Car 16 - Antihypertensives Flashcards
(51 cards)
What are the clinical uses of ACE inhibitors?
HTN. CHF. Post MI. Diabetic renal disease (reduce the progression of proteinuria and diabetic nephropathy).
What are the side effects of ACE inhibitors?
Cough (elevated levels of bradykinin). Angioedema (swelling of lips to the larynx). ^ serum K+. \/ GFR slightly, ^ creatinine (up to 20%). Teratogenic.
What are the side effects of ARBs?
Teratogenic. Hyperkalemia. Renal insuff. DONT CAUSE COUGH. But can cause Angioedema.
What does Aliskiren do?
A renin inhibitor. Only indicated for HTN. Can cause hyperkalemia and renal insuff. Still teratogenic.
What does Hyrdalazine do?
It increases cGMP, activating myosin phosphatase, removing the phosphate from myosin-PO4, causing smooth muscle relaxation. Dilates arterials more than veins.
What are the clinical uses of hydralazine?
HTN in pregnancy. Urgent and emergency HTN.
What four drugs can be safely used during pregnancy for HTN?
[Hypertensive Moms Love Nifedipine] Hydralazine. Methyldopa. Labetalol. Nifedipine.
What are the side effects of hydralazine?
Reflex tachycardia (give beta blocker at same time). Fluid retention. Nausea. Headache. Drug-induced lupus (with antihistone Ab).
What is the MOA of Minoxidil?
Opens K+ channels and hyperpolarizes smooth muscle, resulting in relaxation of vascular smooth muscle (Ca2+ cannot get in).
What are the toxicities associated w/ Minoxidil?
Hypetrichosis. Hypotension. Reflex tachycardia. Fluid retention/edema.
What is the difference in MOA b/w Dihydropyridine CCB vs non-dihydropyridine CCB?
Non-dihydropyridine CCB: Block Ca-channels at pacemaker cells. Dihydropyridine CCB: act on vascular smooth muscle to cause vasodilation.
What are the clinical uses of dihydropyridine CCB?
Hypertension, angina, vasospasm (Prinzmetal’s angina, Raynaud phenomenon), Esophageal spasm, migraine prophylaxis.
What are the clinical uses of non-dihydropyridine CCB?
Hypertension, angina, arrhythmias.
What are five dihydropyridine CCB?
Nifedipine. Amlodipine. Felodipine. Nicardipine. Nisoldipine.
What are two Non-dihydropyridine CCB?
Verapamil. Diltiazem.
What are the side effects associated w/ Dihydropyridine CCB?
Peripheral edema, flushing, dizziness, constipation, reflex tachycardia.
What are the side effects associated w/ non-Dihydropyridine CCB?
Cardiac depression, AV-block, flushing, dizziness, constipation.
What does Hydralazine reduce?
They dilate capillaries more than veins, therefore reduce Afterload.
What doe Nitroglycerin and Isosorbide dinitrate reduce?
They dilate veins more than arteries, therefore reduce Preload.
What do ARBs and ACE inhibitors decrease?
Both preload and afterload.
What are the two clinical uses of nitroglycerin and Isosorbide dinitrate?
Angina. Acute pulmonary edema.
What drug is recommend for patients w/ essential HTN and nothing else?
Thiazide-type diuretics.
What drugs are recommended for patients w/ HTN plus CHF? What do we need to avoid?
Give: Thiazide but if they have edema, use a loop diuretic. Combine w/ ACE inhibitors/ARB, Beta-blockers, or aldo antagonists. Avoid Beta-blocker in acute decompensated CHF or cardiogenic shock and CCB (because of fluid retention and Edema And may have negative inotrophic effects).
What drugs are recommended for patients w/ HTN plus diabetes? What do we need to avoid?
Give: ACE inhibitor/ARB first line (b/c they slow down the progression of proteinuria and diabetic nephropathy). Can combine w/ thiazide. Avoid beta-blockers or use w/ caution (b/c they can raise glycemia a bit, masking adrenergic symptoms of hypoglycemia).
