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ADV PHARM I > ANTIHYPERTENSIVES > Flashcards

ANTIHYPERTENSIVES Flashcards

(45 cards)

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1
Q

essential/primary HTN vs. secondary
- SBP/DBP
- causes
- stages (u know this alr)

A

essential: >130/>80
- identifiable cause
- higher in men, african american, inc age

secondary: caused by underlying ds
- renal ds, endocrine (thyroid, pheochromo, cushings), drug incduced HTN/NSAIDS, social/inc sodium and alc

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2
Q

physiological reg of BP
3 ways

A
  • CO (stroke volume x HR)
  • peripheral vasc resistance (change the flow/muscle tone)
  • baroceptor reflex (postural changes)
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3
Q

non pharm tx

A

lifestyle mods in preHTN and stage 1 should be initiated

  • wt loss, diet, exercise, low sodium, smoking cessation, dec alc intake
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4
Q

initiating drug tx

A
  • start immed- DBP >90
  • start if Bp still >150/90 after 3-6 month lifestyle mods
  • thiazide first line for no comorbid
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5
Q

DIURETICS

diuretics
- MOA
- indications
- subclasses (names)

A
  • MOA: dec BV, SV, CO, BP
  • indications: tx edema assoc w CHF and renal ds
  • subclasses: thiazide, loop, potassium sparing(aldosterone antag)
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6
Q

assoc w thiazide diuretics and?

A

thiazide diuretics and CCB similar effects

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7
Q

DIURETICS

thiazide diuretics
- names

A

HCTZ, chlorthalidone, chlorthiazide, metolazone

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8
Q

DIURETICS

thiazide diuretics
- MOA
- indications
- precautions

A
  • MOA: block Na+ resorp at distal convoluted tubule
  • indications: single drug tx in mild HTN, tx edema in CHF/nephrotic syndrome
  • precautions: ineffective in severe renal ds

thiazides can cause electrolyte imbalance, cannot be corrected w impaired renal function

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9
Q

DIURETICS

thiazide diuretics
- CI
- ADRs
- DDIs

A
  • CI: GOUT/hyperuricemia, sulfa allergy
  • ADRs: electrolyte abnorm (hyponatremia), metabolic effects (hyperglycemia, hyperuricemia, inc TG), sexual dysfunc
  • DDIs: dec by NSAIDs, can inc lithium levels

  • in gout the body is prioritizng removing fluid NOT uric acid
  • in hyponatremia, Na is alr depleted, thiazide diuretic would draw more out
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10
Q

DIURETICS

thiazide diuretics reccomendation

A

first line in most cases
- inc efficacy as MONOtherapy over ACE/ARB in african americans

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11
Q

DIURETICS

loop diuretics (2nd line)
- names
- which can you use in sulfa allergy?

A

furosemide/lasix, torsemide, bumetanide, ethacrynic acid (USED IN SULFA ALLERGY)

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12
Q

DIURETICS

loop diuretics
- MOA
- indications
- precautions
- monitor and why?

A
  • MOA: block Na+ resorp in asc. loop of henle
  • indications: edema assoc w CHF, hepatic, or renal ds, HTN
  • precautions: PROFOUND diuresis, monitor fluid status, renal func, electrolytes

more powerful diuresis than other diuretics

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13
Q

DIURETICS

loop diuretics
- CI
- ADRs!!!
- DDI
- JNC reccomendation

A
  • CI: sulfa allergy
  • ADRs: electrolyte abnorm (hypokalemia, hypocalcemia), renal effects (inc BUN, oliguria), GI, OTOTOXICITY w high and prolonged doses OR rapid doses/IV
  • DDI: NSAIDS, inc lithium levels
  • not recc as first line
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14
Q

DIURETICS

potassium sparing diuretics
- names

A

spirinolactone, eplerenone, amiloride, triamterene

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15
Q

DIURETICS

potassium sparing diuretics (2nd line)
- MOA
- indications
- precautions

A
  • MOA: block Na+ reabsorb, also reduce K+ secretion into urine
  • indications: edema from CHF, HTN
  • precautions: HYPERKALEMIA (esp. in combo w ACEi and K+ supplements)

ACEi and potassium sparing both can cause HYPERKALEMIA (common ADR)

