Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Pharm II > Exam 2 - Anti-hypertensives > Flashcards

Exam 2 - Anti-hypertensives Flashcards

1
Q

What are the four major groups of antihypertensive agents?

A
  • Diuretics
  • Sympathoplegic agents
  • Direct vasodilators
  • Angiotension inhibitors
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

How is efficacy increased and toxicity decreased in antihypertensive drugs?

A

Combination of drugs from different groups

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are some common side effects of diuretics and how can these be avoided?

A
  • ED
  • Increased renin secretion
  • K+ depletion leading to hypokalemia
  • Reduced glucose tolerance and increased plasma lipid concentration (not good for diabetics)

Most can be avoided by using lower doses. Anti-hypertensive doses are much lower than those for diuresis.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the initial recommended drugs in hypertension?

A
  • Thiazides
  • ACE-I
  • ARB
  • CCB
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Thiazide diuretics are more effective in what race?

A

More effective in African Americans than in Caucasians

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

When would you consider a Thiazide diuretic for HTN?

A

Mild to moderate HTN

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

When would you consider a Loop diuretic for HTN?

A

Severe cases (renal insufficiency, HF)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

When would you consider a Potassium diuretic for HTN?

A

In combination with a thiazide or loop diuretic to decrease the loss of potassium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the general MOA of Sympatholytics in HTN?

A
  • Decrease BP by reducing sympathetic vasomotor tone

- Activate baroreflexes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Other than a decrease in BP, what do Sympatholytics generally cause? How can you prevent this?

A

Generally cause Na+ and H2O retention.

Best when combined with a diuretic to prevent water retention.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What type of anti-HTN are Clonidine and Methyldopa?

A

Centrally Acting Sympatholytics (alpha agonist)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is the MOA for Clonidine and Methyldopa?

A
  • Stimulate medullary a2 adrenergic receptors leading to decreased peripheral sympathetic nerve activity in blood vessels, kidney, and heart
  • Decreased SNS outflow and decreased renin secretion leads to decreased BP
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

When is Methyldopa preferred for treatment over clonidine?

A

HTN in pregnancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are differences in the effects/administration of clonidine compared to methyldopa?

A

Clonidine reduces HR and CO more than methyldopa

While both are oral, clonidine can also be used as a patch

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are some adverse effects of Centrally Acting Sympatholytics (clonidine, methyldopa)?

What are some effects specific to Methyldopa?

A
  • Sedation and other CNS
  • Xerostomia (common)

Methyldopa:

  • Hemolytic anemia with a positive Coombs test
  • Hepatotoxic
  • Gynecomastia/lactation due to increased prolactin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are some contraindications/precautions of Centrally Acting Sympatholytics (clonidine, methyldopa)?

A
  • No monotherapy
  • Sudden withdrawal of clonodine can lead to HTN crisis
  • TCA can inhibit clonidine’s therapeutic action
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is the MOA for Prazosin?

A

Block a1-adrenergic receptors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are indications/therapeutic effects of Prazosin?

A
  • Reduces norepinephrine vasoconstriction –> dilate arteries and veins
  • Decreased BP due to decreased peripheral resistance
  • BPH
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is the DOC for a patient suffering from both HTN and BPH?

A

Prazosin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What are some adverse effects of Prazosin?

A
  • Postural hypotension may be pronounced with first dose (“first dose phenomenon”)
  • Na+ and water retention due to increased renin
  • Reflex tachycardia
  • Dizziness, palpitations, headache
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

In what population would B-blockers produce the best effects?

A

Young white males

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Why are B-blockers combined with other drugs?

A

Counteract reflex tachycardia and increased renin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

While B-blockers are no longer recommended for monotherapy, what are some compelling indications to do so?

A

Patient with

  • Angina
  • MI
  • Migraine
  • HF
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What can Nebivolol be helpful in?

A

ED

Increases NO –> direct vasodilation –> decreased ED

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What are some contraindications to using B-blockers?

A
  • Diabetes
  • Severe (end-stage) HF
  • Severe bradycardia
  • Heart block
  • Asthma (as causes bronchoconstriction)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What is the DOC for HTN in pregnancy?

A

Methyldopa

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What anti-HTN drugs can be used in pregnancy?

A
  • Methyldopa
  • Labetalol
  • Hydralazine
  • Nifedipine
28
Q

What are indications/therapeutic effects of Combined a1/B-blockers (Labetalol, Carvedilol)?

A
  • Vasodilation without reflex tachycardia

Labetalol:

  • Decrease BP in HTN emergencies
  • Pregnancy

Carvedilol:
- HTN and HF, especially after MI

29
Q

What are adverse effects of Combined a1/B-blockers (Labetalol, Carvedilol)?

A
  • Orthostatic hypotension
  • Bronchoconstriction

Labetalol:
- Hepatotoxic –> emergency use only!

30
Q

What are contraindications of Combined a1/B-blockers (Labetalol, Carvedilol)?

A

Asthma

31
Q

Hypotension from any vasodilator may be accomapnied by what?

A
  • Reflex tachycardia and increased myocardial contraction
  • Increased renin secretion
  • Fluid retention
  • HA, flushing (vasodilation in brain and skin)
  • Palpitations, dizziness (from orthostatic hypotension)
32
Q

What is the MOA for Hydralazine?

A

Dilates arterioles but not veins via direct action of NO

33
Q

What are the uses of Hydralazine?

