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Pharmacology > Drugs Used in HPN > Flashcards

Drugs Used in HPN Flashcards

1
Q

Toxicities of Thiazides

A 
HYPER GLUC
Glycemia
Lipidemia
Uricemia
Calcemia

hypokalemic metabolic alkalosis

hypercalcemia
hypercalciuria

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2
Q

Toxicities of Loop Diuretics

A

OH DANG

Ototoxicity
Hypokalemia
Dehydration
Allergy to Sulfa
Nephritis
Gout

hypocalcemia
hypercalciuria

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3
Q

Drugs that can cause GINGIVAL HYPERPLASIA

A

Nifedipine
Cyclosporine
Phenytoin
Verapamil

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4
Q

Drugs used to CONTROL BP in PHEOCHROMOCYTOMA

A

Phenoxybenzamine
Phentolamine
Labetalol

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5
Q

Medications that may cause DRUG INDUCED LUPUS

A

HIPP

Hydralazine
Isoniazid
Procainamide
Penicillin

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6
Q

Accelerated form of severe HPN associated w/ rising BP and rapidly progressing end organ damage

A

MALIGNANT HYPERTENSION

Management:

  • Nitroprusside, Fenoldopam or Diaxozide) PLUS Diuretics (Furosemide) and Beta Blockers
  • lower BO to 140-160/90-110
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7
Q

Diuretics

INC UO – DEC BV — DEC CO — DEC BP

A 
THIAZIDE
Chlorothiazide
Hydrochlorothiazide
Indapamide
Chlorthalidone
Metolazone
LOOP 
Furosemide
Torsemide
Bumetanide
Ethacrynic Acid
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8
Q

MOA of Sympatholytics in treating HPN

A

(-) SYMPA – DEC HR

DEC VR. DEC HR, DEC contractile force
DEC CO, DEC TPR

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9
Q

CNS Sympa Outflow Blockers

A

alpha 2 agonist

Clonidine
Methyldopa

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10
Q

Causes rebound HPN upon withdrawal

A

Clonidine

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11
Q

Causes hemolytic anemia and (+) Coombs test

A

Methyldopa

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12
Q

Alpha 1 Blockers

A

Prazosin
Terazosin
Doxazosin
Alfuzosin

Tamsulosin
Silodosin

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13
Q

Causes orthostatic hypotension

A

Alpha 1 Blockers

Prazosin
Terazosin
Doxazosin
Alfuzosin

Tamsulosin
Silodosin

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14
Q

MOA of Beta Blockers in treating HPN

A

DEC HR, DEC contraction –> DEC CO –> DEC BP

block renin secretion

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15
Q

SELECTIVE Beta Blockers

A

BBEAAMC

Betaxolol
Bisoprolol
Esmolol
Atenolol
Acebutol
Misoprolol
Celiprolol
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16
Q

NON SELECTIVE Beta Blockers

A 
Propanolol
Penbutolol
Carteolol
Carvedilol
Labetalol
Timolol
Nadolol
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17
Q

