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CVS II Drugs Used in Angina Pectoris > Antihypertensive Drugs > Flashcards

Antihypertensive Drugs Flashcards

(48 cards)

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1
Q

What are the drugs class we use for HTN?(It’s 10 Dr. Morcos gave)

A
  1. Diuretics
  2. ACEI (Angiotensin converting Enzyme inhibitors
  3. ARB ( Angiotensin Receptors Blockers
  4. BB (Beta Blockers
  5. CCB (Calcium Channels Blockers)
  6. Alpha 2 agonists
  7. Adrenergic Neuronal Blocking Drugs
  8. Alpha Blockers
  9. Direct acting vasodilators
    10.Renin Inhibitors
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2
Q

Which classes of Antihypertensive drugs have proven
To decrease mortality from heart diseases?
A. Beta Blockers
B. ACE inhibitors
C. Thiazides Diuretics

A

A. Beta Blockers

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3
Q

What is recommended for Elevated Blood pressure?

A

Life-style modification
Weight reduction
Moderate alcohol intake
Reduction of sodium intake
Smoking cessation
Regular physical activity

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4
Q

What is Stage 1 HTN numbers?

A

Stage I Hypertension:
Systolic 130-130
Diastolic 80-89

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5
Q

What is recommended. For Stage 1 HTN

A

Consider one drug: Diuretic, ACEI,ARB or. Ccb

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6
Q

What is the B/P for Stage II HTN? And what is recommended?

A

Systolic >140
Diastolic >90
2 Drugs combination: Diuretic + ACEI or ARB or CCB

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7
Q

Jan Doe come sin with HTN + Angina Pectoris. What will be the clinical treatment?

A

Hypertension + Angina Pectoris
Rx: BB and/or CCB

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8
Q

John Doe comes in with HTN + BPH. What will be the clinical treatment?

A

: Alpha blocker

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9
Q

Jan Wilson comes in with HTN + DM? What will be your treatment plan?

A

Rx: ACEI or ARB

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10
Q

Luke Walker comes in with HTN + HF what will you prescribe him?

A

ACEI, ARB, BB, Diuretic,

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11
Q

Judy comes in with HTN + MI. What will be your treatment plan?

A

BB, ACEI

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12
Q

Billy bob comes in with HTN + Dyslipidemia. What will be your treatment plan?

A

Alpha blocker, CCB

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13
Q

Drug of choice for Hypertension with diabetes

A
  1. BB
  2. ACEI
  3. CCB
  4. Diuretic
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14
Q

In a study of a patient with refractory hypertension, which of the
following antihypertensive combinations will reduce the systolic
BP the most?
A. Adding an alpha blocker to a beta blocker
B. Adding an ARB to an ACEI
C. Adding K+ sparing diuretic to a thiazide diuretic
D. Adding a dihydropyridine CCB to a non-hydropyridine CCB

A

C

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15
Q

Which of the following activities can have the greatest
effect on blood pressure reading?
A. The consumption of three alcoholic drinks 12 h before the
measurement
B. The drinking of a cup of coffee 1h before the measurement
C. The smoking of a cigarette 15 minutes before the measurement
D. The use of a cuff that is one size too small for the patient.

A

C

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16
Q

Pregnant female with Pre-eclampsia.
Drug of choice for Hypertension during pregnancy:

A

Labetalol - Hydralazine – Nifedipine - Nitroglycerin

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17
Q

Mechanism Affecting Blood Pressure

A

BP = CO x TPR CO = SV x HR
BP = SV x HR x TPR

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18
Q

Mechanism Affecting Blood Pressure

A
  1. Increase SV: Edema, increase renin-angiotensin activity
    Rx: Diuretics, ACEI or ARB
  2. Increase in HR: Due to decrease vagal tone and increase
    Sympathetic tone
    Rx: BB
  3. Increase Peripheral resistance: Increase sympathetic tone
    Rx: Alpha 2 agonist, alpha blocker, CCB or direct acting
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19
Q

Types of Diuretics

A
  1. Thiazide Diuretics
  2. Loop Diuretics
  3. Osmotic Diuretics
  4. Carbonic Anhydrase inhibitors
  5. K+ sparing Diuretics
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20
Q

Thiazides Diuretics (names)

Mechanism of Action:

Adverse Effects:

Study These Flashcards
A

Chlorothiazide
Hydrochlorothiazide
Chlorthalidone
Indapamide
Metolazone
Mechanism of Action: Inhibit Na/Cl cotransport
Increase excretion: Na+, K+, Cl-, Mg++, HCO3
Decrease excretion: Ca++, Uric acid
Adverse Effects:
Hyponatremia, Hypokalemia, hypomagnesia, metabolic
alkalosis,
Hypercalcemia and hyperuricemia
Thiazide diuretics increase plasma cholesterol and TGs (except indapamide)

21
Q

Loop Diuretics(names)

Mechanism of action

Adverse effects:

Study These Flashcards
A

Furosemide
Bumetanide
Torsemide
Ethacrynic acid
Inhibit the Na+/K+ dichloride cotransport
system
Increase excretion: Na+, K+, Mg++, Cl-, HCO3, and Ca++
Adverse effects: Hyponatremia, hypokalemia, hypomagnesia
Metabolic alkalosis, hypocalcemia and Ototoxicity
Drug Interaction:
Loop diuretic + Antibiotic (aminoglycosides)
Increase risk for Ototoxicity

22
Q

Osmotic Diuretics(names)
MOA
Side effects

Study These Flashcards
A

Mannitol
Glycerol
Mechanism of action: Increase the osmotic pressure in the
proximal tubule which
Lead to inhibition of reabsorption of water and electrolytes
Indications:
Increase intracranial pressure (cerebral edema)
Increase intraocular pressure (acute glaucoma)
Acute renal failure
Adverse Effects:
Excessive plasma volume expansion which can lead to heart failure

23
Q

Carbonic Anhydrase inhibitors

Mechanism of action

Indications
Adverse effects

Study These Flashcards
A

Acetazolamide
Dorzolamide
Mechanism of action: Increase excretion of Na+, K+, and
HCO3
Indications:
High altitude sickness
Glaucoma
Overdose of acidic drugs (Alkalinize the urine)
Adverse effects
Drowsiness
Paresthesia

24
Q

K+ Sparing Diuretics(names)
MOA
Side Effects
Indications

Study These Flashcards
A

Spironolactone (aldosterone antagonist)
Eplerenone (new) less gynecomastia
Amiloride
Triamterene
Mechanism of action: Block Na+ reabsorption
Indications:
Spironolactone +ACEI increased survival in heart failure
Spironolactone is used in Rx of Hirsutism due to its antiandrogenic
effect
Amiloride is used in Rx of Nephrogenic Diabetes insipidus caused by
lithium
Adverse effects:
Hyperkalemia
Nephrolithiasis (Triamterene)
Decrease libido and gynecomastia (Spironolatone)
Treatment of Hyperkalemia: Patiromer

