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Anti-Hypertensive Agents Flashcards

(78 cards)

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1
Q

What is the pre-hypertensive state?

A

Systolic 120-139

Diastolic 80-89

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2
Q

What is Stage I HTN?

A

140-159/90-99

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3
Q

What is Stage II HTN?

A

≥ 160 systolic OR ≥ 100 diastolic

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4
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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5
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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6
Q

What drugs alter venous capacitance?

A

Vasodilators

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7
Q

What drugs alter cardiac output?

A

Beta-blockers

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8
Q

What drugs alter the volume excreted by the kidneys?

A

Diuretics
ACE Inhibitors
Beta-blockers (inhibit renin)

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9
Q

What are the drugs of choice for uncomplicated HTN?

A

Diuretics

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10
Q

Thiazide MOA

A

Inhibits Na+/Cl co-transporter

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11
Q

Thiazide SE

A

Hyponatremia
Hyperglycemia
Increased LDL/HDL
Hypokalemia

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12
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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13
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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14
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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15
Q

Thiazide Contraindications

A

Hypokalemia

Pregnancy (starting after pregnant)

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16
Q

Loop Diuretic MOA

A

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

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17
Q

Loop Diuretic SE

A 
Dehydration/hyponatremia 
Hypokalemia
Increased LDL/HDL
Impaired diabetes control
Ototoxicity
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18
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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19
Q

K+ Sparing Diuretics MOA

A

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

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20
Q

K+ Sparing Diuretics SE

A

Hyperkalemia

Gynecomastia (spironolactone)

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21
Q

K+ Sparing Diuretics Contraindications

A

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

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22
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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23
Q

CCB - Nifedipine Action and SE

A

Nifedipine – dihydropyridine, limited effect on pacemaker or conduction
SE: acute tachycardia, peripheral edema (arteriolar dilation > venodilation)

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24
Q

CCB - Diltiazem Action and SE

A

Diltiazem – non-dihydropyridine, reduces pacemaker and conduction currents
SE: bradycardia

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

Pharmacology (74 decks)

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