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Cardio Exam 3 > Anti-hypertensives > Flashcards

Anti-hypertensives Flashcards

(59 cards)

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1
Q

THIAZIDE DIURETICS MOA

A

Inhibits distal convoluted tubule sodium and
chloride resorption

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2
Q

THIAZIDE DIURETICS Indication

A

HTN, peripheral edema

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3
Q

THIAZIDE DIURETICS contraindications/cautions

A

anuria
caution if renal impairment, severe
caution if electrolyte
abnormalities
caution if volume depletion

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4
Q

THIAZIDE DIURETICS adverse effects

A

hypokalemia, severe
electrolyte imbalance
arrhythmias
pancreatitis
renal failure

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5
Q

THIAZIDE DIURETICS follow up & pearls

A

Follow-up & Monitoring:
Cr at baseline; electrolytes at baseline, then
periodically
PEARLS:
Can work synergistically with loop diuretics
Watch for hyponatremia by itself
ACEi can help mitigate hypokalemia (ACEi can increase K+)

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6
Q

THIAZIDE DIURETICS

A

Chlorthalidone
Hydrochlorothiazide
Indapamide
Metolazone

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7
Q

POTASSIUM-SPARING DIURETICS

A

Amiloride
Triamterene
Aldosterone Receptor Antagonists
Spironolactone
Eplerenone

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8
Q

POTASSIUM-SPARING DIURETICS contraindications

A

hyperkalemia
severe renal dysfxn or dz

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9
Q

POTASSIUM-SPARING DIURETICS adverse reactions

A

anaphylaxis
ventricular arrhythmias
hyperkalemia

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10
Q

POTASSIUM-SPARING DIURETICS BBW

A

hyperkalemia risk
potentially fatal if uncorrected; 10% incidence
if not used w/ kaliuretic diuretic; incr. incidence
in renal impairment, diabetes (even w/out
recognized diabetic nephropathy) and elderly
pts; risk decr. to 1-2% in combo w/ thiazide
diuretics;

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11
Q

POTASSIUM-SPARING DIURETICS MOA

A

inhibits Na reabsorption at the distal convoluted tubule, decreasing water reabsorption
and increasing K retention

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12
Q

LOOP DIURETICS MOA

A

inhibits loop of Henle and proximal and distal convoluted tubule sodium and chloride
resorption

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13
Q

LOOP DIURETICS indications

A

HTN, edema, acute pulm edema, hypercalcemia

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14
Q

LOOP DIURETICS adverse effects

A

hypokalemia, severe
electrolyte imbalance, severe
metabolic alkalosis
hypovolemia/dehydration
ototoxicity

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15
Q

LOOP DIURETICS BBW

A

Fluid and Electrolyte Depletion
potent diuretic in excessive amts can cause profound diuresis w/ water/electrolyte
depletion; individualize dose and schedule w/ medical supervision

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16
Q

ACE INHIBITORS

A

Lisinopril 10-40 mg, QD
Enalapril 5-40, QD-BID
Fosinopril 10-40 mg, QD
Captopril 12.5-150 mg, BID-TID
Ramipril 2.5-10 mg, QD-BID

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17
Q

ACE INHIBITORS MOA

A

inhibits angiotensin converting enzyme, interfering w/ conversion of angiotensin I
to angiotensin II

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18
Q

ACE INHIBITORS Indications

A

HTN, Acute MI, CHF

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19
Q

ACE INHIBITORS Contraindications/Cautions

A

ACE inhibitor angioedema hx
caution if renal impairment
caution if volume depletion
caution if hyponatremia
caution if hypotension
caution in black pts

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20
Q

ACE INHIBITORS Adverse effects

A

angioedema, head/neck
angioedema, intestinal
hyperkalemia

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21
Q

ACE INHIBITORS BBW

A

Fetal Toxicity
fetal/neonatal morbidity/mortality may occur when drugs that act directly on the renin-angiotensin system are used in pregnancy; D/C drug ASAP once pregnancy detected

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22
Q

Angiotensin-Receptor Blockers (ARB)

A

Losartan 25-100 mg, QD
Valsartan 80-320, QD
Olmesartan 20-40 mg, QD
Candesartan 4-16 mg, QD
Irbesartan 150-300 mg, QD

