Anti-Hypertensives Flashcards
(147 cards)
1
Q
When is an antihypertensive indicated?
A
Sustained systolic BP over 140
Sustained diastolic BP over 90
2
Q
Why is hypertension a “silent killer”?
A
Pts are asymptomatic, and heart is struggling. It eventually thickens and causes further problems
3
Q
What two things control arterial blood pressure?
A
Cardiac Output
Peripheral resistance
4
Q
What are the 7 antihypertensive drug subclasses?
A
ACE-inhibitors Angiotensin II receptor blockers Ca Channel blockers Alpha-blockers Beta-blockers Diuretics Other
5
Q
Name 5 ACE inhibitors
A
Lisinopril Benazepril Captopril Enalapril Quinapril
6
Q
What is the common suffice for ACE-inhibitors?
A
-pril
7
Q
What is the MOA of lisinopril?
A
ACE-inhibitor
8
Q
How does an ACE-inhibitor act on the body?
A
Suppresses RAA system and simultaneously inhibits bradykinin degradation
9
Q
What are the common adverse effects of lisinopril (ACE-inhibitors)
A
Photophobia Reduced vision Headache Hypotension Conjunctivitis
10
Q
What are the distinguishing adverse effects of ACE-inhibitors?
A
Cough
Taste disturbances
11
Q
What are the serious adverse hypersensitivity effects of Lisinopril?
A
Angioedema
Eyelid edema
12
Q
What are the serious ocular adverse effects of Lisinopril?
A
Blur
Dry eye
Conjunctival or retinal hemes
Diplopia
13
Q
ACE-inhibitors have important interactions with which two drugs?
A
Acetaminophen
Cyclosporin
14
Q
What does the interaction of Lisinopril and Acetaminophen do?
A
Inhibits renal prostaglandins and antagonizes the therapy
15
Q
What does the interaction of ACE-inhibitors and Cyclosporin do?
A
Induces renal toxicity causing hyperkalemia created by suppressed aldosterone release from the adrenal cortex
16
Q
Lisinopril has one disease in which caution is required. Which disease is it?
A
Sjogren’s syndrome
17
Q
The suffix -sartan belongs to what group of drugs?
A
Angiotensin II receptor blockers - for HTN
18
Q
What are the two angiotensin II receptor blockers?
A
Valsartan
Condesartan
19
Q
What are the indications for an angioensin II receptor blocker?
A
HTN
Congestive heart failure
Post myocardial infarction
20
Q
What is the MOA for an ARB?
A
Selective antagonist of angiotensin II receptor
21
Q
What are the common adverse effects of Valsartan?
A
Headache
Dizziness
22
Q
What are the hypersensitivity reactions of ARBs?
A
Angioedema
Vasculitis
23
Q
What are the two drugs that have important interactions with Valsartan?
A
NSAIDs
Cyclosporine
24
Q
What happens when Valsartan interacts with NSAIDs?
A
Antagonism
25
What happens when ARBs interact with Cyclosporin?
Hyperkalemia
26
What is hyperkalemia?
High blood potassium
27
What does hyperkalemia do to the body?
Can cause abnormal heart rhythms and even heart attack
28
What is the one disease that ACE-inhibitors don't help?
Angina
29
What is the most common drug for HTN?
ACE-inhibitors because it helps so many concomitant disease factors, as well
30
Why is it believe that patients on ACE-inhibitors develop a cough?
Bradykinin accumulation
31
ACE-inhibitors affect metabolism of both ___ and ___.
Polypeptides
| Eicosanoids
32
Angioedema can be mistaken for what?
Preseptal cellulitis
33
How do Aceteaminophen and Aspirin interfere with lisinopril?
They bind to cyclooxygenase and will impari production of key prostaglandins
34
If an NSIAD is added to ACE-inhibtor therapy, what may occur?
Elevation of BP
35
What do ACE-inhibitors inhibit?
The conversion of angiotensin I to angiotensin II
36
When it comes to dosing an ARB, which requires a higher dose, HTN or CHF?
HTN
37
Why does Valsartan cause headaches?
It changes vascular tone
38
What causes the dizziness associated with ARBs?
Lower BP and reduced perfusion to CNS
39
The interaction of Vlasartan and NSAIDs does what?
Inhibits diuretic prostaglandin synthesis
40
Ca is the key ion for what?
Muscle contraction
41
How do Ca channel blockers reduce BP?
They block the Ca channels in the blood vessels, inhibiting contraction and reducing BP
42
What are the four Ca channel blockers?
Amlodipin
Nifedipine
Diltiazem
Verapamil
43
What are the indication for Amlodipine?
HTN
| Coronary Artery Disease
44
What is the MOA of a Ca channel blocker?
Inhibits the trans-membrane CA++ current into vascular smooth muscle (cardiac)
45
What are the common adverse effects of Amlodipine?
Headache
| Dizziness
46
What are the ocular adverse effects of amlodipine?
