What is the 1st line of tx for HTN? - MOA - Characteristics - Common drug (1)

Diuretics lower BP by increasing urine output. - Furosemide (Lasix) s/e: - Ototoxic (hearing/vision loss) - Nocturia - Dehydration - High drug-drug interactions Monitor electrolyte levels (hyperglycemia, hypo/hyperkalemia, hyponatremia)

CCB: vascular selective s/e: - Dizziness, flushing, hypotension - Reflex tachycardia - Peripheral edema - Dysrhythmias - Exacerbation of HF

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What drugs are used in HTN emergencies and ICU settings?

What are important s/e?

Direct Acting Vasodilators: Hydralazine; Nipride (Nitroprusside; ET for pulmonary vasodilation)

S/e: REFLEX TACHYCARDIA, syncope, hypotension, headache

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What is the 1st line of tx for HTN?

MOA
Characteristics
Common drug (1)

Diuretics lower BP by increasing urine output.
- Furosemide (Lasix)

s/e:

Ototoxic (hearing/vision loss)
Nocturia
Dehydration
High drug-drug interactions

*Monitor electrolyte levels (hyperglycemia, hypo/hyperkalemia, hyponatremia)

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Hydrocholorothiazide (HCTZ)

Thiazide: blocks reabsorption of Na, Cl, K @Distal convoluted tubule
- Caffeine + ETOH enhances its hypotensive effects

s/e:

Hyponatremia
Hypokalemia
Hyperglycemia (insulin resistance)

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Cholorothiazide (Diuril)

Thiazide: blocks reabsorption of Na, Cl, K @Distal convoluted tubule

Caffeine + ETOH enhances its hypotensive effects

s/e:

Hyponatremia
Hypokalemia
Hyperglycemia (insulin resistance)

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Metolazone (Zaroxolyn)

Thiazide: blocks reabsorption of Na, Cl, K @Distal convoluted tubule
- Caffeine + ETOH enhances its hypotensive effects

s/e:

Hyponatremia
Hypokalemia
Hyperglycemia (insulin resistance)

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Spironolactone (Aldactone)

- t1/2?

K-sparing: blocks renal aldosterone receptors @Distal tubule
- Long t1/2: 1-2 days

s/e: hyperkalemia

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What circumstances are Mannitol (Osmitrol) / Isosorbide typically used in?

What class of drugs are they? What is their MOA?

Osmotic diuretics
Tx for cerebral edema + intraocular HTN

Pulls water into renal circulation
Inhibits Renin release

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What drug class does Labetalol belong to? What is it used to treat?

Adrenergic antagonist (antihypertensive)
Tx: Pre-eclampsia

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What is the recommended therapeutic dose for Ginseng?

20-30 mg/day

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Losartan (Cozaar)

ARB

s/e: hypotension

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Hyazaar HCT

Cosart-H

Thiazide + ARB combo

Tx: HTN and HF

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Aldactazide - what drug combo is it? Why is it a good option for HTN tx?

K+ sparing and Thiazide combo

Balances out K+
Excellent maintenance HTN therapy

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Ibesartan (Avapro)

ARB

s/e: hypotension

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What are first line medications for HF? What are the s/es?

ACE inhibitors
s/e: severe hypotension

Enalapril (Vasotec)
Captopril
Monopril
Ramipril (Altace)

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Nifedipine (Adalat)

CCB: vascular selective

s/e:

Dizziness, flushing, hypotension
Reflex tachycardia
Peripheral edema
Dysrhythmias
Exacerbation of HF

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Amlodipine (Norvasc)

CCB: vascular selective

s/e:

Dizziness, flushing, hypotension
Reflex tachycardia
Peripheral edema
Dysrhythmias
Exacerbation of HF

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Verapamil (Isoptin)

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CCB: cardio selective

s/e:

Dizziness, flushing, hypotension
Reflex tachycardia
Peripheral edema
Dysrhythmias
Exacerbation of HF

Diltiazem (Cardizem)

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CCB: cardio selective

s/e:

Dizziness, flushing, hypotension
Reflex tachycardia
Peripheral edema
Dysrhythmias
Exacerbation of HF

Prazosin and Phentolamine

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Alpha receptor blockers (adrenergic antagonist)

= peripheral vasodilation

What is the normal fx of Alpha-1 adrenergic receptors?

