Pharm 2 module 2 > Antihypertensives part 2 > Flashcards

Antihypertensives part 2 Flashcards

(105 cards)

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1
Q

What are the different groups of sympathetic antagonist agents

A

Alpha
Beta
*mix of the two
Adrenergic blocking drugs

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2
Q

What are the sites of action for sympathoplegic drugs

A

Peripherally
Centrally
Ganglionic

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3
Q

What drugs block sympathetic system at the peripheral level

A

Prazosin
Doxazosin
Metoprolol
Pindolol

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4
Q

What drugs block the sympathetic system centrally

A

Clonidine

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5
Q

What drugs block the sympathetic system ganglionically

A

Trimethaphan

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6
Q

What is the indication for clonidine

A

Menopausal flushing
opioid/alcohol withdrawal
tourettes
2nd line for ADHD

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7
Q

What is the MOA for clonidine

A

Blocks release of norepinephrine and inhibits sympathetic outflow from the brain

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8
Q

What are the pharmacokinetics of clonidine

A

Oral
don’t take with food
crosses placenta
narrow TI
dose adjust for renal patients

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9
Q

What are some side effects / contraindications of clonidine

A

dysrhythmias
bradycardia
AV block
anorexia
confusion / delirium

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10
Q

Where are alpha 1 receptors found

A

smooth muscle

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11
Q

Where are alpha 2 receptors found

A

Brain stem AND smooth muscle

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12
Q

What are non-selective alpha blocker drugs

A

Phenoxybenzamine
Phentolamine

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13
Q

What is the indication of phenoxybenzamine

A

Sweating and HTN associated with pheochromocytoma

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14
Q

What is the MOA of phenoxybenzamine

A

Irreversible, non-selective blockade of peripheral alpha 1&2 receptors
-decrease vasoconstriction

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15
Q

What are the pharmacokinetics of phenoxybenzamine

A

Oral / IV
Long lasting effects

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16
Q

What are the side effects / adverse reactions of phenoxybenzamine

A

Reflex tachycardia
Orthostatic hypotension
nasal stuffiness / N/V
Inhibit ejaculation

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17
Q

What is the indication of phentolamine

A

Dx / Tx of pheochromacytoma
particular associated with HTN emergencies

Tx of dermal necrosis following extravasation of norepinephrine

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18
Q

What is the MOA of phentolamine

A

Reversible, non-selective blockade of peripheral alpha 1&2 receptors

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19
Q

What are the pharmacokinetics of phentolamine

A

IM or IV
effects last 4 hours

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20
Q

What are the side effects of phentolamine

A

Reflex tachy
orthostatic hypotension

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21
Q

What are the alpha-1 selective blockers

A

Prazosin
doxazosin

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22
Q

What are prazosin & Doxazosin used for

A

-HTN
-Benign prostatic hyperplasia d/t prostate muscle relaxation
-PTSD associated nightmares

