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

Anti-hypertensive drugs Flashcards

(73 cards)

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1
Q

what are the stages of hypertension

A

normal 160 or >100

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2
Q

8 classes of drugs that can be used to treat HTN

A

*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)

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3
Q

what are the 4 sites of action for HTN drugs

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

when is diuretics use

A

*Drugs of choice in uncomplicated hypertension

Effective for mild-moderate hypertension combined with lifestyle modifications

Generics most economical choice

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5
Q

Thiazide diuretics MOA and examples

A

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

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

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6
Q

Thiazide Diuretics side effects

A

Hyponatremia
Hyperglycemia
Increased LDL/HDL
Hypokalemia

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7
Q

mechanism of hypokalemia and metabolic alkalosis with thiazide diurects

A

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

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8
Q

good drug combinations with thiazide diuretics

A

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

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9
Q

drug interactions with thiazide diuretics

A 
NSAIDS
Beta Blockers (can use but be cautious)
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10
Q

contraindications for thiazide diurectics

A

Hypokalemia and pregnancy (as a new therapy)

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11
Q

thiazide diurectis are less effective in which pts

A

pts with renal insufficiency

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12
Q

Loop diurectics MOA and example

A

furosemide (lasix)

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

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13
Q

side effects of loop diurectics

A 
Dehydration/hyponatremia
Hypokalemia
Impaired diabetes control
Increased LDL/HDL
Ototoxicity
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14
Q

loop diurectics drug interactions

A

NSAIDS

Aminoglycosides (increased ototoxicity)

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15
Q

Potassium Sparing Diuretics examples

A

spironolactone and eplerenone, triamterene, amiloride

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16
Q

Potassium Sparing diuretics MOA

A

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

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17
Q

side effects of Potassium sparing diuretics

A

hyperkalemia

gynecomastia (spironolactone)

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18
Q

drug interactions of K+ sparing diuretics

A

NSAIDS
ACE inhibitors
ARBs

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19
Q

contraindications for K+ sparing diuretics

A

RAS inhibitors (ACEI and ARB)

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20
Q

Potassium sparing diuretics are commonly given with

A

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

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21
Q

Calcium 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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22
Q

what are the 3 Ca channel blockers

A

Nifedipine
Diltiazem
Verapamil

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23
Q

side effects of Nifedipine

A

(dihydropyridine) acute tachycardia and peripheral edema

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24
Q

side effects of diltiazem

A

(non-dihydropyridine) bradycardia

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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)
31
Methyldopa side effects and drug interactions
drug interactions levodopa, SE: sedation
32
Methyldopa clinical use
anti-hypertensive during pregnancy
33
Reserpine MOA
blocks VMAT vesicular transporter, prevents storage of NE centrally and peripherally. used with diuretics for mild and moderate hypertension
34
Reserpine side effects
depression (crosses BBB), nasal congestion
35
Alpha Adrenergic Receptor Antagonists examples and MOA
Phenoxybenzamine, Prazosin, terazosis and doxazosin | block α-adrenergic-mediated vasoconstriction at receptor
36
Phenoxybenzamine use and side effect
phenoxybenzamine is non-selective, primarily used in pheochromocytoma, SE- tachycardia
37
prazosin, terazosis, doxazosin MOA and side effects
selective α1-adrenergic antagonist, less tachycardia than direct vasodilators, hypotension w/ 1st dose terazosin and doxazosin have longer half lifes
38
Beta-Adrenergic Antagonists MOA
MOA – decreased cardiac contractility and CO, decreased renin secretion and thus decreased Angiotensin II production
39
Non selective Beta-Adrenergic Antagonists
Propranolol Nadolol (longer half-life) Pindolol (partial agonist, less bradycardia) Carvedilol (alpha receptor antagonist, vasodilator)
40
cardioselective/B1-selective B-Blockers
Metoprolol (lipophilic) Atenolol Labetolol (lipophilic)
41
side effects of Beta Blockers
``` Bradycardia Increased triglycerides Decreased HDLs Hyperglycemia Impaired exercise tolerance ``` Non-selective Increased airway resistance Lipophilic Insomnia chronic fatigue
42
Drug Interactions with Beta blockers
CCBs (reduced contractility and conduction)
43
contraindications for beta blockers
Cardiogenic Shock Sinus bradycardia Asthma Severe heart failure
44
Beta blocker consideration in pts with diabetes
Can mask and prolong insulin-induced hypoglycemia
45
Vasodilators examples and MOA
Hydralazine Minoxidil Nitroprusside vasodilation of small vessels, primarily arterioles
46
when do you use vasodilators such as Hydralazine | Minoxidil, and Nitroprusside?
drug resistant hypertension and emergencies
47
Nitroprusside side effect
cyanide poisoning
48
Hydralazine and Minoxidil
tachycardia, angina aggravation, fluid retention, NSAIDS can reduce effectiveness
49
ACEI MOA
blocks production of Angiotensin II and Ang II-mediated- vasoconstriction
50
ACEI examples
Captopril (short half life) Enalapril (converted to active metabolite, longer half-life) Lisiniopril
51
ACEI side effects
hyperkalemia, rash, dry cough, angioedema (0.2%)
52
ACEI drug interactions
Exacerbates hyperkalemic effect of K+ sparing drugs (no aldosterone = decreased K+ excretion)
53
ACEI contraindications
pregnancy, bilateral renal stenosis
54
benefits of ACEI
Prolongs survival in pts with HF or LV dysfunction after MI Preserves renal function in diabetic patients
55
*Angiotensin II Receptor Blockers (ARBs) example
Losartan
56
Side effect of ARB
hyperkalemia (no aldosterone = decreased K+ excretion)
57
contraindications of ARBs
Pregnancy
58
Drug interactions of ARBs
K+ sparing drugs
59
with ARBs it is better to use them with what other type of drug rather than increase their dose
diuretics
60
thiazide diuretics work well with which other types of drugs for hypertension control
K+ sparing diuretics and BB
61
K+ sparing diurects work well with which other types of drugs for hypertension control
thiazide or loop diuretics
62
Calcium channel blockers work well with what other class of drug
ACEI
63
ACEI cause hyperkalemia when used with what other durg
K+ sparing diuretics
64
why would you not combine ACEI and ARBs in diabetics
no advantage and increases risk of hyperkalemia
65
what is the first choice drug in diabetic patients?
ACEIs - delay loss of renal function | CCBs (few effects on carb metabolism)
66
What is the first choice drug in heart failure patients
ACEI (reduce mortality) combination with diuretics for congestion
67
what are best choices for MI pts
ACEI (reduce remodeling) and BB (reduce arrhythmia and remolding)
68
what drugs must be avoided in pregnancy
ACEI and ARBs and BB (inhibit renin)
69
what is the drug of choice in pregnancy
methyldopa
70
which drugs are less effective in african americans
BB, ACEI (but work well when combined with diuretics)
71
which drugs are most efficacious in African americans
monotherapy with diuretics (CCB are best)
72
what considerations should be take for elderly patients
smaller doses with small increments simple regimens monitor side effects closely
73
what drugs should be avoided in pts with obstructive airway disease
avoid BB

Pharm block 4 hemostasis and cardiac (12 decks)

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