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Pharm 2 module 2 > Antihypertensives > Flashcards

Antihypertensives Flashcards

(98 cards)

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1
Q

What are cardiac output and peripheral vascular resistance controlled by

A

Baroreflexes
&
Renin-angiotensis aldosterone system (RAAS)

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2
Q

What are the different types of hypertension

A

Essential
Malignant
Resistant
Pulmonary
Pseudo
White coat / office
Isolated systolic

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3
Q

What is the general MOA of diuretics

A

Increase water and sodium excretion to lower blood volume which in turn will decrease BP

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4
Q

What are end stage complication of uncontrolled HTN

A

Heart disease
Heart failure
Stroke
CKD

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5
Q

What are the categories of antihypertensive drugs

A

Diuretics
ACE inhibitos
ARBs
Ca2+ blockers
Beta blockers
Alpha blockers

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6
Q

What are the different categories of diuretics

A

Distal tubule
K-Sparing
Loop diuretics
Carbon anhydrase inhibitor
Osmotic

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7
Q

What drugs make up distal tubule diuretics (Thiazides)

A

Hydrochlorothiazide
Chlorthalidone
Metolazone
Indapamide

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8
Q

What is the MOA of thiazide diuretics

A

Inhibit Na+ and Cl- reabsorption in the distal tubule resulting in increase urine output

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9
Q

What is the indication of use for hydrochlorothiazide

A

Starting agent for HTN, Chronic edema, Idiopathic hypercalcinuria

*treats CaOx stones in Meneires disease and nephrogenic diabetes insidious

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10
Q

What are the pharmacokinetics of hydrochlorothiazide

A

Oral (onset 2 hours)
Absorbed rapidly and eliminated mostly unchanged

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11
Q

What are the adverse effects of hydrochlorothiazide

A

Increased digitalis / lithium toxicity

Hypokalemia if given w/ corticosteroids / ACTH

Orthostatic hypotension with EToH/ Barbituates/ narcotis

Contraindicated in gout

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12
Q

Which type of diuretic can be paired with thiazide or loop diuretics

A

Potassium sparing to mitigate potassium wasting

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13
Q

What is the indication for chlorthalidone

A

HTN, HF, hypercalciuria, Diabetes

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14
Q

Which thiazide is available IV

A

Chlorthalidone

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15
Q

What is the pharmacokinetics of chlorthalidone

A

Oral / IV
Long 1/2t and low bioavailability
excreted in urine unchanged

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16
Q

What are the side effects of chlorthalidone, metolazone, and indapamide

A

Hyponatremia, hypochloremia, hypotensions, hypokalemia

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17
Q

What is the indication for metolazone

A

Additive treatment to loop diuretics for tx of edema in HF

10x more potent that HCTZ

Safe in renal insufficiency

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18
Q

What is the indication for indapamide

A

HTN in decompensated HF
**Not commonly used

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19
Q

What are the pharmacokinetics of indapamide

A

Oral
Hepatic metabolism and renal excretion
*AKA excreted in urine and bile

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20
Q

Which drugs make up loop diuretics

A

Furosemide
Bumetanide
Torsemide

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21
Q

What is the MOA of loop diuretics

A

Inhibits Cl- and Na+ reabsorption = prevention of passive reabsorption of water

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22
Q

Which loop diuretic is most common

A

Furosemide

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23
Q

Which loop diuretic is preferred in patients with low GFR and in hypertensive emergencies

A

Furosemide

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24
Q

What is the indication for furosemide

A

Needing to move large volumes of fluid
->HF, Decamp. Cirrhosis, acute pulm. edema

