Anti-Hypertensive Drugs Flashcards
(68 cards)
1
Q
ACE Inhibitors Indication
A
- first line for HTN in patients with CHF or DM
2. post-MI
2
Q
ACE Inhibitors MOA
A
- blocks conversion of angiotensin I to angiotensin II –> less vasoconstriction
- increases bradykinin levels in order to vasodilate
3
Q
ACE Inhibitors Examples
A
- Lisinopril (prinivil/zestril)
- Benazepril (lotensin)
- Quinapril (accupril)
4
Q
ACE Inhibitors CI
A
- Pregnancy, category D
- Renal artery stenosis
- caution with renal impairment
5
Q
ACE Inhibitors SE
A
- DRY COUGH (due to bradykinins)
- Hyperkalemia!!!
- Hypotension
- Renal dysfunction
- Angioedema!!!
6
Q
Benefits of ACE Inhibitors in diabetic patients
A
- delays onset of diabetic neuropathy
2. renal protection
7
Q
ACE Inhibitors special considerations
A
- they decreases absorption of antacids (pepcid, zantac) - separate time of dosing
- check K and creatinine levels (CMP or BMP)
8
Q
ARBs MOA
A
blocks angiotensin II’s binding/effects on blood vessels –> decreases vasoconstriction, increases vasodilation
9
Q
ARBs Indications
A
HTN, second line for CHF patients if cannot tolerate
10
Q
ARBs CI
A
- pregnancy, category D
2. renal artery stenosis?
11
Q
ARBs SE
A
- dizziness, hypotension
- hyperkalemia
- renal failure
- angioedema (less than ACE)
but overall well tolerated
12
Q
ARBs Examples
A
- Losartan (cozaar)
- Valsartan (Diovan)
- Irbesartan (Avapro) - stronger than losartan
Candesartan used for BP and headache
13
Q
Beta Blockers MOA
A
bind beta adrenoceptors and block binding of NE and E which inhibits sympathetic effects –> slow HR and decrease BP
14
Q
3 types of Beta Blockers
A
- Cardioselective - affect beta 1 on heart only
- Non-selective - affect beta 1 and beta 2 (lungs) equally
- Mixed alpha and beta
15
Q
Cardioselective Beta Blockers examples
A
- metoprolol (lopressor/toprol)
2. atenolol (tenormin)
16
Q
Non-selective Beta Blockers examples
A
- propranolol (inderal)
2. nadolol
17
Q
mixed alpha and beta blockers example
A
- carvedilol/coreg (use for stable CHF)
2. labetalol (use in pregnancy, preeclampsia)
18
Q
Beta Blockers Cardiac Indications
A
- CHRONIC CHF
- A fib/A flutter/other tachyarrhythmias
- angina
- HTN (3rd line)
- post-MI (decreases O2 requirement)
19
Q
Beta Blockers Non-cardiac indications
A
- migraine prophylaxis
- anxiety, public speaking
- tremors
- timolol (nonselective) –> glaucoma
20
Q
Beta Blockers CI
A
- Asthmatics, COPD for non-selective
- 2nd/3rd degree heart block
- bradycardia
- sick sinus syndrome
- ACUTE heart failure
- severe hypotension
- caution with diabetics!
