HTN Drugs Flashcards Preview

Cardiovascular > HTN Drugs > Flashcards

Flashcards in HTN Drugs Deck (67):
1

Most common HTN patients

older women, blacks

2

Organs effected by HTN

Heart - heart failure Brain - aneurysm, hemorrhage, stroke Kidney - failure Eye - retinopathy

3

JNC8 guidelines for HTN therapy; goals

>60 = <150, <90

4

Drug classes used in HTN

Vasodilators CCBs SNS-altering RAAS inhibitors Diuretics

5

Vasodilator drugs

Minoxidil, diazoxide, hydralazine, nitroprusside, fenoldopam

6

Mechanism of minoxidil and diazoxide

Increase K+ ATPase = hyperpolarization

7

Fenoldopam; unique feature

Only IV arterial dilator to also increase renal perfusion

8

Hydralazine; unique SE

Lupus-like

9

Common vasodilator side effects

Reflex tachycardia - stimulation of baroreceptors by dropping BP Increased renin/RAAS - stimulation of kidney due to decreased perfusion

10

CCB drugs

Dihydropyridines - nifedipine, amlodipine Non-dihydropyridines - verapamil, diltiazem

11

Dihydropyridines vs non-dihydropyridines

Dihydropyridines = reflex tachycardia; do not effect heart Non-dihydropyridines = decrease AV node conduction = no tachycardia = decreased HR

12

CCB common SE

flushing, headache

13

CCB unique SE

Verapamil - constipation V>D>N - negative inotropic N - edema and refractoriness

14

Vasodilators; a specific use

Hypertensive crisis - BP >180/120 IV arterial dilators - fenoldopam, nitroprusside

15

How to treat hypertensive crisis

IV arterial dilators - fenoldopam and nitroprusside Gradual, titrated treatment - a big BP drop = ischemia and further organ damage

16

Organs and associated SNS receptors

Heart - B1 Lung - B2 Kidney - A1/B1 Arteriole - A1/B2 Venule - A2

17

non-specific alpha antagonists

phenoxybenzamine phentolamine

18

non-specific alpha antagonist side effects

Inhibit A2 = no NE reuptake = rebound HTN when stopping drug

19

A1 specific antagonists

Prazosin, terazosin, doxazosin

20

A1 selective antagonist side effects

First-pass effect -orthostatic hypotension/dizziness/syncope

21

How to avoid A1 selective antagonist side effects

Give first dose at night before bed

22

non-specific beta antagonists

Propranolol - B1 and B2

23

Effects of B1 block

Heart - decreased HR Kidney = decreased RAAS

24

Effects of B2 block

Lung = bronchospasm Liver/pancreas = hypoglycemia, inc TAG/dec HDL Arterioles = constriction

25

B1-selective antagonists

Metoprolol, atenolol -effect B2 at high doses

26

Preferred beta-blocker and why

Metoprolol and atenolol -Safe in = asthmatics, diabetics, peripheral arterial disease

27

beta-blocker SE

impotence, hypoglycemia, bradycardia, depression, excersise intolerance, inc TAGs and dec HDL

28

Mixed beta-blockers

Labetalol and cravedilol - B1 + B2 + A1

29

How to avoid vasodilator SE

Combination therapy w/ beta-blocker and diuretic

30

Central A2 agonists

Clonidine, Guanadine, methyldopa

31

Mechanism of central A2 agonists

Decrease SNS outflow and Increase PNS outflow

32

SE of central A2 agonists

Depression, Na/water retention, orthostatic hypotension, rebound hypertension

33

Methyldopa - unique SE

hepatitis and hemolytic anemia

34

Clonidine - unique SE

anticholinergic (Blind as a bat, dry as a bone, hot as a hare, etc.)

35

Neuronal/ganglionic A2 agonists

Reserpine, guanethidine, guanadril, Trimethaphan

36

Only ganglionic A2 agonist?

Trimethaphan

37

SE of neuronal/ganglionic A2 agonists

increased gastric secretions, diarrhea, Na/water retention, depression, orthostatic hypotension, bradycardia

38

Drug combined w/ A2 agonists?

Diuretics - to prevent fluid retention

39

K+ sparring diuretic

Amiloride

40

Diuretic SE

orthostatic hypotension, hypomagnesium/hypokalemia/hypocalcemia/hyposodium, hyperglycemia/hyperuricemia Photosensitivity and ototoxicity

41

How to treat african americans initially?

Start w/ diuretics - more effects in blacks than ACE inhibitors

42

Aldosterone antagonists

Spironolactone, eplerenone

43

SE of aldosterone antagonists

Hyperkalemia

44

Renin inhibitor

Aliskiren

45

AT2 receptor

Binds angiotensin II/III - opposite effects of AT1 antiinflammatory, vasodilatory, apopototic

46

Special effect of ACE inhibitors and aldosterone antagonists

Regress and prevent heart hypertrophy

47

ACE inhibitors

Captopril, lisinopril, enalapril

48

ARBs

Losartan

49

ACE inhibitors; unique SE

Angioedema (discontinue immediately), cough

50

ACE inhibitors; general SE

Hyperkalemia, neutropenia

51

What to monitor w/ ACE inhibitors?

K+ levels and serum creatinine

52

When are ACE inhibitors contraindicated

In patients w/ renal artery stenosis - bilateral or unilateral; will cause failure Pregnancy

53

ARB side effects

orthostatic hypotension, renal insufficiency, hyperkalemia

54

How fast do ARBs/ACE inhibitors work?

Take 6 weeks to reach max effect

55

SE of renin inhibitor

orthostatic hypotension, hyperkalemia

56

ARBs/ACE inhibitors and drug interactions; what to watch out for

NSAIDs - due to prostaglandins Hyperkalemia inducing drugs

57

An example of synergistic combo therapy involving ACE inhibitors/ARBs

Diuretics - decreased fluid retention = increased renin release by kidney for increased perfusion Diuretics + ACE/ARB combo = no renin release = more effective drop in BP

58

ACE inhibitors and race

not as effective in blacks; diuretics more effective

59

JNC7 vs JNC8

Removed lifestyle modification Added grading system based on importance of guideline Systemic literature review Added racial, CKD, and diabetic subgroups Altered goals of therapy for >60

60

JNC8 first line therapy recommendations

General population

  • First line - ACEi, ARB, thiazide diuretics, CCB

Black

  • First line - thiazide diuretics, CCB

Diabetic

  • First line - thiazide diuretics, CCB, ACEi, ARB

CKD

  • First line - ACEi, ARBs

61

JNC8 therapy strategy

 

First visit = 1 anti-HTN drug

If goal not met w/in a month = add a second drug or increase dose of first drug

If goal not met w/ 2 medications = add a third drug (titrate); do not use ACEi and ARB together (similar action)

If goal not met w/ 3 medications = refractory HTN

62

What to monitory w/ diuretic therapy

BP

BUN/creatinine

Electrolytes - K+, Mg, Ca

uric acid - mainly for thiazide

63

What to consider with ACEi therapy in blacks?

Angioedema - 2 to 4x higher

Diuretics show stronger effect

64

Which drugs are contraindicated w/ LVH

Hydralazine and minoxidil

65

Which anti-HTN can be used w/ pregnancy?

Avoid ACEi/ARBs

 

Use - methyldopa, beta-blockers, vasodilators

66

anti-HTN drugs in sexually active teens?

 

Avoid ACEi/ARBs

67

General Tx strategy

2 or more drugs are usually needed

Thiazide diuretic should be one of those drugs