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16
Q

DIURETICS

potassium sparing diuretics
- CI
- ADRs
- DDIs
- JNC recc

A
  • CI: hyperkalemia (K+ >5 prior to tx)
  • ADRs: hyponatremia, inc BUN, jaundice, n/v/d
  • DDIs: hyperkalemia w/ACEi and K+ suppl, NSAIDS, lithium (inc levels)
  • recc: not first line
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17
Q

DIURETICS

potassium sparing- spirinolactone and eplerenone
- MOA
- uses
- unique ADRs

A

dual MOA: K+ sparing diuretic AND aldosterone antagonist
uses: HTN, CHF, primary hyperaldosteronism, PCOS, hirsuitism
unique ADRs: gynecomastia, ED, amenorrhea

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18
Q

ACEi

assoc response w ACE inhibitors and?

A

ACEi and BB (similar effects on RAAS)

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19
Q

ACEi

ACEi names

Study These Flashcards
A

enalapril, benazapril, quinapril

20
Q

ACEi

ACEi
- MOA
- indications
- precautions

Study These Flashcards
A
  • MOA: RAAS, blocks ACEI to II covnersions, block degradation bradykinin, therefore reduce BP
  • indications: HTN, CHF, post MI
  • precautions: cause renal failure in pts w bilat renal artery stenosis
21
Q

ACEi

ACEi
- CI
- ADRs
- DDI

Study These Flashcards
A
  • CI: angioedema, bilat renal artery stenosis, pregnancy
  • ADRs: dry cough, rash, angioedema, hyperkalemia, dec renal function, abnormal taste
    DDI:
  • antiHTN effect inc w thiazide and loop diuretics
  • hyperkalemia w/ K+ sparing diuretics
  • inc lithium levels
  • NSAIDS dec effect of ACEi
22
Q

ACEi

ACEi reccomendations

Study These Flashcards
A

indications: DM, CKD (except bilat renal artery stenosis), HF, post MI
neutral effect on lipid profile and bronchospastic ds

23
Q

ARB

ARB- Angiotensin Receptor blockers , names

Study These Flashcards
A

losartan, valsartan

24
Q

ARB

ARB
- MOA
- indication, precaution, CI, recc

  • ADRs
Study These Flashcards
A

MOA: block binding angiotensin II to receptors in smooth muscle and adrenal cortex (dec Bp and CO)
- indication, precaution, CI, and recc same as ACEi
- ADRs: same as ACEi, but less effect on kidney and less incidence cough and angioedema, INC INCIDENCE URI