- Raynauds
21
Q
Beta Blockers S/E
A
- Hypotension
- asthma/bronchoconstriction
- Raynauds
- impotence
- fatigue (MC)
- MASK SYMPTOMS OF HYPOGLYCEMIA
- insomnia
- depression
- nightmares
- increased triglycerides, decreased HDL - monitor lipids
22
Q
Calcium Channel blockers types
A
- Dihydropyridines
2. Non-dihydropyridines
23
Q
Dihydropyridines examples
A
- amlodipine/norsac
2. nifedipine/procardia
24
Q
What medication is good for African Americans
A
Calcium Channel blockers - Dihydropyridines
25
Dihydropyridines indications
1. HTN
2. diastolic heart failure
3. prevention/tx of coronary spasms (prinzmetal angina, cocaine induced MI)
26
Dihydropyridines CI
1. pregnancy
2. conditions that worsen with tachycardia (CAD, aortic stenosis, mitral stenosis)
3. Do not take with grapefruit juice
27
Dihydropyridines SE
1. flushing
2. dizziness
3. headache - cerebral vasodilation
4. tachycardia
5. constipation
28
Non-Dihydropyridines examples
1. Diltiazem/cardizem
| 2. verapamil
29
Non-Dihydropyridines effects
decrease BP and SLOW HR
- decreases vascular permeability
- decreases cardiac contractility/conduction
30
Non-Dihydropyridines indications
1. great tx for A fib/A flutter
2. SVT
3. Stable angina
4. HTN
31
Non-Dihydropyridines CI
1. Wolff-Parkinson-White Syndrome
2. Hypotension
3. acute CHF
4. AV blocks
32
Non-Dihydropyridines SE
1. bradycardia
2. worsened HF
3. hypotension
4. constipation (MC)
33
calcium channel blocker MOA
block L-type calcium channels on cardiac myocytes --> inhibit contraction of smooth muscle
- these channels also located on skeletal muscles, neurons, vascular smooth muscle, uterus --> coronary vasodilation, increased myocardial oxygen delivery
34
Types of diuretics
1. Thiazides
2. Potassium sparing diuretics
3. LOOP diuretics
35
Thiazides MOA
enhance excretion of Na and Cl in urine, water also excreted, decreased blood volume
36
Thiazide Example
Hydrochlorothiazide (HCTZ)
37
Potassium sparing diuretic example
Triamterene
38
Potassium sparing diuretic MOA
increases Na excretion but not K excretion because it blocks the exchange of Na and K --> increased secretion of water
39
Diuretic SE
1. thirst, dry mouth
2. increased urination
3. hypotension
4. weakness
5. dizziness
6. tachycardia
7. GI disturbances
40
Potassium sparing diuretic CI
1. electrolyte imbalances
41
LOOP diuretics examples
1. furosemide/lasix
| 2. bumetanide/bumex
42
How long does lasix work for?
6 hours
43
LOOP diuretics MOA
inhibit reabsorption of sodium at loop of henle in nephron
44
What medication can you give a person with altitude sickness?
acetazolamide (carbonic anhydrase inhibitor)
45
Alpha Blockers MOA
bind to alpha adrenoreceptors to relax muscles that are surrounding arteries, cause dilation and decrease BP
46
mixed alpha and beta blockers MOA
vasodilation in periphery and decreases HR
47
Aldosterone receptor blockers example
Spironolactone/Aldactone
48
Aldosterone receptor blockers MOA
block aldosterone receptors, inhibit Na resaborption
49
What can spironolactone also be used for?
acne
50
Nitrates example
nitroglycerine
51
Nitroglycerine MOA
dilates coronary arteries to increases coronary blood flow, increase oxygen supple and decrease oxygen demand of heart
52
Nitrates Indications
1. stable angina - tx and prevention (sublingual)
2. unstable angina/MI (IV)
3. hypertensive emergency
53
Acute MI treatmetn
1. morphine for pain
2. oxygen
3. nitroglycerine - vasodilation and increases O2 to heart
4. aspirin (325 mg)
54
Nitrates CI
1. hypotension
2. cannot co-administer with PDE-5 inhibitors (viagra/sildenafil, cialis, levitra)
3. closed angle glaucoma & other conditions with increased intracranial pressure
4. PERICARDIAL TAMPONADE
5. hx of syncope/syncopal episodes/pre-syncope (ie. aortic stenosis)
55
Nitrates SE
1. headache
2. flushing
3. orthostatic hypotension
56
Risk Factors for HTN
1. obesity
2. stress/anxiety
3. excessive alcohol
4. excessive salt
5. family history
6. diabetes
7. tobacco use
8. African American
57
ACE inhibitor clearance
kidney - dose adjustment
58
what is a benefit of ACE inhibitors?
intermediate duration of action and once daily dosing (except captopril)
59
what medications should you avoid in African Americans?
ACE inhibitors and ARBs (not as effective, higher risk of angioedema)
60
half life and dosing of ARBs
12-24 hrs, once daily dosing
61
patient education for stopping beta blockers
Cannot abruptly stop them because rebound effect - palpitations, sweating
62
difference between dihydropyridines and non-dihydropyridines
1. dihydropyridines: predominantly vasodilator, neutral/increased effects on vascular permeability
2. Non-dihydropyridines: reduce vascular permeability and affect cardiac contractility and conduction
63
carbonic anhydrase inhibitors MOA
increase excretion of Na, K, bicarbonate, water
64
Loop diuretic indications
edema
65
dosing of HCTZ
12.5-50 mg
66
dosing of triamterene
50-100 mg
67
combination treatment dosing
HCTZ + Triamterene 25mg/37.5mg or 50mg/75mg
68
spironolactone dosing
25-50 mg
