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Cardiology Exam > HTN Drugs > Flashcards

HTN Drugs Flashcards

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1
Q

pharmacologic therapy classes for HTN (ABCDs)

A

*A: angiotensin converting enzyme inhibitors (ACEi) / angiotensin II receptor blockers (ARBs)
*B: beta blockers (BBs)
*C: calcium channel blockers (CCBs)
*D: diuretics
*miscellaneous agents (peripheral alpha-1 receptor blockers, vasodilators, centrally acting agents)

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2
Q

classes of diuretics

A

*thiazide diuretics
*loop diuretics
*potassium sparing diuretics:
-aldosterone antagonists
-Na+/K+ exchange inhibitors

note: carbonic anhydrase inhibitors and osmotic diuretics are NOT used as anti-hypertensives

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3
Q

what is the first-line choice diuretic for treating HTN in most patients?

A

*thiazide diuretics

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4
Q

thiazide diuretics - MOA

A

*inhibits Na+ absorption at DISTAL CONVOLUTED TUBULE (block Na+/Cl- exchange at DCT)
*increased urine output → decreased blood volume → DECREASED BP

note - they also vasodilate to reduce BP

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5
Q

thiazide diuretics - examples

A

*hydrochlorothiazide (HCTZ)
*chlorthalidone
*metolazone
*chlorothiazide

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6
Q

thiazide diuretics - metabolism

A

*primarily renal

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7
Q

thiazide diuretics - ADEs

A

*allergy (rash) [sulfa allergy]
*HYPOKALEMIA
*HYPOMAGNESEMIA
*dehydration
*alkalosis (metabolic)
*nephritis
*gout

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8
Q

thiazide diuretics - uses

A

*hypertension (first-line medication used in HTN)
*heart failure (volume overload)

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9
Q

hydrochlorothiazide (HCTZ) - drug class, MOA, uses

A

*thiazide diuretic
*inhibit Na+ absorption at distal convoluted tubule
*used for HTN & heart failure

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10
Q

chlorthalidone - drug class, MOA, uses

A

*thiazide diuretic
*inhibit Na+ absorption at distal convoluted tubule
*used for HTN & heart failure

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11
Q

metolazone - drug class, MOA, uses

A

*thiazide diuretic
*inhibit Na+ absorption at distal convoluted tubule
*used for HTN & heart failure

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12
Q

chlorothiazide - drug class, MOA, uses

A

*thiazide diuretic
*inhibit Na+ absorption at distal convoluted tubule
*used for HTN & heart failure

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13
Q

thiazide diuretics - route & dosing

A

*PO
*taken once per day

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14
Q

which ions are “wasted” by thiazide diuretics?

A

*potassium → HYPOKALEMIA
*magnesium → HYPOMAGNESEMIA

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15
Q

loop diuretics - MOA

A

*inhibit Na+/Cl- absorption at ASCENDING LOOP OF HENLE

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16
Q

loop diuretics - examples

A

*furosemide (Lasix)
*bumetanide
*torsemide
*ethacrynic acid

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17
Q

loop diuretics - metabolism

A

*primarily renal

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18
Q

loop diuretics - ADEs

A

*ototoxicity
*hypokalemia
*hypomagnesemia
*dehydration
*allergy (rash) [sulfa allergy]
*alkalosis (metabolic)
*nephritis
*gout

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19
Q

loop diuretics - route & dosing

A

*mostly PO or IV
*furosemide - 3x per day (TID)
*bumetanide & torsemide - 2x per day (BID)

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20
Q

which ions are “wasted” by loop diuretics?

A

*potassium → HYPOKALEMIA
*magnesium → HYPOMAGNESEMIA

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21
Q

furosemide - drug class, MOA, uses

A

*loop diuretic
*inhibits Na+/Cl- absorption at ascending Loop of Henle
*used for heart failure, HTN, acute/chronic hyperkalemia

note - furosemide is aka Lasix

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22
Q

bumetanide - drug class, MOA, uses

A

*loop diuretic
*inhibits Na+/Cl- absorption at ascending Loop of Henle
*used for heart failure, HTN, acute/chronic hyperkalemia