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PERIPHERAL VASOCONSTRICTION

Dilate pupils
Increase closure of internal urinary sphincter
Stimulate secretions (salivary glands)

What is the normal fx of Alpha-2 adrenergic receptors?

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PERIPHERAL VASOCONSTRICTION

Decrease GI motility
Decrease smooth m. motility
Contract male genitalia during ejaculation

What drug class do Atenolol*; Propranolol**; Metoprolol belong to?

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Beta blockers (stimulate heart)

Atenolol - vasodilation
*Propranolol - antiarrhythmic

What is the normal fx of beta-1 receptors?

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Cardiac muscle

Increase myocardial activity
Increase HR
Increase renin release

What is the normal fx of beta-2 receptors?

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Smooth muscle in BVs, bronchi

Vasodilation/Bronchodilation
Increase glycogenolysis in muscle + liver = Incease glucagon release from alpha cells (pancreas)

Lopressor HCT

Diuretic + Adrenergic antagonist

Clonidine; Methyldopa** Tx?

Centrally-acting Alpha-2 Adrenergic Agonist * NOT 1st line of HTN therapy * *Methyldopa = prodrug Tx: RESISTANT HTN s/e: - Hypotension - Headache

What effects do anti-arrhythmic medications often induce?

1. Slow conductivity b/w nodes + fibres | 2. Synchronized cardial aversion (letting the heart restart by stopping all activity momentarily)

What is atrial fibrillation? What are the clinical presentations? (3) What is the tx protocol?

Blood stasis so heart can't complete systole Presentations: - Irregular HR - Clot formation/Coagulation - Altered Q Tx protocol: 1. Assess cardiac fx 2. Meds: epinephrine > CCB (CS) > Beta blockers

MOA of Centrally-acting Alpha-2 Adrenergic Agonists? Tx for _____?

Directly stimulates CNS Alpha-2 receptors in vasomotor centre. Decreases presynaptic Ca levels > Inhibits release of NE > Net decrease in sympathetic tone in BV Tx: RESISTANT HTN

List the classes of drugs used to treat hypertension.

- Direct acting vasodilators - Duretics - Renin-Angiotensin: ACE inhibitors, ARBs - CCB - Adrenergic antagonists - CA A2 Adrenergic agonists

What are centrally-acting Alpha2 Adrenergic Agonists used to treat? What is the MOA?

Resistant HTN | MOA: stimulates CNS alpha2 receptors in vasomotor centre directly

What is dilated cardiomyopathy? | What is its treatment?

It is when the ventricle stretches and thins out, impairing the heart's contractility. Treatment - If low CO = Acute HF tx - If long term = heart transplant

What are the mechanisms of anti-arrhythmics? (3)

1. slow SA-AV node conduction - Digoxin 2. Depress ectopy (abnormal heartbeats) @ ventricular level 3. Enhance normal AV conduction - Lidocaine (Na channel) - Amiodarone (K channel)

What is SVT and what are the treatments for it?

Type of arrhythmia where a group of abnormally rapid heartbeats start in the atrias d/t issues with electrical system Treatment: 1. Cardioversion (vagal manuvers) 2. Adenosine (inhibits cerebral synapse at receptors; sedative) 3. Anti-arrhythmics

Which class of drugs do the following belong to? - Lidocaine - Amiodarone - Adenosine

Anti-arrhythmics - Lidocaine (Na channel) - Amiodarone (K channel) Sedative - Adenosine (used for SVT tx)

Abdominal Aortic Aneurysm

A bulge formed in a distended aorta d/t weak vessel wall. Sx: - Often asymptomatic - Bruits* - Back + abdomen pain (esp if ruptured = hypovolemic shock)

Aortic Dissection

A tear in the aorta intima, creating a false lumen that blood pools into If ruptures = cardiac tamponade Type A (heart and above) - progresses quickest - Significant change in SBP in arms Type B (below heart) Tx: lower HR first, then lower BP (or else reflexive tachycardia)

Cardiac tamponade - Signs (4)

Blood pools in pericardium sac Sx: 1. Narrow PP 2. Muffled heart sounds 3. Hypotension 4. JVP distention

Pulsus paradoxus

When SBP decreases with inspiration caused by cardiac tamponade ABNORMAL = >10mmHg difference in pressure

How to measure orthostatic hypotension?

Wait 2-5 min b/w each position. Tell HCP if SBP difference is >20mmHg DBP difference is >10mmHg

Cardiology Flashcards

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