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Pharmacology > CVS part 1 hypertension & diuretics > Flashcards

CVS part 1 hypertension & diuretics Flashcards

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1
Q

What 3 things does NA affect to control BP?

A
  1. Alpha 1 receptors on venules & arterioles - vasoconstriction
  2. Beta 1 receptors on the heart - increase CO
  3. Beta 1 receptors on kidneys - increase renin secretion, activates RAAS
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2
Q

What 2 effects does angiotensin 2 have?

A

It acts on angiotensin 1 in the arterioles - causing vasoconstriction
It causes aldosterone secretion - increased salt & H2O retention in kidneys

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3
Q

In what 5 ways can we target high BP?

A
  1. decrease blood volume
  2. decrease vasoconstriction
  3. decrease heart rate
  4. decrease sympathetic outflow
  5. decrease angiotensin effects
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4
Q

What is secondary hypertension?

A

Hypertension caused by a specific pathology in the body. Eg. Kidney failure

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5
Q

What are 4 complications of hypertension?

A
  1. Left ventricular hypertrophy
  2. CVA
  3. Ischemic heart disease
  4. Heart failure
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6
Q

what types of medications can be used to treat angina?

A
  1. Beta-blockers OR
  2. Long-acting calcium channel blocker
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7
Q

what types of medications can be used for prior myocardial infarction?

A

Beta-blocker &
ACE-inhibitor

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8
Q

What medications can be used for heart failure?

A

ACE-inhibitor &
Carvedilol OR
Spironolactone
-if significant volume overload: loop diuretic used

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9
Q

What medication is used for left-ventricular hypertrophy?

A

ACE-inhibitor

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10
Q

What medication is used for secondary stroke prevention?

A

Hydrochlorothiazide &
ACE-inhibitor

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11
Q

what type of medication is used for diabetes type 1 & 2?

A

ACE-inhibitor, usually with diuretic

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12
Q

what medication type is used for chronic kidney disease?

A

ACE-inhibitor, usually with diuretic

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13
Q

What medication is used for systolic hypertension?

A

Hydrochlorothiazide OR
Long-acting calcium channel blocker

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14
Q

What medication is used for hypertension in pregnancy?

A

Methyldopa

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15
Q

what is methyl-dopa’s MOA?

A

It’s a prodrug. Converted to methyl NA in the CNS. Stimulation of central alpha-adrenoreceptors. Increased stimulation leads to decreased sympathomimetic output (less NA released)

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16
Q

what is the half-life & dosage of methyl dopa?

A

2 hrs
Dosage: 250mg bi-daily. Max 3g/d

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17
Q

what is the clinical use of methyl dopa?

A

hypertension in pregnancy

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18
Q

what are the side effects of methyl dopa?

A

Sedation
Haemolytic anemia

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19
Q

what are interactions with methyl dopa?

A

Parkinson’s disease
Geriatrics (fall risk)
Depression

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20
Q

what is the MOA of Clonidine(off-label)? & Moxonidine?

A

Direct stimulation of alpha-adrenoreceptors

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21
Q

what is the half life & dosage of Moxonidine & Clonidine?

A

2-3h
Moxonidine dosage: 0.2-0.4mg/d
Clonidine: 25 micrograms bi-daily (opioid withdrawal/menopausal flushes)

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22
Q

what are Moxonidine & Clonidine used for?

A

Mild to moderate hypertension

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23
Q

What are side effects of Moxodine & Clonidine?

A

Dry mouth, sleep disturbances, sedation, dizziness

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24
Q

what are interactions of Moxodine & Clonidine?

