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Pharm drugs HC > Anti-hypertensive drugs > Flashcards

Anti-hypertensive drugs Flashcards

1
Q

HCTZ: How does it work?

A

Blocks reuptake of Na and Cl after filtration. Causes a decrease in TPR

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2
Q

By how much does HCTZ lower BP?

A

10-15 mm

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3
Q

What competing drug is slightly more effective than HCTZ and in the same class?

A

chlorthalidone

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4
Q

What is the oral fraction of HCTZ?

A

70%

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5
Q

How is HCTZ excreted? In what form?

A

Excreted unchanged in the urine

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6
Q

What is the route of administration for HCTZ?

A

Oral

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7
Q

What is the onset, peak, and duration of HCTZ?

A

2,5,10

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8
Q

What are the toxic effects of HCTZ?

A

K and Mg depletion, Na and CL depletion
Metabolic alkalosis
Volume depletion
worsens hyperuricemia (gout)

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9
Q

What pregnancy class is HCTZ?

A

Class D. Would not want to give it to pregnant women unless it were a last choice.

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10
Q

Which populations would you worry about giving HCTZ to?

A

Pregnant women, geriatric pts (more side effects) and pts with reduced GFR

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11
Q

What should you monitor in a pt on HCTZ?

A

BP, weight, edema, K, Mg, BUN, creatinine

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12
Q

What is lisinopril used for?

A

Treatment of HTN, CHF, management of MI

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13
Q

What therapeutic class is lisinopril in?

A

ACE inhibitor. Prevents vasoconstriction and aldosterone release from Angiotensin II

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14
Q

What is the onset, peak, and duration of lisinopril?

A

1 hr, 6 hr, 24 hr

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15
Q

What are the toxicities of lisinopril?

A

orthostatic hypotension; reduces GFR (be careful in pts with renal stenosis), angioedema, cough, acute renal failure.

Can have hyperkalemia if KCl is given.

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16
Q

Which pts would you want to be careful giving lisinopril to?

A

Pts who are already on diuretics or have aortic stenosis. Also, pts with renal stenosis.

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17
Q

What pregnancy category is lisinopril in?

A

Category C/D because it can cause abnormal cartilage development

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18
Q

What would you need to monitor with lisinopril?

A

BP, weight, edema, K, BUN, and creatinine

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19
Q

What are some toxicities with lisinopril?

A

Orthostatic hypotension, renal effects, angioedema, cough

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20
Q

What are some interactions with lisinopril?

A

Additive, NSAIDS interfere with drug, Hypercalcemia with KCL administration

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21
Q

What are some special considerations with lisinopril?

A

Abnormal cartilage development, renal stenosis, aortic stenosis, discontinue diuretics before starting, preserves renal function in renal failure

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22
Q

What can lisinopril be used to treat?

A

HTN, CHF, preserves renal function in renal failure, preserves LV after MI and during acute management

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23
Q

What therapeutic class is Losartan in?

A

ARB

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24
Q

How does Losartan work?

A

Blocks binding of ATII to the ATI receptor. Decreases vasoconstriction and aldosterone release

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25
Q

Pharmacokinetics of losartan

A

Effects at 6hrs, long half life, extensive 1st pass metabolism (make sure they are sitting down!). Active metabolite is 40x more potent

26
Q

Losartan toxicity problems

A

Dizziness, orthostatic hypotension, worsening of renal failure

27
Q

What pregnancy class is Losartan?

A

Pregnancy C/D

28
Q

What are some special considerations with losartan?

A

Caution with pts on diuretics, renal artery stenosis, mitral/aortic stenosis

29
Q

What do you need to monitor with Losartan?

A

BP, weight, Edema, Electrolytes, BUN, creatinine

30
Q

What therapeutic class is nitroprusside in?

A

Direct vasodilator

31
Q

How does nitroprusside work?

A

Direct effect on vascular smooth muscle, with BOTH VENO and VASO constriction. Releases both CN and NO.

32
Q

What is the route of administration with nitroprusside?

A

IV

33
Q

How long does it take for nitroprusside to work?

A

Within minutes

34
Q

How is nitroprusside metabolized?

A

Conversion of CN- to SCN in the liver

35
Q

Nitroprusside toxicities:

A

Excessive hypotension, CN/SCN accumulation, headache, decreased perfusion to the brain

36
Q

What are some interactions with nitroprusside?

A

Additive effects with other anti-HTNs

37
Q

What are some special considerations with Nitroprusside?

A

It requires a central line, so must be given in the ICU. NOT GIVEN CHRONICALLY.

38
Q

Which patient population must you be cautious in giving nitroprusside to?

A

Pts with high intracranial pressure

39
Q

What do you need to monitor with nitroprusside?

A

BP, HR, metabolic acid, arterial line

40
Q

What therapeutic class does hydralazine belong to?

A

Vasodilator

41
Q

What else is hydralazine used to treat aside from HTN? What other anti-hypertensive can be used for this purpose?

A

CHF. Lisinopril can also be used for CHF.

42
Q

How does hydralazine work?

A

Direct vasodilator that induces the arterial endothelium to produce NO. Mostly VASODILATION NOT VENODILATION.

43
Q

How is hydralazine metabolized?

A

Metabolized in the GI/Liver.

44
Q

How is hydralazine administered? What is the onset time with each?

A

Administered orally or through IV. Oral: 30 min. IV: 10 min.

45
Q

How long do the effects of hydralazine last?

A

2-6 hrs

46
Q

What are the potential toxic effects of hydralazine?

A

Hypotension, drug-induced lupus

47
Q

What are the drug interactions of hydralazine?

A

Additive with other anti-HTNs

48
Q

Which pts would you be cautious in giving hydralazine to?

A

Pts with renal disease, prior stroke, angina, CAD

49
Q

What are some special considerations with hydralazine?

A

Never given as a monotherapy. Concerns with edema and reflex tachycardia

50
Q

What do you need to monitor with Hydralazine?

A

BP, edema, weight, BUN, creatinine, lupus, angina

51
Q

What therapeutic class does Verapamil belong too?

A

CCB

52
Q

What can verapamil be used to treat aside from HTN?

A

angina, arrhythmias

53
Q

How does verapamil work?

A

Inhibits calcium channels to dilate peripheral arterioles. Decreases inotropy, afterload, and also reduces coronary artery spasms

54
Q

How is verapamil metabolized?

A

By the liver and kidney.

55
Q

What are the routes of administration with Verapamil? What is the onset for each?

A

Oral (2 hr), IV (1-5 min)

56
Q

What is the half life of verapamil?

A

6-12 hrs

57
Q

Verapamil toxicity

A

hypotension, AV block, worsen CHF, bradycardia

58
Q

What are verapamil interactions?

A

Additive, toxicity when combined with beta blockers

59
Q

What are some special considerations with verapamil?

A

Pts with renal and hepatic disease will want to decrease dose because it is broken down through the kidneys and liver.

60
Q

What pregnancy class is verapamil in?

A

Pregnancy class C

61
Q

What do you want to monitor with verapamil?

A

BP, weight, edema

Pharm drugs HC (3 decks)

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