Exam 5 - HTN part II Flashcards by Korey koper

Beta Blockers are competitive ___________ that block the receptor sites for the endogenous ______________ epinephrine (adrenaline) and norepinephrine ( noradrenaline)

antagonist

catecholamines

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Beta Blockers block adrenergic beta receptors, of the ___________ nervous system , which mediates the flight-or-fight response.

sympathetic

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Common uses for BB’s?

HTN
Angina
Cardiac Arrhythmias
Migraine prophylaxis
Mitral Valve Prolapse
Acute Aortic Dissection - 
Hypertrophic Obstructive Cardiomyopathy
Anxiety - BB

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Use of beta blockers around the time of cardiac surgery decreases the risk of heart _____________.

dysrhythmias

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Non-selective beta blocker agents ?

Propranolol
Carvedilol 
Labetalol 
Nadolol
Sotalol
Timolol

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Some beta blockers exhibit _________ ______________ activity .

intrinsic sympathomimetic activity (ISA).

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ISA agents are capable of exerting low-level agonist activity at the __________________ while simultaneously acting as a receptor site antagonist.

β-adrenergic receptor

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BB Agents with ISA are not used after what?

Also be less effective than other beta blockers in the management of angina and tachyarrhythmia

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Beta-1 selective agent examples?

EMAA

Atenolol
Metoprolol
Acebutolol
Esmolol

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What are the two types of CCB’s?

Dihydropyridine

Non-dihydropyridine

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Dihydropyridine is _____ acting.

short

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Non-dihydropyridine is ____ acting.

long

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CCB’s MOA?

Inhibit calcium ions from entering slow or voltage-gated channels seen in

Vascular smooth muscle - Relaxation of blood vessels - vasodilation

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CCB’s effects on myocardium?

Depress SA node activity

Slow AV node conduction

Reduce cardiac contractility

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CCB’s examples Verapamil (Calan, Isoptin),

Diltiazem (Cardizem) act on _____ and _____ _______.

heart

blood vessels

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Amlodipine (Norvasc), nifedipine (Procardia), and all other calcium channel blockers act primarily on what?

blood vessels

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Nicardipine (Cardene)?

AHA stroke protocol standard

Easily titrated IV

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CCB’s clinical uses?

Cardiac arrhythmias (verapamil and diltiazem)

Angina

Vasospastic angina (Prinzmetal’s)

Diastolic heart failure

HTN

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Many side effects with CCB’s but remember what?

peripheral edema

gingival hyperplasia!

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Alpha-2 adrenergic receptor agonists AKA Central alpha agonists _____ blood pressure by stimulating alpha-receptors in the _____ which open peripheral arteries easing blood flow

lower

brain

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When is Centrally Acting  Alpha-Agonists prescribed?

when other medications have failed

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What are Centrally Acting  Alpha-Agonists typically combined with?

diuretic

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Example of Centrally Acting  Alpha-Agonists?

Clonidine (Catapres)

Methyldopa (Aldomet)

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Clonidine (Catapres) MOA?

Activates inhibitory neurons

Reduces CNS sympathetic output

Decreases peripheral resistance via peripheral artery dilation

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Methyldopa (Aldomet) decreases __________ outflow at the Heart, peripheral vasculature, and kidneys

sympathetic

Why do you have to be careful with Methyldopa ( Aldomet)?

Drug-induced lupus - autoimmune disorder (similar to systemic lupus erythematosus caused use of certain drugs Hemolytic anemia Positive Coombs test - Coombs test is used to test for autoimmune hemolytic anemia

Hydralazine (Apresoline) produces direct __________ of vascular smooth muscle

relaxation

Hydralazine (Apresoline) | is used in ________ to ______ HTN.

moderate severe

Hydralazine (Apresoline) may cause drug-induced _____, and can be administer both __ & __.

lupus IV & PO

Minoxidil (Loniten) can cause drug induced _________.

Hirsutism

Minoxidil (Loniten) decreased __________ vascular resistance

peripheral

Minoxidil (Loniten) | is used in HTN with end-organ damage not controlled with a _______ plus 2 other __________________.

diuretic antihypertensives

Minoxidil (Loniten) is also known as ?

Rogaine

What is the drug of choice for HTN emergencies ?

Nitroprusside (Nitropress)

Nitroprusside (Nitropress) generally relaxes _____ more than ________ and is _____ acting.

veins more than arteries short acting

How long does therapy last with Nitroprusside (Nitropress) | ?

Therapy to last no longer than 1 to 3 days

Nitroprusside (Nitropress) | side effects?

Toxic metabolite, thiocyanate, may cause cyanide poisoning

If on Nitroprusside (Nitropress) what levels must be monitored for toxicity?

Thiocyanate

Nitroprusside (Nitropress) can cause what?

Methemoglobinemia

What is Methemoglobinemia | ?

presence of a higher than normal level of methemoglobin (Fe3) decreased ability to bind oxygen

Nesiritide (Natrecor) increases ____, which results in what?

cGMP resulting in smooth must relaxation

When is Nesiritide (Natrecor) | used?

Used in acute decompensated heart failure

Nesiritide (Natrecor) reduces _________ _________ resistance and systemic ________ pressure.

pulmonary capillary resistance and systemic arterial pressure

What do diuretics cause?