Hypercalcemia
*Can combine with thiazide

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25
What are the pharmacokinetics of furosemide
Oral Diuresis begins 60min post admin and lasts 8 hours Hepatic metabolism nd renal excretion
26
Which drugs will inhibit furosemide
Probenecid indomethacin
27
What drug interaction will loop diuretics have
Digoxin K+ sparing diuretics Lithium NSAIDS
28
Which patients do you need to use extra caution with in regards to loop diuretics
Patients with sulfa allergies
29
What are some common adverse effects with furosemide
Hyponatremia, hypochloremia, dehydration, ototoxicity, hyperglycemia
30
What is the most potent loop diuretic
Bumetanide
31
What is the indication for bumetanide
Edema caused by HF CKD Cirrhosis hypercalcemia
32
What are the pharmacokinetics of bumetanide
Oral Onset 30-60min Duration 4-6 hours
33
What are some adverse effects of bumetanide
Dehydration severe myalgias
34
What is the indication of torsemide
Edema caused by HF CKD Cirrhosis Hypertension Hypercalcemia
35
What are some adverse reactions to torsemide
Dehydration ototoxicity headache dizziness
36
What are the K+ sparing diuretics
Spironolactone Eplerenone Amiloride Triamterene Acetazolamide Mannitol
37
What is the MOA of K+ sparing diuretics
inhibits K+ secretion and influence sodium excretion
38
What is the indication for spironolactone
HTN Edema in HF Ascites nephrotic syndrome hyperaldosteronism
39
What is spironolactone often prescribed with
Thiazide/loop diuretics to counteract K+ wasting effect
40
Which K+ sparing meds are aldosterone antagonists
Spironolactone eplerenone
41
What are the pharmacokinetics of spironolactone
Oral Effects can take up to 48hours to set in
42
What are the adverse effects of spironolactone
Gynecomastia hyperkalemia risk of digitalis toxicity when coadministered
43
What is the indication for eplerenone
Edema in HF Resistant HTN primary Hyperaldosteronism
44
What are the indications for amiloride
3rd / 4th line to tx HTN, HF May correct polyuria/polydipsia due to lithium induced nephrogenic diabetes insipidus
45
What is the MOA of Amiloride
Inhibit K+ loss by direct blockade of Na+/K+ exchange in the distal nephron
46
What are the adverse reactions with amiloride
Hyperkalemia Vomiting Leg cramps Dizziness *Glucose intolerance in diabetics
47
What is the indication for triamterene
HTN Edema alone or in combo
48
What are the pharmacokinetics of triamterene
Oral Initial response develops within hours
49
What are the adverse reactions of triamterene
Blue urine Hyperkalemia leg cramps dizziness
50
What is the indication of Acetazolamide
Chronic open angle glaucoma prophylaxis of altitude sickness
51
What is the MOA for Acetazolamide
Inhibits carbonic anhydrase which promotes renal excretion of Na+/K+, bicarb, and water
52
What are the pharmacokinetics of acetazolamide
Oral / IV Eliminated renally
53
What are the adverse reactions of acetazolamide
Metabolic acidosis renal stones Hyperammonemia in cirrhotic patients NO IN SULFA ALLERGIES
54
What are osmotic diuretic drugs
Mannitol
55
What is the indication of mannitol
Maintains urine flow following acute toxic ingestion of substances capable of producing acute renal failure (Lithium excretion) Reduction in ICP Glaucoma TX
56
What is the MOA of mannitol
Incr concentration of filtrates in the kidney and blocks reabsorption of water
57
What are the pharmacokinetics of mannitol
IV Onset 30-60 min and lasts 6-8 hours *safe in pregnancy
58
What are the side effects of mannitol
HA Nausea dizziness polydipsia dehydration confusion chest pain
59
Why can thiazides not be used in the treatment of hypercalcemia
Thiazides can exacerbate hypercalcemia by increasing tubular calcium resorption
60
Which drugs are ACE inhibitors
Captopril Enalapril Lisinopril
61
What are the indications of use for ACE inhibitors
Treatment of: HTN DM Stroke MI HF CKD *preferred in patients with diabetic neuropathy
62
What is the MOA of ACE inhibitors
inhibits ACE which reduces levels of angiotensin 2, suppress aldosterone excretion, decrease peripheral resistance and increase sodium and water retention
63
What are some contraindications with ACE inhibitors