Ganglion Blockers

NOT longer used d.t. side effects

A

Hexamethonium
Trimethaphan
Mecamylamine

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18
Q

Nerve Terminal Blockers

NOT used anymore d.t. PSYCHIATRIC side effects

A

Reserpine

Guanethidine

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19
Q

Irreversibly blocks VMAT

A

Reserpine

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20
Q

(-) Vesicular Release of NE

A

Guanethidine

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21
Q

Vasodilators

directly RELAXES arterioles – DEC TPR

A

Hydralazine
Sodium Nitroprusside
Diazoxide
Minoxidil

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22
Q

Adverse effects of Hydralazine

A

SLE

reflex tachycardia

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23
Q

Adverse effects of Sodium Nitroprusside

A

hypotension

cyanide toxicity

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24
Q

MOA of CCB in treating HPN

A

smooth muscle relaxation –> vasodilation –> DEC TPR –> DEC BP

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25
Q

DIHYDROPYRIDINE CCB

A

1st Gen
Nifedipine

2nd Gen
Amlodipine
Felodipine
Isradipine
Nicardipine
Nisoldipine
Nimodipine
26
Q

NON - DIHYDROPYRIDINE CCB

A

Verapamil

Diltiazem

27
Q

Adverse effects of DIHYDROPYRIDINE CCB

A

pretibial edema

constipation

28
Q

Adverse effect of Verapamil

A

gingival hyperplasia

29
Q

MOA of Nitroprusside in treating HPN

A

INC NO –> INC cGMP –> smooth muscle relaxation

30
Q

MOA of Fenoldopam in treating HPN

A

DOPAMINE AGONIST

arteriolar vasodilation of afferent and efferent arterioles

31
Q

MOA of ACE (-) in treating HPN

A

DEC angiotensin –> DEC vasoconstriction –> PR

DEC angiotensin II –> DEC aldosterone –> NaH20 retention –> DEC BV –> DEC CO

DEC aldosterone –> K retention (hyperkalemia)

32
Q

ACE Inhibitors

A

-PRIL

Captopril
Enalapril
Benazepril
Fosinopril

33
Q

MOA of Angiotensin Receptor Blockers in treating HPN

A

blocks the binding of ang II to ang II receptors –> DEC TPR (afterload) and DEC venous tone (preload)

DEC aldosterone –> K retention (hyperkalemia)

34
Q

Adverse effects of ACE Inhibitors

A

cough

angioedema

35
Q

Adverse effects of Angiotensin Receptor Blockers

A

hypotension
hyperkalemia
teratogenic

36
Q

Treatment for Uncomplicated HPN

140/90 - therapeutic threshold
130/80 - GOAL

A

MONOTHERAPY/ COMBINED

ACE (-) or ARBs
CCBs
Thiazide

37
Q

Treatment for HPN w/ CAD, ACS, high sympathetic drive and pregnant women

A

Beta Blockers

CHF
*Bisoprolol, Carvedilol, Metoprolol Succinate, Nebivolol

38
Q

Treatment for

BP >150/100
elderly - BP 160/100

A

ARB or ACE (-)
PLUS
CCB or Diuretics

39
Q

Treatment for HPN + DM

≥ 140/90 - therapeutic threshold
130/80 - GOAL

XXX - 120/70

A

LOW DOSE COMBINATION of RAAS BLOCKERS (ACE (-) OR ARBs) AND CCB OR Thiazide or Thiazide like diuretics

40
Q

Treatment for CKD

PREDIALYSIS
≥ 140/90 - therapeutic threshold
<140/90 - TARGET for LOW RISK
<130/80 - TARGET for HIGH RISK

A

REDUCE CV EVENTS IN CKD Px

ACE (-)
ARBs
Thiazide-like diuretics
Dihydropyridine Calcium Blockers

41
Q

Treatment for CKD + albuminuria/proteinuria

A

ACE (-) or ARBs (at maximally tolerated dose) - 1ST LINE
*UACR ≥ 30

CCB (NON-Dihydropyridine)
Verapamil
Diltiazem

42
Q

ACE (-) or ARBs used for the treatment of CKD albuminuria/proteinuria should NOT be discontinued UNLESS

A

serum crea rise >30% over baseline during the 1st 2 mos

hyperkalemia (>5.6 mmol/L)

43
Q

Treatment for CKD + resistant HPN

A

Mineralocorticoid Receptor Antagonist

  • Eplerenone
  • Spironolactone
44
Q

Treatment for CKD BP ≥ 160/100

A

2 DRUGS or SINGLE PILL COMBINATIONS

address volume depletion type of HPN
*CCB and Diuretics

for renin dependent type
*ACE, ARB, Beta Blockers

45
Q

Acute Ischemic Stroke (AIS) eligible for IV thrombolysis but NOT for mechanical thrombectomy