25
# CCB CCBs - MOA - indications - precautions
- MOA: smooth muscle relaxation, suppress cardiac activity, inc O2 supply/dec myocardial O2 demand - indications: HTN, angina (prinzmetals), arrhythmias (central acting), migraine, raynauds - Precautions: periph edema and reflex tachy common (slowly titrate dose) CI- SBP <100, Hr <60, EF <40%
26
# CCB CCBs - CI - ADRs (central and periph acting) - DDI
- CI: central acting Ci in hypotension, cardiogenic shock, sick sinus syndrome, 2nd/3rd degree heart block - ADRs- constipation, bradycardia, flushing, reflex tachy, periph edema - CHF, heart block, hypotension w CENTRAL acting !!!!!! - nifedipine short acting form adv events in tx for HTN EMERGENCY DDI- digoxin, amiodarone, azoles (w verap and diltiaz)
27
# CCB CCB reccs - non DHP in? - avoid non DHP in?
- Non DHP: atrial tachyarrythmia, angina, raynauds - neutral effect on lipids, bronchospastic ds - avoid nonDHP in 2nd 3rd degree heart block
28
# second line antiHTN Beta Blockers - MOA - indications
MOA- dec HR, BP, CO, and myocardial O2 demand Indications- HTN, CHF, typical angina, Mi, certain arrythmias, migraine precaution: avoid abrupt withdrawal, concurrent use w/verapamil and dilt, bronchospastic ds use B1 selective blocker
29
# second line anti HTN Beta Blockers - CI - ADRs - DDIs - recc
CI- sinus bradycardia, SBP <100, heart block, cardiogenic shock ADRs- hypotension, bradycardia, bronchospasm, hypercholesteremia DDIs- digoxin and BB (inc bradycardia), NSAIDS recc: not first line, good for post MI, avoid non selective in bronchospastic ds
30
# second line antiHTN BB names - non selective, B1 selective, BB w ISA, alpha beta (2), cardioselective w/stim of NO
nonselective- prop, nad, tim B1 selective- aten, meto, bispro, nebiv BB w ISA activity (causes less bradycardia)- acebut, penbut, pindolol alpha/beta- carvedilol for CHF alpha/beta- labetolol for pregnancy cardioselective w stim NO- nebivolol
31
# a1 blockers a1 blockers - MOA - indications - precuations
- MOA: block constriction periph vasc smooth muscle - indications: HTN, BPH - precaution: orthostat hypotension, syncope (concurrent use PDE-5 inhibitors worsens)
32
# a1 blockers a1 blockers - CI - ADRs - recc - names
- CI: some with PDE-5 inhibitors - ADRs: orthostat hypo, sexual dysfunc, reflex tachy, dizzy/n/v/d, epistaxis - recc: preferred for BPH, pos effect on lipids (dec LDL, inc HDL) - -azosin
33
# centrally acting agent centrally acting agents - MOA - indications - precautions
- MOA: dec SNS outflow, dec BP (HR and CO either reduced or remain unchanged) - indications: refractory HTN after other agents FAIL - precautions: avoid rapid withdrawal/taper to avoid rebound HTN, TCAs can block effects
34
centrally acting agents - ADRs
- ADRs: bradycardia, heart block, impotence, CNS, dry mouth, sedation
35
centrally acting agents - names
clonidine, methyldopa, guanethidine and reserpine
36
# central acting agent clonidine - MOA - non FDA uses - patch may contain?
- MOA: alpha 2 agonist - non FDA use: heroin and nicotine withdrawl, severe pain, ADHD - patch form may contain metal, remove prior to MRI
37
# central acting agents methyldopa - preferred for - MOA - side effect
- preferred for: pregnancy - MOA: inferfere with dopamine conversion to norepi - immunologic side effect, combs positive hemolytic anemia
38
# central acting agents guanethidine, reserpine
neuronal blockers, rarely used
39
direct vasodilators - MOA - indications - precaution/CI - ADRs
- MOA: directly dilates arteriolar smooth muscle - indication: refractory HTN after agents fail - CI: specific to each agent - ADR:** reflex tachy, angina,** MI, edema
40
direct vasodilators names and uses/ADRs
hydralazine - HTN secondary to eclampsia, CHF, primary pulm htn - ADR- lupus like syndrome minoxidil- topical for baldness sodium nitroprusside- htn crisis siazoxide- htn crisis
41
direct renin inhibitors -name MOA, indication, ADR
aliskiren MOA- inhibit RAAS indication- HTN, HF and nephropathy same preg category as ACE and ARBs ADRs- diarrhea, cough, angioedema
42
combos
ACEi+CCB or diuretic - benazepril and amlodipine - ben and HCTZ BB + diuretic - bisoprolol and HCTZ
43
drug choice based on demo - african american - whites - elderly - pregnancy - men w BPH
- african american- thiazides, CCB - whites- BB/ACEi/ARB - elderly- diuretics - pregnancy- chronic htn v eclampsia v preeclam - men w BPH- a1 blockers
44
# hypertensive emergency htn emergency IV options - drug names, best for which pts?
BB (esmolol and labetalol) nitrovasodilators (sodium nitroprusside and NTG) - NTG if Acute MI or HF (HA, reflex tachy, tolerance) - SNP if HF with increased SVR (systemic vasc resistance)---contains cyanide, need good kidney and liver for removal vasodilators (hydralazine) dopamine receptor agonist -- for pt w renal dysfunc CCB (nicardipine and clevidipine)--- CI in soy or egg allergy, short act, good for CABG ACEi- enalaprilat ---HF pt ## Footnote esmolol, labetalol, hydralazine, NTG, SNP, nicardipine, enalaprilat
44
hypertensive - crisis - emergency - urgency tx and goal
crisis: SBP >180 or DBP >120 emergency: severe inc w evidence target end organ damage - dec bp over minutes to hours - <25% within 1st hr - Iv meds urgency: severe inc w OUT evidence target end organ damage - reduce BP DBP to be under 100 over 24-48 hrs - can tx outpatient w follow up PO meds - tx over several hours to days

ADV PHARM I (13 decks)

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