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23
Q

What are the MOA of selective alpha-1 blockers

A

Selective a1 inhibition = decrease vasoconstriction

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24
Q

What are the side effects of prazosin and doxazosin

A

Dizziness
lack of energy
nasal congestion
HA
Drowsiness
orthostatic hypotension

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25
What selective alpha 1 blocker is longest acting `
Doxazosin
26
What drugs are nonselective beta antagonists
Propranolol nadolol pindolol timolol
27
What is the indication for propranolol
performance anxiety postural tremor migraine prophylaxis thyrotoxicosis portal HTN
28
What is the MOA of propranolol
Nonselective B1 & B2 inhibition
29
What is the pharmacokinetics of propranolol
oral admin 1x/day extensively metabolized and excreted in urine
30
What are the adverse effects / side effects of propranolol and nadolol
Bronchoconstriction dizziness lethargy visual disturbance short term memory loss vivd dreams
31
What is the indication of Nadolol
HTN Management of chronic angina more potent that propranolol (rarely used)
32
What is the MIA of nadolol
Non-selective Beta 1&2 inhibition
33
What are the pharmacokinetics of nadolol
Oral admin 1/2t of 14-24 hours
34
What is the indication of pindolol
HTN
35
What is the MOA of pindolol
PARTIAL beta 1&2 agonist *at high doses, posses similar effects of epi
36
What are the adverse effects / contraindications of pindolol
Bronchoconstriction Dizziness Hallucinations Short term memory loss vivid dreams *Avoid in patients with previous MI / angina
37
What is the indication for timolol
Chronic glaucoma management (open angle)
38
What is the MOA of timolol
Non-selective beta 1&2 inhibition reduces production of aqueous humor in the eye
39
What is the pharmacokinetics of timolol
Topical oral can be used for HTN (rare)
40
What are the selective beta 1 sympathetic antagonists
Metoprolol atenolol nebivolol
41
What is the indication for metoprolol
HTN Stable / unstable angina acute MI SVT / Vtach Tachycardia Chronic stable HF Migraine prophylaxis
42
What is the pharmacokinetics of metoprolol
Oral Extensively metabolized 1/2t = 3-4 hours
43
What are the side effects / contraindications of metoprolol
Bradycardia decrease CO AV heart block **NOT approved for acute HF
44
What is the indication of atenolol
Same as metoprolol just less effective
45
What is the pharmacokinetics of atenolol
Excreted primarily in urine 1/2t = 6hours
46
What are the side effects of atenolol
Bradycardia reduced CO AV heart block
47
What is the indication for nebivolol
HTN HF
48
Which selective beta 1 blocker is MOST cardio selective
Nebivolol
49
What is the side effects of nebivolol
Bradycardia Reduced CO AV heart block
50
what does nebivolol stimulate
beta 3 receptors in peripheral vasculature = vasodilation from being nitric oxide potentiating
51
Which drugs are both alpha and beta blockers
Carvedilol Labetolol
52
What is the indication for carvedilol
Primarily in chronic stable HF -decreases mortality rates in patients after MI
53
What is the MOA of carvedilol and labetolol
Nonselectively blocked alpha 1, beta 1, beta 2 peripheral vasodilation
54
What is the pharmacokinetics of carvedilol
Oral 1x/day
55
What is the pharmacokinetics of labetolol
Oral / IV SAFE IN PREGNANCY (often used in preeclampsia) can be taken up to 3x daily
56
What are the side effects of labetolol and cavedilol
Orthostatic hypotension dizziness hypoglycemia
57
Which drugs are cardio-selective calcium channel blockers? (non-dihydropyridines)
Verapamil Diltiazem
58
What is the indication of use for verapamil and diltiazem
stable / vasospastic angina essential HTN dysrhythmias
59
What is the MOA for non-dihydropyridine ca2+ channel blockers
-Selectively blocks Ca2+ channels in the myocardium = decr arterial pressure, incr coronary perfusion, decr heart rate, decr AV nodal conduction, decr force of contraction
60
What are the pharmacokinetics of verapamil
Oral or IV hepatic metabolism dose adjust for renal impairment
61
What is the pharmacokinetics of diltiazem
oral 50% bioavailability effects begin quickly and peak in 30min
62
What are the side effects / contraindications of verapamil and diltiazem
Constipation bradycardia AV block HF hypotension LE edema Contra in patients with heart block and heart failure
63
Which drugs are dihydropyridines
Nifedipine amlodipine
64
What is the indication for nifedipine
HTN stable / vasospastic angina migraine reynauds
65
What is the indication of amlodipine
HTN Stable and vasospastic angina **VERY COMMON
66