A

CNS depressants (eg. alcohol)
Geriatrics, glaucoma, epilepsy
Depression

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25
What is the MOA of Doxazosin & terazosin
Alpha-1 antagonist, prevents NA from binding leading to reduced vasoconstriction
26
What is the time of onset and half-life for Doxazosin & terazosin?
Onset: 1-2h Half-life: 19-22h
27
what is the dosage for Doxazosin & terazosin?
Hypertension: 4-8mg controlled release BPH(benign prostate hyperplasia): 1-4mg/d at night
28
what is Doxazosin & terazosin used to treat?
Hypertension, BPH, phaeochromocytoma hypertension
29
What are side effects of Doxazosin & terazosin?
Hypotension (1st dose), vertigo, dizziness, palpitations, tachycardia, peripheral oedema, nervousness, somnelence
30
What are the interactions of Doxazosin & terazosin?
GIT & oesophagal obstructions Never used as monotherapy
31
what is the MOA of hydralazine?
Induces arteriolar vasodilation by preventing oxidation of NO (nitric oxide) & therefore lowering BP
32
what is the half life & dosage of Hydralazine?
2-4h 20-25mg bi-daily
33
what are the 3 uses of Hydralazine?
Hypertension, BPH, phaeochromocytoma hypertension
34
what are the side effects of hydralazine?
Hypotension (1st dose); reflex tachycardia, headache, lupus-like syndrome, fluid retention
35
what are the interactions of hydralazine? (lots that's why it's a 4th line drug)
Aortic stenosis Hypertrophic obstructive cardio myopathy Tachycardia Lupus Other anti-hypertensives
36
What is the MOA of nitroprusside?
Direct, causes vasodilation via release of NO
37
what is the clinical use of nitroprusside?
Hypertensive emergencies
38
what is the half-life & dosage of nitroprusside?
1-10min 0.3-1.5 micrograms/kg/min
39
what is the side-effect of nitroprusside?
Severe hypotension
40
what are the interactions with nitroprusside?
Tachycardia Other anti-hypertensives
41
what is Diazoxide used for?
Hypertensive emergencies Hypoglycemia
42
what is the MOA of Diazoxide?
Activates potassium channels, causing arteriolar dilation
43
Side effects of Diazoxide?
Hyperglycemia, hypotension, sodium & water retention
44
How do Dihydropyridines work?
Block calcium channels, calcium can't enter muscle cells, causing vasodilation & decreased BP
45
Amlodipine, Felodipine, Lercanidipine, Nifedipine, Nimodipine are all examples of what type of drug?
Calcium channel blockers
46
what are indications for Amlodipine?
Hypertension, angina, Raynaud's syndrome
47
what are the side effects of Amlodipine?
Peripheral oedema, dizziness, headache, flushing & hypotension
48
what is the onset time & dosage of Amlodipine?
6-12hrs (long-acting) 2.5-10mg/d (single dose)
49
what are the interactions of Amlodipine?
CYP3A4 inhibitors increase levels (eg. grapefruit) Simvasatin (not above 20mg/d) will cause oedema, fatigue, constipation. Other anti-hypertensives
50
What are indications for Felodipine?
Hypertension & angina
51
what are the side effects of Felodipine?
Headache, dizziness, flushing, peripheral oedema
52
what is the onset time & dosage of Felodipine?
Onset time: 2-5hrs 5-20mg/d (single dose)
53
what are the interactions with Felodipine?
similar to Amlodipine, avoid grape juice
54
what is the indication for Lercanidipine?
Hypertension
55
What are the side effects of Lercanidipine?
Peripheral oedema, headache, dizziness, flushing
56
what is the onset time & dosage for Lercanidipine?
1.5-3hrs 10-20mg/day (single dose)
57
what are the interactions with Lercanidipine?
Strong CYP3 metabolism - avoid grapefruit juice & strong inhibitors (ketoconazole & clarithromycin)
58
what are indications for Nifedipine?
Hypertension, angina, Raynaud's syndrome
59
what are side effects of Nifedipine?
Reflex tachycardia, oedema, flushing, gingival hyperplasia- gums become thicker
60
what is the onset time & dosage of Nifedipine?
30-60min (IR), 6hrs (ER) 30-90mg/d (ER formulation)
61
what are the interactions with Nifedipine?
Avoid immediate-release formulation for chronic hypertension CYP3A4 metabolism
62
what are the indications for Nimodipine? Nimo= Nemo = special
Subarachnoid hemorrhage (prevention of vasospasm)
63
what are the side effects for Nimodipine?
Hypotension, headache, nausea, flushing
64
what is the onset time & dosage for Nimodipine?
1 hour 60mg every 4hrs for 21 days (oral)
65
what is the interactions for nimodipine?
Avoid IV use (risk of severe hypotension) Strong CYP3A4 interactions
66
what are the effects of beta-1 receptors on the heart?
Positive ionotropic & chronotropic effects, increase automaticity
67
which 3 drugs are non-selective beta-blocking agents?
Propranolol, Sotalol, Timolol
68
which drugs are beta-1 selective?
Atenolol, Bisoprolol, Metoprolol, Nebivolol
69
which drug is a vasodilatory non-beta-1 selective?
Carvedilol
70

Pharmacology (6 decks)

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