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23
Q

torsemide - drug class, MOA, uses

A

*loop diuretic
*inhibits Na+/Cl- absorption at ascending Loop of Henle
*used for heart failure, HTN, acute/chronic hyperkalemia

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24
Q

loop diuretics - uses

A

*heart failure (volume overload)
*hypertension
*acute/chronic hyperkalemia

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25
which diuretic causes more urine production compared to the other: loop diuretics or thiazide diuretics?
*LOOP diuretics produce more urine output compared to thiazide diuretics
26
potassium sparing diuretics: aldosterone antagonists - examples
*spironolactone *eplerenone
27
potassium sparing diuretics: aldosterone antagonists - MOA
*block effects of aldosterone in distal tubules *competitive aldosterone receptor antagonists in cortical collecting tubule
28
potassium sparing diuretics: aldosterone antagonists - route & dosing
*PO *taken once per day
29
potassium sparing diuretics: aldosterone antagonists - metabolism
*hepatic
30
potassium sparing diuretics: aldosterone antagonists - ADEs
*HYPERKALEMIA (both spironolactone & eplerenone) *spironolactone additional ADEs: -gynecomastia -breast tenderness -hirsutism
31
potassium sparing diuretics: aldosterone antagonists - uses
*heart failure (volume overload; slows progression of HF) *hypertension *hyperaldosteronism *cirrhosis (edema)
32
spironolactone - drug class, MOA, uses
*aldosterone antagonist, potassium sparing diuretic *block effects of aldosterone in distal tubules *used for heart failure, HTN, hyperaldosteronism, and cirrhosis
33
eplerenone - drug class, MOA, uses
*aldosterone antagonist, potassium sparing diuretic *block effects of aldosterone in distal tubules *used for heart failure, HTN, hyperaldosteronism, and cirrhosis
34
potassium sparing diuretics: Na+/K+ exchange inhibitors - examples
*amiloride *triamterene
35
potassium sparing diuretics: Na+/K+ exchange inhibitors - MOA
*inhibit Na+/K+ exchange in collecting duct, distal tubule - secreted into lumen by proximal tubule cells
36
potassium sparing diuretics: Na+/K+ exchange inhibitors - route & dosing
*PO *taken once per day
37
potassium sparing diuretics: Na+/K+ exchange inhibitors - metabolism
*amiloride - renal metabolism *triamterene - hepatic metabolism
38
potassium sparing diuretics: Na+/K+ exchange inhibitors - ADEs
*hyperkalemia *rash
39
potassium sparing diuretics: Na+/K+ exchange inhibitors - uses
*hypertension (rarely used) *volume overload *chronic hypokalemia
40
calcium channel blockers - MOA in arteries/arterioles (vasculature)
*inhibit Ca2+ transport → VASODILATION → decreased BP note - dihydropyridine CCBs primarily affect the vasculature
41
calcium channel blockers - MOA in electrical system of heart
*inhibit Ca2+ transport → decreased HR or decreased contractility note - non-dihydropyridine CCBs primarily affect the heart tissue (SA/AV node and ventricular myocardium)
42
calcium channel blockers: 2 subclasses
1. non-dihydropyridines (NDHP) → primarily SA & AV node inhibition → decreased HR and ventricular myocardium inhibition → decreased contractility 2. dihydropyridines (DHP) → primarily inhibit calcium ions in the vasculature → vasodilation → decreased BP
43
dihydropyridine CCBs - examples
*nifedipine *amlodipine (Norvasc) *R-pine
44
dihydropyridine CCBs - MOA
*arterial VASODILATORS *inhibit Ca2+ transport in the vasculature (arteries/arterioles) → VASODILATION → decreased BP
45
dihydropyridine CCBs - ADEs
*pedal edema *reflex tachycardia
46
dihydropyridine CCBs - uses
*hypertension *stable angina *vascular vasospasm
47
dihydropyridine CCBs - metabolism
*hepatic
48
nifedipine - drug class, MOA, uses
