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Pharm Block 2 > Antihypertensive Agents > Flashcards

Antihypertensive Agents Flashcards

1
Q

Which drugs have a side effect of a cough and what is the cause of that?

A

the ACE inhibitors cause cough due to reduced inactivation of bradykinin (more active)

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2
Q

How can ace inhibitors result in hyperkalemia

A

If patient already on potassium-sparing diuretics.

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3
Q

What are side effects of ACE inhibitors

A

hyperkalemia, hypotension, cough, taste changes, skin rash, angioedema

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4
Q

What are the curable forms of hypertension?

A

RECAP ABCDE
R: renal disease. E: estrogens. C: Coarctation
A: Aldosteronism P: Pheochromocytoma
A: Alcoholisms B: Brain lesions C: Cushings syndrome D: Drugs Sympathomimetic
E: excessive thyroxine or para.t.hormone

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5
Q

What is the function of ACE inhibitors, Angiotensin Receptor Blockers, and Renin Inhibitors?

A

The goal of all 3 is to decrease Angiotensin II, the most potent vasoconstrictor of the body, and decrease aldosterone production.

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6
Q

What are Angiotensin II effects on the body

A
  1. decreased output of sympathetic NS
  2. vasodilation of vascular smooth muscle
  3. Increased levels of bradykinin
    All three lead to decreased blood pressure
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7
Q

What is Aldosterone’s effect on the body?

A

Reduced retention of sodium and water, leading to reduced blood pressure

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8
Q

What are the 2 drug names to remember as ACE Inhibitors?

A

Captopril and Enalapril (both are oral)

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9
Q

What are the uses of ACE inhibitors?

A

Congestive heart failure, hypertension, and diabetic renal vascular disease (nephroprotective)

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10
Q

When are ACE Inhibitors contraindicated?

A

Pregnancy due to fetotoxicity

Excessive response after renal artery stenosis

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11
Q

What drugs are the Angiotensin II receptor blockers (2)

A

Losartan and Candesartan.

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12
Q

What is the action of Angiotensin II Receptor Blockers?

A

Inhibit Angiotensin II vasoconstriction
Inhibit aldosterone release
- do NOT alter bradykinin (less cough)
- do NOT adversely affect lipid levels, glucose, uric acid

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13
Q

What are the side effects associated with Angiotensin II Receptor Blockers?

A 
Hyperkalemia
Neutropenia
Elevation of serum AST and ALT
Angioedema
Contraindicated in pregnant women (fetotoxicity)
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14
Q

What is the name of the renin inhibitor?

A

Aliskiren. Same function as ACE and ARB

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15
Q

What are the names of the Calcium channel blockers to remember (4)

A

Amlodipine, Diltiazem, Nifedipine, Verapamil

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16
Q

What do calcium channel blockers do?

A

Block Type L Calcium Channels, which reduces constriction, promote excretion of sodium.

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17
Q

Some Calcium channel blockers cause bradycardia and tachycardia. Which ones cause brady and which ones cause tachy?

A

Tachycardia occurs Nifedipine (all the PINES), and bradycardia occurs with Verapamil and Diltiazem. All dilate coronary vessels, but only Verapamil and Diltiazem decrease AV conduction.

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18
Q

What are some side effects of Verapamil and Diltiazem?

A

Bradycardia, hypotension, CHF, Skin rash, Constipation

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19
Q

What are side effects of dihydropyridines?

A

PINES: Reflex tachycardia, hypotension, dizziness, skin rash, peripheral edema, constipation

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20
Q

Which antihypertensives should diabetics avoid?

A

Calcium channel blockers, these reduce glucose tolerance

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21
Q

What drugs have sympatholytic action?

A

Non-selective alpha blockers: Phenoxybenzamine and Phentolamine.
Selective alpha 1 blockers: Doxazosin
Non-selective Beta blockers: Propranolol
Selective B1 blockers: metoprolol

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22
Q

Which alpha blocker can be given oral, IV, or IM? Which one just Oral?