25
Antidiuretic Hormones Antagonists Vasopressin Antagonists MOA S/E Indications
Antidiuretic Hormones Antagonists Vasopressin Antagonists Conivaptan Tolvaptan Mechanism of action: Conivaptan (V1A and V2 receptors blocker) Tolvaptan (Selective V2 receptors blocker Indications: Euvolemic and hypervolemic hyponatremia Adverse effects: Infusion site reaction Hypokalemia
26
ACE inhibitors Angiotensin Converting Enzyme Inhibitors(names)
Widely used drugs ending in “PRIL” Captopril Enalapril Lisinopril Ramipril Fosinopril Benazepril Quinapril
27
ACE inhibitors Angiotensin Converting Enzyme Inhibitors MOA
1. Prevent the conversion of angiotensin I to Angiotensin II Decrease the vasoconstrictive effects of angiotensin II peripherally (reduce afterload) and in the kidney causing efferent arteriolar dilation 2. Decrease the release of aldosterone which lead to decrease salt and water retention 3. Prevent the conversion of Bradykinin to inactive compound Increase Bradykinin has a good vasodilatory effects May contributes to dry cough in some patients
28
ACEI clinical use S/E
Clinical Use: Heart failure LV systolic dysfunction (Post MI) Hypertension and Diabetes Stroke Adverse effects Hyperkalemia Angioedema Proteinuria Elevated BUN and Cr
29
ACEI are the drug of choice for patients with Hypertension and Diabetes Why?
Diabetic patient tend to develop Nephropathy ACEI slow down renal damage
30
Contraindications of ACEI
Contraindications of ACEI 1. Pregnancy may cause Fetopathy Oligohydramnios, IUGR, Hypocalvaria and renal failure 2. Angioedema 3. Bilateral renal artery stenosis
31
ARB (Angiotensin II Receptors Blockers) names
Drugs ending in “SARTAN” Losartan Valsartan Candesartan Irbesartan
32
ARBs MOA & S/E
Mechanism of action They block angiotensin II receptors NO effect on Bradykinin metabolism (no dry cough) Adverse Effects Hyperkalemia Angioedema Contraindicated in Pregnancy
33
BB Beta Blockers names
Drugs ending in “OLOL” Non-Selective B Blockers Propranolol Nadolol Timolol Selective B1 blockers Metoprolol Atenolol Bisoprolol Betaxolol B-Adrenergic Partial agonist Acebutolol B-Blocker and NO release Nebivolol Non-selective Beta and alpha Blockers Carvedilol Labetalol
34
Clincial use of BB Beta block & S/E?
Clinical use: 1. Coronary artery diseases 2. Tachyarrhythmias 3. Migraine Headaches 4. Anxiety Adverse effects Bradycardia Fatigue Sexual disfunction AV Block Abrupt withdrawal can cause rebound hypertension due To upregulation of # of receptors Mask signs of Hypoglycemia Cautions: Asthma and Heart block
35
CCB Calcium Channel Blockers names
Drugs ending in “DIPINE” Dihydropyridines (Vascular Tissues) Amlodipine Nifedipine Felodipine Isradipine Nicardipine Clevidipine Non-hydropyridines (heart) Diltiazem Verapamil
36
Dihydropyridines Mechanism of action:
Dihydropyridines Mechanism of action: Block L-type Ca++ channels Causing vasodilation and decrease peripheral resistance
37
Dihydropyridines Adverse Effects
Adverse Effects: Reflex tachycardia Ankle edema Gingival hyperplasia
38
Non-Dihydropyridines: Mechanism of action * Adverse effects
Non-Dihydropyridines: Mechanism of action Decrease heart rate and conduction velocity Adverse effects AV conduction block Constipation
39
What are the Alpha 2 agonists use for HTN
Clonidine: Activates presynaptic alpha 2 receptors Used in Mild to moderate hypertension Adverse effects: Edema, rebound hypertension after withdrawal Alpha Methyl Dopa: Prodrug Safe in pregnancy Agonist at the presynaptic alpha 2 receptors Adverse Effects: Autoimmune hemolytic anemia (+ve Coombs test) Hepatitis
40
Adrenergic Neuronal blocking agents
Guanethidine Binds to storage vesicles and inhibits release of NE Contraindicated with Tricyclic antidepressants Reserpine Binds to storage vesicles and destroys them It causes depletion of NE, DA, and serotonin Adverse effects Major depression Suicidal thoughts GI complications
41
Alpha Blockers(names) Clinical use A/E
Prazocin, Doxazocin and Terazocin Selective antagonists of peripheral alpha 1 receptors Reduce blood pressure by relaxing vascular smooth muscle and decrease arteriolar resistance They are used for Hypertension patients with BPH Adverse effects First dose syncope: Orthostatic hypotension Incontinence in women: When coughing, sneezing or trying to lift a weight. This is due to alpha blockade relaxing effect on the bladder. Retrograde ejaculation
42
Direct acting Vasodilators(names) MOA S/E
Have no effects on ANS Hydralazine: Selective arteriolar dilation Prodrug of NO Used for moderate to severe hypertension Adverse effects: SLE like syndrome in “slow acetylators” Reflex tachycardia Sodium Nitroprusside Causes venous and arterial vasodilation through cGMP Given IV for hypertensive crisis Adverse effects: Cyanide poisoning Controlled by administering sodium nitrite followed by Na thiosulfate or Vit B12 cyanocobalamin
43
Direct acting Vasodilators (names part 2) MOA S/E
Minoxidil Potent direct vasodilator Activates ATP-Dependent K+ channels Side Effects Hypertrichosis Reflex tachycardia and edema Used as topical hair products for male and female baldness (Rogaine) Fenoldopam: Stimulates D1 and alpha-2 adrenergic receptors Protects the kidney
44
What potent VD side effects is Hypertrichosis
Minoxidil
45
What are the S/E for Hydralazine?
SLE
46
What VD causes cyanide poisoning
Sodium Nitroprusside
47
Renin Inhibitor(name) MOA S/E Contraindicated
Renin Inhibitor Aliskiren It directly inhibits the enzyme renin Block the conversion of Angiotensinogen to angiotensin I Adverse effects Hyperkalemia Angioedema Contraindicated in Pregnancy
48
Drugs used in Hypertensive Emergencies
1. Calcium channel blockers Nicardipine Clevidipine 2. Beta Blockers Labetalol Esmolol 3. Vasodilator/Nitrates Fenoldopam

CVS II Drugs Used in Angina Pectoris (18 decks)

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