Conjunctivitis
Diplopia
Pain
47
What are the drugs that interact with Amlodipine?
Dexamethasone
Cyclosporine, erythromycins, azoles
Ophthalmic Alpha-2 agonists
ophthalmic beta-blockers
48
What happens in the dexamethasone/Ca channel blocker interaction?
Enhances the metabolism of the Ca channel blocker
49
What happens in the cyclosporine/erythromycin/azole and Amlodipine interaction?
They suppress the metabolism of amlodipine, causing an elevation of the drug, increasing the possibility of the side effects
50
What happens in an ophthalmic alpha-2 agonist and amlodipine interaction?
Additive effect, causing excessive BP lowering, dizziness, and hypotension
51
What occurs in an ophthalmic beta-blocker and amlodipine interaction?
Additive effect, causing excessive BP lowering
52
Alpha-2 agonists shut down which pathway?
Sympathetic
53
What do alpha-1 do?
Regulates vascular tone throughout the body
54
What happens when alpha-1 is stimulated?
Vasoconstriction
55
What is the one alpha blocker for HTN?
Terazosin [hytrin]
56
What are the indications for Terazosin?
HTN
| Benign prostatic hyperplasia
57
When is Terazosin supposed to be taken?
Before bed
58
What is the MOA of Terazosin?
Antagonizes peripheral alpha-1 adrenergic receptors
59
What are the common adverse effects of Alpha blockers?
Headache
Dizziness
Pain
Paresthesia
60
What is the distinguishing adverse effect of Terazosin?
Floppy iris syndrome
61
If a patient is on Terazosin, is it safe to dilate them? Why or why not?
Not really. They don't dilate well.
62
What are the two drug types that Alpha blockers interact with?
Sympathomimetics
| Beta-blockers
63
What happens in the terazosin and sympathomimetic drug interaction?
Reduces the amount of BP lowering
64
What is a common sympathomimetic that we might see?
Phenylephrine (visine) - Phenyl tries to stimulate alpha-1 receptors
65
What happens in the Alpha blocker and beta-blocker drug interaction?
Enhanced BP lowering
66
Patients on Terazosin are cautioned with what?
Cataract surgery or retinal surgery
67
The suffix -olol goes on what kind of drugs?
Beta blockers
68
What are the three beta blockers?
Metoprolol
Atenolol
Propranolol
69
What are the indications for metoprolol?
HTN
Angina
Post myocardial infarction
70
Which of the anti-HTN drugs is hemodynamically stable?
Metoprolol
71
What is the MOA of beta-blockers?
Selective competitive antagonism of Beta-1 receptors (reduces systolic BP and CO)
Central acting inhibition of sympathetic outflow
Suppression of renin activity
72
What are the common adverse effect of Metoprolol?
Visual disturbances
Decreased tear secretion
Headache
73
What are the distinguishing adverse effects of metoprolol?
Depression
| Short Term Memory loss
74
What are the ocular adverse effects of Metoprolol?
```
Increased migrainous scotomata
Reduced IOP
Glaucoma progression
Corneal anesthesia
Exacerbation of myasthenia gravis
```
75
The adverse effects of metoprolol can mimic what eye problem?
Herpes keratitis
76
Why does metoprolol cause dry eye?
It numbs the cornea, so you don't blink as much
77
Is metoprolol a sympathomimetic or a sympatholytic?
Sympatholytic
78
What is a sympatholytic?
A drug that inhibits the postganglionic functioning of the sympathetic nervous system
79
What is the effect of an ophthalmic alpha-2 agonist interaction with metoprolol?
Additive effect
80
What is the effect of an ophthalmic beta-blocker interaction with metoprolol?
Additive
81
What is the effect of pilocarpine with metoprolol interactions?
Additive
82
What kind of drug is pilocarpine?
Parasympathomimetic
83
What is the effect of an NSAID interaction with metoprolol?
Antagonistic
84
What is the effect of an ophthalmic decongestant reaction with metoprolol?
Antagonisti
85
What three drugs interact with Metoprolol to cause an additive effect?
Ophthalmic Alpha-2 agonists
Ophthalmic beta-blockers
Pilocarpine
86
What two drugs interact with Metoprolol to cause an antagonistic effect?
NSAIDs
| Ophthalmic decongestants
87
What receptor does cocaine block?
Reuptake receptors for NE
88
What is the suffix for diuretics?
-ide and tone
89
Which diuretic is contraindicated for people with sulfa allergies?
Furosemide
90
What are the three diuretics used for HTN?
Furosemide
Hydrochlorothiazide
Spironolactone
91
What are the indications for Furosemide?
Hypertension
Acute pulmonary edema
Hypercalcemia
92
How does furosemide help with hypercalcemia?
Enhances urinary output of calcium
93
What do diuretics inhibit?
Reabsorption of calcium (I think)
94
What two ions does furosemide deplete?
Ca++ and K+
95
What is the MOA of diuretics?