Contra in pregnancy -Interactions w diuretics, antihypertensives, drugs that raise K+ levels, lithium, NSAIDS
64
What is the pharmacokinetics of captopril
oral 2-3x/day dose adjust in kidney disease
65
What are the adverse effect is captopril
First dose hypotension, cough, hyperkalemia, renal failure, angioedema, neutropenia, proteinuria
66
What are the adverse effects from enalapril
First dose hypotension, cough, hyperkalemia, renal failure, angioedema, proteinuria
67
What are the pharmacokinetics of enalapril
Oral (pro-drug) / IV Dose adjust in kidney disease
68
What are the adverse effects of lisinopril
First dose hypotension, cough, hyperkalemia, renal failure, angioedema, neutropenia, proteinuria
69
What are symptoms of severe hypercalcemia
Neuromuscular effects GI effects Renal effects CV effects
70
What is the safest and most effective treatment of hypercalcemic crisis
Saline rehydration Furosemide diuresis
71
What is nephrogenic diabetes insipidus
Where kidneys have partial or complete resistance to effects of antidiuretic hormone (vasopressin) -polyuria / polydipsia are signs
72
What is the main goal while treating nephrogenic DI
Proper fluid intake and reduction in urine output
73
What drugs can be used to help treat nephrogenic DI
HCTZ -> corrects hypernatremia *Sometimes in conjunction with amiloride to help body maintain K+ level
74
What drug classes make up the renin-angiotensin aldosterone system (RAAS)
ACE inhibitors (ACEi) Angiotensin receptor blockers (ARBs) Aldosterone antagonists
75
Where is Renin released from
Kidneys
76
What is the main MOA of ACEi
Angiotensin converting enzyme (ACE) is released from the lungs and converts angiotensin 1 into angiotensin 2 angiotensin 2 then stimulates vasoconstriction and causes the adrenals to release aldosterone Aldosterone then causes the kidneys to increase reabsorption of N+ and Cl- = increase BP
77
Why are ACEi preferred in patients with diabetic nephropathy
B/c glucose levels are not effected and drugs are renoprotective
78
Which drugs are in the ARBs class
Losarten Valsartan Candesartan Olmesartan
79
What is the MOA for ARBs
-Blocks angiotensin II receptors in blood vessels, adrenals, and other tissues, dilation of arterioles and veins
80
What is the indication for Losartan
HTN Stroke prevention diabetic neuropathy reduces uric acid levels
81
What was the first ARB approved for HF
Valsartan
82
What is the indication for olmesartan
HTN (mean BP reduction)
83
What is the indication for Candestartan
HTN HF
84
What is the pharmacokinetics of Losartan
Oral 1x daily Extensive first pass metabolism
85
What is the pharmacokinetics of valsartan
Oral 2x daily
86
What are the pharmacokinetics of candesartan and olmesartan
oral 1x daily dosing
87
What are the adverse effects / contraindications of losartan, valartan, candesartan
Angioedema, renal failure, dry cough, rash, altered taste -Drug interactions: additive effect w antihypertensive drugs -Contra in 2nd and 3rd trimesters of pregnancy
88
What is the adverse reaction and contraindication of olmesartan
Drug interactions: additive effect w antihypertensive drugs -Contra in 2nd and 3rd trimesters of pregnancy
89
What drug is a renin inhibitor
Aliskiren
90
What is the MOA of Aliskiren
Inhibits renin by binding to it, preventing the cleavage of angiotensinogen , acting early in the RAAS
91
What is the indication for aliskiren
HTN *side effects make it less favorable
92
What are the side effects / contraindications of aliskiren
Diarrhea Cough Angioedema *contraindicated in pregnancy
93
What are the pharmacokinetics of aliskiren
Oral CYP metabolism Bioavailability low, becomes lower with high fat meal 1/2t 24 hours
94
What are the endothelia antagonists
Ambrisentan Bosentan
95
What is the MOA of ambrisentan
Slectively blocks type A endothelin receptors
96
What is the indication for ambrisentan
PAH Improve exercise, delay clinical worsening *Can be used in combo with tadalafil
97
What is the indication for bosentan
PAH Decrease digital ulcerations in patients with scleroderma
98
What are the adverse effects of Ambrisentan
Edema nasal congestion palpitations abdominal pain constipation

Pharm 2 module 2 (4 decks)

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