A

Phentolamine all 3, Phenoxybenzamine just oral

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23
Q

What are side effects of Alpha non-selective blockers?

A

postural hypotension, tachycardia, nasal congestion, impotence, increased GI motility

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24
Q

What are side effects of selective alpha 1 blockers?

A

dizziness and headache, may increase HDL (good cholesterol), can cause orthostatic hypotension with first dose or increasing dose. Experience Na/water retention so combine with diuretic.

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25
Q

What are side effects of Beta Blockers?

A

N,V,D. Heart failure, hypotension, increased airway resistance, depression, fatigue, impotence, decreased libido.

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26
Q

What are contraindications to beta blockers

A

Diabetes and asthma

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27
Q

Sudden withdrawal of beta blockers can lead to what?

A

exacerbation of angina and myocardial infarction

28
Q

Do patients on Beta Blockers tend to show an increase or decrease in LDL/TAGs?

A

Increase

29
Q

What is the mechanism of Beta Blockers?

A

reduce beta 1 activation of heart: decrease in CO
Reduce renin release: decreased resistance, decreased aldosterone which leads to decreased sodium/water retention. all these work to decrease BP.

30
Q

What are the names of the non-selective beta blockers we need to know?

A

Carteolol, Penbutolol, Pindolol, Propranolol, Timolol (most potent)

31
Q

What are the names of the Beta 1 selective blockers (3)

A

Acebutolol, Atenolol, Metopropolol

32
Q

What are the combined Alpha 1 and Beta Blockers?

A

Carvedilol and Labetalol. Carvedilol used in patients with CHF, structural changes in heart blocked.

33
Q

What is the name of a selective beta 1 blocker with direct vasodilation action

A

Nebivolol.

34
Q

What are the Third step drugs for hypertension?

A

the peripheral adrenergic antagonists. Guanadrel and guanethidine.

35
Q

What is the action of Guanadrel and Guanethidine

A

Guanadrel is rapid and Guanethidine is longer acting. Both treat severe hypertension by interfering with release/storage of Norepi. “Big Guns” with many side effects

36
Q

What are the side effects of Guanadrel and Guanethidine?

A

orthostatic hypotension, exercise hypotension, sexual dysfunction, diarrhea.

37
Q

What medications can inhibit the function of Guanethedine and Guanadrel?

A

tricyclic antidepressents, phenothiazines and ephedrine can inhibit uptake and decrease the antihypertensive effects of guanadrel and guanethidine.

38
Q

Reserpine does what in the body?

A

Inhibits neuronal and vesicular catecholamine uptake, preventing storage and leading to depletion of NTs. It treats hypertension.

39
Q

What are side effects of Reserpine?

A

severe mental depression, nasal congestion, diarrhea

40
Q

Where do the sympatholytic anti-hypertensives bind?

A

They bind to the alpha-2 receptors and imidazoline receptors pre-synaptically to decrease sympathetic outflow from the CNS.

41
Q

What are the effect of the central sympatholytic anti-hypertensives?

A

Reduce TPR and Blood pressure
CO and Blood flow to vital organs is unchanged
Limited reflex responses compared to peripherally acted drugs

42
Q

What are the drugs with central sympatholytic actions

A

Clonidine
Guanabenz
Guanfacine
Methyldopa

43
Q

What are side effects of methyldopa

A

Coomb’s positive hemolytic anemia
false positive tests in diagnosis of pheochromocytoma
sedation and drowsiness
Often given with diuretic

44
Q

What are side effects of all centrally acting sympatholytics?

A

sexual dysfunction (impotence, decrease libido, impaired ejaculation, gynecomastia) and rebound hypertension with rapid withdrawal in all but methyldopa

45
Q

What are the arteriolar dilators?

A

Diazoxide, Hydralazine, Minoxidil, Nitroprusside, Fedoldapam

46
Q

What is the mechanism for the arteriolar dilators and what are they used for?

