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Pharm II Unit II > Antihypertensives > Flashcards

Antihypertensives Flashcards

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1
Q

10-15% of hypertension is caused by…

A

A specific cause

Examples:
Renal artery constriction
Coarctation of the aorta
Pheochromocytoma 
Cushings
Primary aldosteronism
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2
Q

What’s the difference between Stage 1 and Stage 2 HTN?

A

Stage 1 (130-139/80-89) only needs 1 med

Stage 2 (≥140/90) requires two meds

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3
Q

Blood pressure is directly proportional to …

A

CO and vascular resistance

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4
Q

What is the key to treatment of HTN?

A

Lifestyle modifications before or combined with drug therapy

Examples:
Increased physical activity/exercise
Weight reduction
Moderation of dietary salt, fats, EtOH
Avoid/reduce smoking
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5
Q

What is the most common cause of HTN treatment failure?

A

Non-compliance

The drugs have a lot of side effects so people don’t like to take them

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6
Q

HTN drug treatment OR lifestyle mods can reduce BP by…

A

~15 mmHg

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7
Q

Why do we use drug combos for HTN rather than maxing out the dose of a single drug?

A

Can reduce side effects produced by single drugs

Reduce doses by using different mechanisms to reduce BP

Cause synergism between drugs

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8
Q

Main goals of HTN treatment are…

A

Reduce BP and keep it normal
Reduce CV risk
Produce minimal side effects without reducing quality of life

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9
Q

What are the four groups of HTN agents?

A

Diuretics
Sympathoplegic agents
Direct vasodilators
Angiotensin inhibitors

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10
Q

________ diuretics are used to treat mild to moderate hypertension, reducing BP in 40-60% of patients

A

Thiazide diuretics

Lower BP by 10-15 mmHg

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11
Q

How do thiazides lower BP?

A

Short term by reducing CO

Long term by reducing peripheral vascular resistance

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12
Q

Thiazide diuretic that is also a direct vasodilator

A

Indapamide (has the most pronounced effect)

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13
Q

Common side effects of diuretics

A 
Impotence
Gout
Increased renin (baroreflex)
Hypokalemia
***Reduced glucose tolerance
***Increased plasma lipid concentration

Most can be avoided by lowering doses

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14
Q

HTN doses of diuretics are _______ than those used for diuresis

A

Much lower

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15
Q

Thiazide diuretics are most effective at lowering BP in …

A

African Americans

Elderly

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16
Q

When are Loop Diuretics used for HTN management?

A

In severe cases (renal insufficiency, HF)

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17
Q

Sympatholytics reduce BP by…

A

Reducing sympathetic vasomotor tone —> reducing peripheral resistance

Activate baroreflexes and generally cause Na and H2O retention but DO NOT cause reflex tachycardia

Best when combined with a diuretic

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18
Q

Examples of central acting sympatholytics

A

Clonidine

Methyldopa

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19
Q

MOA for central acting sympatholytics

A

Stimulate medullary a2 adrenergic receptors —> reduced peripheral sympathetic nerve activity —> reduced renin and reduced BP

Clonidine will reduce HR and CO more than methyldopa

Both given orally, but clonidine can also be used as a patch

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20
Q

Which central acting sympatholytics can safely be used to treat HTN in pregnancy?

A

Methyldopa

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21
Q

Adverse effects of Central Acting Sympatholytics?

A

SEDATION and other CNS effects

XEROSTOMIA

ED

Methyldopa —> hemolytic anemia with a (+) Coombs test, hepatotoxicity, GYNECOMASTIA/lactation

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22
Q

Why don’t you want to suddenly withdraw clonidine?

A

Can induce hypertensive crisis

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23
Q

What drugs can inhibit clonidine’s therapeutic action?

A

Tricyclic antidepressants

Yohimbine (b/c it’s an a2 antagonist)

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24
Q

What drugs are a1 adrenergic antagonists?

A

The “-zosins”