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23
Q

Angiotensin-Receptor Blocker (ARB) MOA

A

Selectively antagonizes angiotensin II AT1 receptors

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24
Q

Angiotensin-Receptor Blocker (ARB) Indications

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A

HTN, HFrEF, Stroke prevention, DM nephropathy

25
Angiotensin-Receptor Blocker (ARB) Adverse reactions
hyperkalemia* angioedema anaphylaxis hypotension, severe
26
BETA BLOCKERS, CARDIO-SELECTIVE (BB)
Metoprolol Succinate 50-200 mg, QD Metoprolol Tartrate 100-400, BID Atenolol 25-100 mg, QD-BID
27
BETA BLOCKERS, CARDIO-SELECTIVE (BB) MOA
selectively antagonizes beta-1 adrenergic receptors
28
BETA BLOCKERS, CARDIO-SELECTIVE (BB) Indications
HTN, angina, acute MI, post-MI prevention, CHF, migraine prophylaxis
29
BETA BLOCKERS, CARDIO-SELECTIVE (BB) contraindications/cautions
sinus bradycardia HR <45 bpm (MI use) 2nd or 3rd degree AV block AV block, PR interval >0.24sec (MI use) heart failure, uncompensated heart failure, mod-severe (MI use) SBP <100 mmHg (MI use) cardiogenic shock sick sinus syndrome w/o pacemaker
30
BETA BLOCKERS, CARDIO-SELECTIVE BBW
Avoid Abrupt Cessation severe angina exacerbation, MI, and ventricular arrhythmias in angina pts after abrupt D/C; taper gradually over 1-2wk and monitor when D/C chronic tx, especially in ischemic heart dz; restart tx even temporarily if angina worsens or acute coronary insufficiency develops; warn pts to avoid tx interruption or D/C w/o MD advice; avoid abrupt D/C in all pts in case of unrecognized CAD
31
BETA BLOCKERS, NON-SELECTIVE (BB)
Propranolol 160-480 mg, BID Labetalol 200-800, BID Carvedilol 3.25-50 mg, BID
32
BETA BLOCKERS, NON-SELECTIVE (BB) MOA
selectively antagonizes alpha-1 adrenergic receptors (carvedilol); antagonizes beta-1 and beta-2 adrenergic receptors (selective alpha and non-selective beta blocker)
33
BETA BLOCKERS, NON-SELECTIVE (BB) Indications
HTN, CHF, HTN emergency
34
BETA BLOCKERS, NON-SELECTIVE (BB) Contraindications/cautions
bradycardia, severe 2nd or 3rd degree AV block heart failure, uncompensated cardiogenic shock sick sinus syndrome w/o pacemaker
35
BETA BLOCKERS, NON-SELECTIVE (BB) side effects
dizziness fatigue bradycardia dyspnea asthenia
36
VASODILATORS MOA
directly dilates peripheral vessels
37
VASODILATORS
Hydralazine 10-200 mg, BID-TID Minoxidil 5-100 mg, QD-TID
38
VASODILATORS indications
HTN, CHF, HTN emergency/crisis
39
CALCIUM CHANNEL BLOCKERS, DHP
Amlodipine 2.5-10 mg, QD Felodipine 5-10 mg, QD Nifedipine LA 60-120 mg, QD Nicardipine SR 5-20 mg, QD
40
CALCIUM CHANNEL BLOCKERS, DHP Side effects
peripheral edema
41
CALCIUM CHANNEL BLOCKERS, NON-DHP
Verapamil IR 40-80 mg, TID Diltiazem SR 180-360 mg, BID
42
CALCIUM CHANNEL BLOCKERS, NON-DHP MOA
Inhibits calcium ion influx into vascular smooth muscle and myocardium (class IV antiarrhythmic)
43
CALCIUM CHANNEL BLOCKERS, NON-DHP Indications
HTN, angina, PSVT conversion, PSVT prevention, AFib/Aflutter, Migraine prophylaxis
44
CALCIUM CHANNEL BLOCKERS, NON-DHP Contraindications/Cautions
LV dysfxn, severe 2nd or 3rd degree AV block atrial fibrillation or flutter w/ bypass tract sick sinus syndrome
45
CALCIUM CHANNEL BLOCKERS, NON-DHP Pearl
PEARL: can be constipating
46
ALPHA-2 AGONISTS
Methyldopa 250-1000 mg, BID Clonidine 0.1-0.8 mg, BID
47
ALPHA-2 AGONISTS MOA
stimulates alpha-2 adrenergic receptors (centrally-acting antihypertensive). Suppressing norepinephrine, renin -> thus decrease vascular resistance
48
ALPHA-2 AGONISTS Indications
HTN mod-severe
49
SELECTIVE ALPHA-1 BLOCKER
Prazosin 2-20 mg, BID-TID Doxazosin 1-8 mg, QD Terazosin 5-10 mg, QD
50
SELECTIVE ALPHA-1 BLOCKER MOA
antagonizes peripheral alpha-1 adrenergic receptors
51
SELECTIVE ALPHA-1 BLOCKER Indications
HTN, BPH, PTSD nightmares, Pheo*
52
SELECTIVE ALPHA-1 BLOCKER combination to be cautious of
Caution with PDE-5 inhibitors à combination can result in severe hypotension
53
DIRECT RENIN INHIBITOR
Aliskiren 150-300 mg, QD
54
DIRECT RENIN INHIBITOR MOA
decreases plasma renin activity, interfering w/ conversion of angiotensinogen to angiotensin I (direct renin inhibitor)
55
DIRECT RENIN INHIBITOR Indication
HTN
56
DIRECT RENIN INHIBITOR BBW
Fetal Toxicity fetal/neonatal morbidity/mortality may occur when drugs that act directly on the renin-angiotensin system are used in pregnancy; D/C drug ASAP once pregnancy detecte
57
Polypills, combination pills use
Given that these individuals may already require multiple types of medications, may have several different conditions, and their hypertension may be difficult to control with just one antihypertensive, combination pills help reduce pill intake burden, may reduce co- pay costs, and improve medication adherence
58
Common combinations of polypills
1) Diuretic + diuretic 2) BB + diuretic 3) ACEi + diuretic 4) ARB + diuretic 5) Misc combos
59
guiding principles for adding a HTN med
1) Start low, go slow on titration 2) Measure, measure, measure - BP before and after medication 3) Discuss BP symptoms, and drug class related symptoms to watch for

Cardio Exam 3 (8 decks)

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