Inhibits reabsorption of NaCl at the proximal/distal convoluted tubule and loop of henle
96
To whom are loop diuretics prescribed?
Patients with impaired renal function
97
How do loop diuretics enhance renal blood flow?
By increasing prostaglandin production
98
What are the common adverse effects of Furosemide?
Blurred vision
Hypotension
Puritis
99
What is puritis?
Itch
100
What are the potential hypersensitivity reactions from Furosemide?
Steven's Johnson syndrome
| Erythemia multiforme
101
What adverse effects can furosemide have on the cardiovascular system?
Decrease K+
| Vasculitis
102
If furosemide depletes too much K+, that can be a problem for which organ?
The heart
103
What effect occurs when Furosemide interacts with Aminoglycosides?
Additive nephrotoxicity
104
What effect occurs when Furosemide interacts with NSAIDs?
Induced ototoxicity and antagonism
105
What effect occurs when Diuretics interact with Carbonic Anhydrase Inhibitors?
Prolonged QT interval
106
What effect occurs when diuretics interact with erythromycins?
Prolonged QT interval
107
If you do a DFE and not anemia and the patient reports being on a HTN drug, which drug is most likely?
Diuretic - Furosemide
108
Why is the drug interaction effect of prolonging the QT interval bad?
It is potentially life threatening
109
Which patients require caution with Furosemide?
People with hypersensitivity to sulfonamides
110
If depletion of Ca and K is not desired, which Diuretic is used?
HCTZ - hydrochlorothiazide
111
When in hydrochlorothiazide indicated?
Hypertension
Peripheral edema
Congestive heart failure
Osteoporosis
112
Between HCTZ and Furosemide, which one is Ca depleting?
Furosemide
113
What is the MOA of HCTZ?
Inhibits NaCl reabsorption at the distal convoluted tubule
114
What are the common adverse effects of HCTZ?
Photosensitivity
| Headache
115
What hypersensitivity reactions are possible with HCTZ?
Erythema multiforme
| Steven's-Johnson syndrome
116
What hematological adverse effects are possible with HCTZ?
Anemia
Leukopenia
Thrombocytopenia
117
What are the potential ocular adverse effects of HCTZ?
Angle closure glaucoma
118
What is thrombocytopenia?
Reduction in thrombocytes
119
What do thrombocytes do?
Reduce platelets
120
What may thrombocytopenia cause?
Low platelet count and hemorrhaging
121
What is the effect of CAI interactions with HCTZ?
Synergy - they both cause a reduction in fluid production
122
What is the effect os NSAID interactions with HCTZ?
Antagonistic
123
What is the effect of erythromycin interaction with HCTZ?
QT prolongation
124
When should caution be taken when prescribing HCTZ?
Hypersensitivity to sulfonamides
125
What are the indications for Sprionolactone?
HTN
Congestive heart failure
Hyperaldosteronism
Hypokalemia
126
What kind of drug is Spironolactone?
Diuretic
127
Spironolactone is a ___ sparing drug.
K+
128
What unique relationship does Sprionolactone have?
Hyperaldosteronism
129
If a patient with hyperaldosteronism is put on spironolactone, what may occur?
BP may increase, instead of decrease, because they are putting out too much aldosterone
130
What is the MOA for spironolactone?
Antagonizes the aldosterone receptors in the distal convoluted tubule (kidney), resulting in Na/water loss and K retention
131
What are the common adverse effects of Spironolactone?
Headache
132
What are the distinguishing adverse effects of Spironolactone?
Gynecomastia
| Menstrual irregularities
133
What occurs when Sprionolactone interacts with cyclosporine?
Hyperkalemia - additive effect
134
What occurs when spironolactone interacts with NSAIDs?
Decreases the amount of BP lowering (antagonistic)
135
What are the two "other" HTN drugs?
Clonidine
| Hydrolzine
136
What are the indications for Clonidine?
HTN
| Severe cancer-related pain
137
Which drug can be given via epidural injection?
Clonidine
138
What is the MOA for Clonidine?
Stimulates the central and spinal alpha-2 adrenergic receptors (presynaptic and post-junstional
139
What are the serious adverse effects of Clonidine?
Angioedema
140
What is the effect of the interaction between antihistamines or opioids and Clonidine?
Enhanced CNS depression (agonistic)
141
What is the effect of the interaction between ophthalmic beta-blockers and Clonidine?
Antagonistic
142
What is the effect of the interaction between ophthalmic decongestants and Clonidine?
Antagonistic
143
What is the effect of the interaction of ophthalmic alpha-2 agonists and clonidine?
Additive
144
Clonidine inhibits ___ activity.
Sympathetic
145
What are the indications for Hydralazine?
Hypertension
Congestive heart failure
HTN crisis
146
What is the MOA for Hydralazine?
Directly dilates peripheral vessels via hyperpolarization of vascular smooth muscle, which inhibits CA++ influx (depolarization
147
What are the common adverse effects of Hydralazine?
Headache
| Lupus erythematosus