PRAZOSIN, Terazosin, Doxazosin

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25
MOA for the zosins
Specifically block a1-adrenergic receptors —> reducing NE vasoconstriction —> vasodilation Reduces peripheral resistance —> lower BP
26
What are the main benefits of using a1 adrenergic antagonists to lower BP?
Do not adversely effect plasma lipids Beneficial in BPH****
27
What is the “first dose phenomenon”?
Postural hypotension pronounced with the first dose of an a1 antagonist (zosin)
28
Besides first dose phenomenon, what are some other adverse effects of a1 antagonists?
Na and H2O retention (increased renin) - so maybe combine with a diuretic) Reflex tachycardia
29
***What is the only beta blocker that is a vasodilator?
Nebivolol (b/c it increases NO release)
30
What are the non-selective beta blockers?
Propranolol Nadolol Timolol
31
Which are the selective B1 blockers?
Metoprolol Atenolol Nebivolol Acebutolol
32
MOA for beta blockers in HTN
Reduce BP by blocking beta adrenergic receptors: • In heart to reduce CO • In kidneys to reduce renin • In CNS to reduce sympathetic vasomotor tone ***Not direct vasodilators (except Nebivolol)
33
Beta blockers work best in what population?
Young white males
34
Beta blockers are combined with other drugs to..
Counteract reflex tachycardia and increase renin secretion No longer recommended for monotherapy
35
Beta blockers are the preferred drug for patients with...
Angina Post MI Migraine Nebivolol —> those with ED
36
Beta blockers are the least preferred drug for patients with...
``` High physical activity African heritage ***Asthma*** DM Hypercholesterolemia Peripheral vascular disease ```
37
Contraindications for beta blockers
``` DM End-stage HF Severe bradycardia Heart block Asthma ```
38
Which drugs are combined a1 and beta blockers?
Carvedilol - good for patients with both HTN and HF, especially after MI Labetalol - used for hypertensive emergencies and in pregnancy (stronger than methyldopa, but some hepatotoxicity so not used long term)
39
Adverse effects of combined a1/B blockers (Carvedilol/Labetalol)
Orthostatic hypotension (worse than beta blockers) Bronchospasm Hepatotoxicity (that’s why Labetalol is for emergency use only)
40
All vasodilators relax arterial smooth muscle but sodium nitroprusside preferentially relaxes...
Veins
41
Why do the effects of vasodilators diminish with time?
Reflex tachycardia and increased renin secretion
42
Hypotension from any vasodilator may be accompanied by:
Reflex tachycardia and increased myocardial contraction Increased renin secretion Fluid retention Headaches, flushing Palpitations, dizziness
43
Which vasodilator is one of the HIP drugs —> SLE?
Hydralazine
44
Hydralazine dilates ______ but not ______
Arterioles Used in chronic therapy of severe hypertension or hypertensive emergencies in pregnancy
45
What is the MOA for sodium nitroprusside (Nitropress)
Rapidly lowers BP in minutes by venodilation Effect disappears in minutes after d/c Used for emergency hypertensive situations - IV infusion only
46
Adverse effects of sodium nitroprusside
Cyanide accumulation (b/c metabolized in liver to thiocyanate before excreted by kidneys) Metabolic acidosis, arrhythmias, excessive hypotension, death (esp in patients with severe liver disease)
47
Topical minoxidil stimulates hair growth but orally it reduces BP by...
Opening the potassium channels and stabilizing membrane Used for severe hypertension that is refractory to other drugs Can cause tachycardia, palpitations, angina, etc but also HYPERTRICHOSIS
48
What is the MOA for Fenoldopam?
Specific D1 agonist Postsynaptic D1 receptor stimulation relaxes arteriolar smooth muscle Used for emergency hypertensive situations IV administration with short half-life
49
Which drugs are dihyropyridine calcium channel blockers?
NIFEDIPINE Nimodipine (Amlodipine - has a longer half life)
50
Which drugs are non-dihydropyridine CCBs?
Diltiazem | Verapamil
51
What is the MOA for CCBs?
Orally active, bind to L-type channels in the myocardium to reduce cardiac contractility, automaticity, and conduction Bind to calcium channels in vascular smooth muscles —> vasodilation (Vascular smooth muscle most sensitive but affects ALL smooth muscles)
52
Which CCB is best for relaxing vascular smooth muscle?
Nifedipine >> Diltiazem >> Verapamil
53
Which CCB works most specifically on cardiac muscle?
Verapamil >> Diltiazem >> Nifedipine
54
Major cardiac effects of CCBs
Negative inotropy (contractility) Negative chronotropy (SA node impulse generation) Negative dromotropy (av node conduction)
55
Nifedipine will _____ HR while Verapamil with _____ HR
Nifedipine increases | Verapamil decreases
56
Which CCB is used for reducing HTN during pregnancy?
Nifedipine
57
Which CCB is most likely to produce reflex tachycardia?
Nifedipine (highest vasodilation) Verapamil and diltiazem are weaker vasodilators so they are less likely to elicit reflex tachycardia
58
Which CCBs are more likely to depress SA and AV node function?
Verapamil and Diltiazem
59
Which antihypertensive is known to cause gingival hyperplasia?
The “-dipines” - Dihyropyridine CCBs
60
________ is the most common side effect of verapamil
Constipation
61
Contraindications for CCBs
Verapamil and diltiazem contraindicated in patients with SA or AV node abnormalities, beta blockers, and in HF Dihydropyridines should be used cautiously in hypertensive patients with HF
62
Why are ACE’s so awesome?
Lower BP without compromising heart, brain, or kidneys Mild and fewer side effects, no lipid changes Do not cause reflex sympathetic activation or tachycardia b/c of baroreceptor resetting Effective orally and can be used for monotherapy
63
ACE inhibitors are most effective in what population?
Young and middle-aged caucasians
64
ACEIs are the definitive DOC for HTN in patients with...
DM (esp for preventing DM nephropathy) CKD HFrEF
65
Adverse effects of ACEIs
Orthostatic hypotension and dizziness Dry, hacking, non-productive COUGH Angioneurotic edema May cause hyperkalemia Acute renal failure in patients with BL renal artery stenosis
66
When are ACE/ARBs absolutely contraindicated?
Pregnancy (teratogenic)
67
ARBs are similar to ACEs except
Don’t have the cough/angioedema (b/c no effect on bradykinin)
68
What HTN drug should you pick: Age over 65
Diuretic ACE/ARB CCB NO Central acting agonists
69
What HTN drug should you pick: African heritage
Diuretic CCB NO BBs
70
What HTN drug should you pick: Pregnant
Methyldopa Nifedipine Labetalol (emergency IV only) NO ACE/ARBs
71
What HTN drug should you pick: Angina pectorals
BB CCB No: Hydralazine, minoxidil
72
What HTN drug should you pick: Post MI/Clinical CAD
ACE/ARB | BB
73
What HTN drug should you pick: HF
ACE/ARB + BB + diuretic + aldosterone antagonist No CCB
74
What HTN drug should you pick: Recurrent stroke prevention
Diuretic | ACE/ARB
75
What HTN drug should you pick: CKD
ACE/ARB
76
What HTN drug should you pick: DM
ACE/ARB CCB NO Diuretic or BB
77
What HTN drug should you pick: Asthma
CCB ACEI NO BB
78
What HTN drug should you pick: BPH
Alpha blocker
79
What HTN drug should you pick: Migraines
BB | CCB
80
What HTN drug should you pick: Osteoporosis
Diuretic

Pharm II Unit II (8 decks)

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