BP >185/110 - therapeutic threshold

BP <185/110 - maintained prior to treatment and during infusion

BP <180/105 next 24 h after treatment

A

referral to neurologist or stroke generalist

NICARDIPINE 1-5 mg/h titrated up by 2.5 mg/h q 5-15 mins w/ maximum of 15 mg/h

LABETALOL 10 mg IV now over 1-2 min followed by continuous IV infusion of 2-8 mg/min

46
Q

Acute Ischemic Stroke (AIS) NOT eligible for IV thrombolysis or mechanical thrombectomy

110-130 mmHg - MAP TARGET

> 220 SBP - therapeutic threshold
120 DBP

A

NICARDIPINE

reduce the BP by 15% during the 1st 24 h after the onset of stroke

47
Q

Acute Hypertensive Parenchymal Intracerebral Hemorrhage (ICH)

SBP ≥ 180 - Therapeutic Threshold

SBP <180 - GOAL

A

NICARDPINE - DOC
Labetalol

careful lowering to 140-160

48
Q

(+) history of stroke

140/90 - Therapeutic Threshold
≤ 130/80 - GOAL

A

RAS Blockers, CCBs, Thiazides

49
Q

Thiazide Diuretics

(-) Na/Cl transporters

for HPN, HF, hypercalciuria, renal calcium stones, nephrogenic diabetes insipidus

A

“MICH”

Metolazone
Indapamide
Chlorthalidone
Hydrochlorothiazide

50
Q

Appears in cord blood and crosses placenta and may cause hypokalemia, hyponatremia, hypoglycemia, jaundice and thrombocytopenia

A

Metolazone

51
Q

Loop Diuretics

(-) Na/K/2Cl transporter

powerful diuresis, increased calcium excretion

HF, pulmonary edema
hypercalcemia, acute renal failure, anion overdose

A

Furosemide
Bumetanide
Torsemide
Ethacrynic Acid - can be used in px with sulfur allergy

52
Q

Drugs used to control BP in pheochromocytoma

A

Phenoxybenzamine
Phentolamine
Labetalol

53
Q

Common SE of vasodilators

A

hypotension
reflex tachycardia
edema
headache

54
Q

Most effective vasodilator
Bort arteriolar and venodilator

SE: cyanide toxicity

A

Nitroprusside

increase NO – increase cGMP – smooth muscle relaxation

55
Q

D1 receptor agonist

Arteriolar vasodilation of afferent and efferent arterioles

INCREASED renal blood flow

A

Fenoldopam

56
Q

MOA of Vasodilators

A

alters intracellular calcium metabolism (Hydralazine)

opens K channels in vascular smooth muscle = hyperpolarization - smooth muscle relaxation = vasodilation (Minoxidil, Diazoxide)

Calcium channel blockade

increase NO – increase cGMP – smooth muscle relaxation

D1 receptor agonist - Fenoldopam

57
Q

Alters intracellular calcium metabolism

vasodilates ARTERIOLES – decreased afterload

for preeclampsia, HPN
heart failure - + ISDN

SE: psychiatric depression, suicidal ideation

DRUG INDUCED LUPUS
MI

A

Hydralazine

58
Q

Opens K channels in vascular smooth muscle = hyperpolarization - smooth muscle relaxation = vasodilation

for alopecia, HPN

SE: hirsutism

DRUG INDUCED LUPUS

A

Minoxidil
*stimulates hair follicles (telogen phase) to differentiate into growth follicles (anagen phase)

Diazoxide

59
Q

Angiotensin Receptor Blockers

A

-SARTANS

Losartan
Candesartan
Valsartan
Telmisartan
Irbesartan
Eprosartan
Azilsartan
Olmesartan
60
Q

Drug Induced Lupus

A

HIPP

Hydralazine
Isoniazid
Procainamide
Penicillamine

61
Q

Why are patients with diabetic nephropathy treated with ACE (-)

A

ACE (-) decrease albumin excretion and slow progression from micro - to - macroalbuminuria (renoprotective effect)

Pharmacology (72 decks)

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