*dihydropyridine calcium channel blocker (DHP CCB) *inhibits Ca2+ transport in arterial vasculature → arterial VASODILATION → decreased BP *used for HTN, stable angina, and vascular vasospasm
49
amlodipine - drug class, MOA, uses
*dihydropyridine calcium channel blocker (DHP CCB) *inhibits Ca2+ transport in arterial vasculature → arterial VASODILATION → decreased BP *used for HTN, stable angina, and vascular vasospasm note - amlodipine is aka Norvasc
50
non-dihydropyridine CCBs - examples
*verapamil *diltiazem
51
non-dihydropyridine CCBs - MOA
*inhibit Ca2+ transport in the heart: -inhibition in the SA/AV nodes → decreased HR (negative chronotropic effect: verapamil > diltiazem) -inhibition in the ventricular myocardium → decreased contractility (negative inotropic effect: verapamil > diltiazem)
52
of the two non-dihydropyridine calcium channel blockers (verapamil & diltiazem), which is more INOTROPIC? which is more CHRONOTROPIC?
*VERAPAMIL is both more inotropic (decreases contractility more) and more chronotropic (decreases HR more) than diltiazem
53
non-dihydropyridine CCBs - metabolism
*hepatic (numerous drug-drug interactions)
54
non-dihydropyridine CCBs - ADEs
*decreased HR *AV nodal blockade *hypotension *constipation *gingival hyperplasia *rash
55
verapamil - drug class, MOA, uses
*non-dihydropyridine calcium channel blocker (NDHP CCB) *inhibits Ca+ transport in the heart → negative inotropy (decreased contractility) & negative chronotropy (decreased HR) *used for HTN, stable angina, antiarrhythmic, ventricular rate control, migraine prophylaxis note - verapamil is more negatively chronotropic & inotropic compared to diltiazem (verapamil decreases HR and contractility more)
56
diltiazem - drug class, MOA, uses
*non-dihydropyridine calcium channel blocker (NDHP CCB) *inhibits Ca+ transport in the heart → negative inotropy (decreased contractility) & negative chronotropy (decreased HR) *used for HTN, stable angina, antiarrhythmic, ventricular rate control, migraine prophylaxis note - diltiazem is LESS negatively chronotropic & inotropic compared to verapamil (diltiazem decreases HR and contractility LESS)
57
non-dihydropyridine CCBs - uses
*hypertension *stable angina *ventricular rate control *vascular vasospasm *migraine prophylaxis note - NDHP CCBs are class IV antiarrhythmics
58
how long does amlodipine take to work?
*takes about 3 days to fully kick in
59
beta blockers - MOA (in HTN)
*block either beta1 receptor (cardioselective) or both beta1 and beta2 *decrease HR/contractility *decrease BP
60
cardioselective beta blockers (beta1 blockers) - examples
*metoprolol *esmolol *atenolol *bisoprolol
61
beta blockers (beta1 & beta2 blockers) - examples
*labetalol (alpha1, beta1, beta2 blockers) *carvedilol (alpha1, beta1, beta3 blockers) *propranolol (beta1, beta2 blockers)
62
beta blockers - ADEs
*drowsiness *lethargy *confusion *broncho-reactive events *AV nodal blockade
63
metoprolol - drug class, MOA, uses, metabolism
*beta blocker, specific to beta1 (cardioselective) *blocking beta1 receptor → decreased HR/contractility, decreased BP *used in heart failure, HTN (not first line) *metabolism: cleared by liver with moderate lipophilicity (penetrates blood-brain barrier easily → drowsiness, lethargy, confusion, etc)
64
labetalol - drug class, receptor activity
*beta blocker *NON-SPECIFIC: blocks alpha 1, beta 1, and beta 2
65
carvedilol - drug class, receptor activity
*beta blocker *NON-SPECIFIC: blocks alpha 1, beta 1, and beta 2
66
propranolol - drug class, receptor activity, ADEs
*beta blocker *blocks beta1 AND beta2 *most lipophilic (lipid soluble) beta blocker → high risk of CNS side effects (drowsiness, confusion, lethargy)
67
angiotensin converting enzyme inhibitors (ACEi) - MOA