What is the MOA of nifedipine and amlodipine
Blocks Ca2+ channels in arterioles (vasodilation) -Does not alter conduction through AV node
67
What are the side effects of nifedipine
-Flushing, dizziness, headache, LE edema, gingival hyperplasia, reflex tachycardia -Avoid in pts w HF, grapefruit juice
68
What is the side effects of amlodipine
Lightheadedness, hypotension, bradycardia, LE edema -Avoid in pts w HF, grapefruit juice
69
What drugs are venous vasodilators
Isosorbide dinitrate Nitroglycerine
70
what is the indication for nitroglycerine
All types of angina severe HTN
71
What is the MOA for venous vasodilators
Converted to nitric oxide in the body -> vasodilation -> decr cardiac O2 demand
72
What is the indication for isosorbide dinitrate
angina prophylaxis esophageal spasm HF tx in black people in combo with hydralazine
73
What is the pharmacokinetics of nitroglycerine
Sublingual IV, path, or ointment also available -pro-drug
74
What is the pharmacokinetics of isosorbide dinitrate
Sublingual / oral taken daily
75
What are the side effects / contraindications of nitroglycerine and Isosorbide dinitrate
HA Hypotension tachycardia *tolerance can rapidly develop * drug interactions with PDE-5i
76
What are arterial vasodilator drugs
Hydralazine Diazoxide minoxidil
77
What is the indication of hydralazine
Essential HTN Almost always given w/ beta blocker -used to decrease after load in pts. w/ HF
78
What is the MOA of hydralazine
-Exact MOA unknown -Selective dilation of arterioles -> decr peripheral resistance and decr BP
79
What is the pharmacokinetics of hydralazine
oral / IV Inactivated by acetylation *dose adjust in acetylators
80
What is the side effects / contraindications of hydralazine
Postural hypotension HA N reflex tachy SLE syndrome
81
What is the indication of minoxidil
Patient with severe HTN who are unresponsive to safer drugs *stimulant for hair growth
82
What is the MOA for minoxidil
Opens K+ channels in vascular smooth muscle -> K+ flows out, decr cells ability to contract -> arteriolar dilation -> decr periph resistance and decr BP
83
What is minoxidil metabolized into
minoxidil sulfate
84
What are the side effects of minoxidil
Reflex tachycardia Na+ / H2O retention excessive hair growth
85
What is the indication of Diazoxide
Acute / malignant HTN Hypoglycemia (prevents insulin release from pancreas)
86
What is the MOA of Diazoxide
Long acting K+ channel opener = Na+ and water retention
87
What is the side effects of diazoxide
Excessive hypotension -some cases resulted in stroke and MI
88
What drugs are vasodilators for both arteries and veins
Nitroprusside
89
What is the indication for sodium Nitroprusside
HTN emergencies
90
What is the MOA for Nitroprusside
Breaks down and releases nitric oxide, activates guanylate cyclase = catalyze the production of cyclic GMP = relaxation in smooth muscles in arterioles and veins to decrease BP
91
What is the pharmacokinetics of nitroprusside
Continuous IV infusion *Effects begin w/in seconds
92
What are the side effects of nitroprusside
Cyanide poisoning thiocyanate toxicity
93
What agents are centrally acting (alpha 2 blockers)
Clonidine Methyldopa
94
what is the indication of clonidine
Menopausal flushing opioid / alcohol withdrawal / Tourettes *second line agent for ADHD
95
What is the indication for methyldopa
Mostly for HTN during pregnancy
96
What is the MOA of clonidine and methyldopa
Agonist at centrally located a2 receptors = inhibits further release of norepi and inhibits sympathetic outflow from the brain
97
What are the side effects of clonidine
Rebound hypertension lethargy sedation xerostoma constipation
98
What are the side effects of mehtyldopa
Sedation occasional lactation *Long term can lead to autoimmune hemolytic anemia
99
Which patients should be started on combination therapy immediately for hypertension
BP is greater than 20mmHg above systolic goal OR 10mmHg above diastolic goal
100
What drug classes are best for treating high risk angina pectoris
Beta blockers (1st choice)` calcium channel blockers
101
What drug classes are best for treating hypertension in diabetics
Diuretics ACE inhibitors ARBs
102
Which drugs should be used for treating HTN in someone who had a stroke
ACE inhibitors
103
Which drugs should be used for treating HTN in HF
Diuretics Beta blockers ACE-i ARBs Aldosterone receptor antagonists
104
Which drugs should be used to treat HTN in someone with a history of MI
Beta clockers ACE-i Aldosterone receptor antagonists
105
If someone has CKD, how would you treat NTN
ACE-i ARBs

Pharm 2 module 2 (4 decks)

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