A

act directly on arteriolar vascular smooth muscle to cause relaxation
increase renin release
rapidly reduces BP in hypertensive crisis, hypertensive encephalopathy, eclampsia
- baroreceptor activation limits their long term use

47
Q

What is the action of Diazoxide?

A

acts as a potassium channel activator, can cause hyperglycemia

48
Q

Hydralazine has what side effects?

A

chronic high doses can produce a lupus-like syndrome
may precipitate angina or myocardial infarctions
Headache, tachycardia, palpitations, sweating, flushing

49
Q

What are side effects of Minoxidil

A

Headache, tachycadia, sodium and water retention (use with diuretic), hypertrichosis (hair growth on face and body - found in shampoos), marked fluid retention can lead to pericardial effusion

50
Q

What are the side effects of nitroprusside?

A

Light sensitive formula so comes in brown bottle, prolongued in overly rapid infusion causes cyanide poisoning

51
Q

What is the action of Fenoldapam?

A

D1 receptor agonist, increases renal perfusion while decreasing BP systemically

52
Q

Which ganglionic blocking agents are used in hypertensive emergencies?

A

Mecamylamine, trimethaphan

53
Q

Which diuretics are used anti-hypertensives?

A

thiazides
Furosemides
Spironolactone

54
Q

What is the action the thiazides and name the hallmark drug

A

inhibits Na+/Cl pump in distal tubule, to increase excretion of sodium and water follows. Drug - Hydrochlorothiazide (HCTZ)

55
Q

What are the uses of thiazides?

A

Antihypertensive, decrease renal excretion of calcium, fluid reduction in congestive heart failure

56
Q

What are adverse effects of diuretics acting in distal tubule?

A

Hyperuricemia, Hypokalemia, Hyponaturemia, Hyperglycemia, Hypercalcemia, Hypokalemic metabolic alkalosis, volume depletion. Efficacy of thiazides decreases with acute kidney issues.

57
Q

Where do the loop diuretics act and what is the Hallmark drug?

A

These inhibit the Na+/K+/Cl- pump in the ascending limb. Drug - Furosemide/Lasix.

58
Q

What are the uses for loop diuretics?

A

Rapidly remove fluids in ascites, acute pulmonary edema, CHF (within minutes, urine production).
Decrease serum calcium concentration (give hydration + electrolytes with diuretic)
combat chronic kidney disease and to pull fluid off lungs

59
Q

What are adverse effects of loop diuretics?

A

Hypokalemic alkalosis, hyperuricemia, hypokalemia, hypocalcemia

60
Q

What are the Potassium sparing diuretics?

A

Spironolactone, Eplerenone, Amiloride, Triamterene

61
Q

Which potassium sparing diuretics inhibit aldosterone receptor?

A

Spironolactone and Eplerenone - spare potassium, waste sodium

62
Q

Which potassium sparing diuretics inhibit sodium channels?

A

Amiloride, Triamterene

63
Q

What are the uses for potassium sparing diuretics like Spironolactone?

A
  1. Treat hyperaldosteronism since Spironolactone is a competitive inhibitor of the Aldosterone receptor,
  2. as an adjunct diuretic to potassium wasting diuretic
  3. as an adjunct to ACE inhibitors, Beta Blockers, thiazides and digoxin
64
Q

What are adverse effects of the Potassium sparing diuretics?

A

Hyperkalemia, Hyperchloremic acidosis, endocrinological effects of gynecomastia, impotence, menstrual irregularities

65
Q

Rules for potassium sparing diuretics

A

don’t give K+ supplements
don’t combine with other K+ sparing diuretics
Careful when combining with Ace Inhibitors
NSAIDs can reduce effects

66
Q

Which drugs can cause sexual dysfunction?

A

Thiazides, Sympatholytics, Beta Blockers

Pharm Block 2 (5 decks)

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