOPA - inhibits DOPA decarboxylase
35
Methyldopa Contraindications
Liver Disease
36
What is the major indication of methyldopa?
Most extensively used anti-hypertensive in pregnancy
37
Reserpine MOA
Blocks VMAT vesicular transporter, prevents storage of NE centrally and peripherally
38
How is reserpine used?
Combined with diuretics | Used for mild and moderate hypertension.
39
Reserpine SE
Depression | Nasal Congestion
40
Phenoxybenzamine MOA
Non-selective α-receptor antagonist
41
Phenoxybenzamine SE
Tachycardia
42
Phenoxybenzamine Indications
Pheochromocytoma
43
Prazosin MOA
Selective α1-adrenergic antagonist - less tachycardia than direct vasodilators
44
Prazosin SE
Hypotension with the 1st dose
45
Beta Blocker MOA
Decreased cardiac contractility and CO, decreased renin secretion
46
Propranolol
Non-selective, used for mild to moderate hypertension, used as adjunct to prevent tachycardia with vasodilators and is lipophilic
47
Nadolol
Non-selective with longer half life than propranolol
48
Pindolol
Non-selective partial agonist that causes less bradycardia than propranolol
49
Metoprolol
ß1-selective and somewhat lipophilic
50
Atenolol
ß1-selective and hydrophilic
51
Labetolol
Mixed beta/alpha receptor antagonist; lipophilic
52
Carvedilol
Non-selective blocker with additional alpha receptor antagonist properties, vasodilatory
53
What is the difference between atenolol and metoprolol?
Metoprolol crosses the BBB while atenolol does not
54
What are the side effects of the beta blockers?
``` Bradycardia Impotence Increased triglycerides Decreased HDLs Hyperglycemia Impaired exercise tolerance ```
55
What are the drug interactions of the beta blockers?
CCBs (reduced contractility and conduction)
56
Beta Blocker Contraindications
Cardiogenic Shock Sinus bradycardia Asthma Severe heart failure
57
Vasodilator MOA
Vasodilation of small vessels, primarily arterioles
58
Hydralazine Indications
Orally effective, used in drug resistant hypertension and in emergencies, long term efficacy is poor.
59
Hydralazine SE
Tachycardia, angina aggravation, fluid retention NSAIDS can reduce effectiveness
60
Minoxidil Indications
Drug resistant hypertension - similar to hydralazine
61
What is another use for minoxidil?
Hair growth
62
Nitroprusside MOA
Vasodilator
63
Nitroprusside Indications
Emergencies
64
Nitroprusside SE
Cyanide poisoning
65
ACE Inhibitor MOA
Blocks production of Angiotensin II and Ang II-mediated- | vasoconstriction
66
Captopril
Short half life ACE-I
67
Enalapril
Converted to active metabolite enalaprilat, longer onset of action, longer half-life ACE-I than captopril
68
Lisinopril
Water soluble, excreted unchanged by kidney, longer half-life, allows 1x daily dosing
69
ACE-I SE
Hyperkalemia, dry cough, angioedema
70
ACE-I Contraindications
Pregnancy and bilateral renal stenosis
71
ACE-I Indications
Prolongs survival in pts with HF or LV dysfunction after MI Preserves renal function in diabetic patients
72
ANG-II Receptor Blocker MOA
ANG-II receptor antagonist
73
Losartan MOA
Selective AT1 receptor antagonist
74
Losartan SE
Hyperkalemia
75
Losartan Contraindications
Pregnancy | K+ Sparing Diuretics
76
What are good combinations of drugs for HTN?
- Thiazide or Loop diuretic with K+ sparing diuretic - Thiazide diuretic with BB’s - CCBs with ACEI
77
What is the main HTN drug for diabetics?
ACE-I
78
What is the main HTN for HF?
ACE-I combined with diuretics
79
What are the main HTN drugs for MI?
ACE-I and beta blockers
80
What drugs are less effective in African Americans?
Monotherapy with BBs and ACEIs not as effective

►Pharmacology (73 decks)

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