Anti-hypertensive drugs Flashcards Preview

Pharm block 4 hemostasis and cardiac > Anti-hypertensive drugs > Flashcards

Flashcards in Anti-hypertensive drugs Deck (73)
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1

what are the stages of hypertension

normal 160 or >100

2

8 classes of drugs that can be used to treat HTN

*Diuretics
*Calcium Channel Blockers (CCBs)
Centrally-acting Agents
Alpha Adrenergic Blockers
Beta Adrenergic Blockers (BBs)
Vasodilators
*Angiotensin Converting Enzyme inhibitors (ACEIs)
*Angiotensin Receptor Blockers (ARBs)

3

what are the 4 sites of action for HTN drugs

1. arterioles (resistance)
2. venules (capacitance)
3. Heart (pump output)
4. Kidneys (volume)

4

when is diuretics use

*Drugs of choice in uncomplicated hypertension

Effective for mild-moderate hypertension combined with lifestyle modifications

Generics most economical choice

5

Thiazide diuretics MOA and examples

Hydrochlorothiazide, Chlorthalidone
Mode of Action (MOA) – inhibits Na+/Cl co-transporter

Initial volume contraction
later decreased in peripheral resistance (prostaglandin)
Mild Na+ excretory effect

6

Thiazide Diuretics side effects

Hyponatremia
Hyperglycemia
Increased LDL/HDL
Hypokalemia

7

mechanism of hypokalemia and metabolic alkalosis with thiazide diurects

Low plasma Na+ stimulates aldosterone -acts in collecting duct cells

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

8

good drug combinations with thiazide diuretics

Combined with BBs, ACEIs, ARBs and centrally acting anti- hypertensive

9

drug interactions with thiazide diuretics

NSAIDS
Beta Blockers (can use but be cautious)

10

contraindications for thiazide diurectics

Hypokalemia and pregnancy (as a new therapy)

11

thiazide diurectis are less effective in which pts

pts with renal insufficiency

12

Loop diurectics MOA and example

furosemide (lasix)
MOA – blocks Na+/K+/Cl co-transporter, causes venous dilation via prostaglandins

13

side effects of loop diurectics

Dehydration/hyponatremia
Hypokalemia
Impaired diabetes control
Increased LDL/HDL
Ototoxicity

14

loop diurectics drug interactions


NSAIDS
Aminoglycosides (increased ototoxicity)

15

Potassium Sparing Diuretics examples

spironolactone and eplerenone, triamterene, amiloride

16

Potassium Sparing diuretics MOA

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

17

side effects of Potassium sparing diuretics

hyperkalemia
gynecomastia (spironolactone)

18

drug interactions of K+ sparing diuretics

NSAIDS
ACE inhibitors
ARBs

19

contraindications for K+ sparing diuretics

RAS inhibitors (ACEI and ARB)

20

Potassium sparing diuretics are commonly given with

thiazide and loop diuretics to prevent hypokalemia (excretion of K+)

21

Calcium channel blockers MOA

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

22

what are the 3 Ca channel blockers

Nifedipine
Diltiazem
Verapamil

23

side effects of Nifedipine

(dihydropyridine) acute tachycardia and peripheral edema

24

side effects of diltiazem

(non-dihydropyridine) bradycardia

25

side effects of verapamil

(non-dihydropyridine)
constipation
bradycardia

26

Non-dihydropyridines Ca Channel blockers are contraindicated in which pts

pts with conduction disterbances

or in uncompensated heart failure (cardiogenic shock)

27

Clonidine and Guanfacine MOA

α2-adrenergic receptor agonist in medullary cardiovascular center decreases sympathetic outflow from CNS

28

Clonidine side effects and drug interactions

SE: sedation (12-35%), dry mouth (25-40%), bradycardia, dermatitis

Caution pt about missing doses withdraw slowly to prevent rebound hypertension

Drug interactions : CNS depressants

29

advantages of Guanfacine over clonidine

longer half life and less risk of rebound

30

Methyldopa MOA

converted to methylnorepinephrine
α2-adrenergic receptor agonist (same MOA as clonidine)
Competes with L-DOPA for DOPA decarboxylase (inhibits dopamine production) (do not give to someone with parkinsons)