A

Used in chronic therapy of severe HTN
**Last choice though and only used in combination when other drugs have failed

Also used for severe HTN or HTN emergency in pregnancy (compelling indication)

34
Q

What are some adverse effects of Hydralazine?

A
  • SLE in slow acetylators (HIP drug)
  • HA, nausea, palpitations, sweating, flushing
  • Angina
35
Q

What is the MOA for Sodium nitroprusside (Nitropress)?

A

Rapidly lowers BP (in minutes) via direct action of NO, and effect disappears in minutes after discontinuation

36
Q

What are the uses of Sodium nitroprusside (Nitropress)?

A

Used for emergency HTN situations (IV and disappears quickly, so not for chronic use)

37
Q

What are the pharmacokinetics of Sodium nitropresside (Nitropress)?

A
  • Metabolized by liver rapidly to thiocyanate and excreted by the kidney
  • IV ONLY
38
Q

What are adverse effects of Sodium nitropresside?

A
  • Cyanide accumulation which can be caused by too high of infusion, severe kidney disease, anuria
  • Metabolic acidosis , arrhythmias, hypotension, death in patients with deficiency in cyanide metabolism or severe liver disease
39
Q

What is the MOA for Fenoldopam?

A

D1 receptor agonist - relaxes arteriolar smooth muscle

40
Q

What are the uses of Fenoldopam?

A

Used for emergency HTN situations

41
Q

Nifedipine, Amlodipine, Diltiazem, and Verapamil belong to what drug class?

A

Calcium Channel Blockers

42
Q

What is the MOA of CCB?

A

Bind to L-type calcium channels in the:

  • Myocardium to decrease contractility, impulse generation, and conduction
  • Vascular smooth muscle to relax it and produce vasodilation
43
Q

What specific CCB is vascular smooth muscle the most sensitive to?

A

Nifedipine

44
Q

What specific CCB is cardiac muscle most sensitive to?

A

Verapamil

45
Q

Even though Nifedipine and Verapamil are both CCBs, how do they differ in their effect on the heart?

A
  • Nefedipine: Increases HR (as main effect is vasodilation in smooth muscle which will initiate baroreflex and cause reflex tachycardia)
  • Verapamil: Decreases HR
46
Q

Which CCBs are classified as Dihydropyridines?

A

Nifedipine and Amlodipine

47
Q

What are adverse effects of Dihydropyridine CCBs (Nifedipine and Amlodipine)?

A
  • Vascular-like effects such as reflex tachycardia, HA, flushing, dizziness, peripheral edema
  • Gingival hyperplasia
48
Q

What is the most common side effect of verpamil (CCB)?

A

Constipation

49
Q

What are some contraindications/precautions of Verapamil and Diltiazem (CCBs)?

A
  • SA or AV node abnormalities or use with B-blockers (can lead to excessive bradycardia or heart block)
  • HF (these drugs decrease inotropic ability which a patient with HF is already struggling with)
50
Q

What are some contraindications/precautions of Dihydropyridines (CCBs)?

A

Use caution in HTN patients with HF

51
Q

What two classes of drugs are considered Inhibitors of the Renin-Angiotensin System?

A
  • ACE-I (“prils”)

- ARBs (“sartans”)

52
Q

What is the MOA for ACE-I?

A

Inhibiting ACE –> Decrease in angiotensin II –> Decreased BP

(reduced direct vasoconstriction by angiotensin II and reduced release of aldosterone)

53
Q

What are advantages of using an ACE-I?

A
  • Lower BP without compromising heart, brain, or kidneys

- Do not cause reflex sympathetic activation/tachycardia due to baroreceptor resetting

54
Q

ACE-I are definitive DOC for HTN in patients with what other complications?

A
  • Diabetes
  • CKD
  • HFrEF
55
Q

What do ACE-I do in regards to diuretics?

A
  • Enhance the anti-HTN efficacy of diuretic drugs

- Balance the adverse effects of diuretics (increased K+ will oppose the diuretic-induced hypokalemia)

56
Q

What is DOC for CKD even w/o HTN?

A

ACE-I

57
Q

What is DOC for patient with HTN + DM?

A

ACE-I

58
Q

What is DOC for patient with HTN + CKD?

A

ACE-I

59
Q

What is DOC for patient with HTN + HFrEF?

A

ACE-I

60
Q

What are some adverse effects of ACE-I?

A
  • Orthostatic hypotension and dizziness (severe in hypovolemic patients/diuretic users)
  • Cough (due to increased bradykinin)
  • Angioneurotic edema (due to increased bradykinin)
  • Hyperkalemia due to inhibited aldosterone secretion
  • Acute renal failure in patients with bilateral renal artery stenosis
61
Q

In what population can ACE-I cause severe orthostatic hypotension and dizziness?

A

Hypovolemic/diuretic users

62
Q

What are some contraindications/precautions of ACE-I?

A
  • 2nd/3rd trimester of pregnancy due to being teratogenic
  • Use with K+ sparing diuretics –> hyperkalemia
  • Combination with NSAIDs will cause decreased vasodilation
63
Q

What is the MOA of ARBs?

A

Block AT1 receptors selectively without affecting AT2 receptors

64
Q

What is the difference in side effects between ACE-I and ARBs?

A

ARBs do not cause cough or angioedema as they do not increase bradykinin

65
Q

In what population are ACE-I least effective?

A

Elderly African-Americans

Pharm II (10 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions