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Cardio Exam 3 > Anti-hypertensives > Flashcards

Anti-hypertensives Flashcards

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

A

HTN, HFrEF, Stroke prevention, DM nephropathy

25
Q

Angiotensin-Receptor Blocker (ARB) Adverse reactions

A

hyperkalemia*
angioedema
anaphylaxis
hypotension, severe

26
Q

BETA BLOCKERS, CARDIO-SELECTIVE (BB)

A

Metoprolol Succinate 50-200 mg, QD
Metoprolol Tartrate 100-400, BID
Atenolol 25-100 mg, QD-BID

27
Q

BETA BLOCKERS, CARDIO-SELECTIVE (BB) MOA

A

selectively antagonizes beta-1 adrenergic receptors

28
Q

BETA BLOCKERS, CARDIO-SELECTIVE (BB) Indications

A

HTN, angina, acute MI, post-MI prevention, CHF, migraine prophylaxis

29
Q

BETA BLOCKERS, CARDIO-SELECTIVE (BB) contraindications/cautions

A

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
Q

BETA BLOCKERS, CARDIO-SELECTIVE BBW

A

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
Q

BETA BLOCKERS, NON-SELECTIVE (BB)

A

Propranolol 160-480 mg, BID
Labetalol 200-800, BID
Carvedilol 3.25-50 mg, BID

32
Q

BETA BLOCKERS, NON-SELECTIVE (BB) MOA

A

selectively antagonizes alpha-1 adrenergic receptors (carvedilol); antagonizes beta-1
and beta-2 adrenergic receptors (selective alpha and non-selective beta blocker)

33
Q

BETA BLOCKERS, NON-SELECTIVE (BB) Indications

A

HTN, CHF, HTN emergency

34
Q

BETA BLOCKERS, NON-SELECTIVE (BB) Contraindications/cautions

A

bradycardia, severe
2nd or 3rd degree AV block
heart failure, uncompensated
cardiogenic shock
sick sinus syndrome w/o pacemaker

35
Q

BETA BLOCKERS, NON-SELECTIVE (BB) side effects

A

dizziness
fatigue
bradycardia
dyspnea
asthenia

36
Q

VASODILATORS MOA

A

directly dilates peripheral vessels

37
Q

VASODILATORS

A

Hydralazine 10-200 mg, BID-TID
Minoxidil 5-100 mg, QD-TID

38
Q

VASODILATORS indications

A

HTN, CHF, HTN emergency/crisis

39
Q

CALCIUM CHANNEL BLOCKERS, DHP

A

Amlodipine 2.5-10 mg, QD
Felodipine 5-10 mg, QD
Nifedipine LA 60-120 mg, QD
Nicardipine SR 5-20 mg, QD

40
Q

CALCIUM CHANNEL BLOCKERS, DHP Side effects

A

peripheral edema

41
Q

CALCIUM CHANNEL BLOCKERS, NON-DHP

A

Verapamil IR 40-80 mg, TID
Diltiazem SR 180-360 mg, BID

42
Q

CALCIUM CHANNEL BLOCKERS, NON-DHP MOA

A

Inhibits calcium ion influx into vascular smooth muscle and myocardium (class IV
antiarrhythmic)

43
Q

CALCIUM CHANNEL BLOCKERS, NON-DHP Indications

A

HTN, angina, PSVT conversion, PSVT prevention, AFib/Aflutter, Migraine
prophylaxis

44
Q

CALCIUM CHANNEL BLOCKERS, NON-DHP Contraindications/Cautions

A

LV dysfxn, severe
2nd or 3rd degree AV block
atrial fibrillation or flutter
w/ bypass tract
sick sinus syndrome

45
Q

CALCIUM CHANNEL BLOCKERS, NON-DHP Pearl

A

PEARL: can be constipating

46
Q

ALPHA-2 AGONISTS

A

Methyldopa 250-1000 mg, BID
Clonidine 0.1-0.8 mg, BID

47
Q

ALPHA-2 AGONISTS MOA

A

stimulates alpha-2 adrenergic receptors (centrally-acting antihypertensive).
Suppressing norepinephrine, renin -> thus decrease vascular resistance

48
Q

ALPHA-2 AGONISTS Indications

A

HTN mod-severe

49
Q

SELECTIVE ALPHA-1 BLOCKER

A

Prazosin 2-20 mg, BID-TID
Doxazosin 1-8 mg, QD
Terazosin 5-10 mg, QD

50
Q

SELECTIVE ALPHA-1 BLOCKER MOA

A

antagonizes peripheral alpha-1 adrenergic receptors

51
Q

SELECTIVE ALPHA-1 BLOCKER Indications

A

HTN, BPH, PTSD nightmares, Pheo*

52
Q

SELECTIVE ALPHA-1 BLOCKER combination to be cautious of

A

Caution with PDE-5 inhibitors à combination can result in severe hypotension

53
Q

DIRECT RENIN INHIBITOR

A

Aliskiren 150-300 mg, QD

54
Q

DIRECT RENIN INHIBITOR MOA

A

decreases plasma renin activity, interfering w/ conversion of angiotensinogen to
angiotensin I (direct renin inhibitor)

55
Q

DIRECT RENIN INHIBITOR Indication

A

HTN

56
Q

DIRECT RENIN INHIBITOR 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 detecte

57
Q

Polypills, combination pills use

A

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
Q

Common combinations of polypills

A

1) Diuretic + diuretic
2) BB + diuretic
3) ACEi + diuretic
4) ARB + diuretic
5) Misc combos

59
Q

guiding principles for adding a HTN med

A

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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