*inhibit ACE → decreased AT II → decreased GFR by PREVENTING CONSTRICTION of efferent arterioles *prevents inactivation of bradykinin (a potent vasodilator) → more bradykinin note - ACEi are a type of anti-RAS agents
68
angiotensin converting enzyme inhibitors (ACEi) - examples
*captopril *enalapril *lisinopril *ramipril note - ACE inhibitors end in -pril
69
angiotensin converting enzyme inhibitors (ACEi) - ADEs
*HYPERKALEMIA *ANGIOEDEMA *acute kidney injury *COUGH *hypotension *avoid use in pregnancy (teratogenic)
70
angiotensin II receptor blockers (ARBs) - MOA
*selectively block binding of angiotensin II to AT1 receptor *prevents vasoconstriction of arterioles
71
angiotensin II receptor blockers (ARBs) - examples
*losartan *candesartan *valsartan note - ARBs end in -sartan
72
angiotensin II receptor blockers (ARBs) - ADEs
*hyperkalemia *angioedema *acute kidney injury *hypotension *avoid use in pregnancy (teratogenic)
73
aliskiren - drug class, MOA, ADEs
*renin inhibitor *MOA: direct renin inhibitor → blocks conversion of angiotensinogen to angiotensin I → ultimately prevents vasoconstriction *ADEs: hyperkalemia, angioedema, acute kidney injury, hypotension, avoid use in pregnancy (teratogenic)
74
doxazosin - drug class, MOA, ADEs, uses
*peripheral alpha-1 receptor blocker *MOA: blocks alpha-1 receptors in peripheral vasculature → vasodilation *ADEs: first dose syncope, dizziness, lethargy *use: 4th or 5th line drug for HTN
75
hydralazine - drug class, MOA, ADEs, uses
*vasodilator *MOA: increases cGMP → smooth muscle relaxation (VASODILATION) *ADEs: reflex tachycardia, drug induced lupus *use: 4th or 5th line drug for HTN
76
minoxidil - drug class, MOA, ADEs, uses
*vasodilator *MOA: increases cGMP → smooth muscle relaxation (VASODILATION) *ADEs: hair growth, sodium/water retention *use: 4th or 5th line drug for HTN
77
clonidine - drug class, MOA, ADEs, uses
*alpha-2 receptor agonist *MOA: stimulate alpha-2, blunting sympathetic nervous system *ADEs: DRY MOUTH, SEDATION, mental status changes, confusion, REBOUND HYPERTENSION if abruptly stopped *use: 4th or 5th line drug for HTN
78
methyldopa - drug class, MOA, ADEs, uses
*alpha-2 receptor agonist *MOA: stimulate alpha-2, blunting sympathetic nervous system *ADEs: dry mouth, sedation, mental status changes, confusion *use: 4th or 5th line drug for HTN
79
"compelling indications" in HTN treatment - defined
*clinical scenario where HTN & another existing comorbidity can be treated with a single drug
80
compelling indication tx: HTN + HFrEF
*thiazides *loops *ACEi *ARBs *BBs *aldosterone blockers
81
compelling indication tx: HTN + HFpEF
*thiazide *loops *ACEi *ARBs *BBs *aldosterone blockers
82
compelling indication tx: HTN + post-MI
*BB *ACEi *ARBs *aldosterone blockers
83
compelling indication tx: HTN + coronary artery disease
*BB *ACEi *CCBs *thiazides
84
compelling indication tx: HTN + diabetes
*thiazides *ACEi *ARBs *CCBs
85
compelling indication tx: HTN + chronic kidney disease
*ACEi *ARBs
86
compelling indication tx: HTN + recurrent stroke prevention
*thiazides *ACEi
87
compelling indication tx: HTN + atrial fibrillation/flutter
*BBs *NDHP CCBs (for ventricular rate control)
88
compelling indication tx: HTN + PREGNANCY
*nifedipine *methyldopa *labetalol *hydralazine
89
drug-related HTN
*corticosteroids → fluid retention *cocaine, amphetamines → vasoconstrictors *cyclosporine/tacrolimus *caffeine/nicotine → vasoconstrictors *NSAIDs → fluid retention *oral contraceptives → fluid retention *decongestants → vasoconstrictors *herbal products
90
antihypertensive medications for hypertensive emergency/urgency
*nitroglycerin (venodilator) *nitroprusside (arterial/venodilator) *nicardipine (CCB) *clevidipine (CCB) *esmolol (beta1 selective BB) *labetalol (nonselective BB) *enalaprilat (ACEi) *hydralazine (arterial vasodilator)

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