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PCM Exam 2 > Antihypertensives > Flashcards

Antihypertensives Flashcards

1
Q

What are the 4 anatomic sites of BP control?

A
  • resistance in arterioles
  • capacitance in venules
  • pump output of the heart (CO)
  • kidneys (most common site of action to treat HTN)
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2
Q

What are two compensatory response to ↓ BP?

A
  • tachycardia (due to the ↑ sympathetic outflow that results form the dec. BP)
  • salt and water retention
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3
Q

What are first line agents for treatment of HTN?

A
  • ACE inhibitors, alpha receptor blockers, calcium channel blocker and thiazide diuretics
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4
Q

Second line agents for HTN:

A
  • β blockers, aldosterone antagonists
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5
Q

α blockers are _______ line treatment for HTN

A

1st line

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6
Q

What drugs are ACE inhibitors? And what patients are they usually given to?

A
  • captopril
  • enalapril
  • lisinopril
  • PRIL

1st line for HTN, especially for diabetics and patients with chronic kidney disease

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7
Q

Patient with HTN and also has diabetes and/or chronic renal disease. What drug would you give to treat their HTN?

A

Ace inhibitor: captopril, enalapril, lisinopril

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8
Q

ACE converts _______ to _______ and also breaks down _________

A

Angiotensin I → angiotensin II

Bradykinin

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9
Q

______________ drugs to treat HTN do NOT induce reflex tachycardia

A

ACE inhibitor

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10
Q

what is the effect of bradykinin levels in someone taking ACE inhibitors?

A

↑ bradykinin because ACE breaks it down;

The ↑ bradykinin produces a cough in patients

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11
Q

Angiotensin II acts on the __________ receptors which leads to: (3)

A

AT1 receptors;

  • vascular growth
  • vasoconstriction
  • Na retention
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12
Q

When giving an ACE inhibitor, can expect ↑ levels of ________ and ______

A

Renin and angiotensin I ; but doesnt do anything because ACE is inhibited

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13
Q

What is the effect of ACE inhibitors on sodium and postssium?

A

↓ in sodium retention

↑ in potassium rention (HYPERKALEMIA)

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14
Q

__________ preserve renal function in patients with either diabetic or non diabetic nephropathy when treating HTN

A

ACE inhibitors; angiotensin constricts the efferent arterioles so ACE inhibitors will vasodilate it and thus improving blood flow

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15
Q

Drugs that effect the renin pathway to treat HTN has show to be more effective in white/black patients

A

White

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16
Q

Someone taking a ACE inhibitor will have a slight ________ in GFR

A

↓ (vasodilation of efferent arteriole)

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17
Q

Clinical uses of ACE inhibitors:

A
  • HTN
  • preserve renal function in patients with diabetic or non diabetic nephropathy
  • treatment in chronic heart failure
  • standard fo care in patients following MI
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18
Q

What is a potential life threatening adverse effect of ACE inhibiti9ors?

A

Angioedema

19
Q

ACE inhibitors should be given to patients with unilateral/bilateral/both renal artery stenosis.

A

UNILATERAL

Giving ACE inhibitors to someone with BILATERAL renal artery stenosis is CONTRAINDICATED

20
Q

Contraindications of ACE inhibitors

A
  • pregnancy
  • patients wit BILATERAL renal artery stenosis → the efferent arteriole constriction is what maintains the GFR but giving ACE inhibitor will take this away and there is no other functional kidney to compensate
  • patients with history of angioedema related to previous treatment with an ACE inhibitor and in patients with hereditary or idiopathic angioedema
21
Q

Losartan and Vallartan and what type of drugs?

A

Angiotensin receptor blockers

22
Q

MOA of angiotensin receptor blocker drugs:

A
  • drugs: losartan and valsartan
  • blocks angiotensin 2 type 1 receptors
  • ↓ BP by: arteriolar and venous dilation
  • blocks aldosterone secretion
  • ↓ diabetic nephrotoxicity

NO INCREASE IN BRADYKININ LEVELS

23
Q

With ARB’s we will see an ↑ in _______ which we dont see with ACE inhibitors

A

Angiotensin II; both will have ↑ renin and angiotensin I

24
Q

What is the risk of angioedema in angiotensin receptor blockers?

A

Significantly lower compared to the risk seen with ACE inhibitors

25
Q

_______ is a angiotensin receptor blocker that can be used to treat gout because ________

A

Losartan; it blocks URAT1 which then reduces plasma uric acid levels

26
Q

What drug is a renin inhibitor and what conversion does it inhibit?

A

Aliskiren;

Angiotensinogen → angiotensin I

27
Q

Patient has HTN and also has diabetes with albnumuria. What drug would you give to treat their HTN?

A

Captopril or other ACE inhibitors

28
Q

Which drugs are calcium channel blockers?

A
  • verapamil, diltiazem, nifedipine, amlodipine
29
Q

Verapamil and other similar drugs in its class are 1st line agents for ______

A

HTN particularly in black or elderly patients

30
Q

The least selective calcium channel blocker is _________ and thus has significant effects on:

A

Verapamil;

Cardiac AND vascular smooth muscle

31
Q

What is verapamil used to treat?

A

Angina, supraventricular tachyarrhythmias, HTN, migraine and cerebral vasospasm

32
Q

________ is also another non selective calcium channel blocker but has more/less effect on the heart than verapamil

A

Diltiazem; LESS

Both have same uses

33
Q

Dihydropyridines (_________ and _________) which is a sub class of calcium channel blockers, have a greater affinity for _____________ calcium channels

A

Amlodipine and nifedipine;

Greater affinity for VASCULAR calcium channels than cardiac

34
Q

The primary use of amlodipine is ________

A

HTN because it has affinity for vascular calcium channels

35
Q

_____________ reduce calcium entry into smooth muscles to cause coronary and peripheral _________ and ____ BP

A

Dihydropyridines: amlodipine and nifedipine;

Vasodilation; ↓

36
Q

You will not see reflex tachycardia in calcium channel blockers EXCEPT: ___________

A

Dihydropyridines: amlodipine and nifedipine

37
Q

Can dihydropyridines be used to treat arrythmias?

A

NO because amlodipine/nifedipine only work on the vascular calcium channels and not the cardiac ones so they have no effect on the action potentials

38
Q

High doses of short actin dihydropyridines calcium channel blockers can ↑ risk of ______

A

MI: excessive vasodilation and reflex cardiac stimulation)

39
Q

Constipation is an adverse effect of what calcium channel blocker?

A

Verapamil

40
Q

What are the AE’s of verapamil?

A
  • constipation
  • NEGATIVE inotropic effects
  • gingival hyperplasia
41
Q

non - dihydropyridine calcium channel blockers are contraindicated in:

A
  • patients taking β blockers
  • patients with 2nd or 3rd degree AV block
  • patients with severe left ventricular systolic dysfunction
42
Q

Thiazides are first line agents for ___________

A

Black or elderly patients with HTN

43
Q

_____ diuretics are given in conjunction with loop or thiazides

A

K sparing

44
Q

A patient has HTN with severe left ventricular dysnfunction, what is the first line treatment you prescribe them?

A

Aldosterone antagonist: spironolactone

PCM Exam 2 (32 decks)

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