Increase sodium and water excretion by the kidney Decreases intravascular volume Decreases preload, stroke volume, and cardiac output

What are the Six classes of diuretics classified by site of action in the nephron?

``` Thiazide Thiazide-like Loop Potassium sparing Osmotic Carbonic anhydrase inhibitors ```

Thiazide diuretics MOA?

Inhibit NA/Cl transporter in the distal convoluted tubule

Clinical uses of thiazide diuretics?

Mild to moderate HTN, CHF, cirrhosis, renal insufficiency, nephrotic syndrome

Pharmacokinetics of thiazide diuretics ?

Rapid absorption after oral administration Well distributed into extracellular space Excreted unchanged by the kidneys

Examples of Thiazide diuretics?

Hydrochlorothiazide (HCTZ, HCT, HZT)

What is a drug that is common combo with ARB's, BB's, CCB's?

Hydrochlorothiazide (HCTZ, HCT, HZT)

Indications for Hydrochlorothiazide (HCTZ, HCT, HZT) | ?

CHF High Ca Gout Edema

Thiazide Diuretics cautions?

Caution renal impaired Caution gout Caution elderly Causes electrolyte imbalance hypokalemia / hyponatremia

Thiazide Diuretics special populations / category?

Cat B

Thiazide Diuretics: Adverse  Reactions?

CV: hypotension Endo: hyperglycemia GI: anorexia, nausea, cramping, vomiting GU: erectile dysfunction META: metabolic alkalosis MS: muscle cramps Neuro: dizziness, drowsiness, lethargy, weakness

Thiazide Diuretics: Interactions?

Potentiates digoxin toxicity NSAIDS reduce diuretic effect Corticosteroids enhance hypokalemia Get synergistic effect if used concurrent with loop diuretics

Thiazide Diuretics may reduce effectiveness of?

lithium, warfarin, vitamin D

Why may diuretics be limited?

dehydration

What do you want to do before you prescribe thiazide diuretics?

Perform initial determination of serum electrolytes, BUN uric acid, and glucose to monitor for electrolyte imbalances Watch for drugs that alkalinize urine Always review for possible drug interactions Use with care if using insulin

Thiazide diuretic family/patient education?

Advise urination increase at start but it subsides in a few weeks If drug causes GI upset take with food or milk Advise to take during day Advise to notify clinician is any side effects occur Avoid prolonged sunlight exposure due to potential for photosensitivity rash If diabetic patient, watch for increase in blood sugar Do not adjust or interrupt dosage Avoid alcohol

Thiazide-Like Diuretics are ___________ diuretic that has similar physiological properties to a thiazide diuretic

Sulfonamide

Examples of Thiazide-Like Diuretics?

Metolazone | Chlortalidone

When are Thiazide-Like Diuretics used?

Often used in the management of hypertension and edema

Thiazide-Like Diuretics may be used in patients with ____ and ________ because it does not cause ____________ and _______?

gout and diabetes hyperuricemia or does not increased glucose

What diuretic is a Safer alternative to use in patients with decreased creatinine clearance?

Thiazide-Like Diuretics

Examples of Loop diuretics?

Furosemide (Lasix) Torsemide (Demadex) Bumetanide (Bumex)

Loop Diuretics MOA?

Inhibit the Na/K/Cl cotransporter on the thick ascending Loop of Henle

What is there a risk of if on loop diuretics?

Risk of hypocalcemia, hypokalemia, hyperglycemia, and hyperuricemia ? Involve worsening of insulin resistance, inhibition of glucose uptake, and decreased insulin release

Loop diuretics produce transient diuresis not limited by what?

dehydration

Side effects of Loop Diuretics?

Ototoxicity may occur

What may enhance with use of loop diuretics?

amino glycoside use

Examples of potassium-sparing diuretics?

Spironolactone Spironolactone/hydrochlorothiazide – (Aldactazide) Triamterine/hydrochlorizide – (Maxzide, Dyazide)

Potassium-Sparing Diuretics MOA?

Inhibit Na reabsorption; dependent on K and H+ exchange

Potassium-Sparing Diuretics block what?

Block aldosterone receptor

What is there a risk of when on Potassium-Sparing Diuretics?

Risk of hyperkalemia, hyponatremia, metabolic acidosis

Potassium-Sparing Diuretics are ____ diuretics, usually use in combination with other ________ classes?

weak diuretic classes

What causes blue colored Urine? and is a Potassium-Sparing Diuretics?

Triamtrene

What potentates hyperkalemia

ACEI's

Examples of Osmotic Diuretics?

Mannitol (osmitrol)

What is the Type of diuretic that inhibits reabsorption of water and sodium (Na)?

Osmotic Diuretic - Mannitol Non-reabsorbable solute

Where is Mannitols major effect?

proximal convoluted tubule and the descending limb of Henle's Loop

What has an opposite action of ADH in the collecting tubule?

Mannitol

Osmotic diuretic are used in treatment of _____ conditions only? like?

acute Acute renal failure Glaucoma Cerebral edema

Examples of carbonic anhydrase Inhibitors ?

Acetazolamide

Acetazolamide is used for what?

laucoma, epilepsy (rarely) idiopathic intracranial hypertension altitude sickness (respiratory alkalosis/HCO3)

Carbonic anhydrase inhibition results in _________ excretion of __, _, and ______ ___________.

increased Na, K and sodium bicarbonate

What is the weakest diuretic ? and Not a mainstay in HTN therapy?

Carbonic Anhydrase Inhibitors

What is Mainly used in the treatment of open-angle glaucoma?

Carbonic Anhydrase Inhibitors

What is there a risk of when using Carbonic Anhydrase Inhibitors?

Risk of Stevens-Johnson syndrome erythema multiforme toxic epidermal necrolysis bone marrow suppression

When can you not use Carbonic Anhydrase Inhibitors?

Cannot use in patients with sulfa allergy Caution advised with high-dose aspirin

Diuretic Resistance and Adaptation?

The body’s ability to adapt to repeated administration of many drugs With diuretics, adaptation occurs as compensatory changes in body sodium retention increases while ion transporters become enhanced (diuretic braking).

What is diuretic braking?

sodium retention increases while ion transporters become enhanced