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Renal 2 > HTN Drugs - Kruse > Flashcards

HTN Drugs - Kruse Flashcards

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1
Q

4 categories of HTN drugs

A
  1. Vasodilators
  2. Sympathetic antagonists
  3. Diuretics
  4. ACE Inhibitors/ARBs
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2
Q

How to use vasodilator drugs?

A

W/ diuretic or beta blocker – for compensatory tachycardia, salt/water retention, etc.

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3
Q

Classes of vasodilator drugs

A
  • Calcium channel blockers (DHP, non-DHP)
  • Potassium channel openers
  • D1 agonists
  • N.O. release agents
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4
Q

Function of calcium channel blockers

Channel types?

A

Block L-type (voltage-gated) Ca++ channels to reduce frequency of opening w/ depol.

  • Vascular channels = vasodilate
  • Cardiac channels = decreased ht function
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5
Q

When not to use CCBs

A

Heart slowing failure of any kind (CHF, bradycardia, heart block)

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6
Q

Types of CCBs

A
  • DHPs = vascular selective

- Non-DHPs = both L-type channels

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7
Q

DHP CCB drug names

A
  • Nifedipine

- Amlodipine

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8
Q

Non-DHP CCB drug names

A
  • Verapamil

- Diltiazem

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9
Q

Nifedipine vs. Amlodipine

A

Both DHP CCBs

N = short acting, no AV problems
A = long acting, some AV problems
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10
Q

Nifedipine vs. Amlodipine:

Use when?
Don’t use when?

A

N - use for AV conduction abnormality, short term. DON’T USE for chronic HTN

A - use for angina or HTN. DON’T USE for heart failure

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11
Q

Verapamil and Diltiazem (Non-use)

A

Both non-DHP CCBs

 - Decrease vascular AND cardiac mm. fxn
 - NOT w/ BETA BLOCKER
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12
Q

Verapamil side effect

A

Constipation

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13
Q

Diltiazem side effect

A

Facial rash

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14
Q

A patient is on Nifedipine or Amlodipine. What else should they be on?

A

Other vasodilator (CCB, K+ channel opener, D1 agonist, N.O. modulator)

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15
Q

K+ channel opener drug names

Function?

A
  • Diazoxide
  • Minoxidil

Relax smooth muscle (hyperpolarize)

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16
Q

Diazoxide

A

Long-acting K+ channel opener
Injections

USE - hypertensive emergency
DON’T - renal failure, beta blockers, ischemic ht disease

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17
Q

Minoxidil

A

K+ channel opener
Pro-drug
Use with BETA-BLOCKER and LOOP DIURETIC

USE - long term outpatient severe HTN

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18
Q

Side effects of Minoxidil

A
  • HA, sweating, hair growth (Rogaine)

- REFLEX SNS stimulation –> tachycardia, palpitations, angina, edema

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19
Q

Fenoldopam

A 
D1 agonist
Peripheral vasodilation
Needs continuous IV for short 1/2 life
USE - HTN emergency, operative HTN
DON'T - glaucoma (increased IOP)
S.E.'s = reflex SNS, HA, sweating
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20
Q

N.O. release drugs

Function?

A
  • Hydralazine
  • Nitroprusside

Arteriolar dilation via cGMP

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21
Q

Hydralazine:

Function?
Use? (alone)
Don’t?
Side effects?

A

Fxn = N.O. release (cGMP)
Use - long term HTN
Don’t - Ischemic ht disease
Sides = reflex tach (could lead to arrhythmias in ischemic heart disease)

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22
Q

When might hydralazine be used in combo with something else? (2)

A

HTN + heart failure = Hydralazine + nitrates

HTN + pregnancy = Hydralazine + methyldopa

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23
Q

Nitroprusside:

Function?
Use?
Side effects?

A

Fxn = Metabolized into N.O. –> dilates ALL
- Rapid on, rapid off (continuous IV needed)

Use - HTN emergencies, acute decompensated heart failure, aortic dissection

Sides = Cyanide poisoning (chronic use)

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24
Q

Nitroglycerin:

Function?
Use?
Don’t?
Side effects?

A

Fxn = N.O. release (VEINS smooth muscle)

Use - HTN emergencies, angina, heart failure

Don’t - Increased ICP, PDE5 inhibitors (-afil) (worsened hypotension)

Sides = Tolerance (use 8 hrs between), hypotension, syncope, THROBBING HA’s

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25
How to use sympathoplegic drugs?
With a diuretic (avoid compensatory Na/H2O retention due to hypotension)
26
Classes of sympathoplegic drugs for HTN?
- Beta blockers - Alpha-1 blockers - Alpha-2 agonists
27
Function of beta-blockers for HTN
- Decrease cardiac output | - Decrease renin release (volume deplete)
28
When NOT to use beta blockers?
- Asthma - COPD (unless ischemic ht disease) - Type 1 DM (unless after M.I.) - W/ non-DHP CCB's (heart block)
29
Side effects of beta blockers?
- Bradycardia, fatigue | - Withdrawal --> HTN, angina, MI
30
Propranolol and Carvedilol (compare) Propranolol vs. Carvedilol (contrast)
Both - non-selective w/o ISA --> decrease C.O. Prop - lipophilic --> crosses BBB Carv - Alpha-1 partial agonist too --> decrease PVR via vasodilation
31
Labetalol
Non-selective w/ ISA (alpha-1 block)
32
Metoprolol and Atenolol (compare) Metoprolol vs. Atenolol (contrast)
Both - beta-1 selective, no ISA (decrease C.O.)
33
Which beta blockers to use for: HTN? HF? IHD? Arrhythmia?
HTN - Metoprolol, Atenolol (NOT-initial treatment) HF - Metoprolol, Carvedilol IHD - Metoprolol, Propranolol (prolong life after MI) Arrh - ALL OF THEM
34
Prazosin: Function? Use? With anything? Side effects?
Fxn = Alpha-1 reversible antagonist Use - HTN + BPH (prostate s.m. relax) - Less reflex tach. than non-selective alpha blockers Use with - Diuretic (for compensatory Na/H20 retention) Side effects - Hypotention, dizziness, palpitations, headache
35
Alpha-2 agonists for HTN Function? Benefit of it?
- Clonidine - Methyldopa Decreases CNS sympathetics Baroreceptor response IN TACT
36
Clonidine: Function? Side effects?
Fxn - decreased C.O., vasodilate, derease PVR S.E. = dry mouth, sedation, depression, sexual dysfunction WITHDRAWAL CAUSES BAD HTN CRISIS
37
Methyldopa: Function? Use? Side effects?
Fxn = NE agonist - converted to alpha-methylNE (like L-dopa is converted to NE) Use - PREGNANCY HTN S.E. = dry mouth, sedation, depression, sexual dysfunction
38
Types of diuretics
- Carbonic anhydrase inhibitors - Loop diuretics - Thiazides - K+ sparing diuretics - Osmotic agents - ADH antagonists
39
C.A. inhibitor (name) Function? HCO3-? Body pH? Urine pH?
Acetazolamide - prevent Na+ and HCO3- absorption in PCT - HCO3- excretion - DECREASED body pH - INCREASED urine pH
40
When is acetazolamide used? With anything? When is it NOT used? Side effects?
Use - glaucoma With KCl replacement NOT - diuresis, cirrhosis, acidosis (COPD, etc) S.E. = metabolic acidosis, renal stones, K+ wasting
41
Loop diuretic (name) Function? Electolyte results? pH results?
Furosemide - NaKCl2 transporter inhibitor (TAL) - Na, Cl, K+, Mg, Ca, H+ excretion - INCREASED body pH
42
When to use loop diuretics? When NOT to use loop diuretics? Side effects?
Use - acute edema, HTN + HF, hyperkalemia, hypercalcemia, ANION OD (bromide, fluoride) Don't - Hyponatremia, hypokalemia, metabolic alkalosis, hypomagnesemia, liver disease, sulfonamide sensitivity, renal failure, hypocalcemia, w/ lithium, aminoglycosides, or digoxin Side effects - HypoNa, hypoK, hypoCa, hypoMg, metabolic alkalosis, hearing loss, allergic reaction, dehydration, uric acidemia
43
Hydrochlorothiazide: Function? Electolyte changes? pH changes? Side effects?
- Inhibit Na/Cl cotransporter in DCT --> NaCl excretion - K+ wasting, HCO3- wasting - INCREASED body pH S.E. = Hypokalemia, WORSENED INSULIN DEPLETION, hyperlipidemia, hyponatremia, hypercalcemia, hyperuricemia
44
When not to use HCTZ?
- Sulfonamide hypersensitivity - Anticoaguable state - Gout - Diabetes mellitus
45
When to use HCTZ?
- Nephrolithiasis - Nephrogenic D.I. - HF
46
Types of K+ sparing diuretics
- MR (aldosterone) antagonists | - Na+ channel inhibitors
47
MR antagonist drugs
Spironolactone, eplerenone
48
Na+ channel inhibitors
Amiloride, triamterene
49
MR antagonist drugs: Function? Use? Don't?
Fxn - Aldosterone competitive inhibitor --> decreased ENaC and decreased Na/K ATPase Use - Ht failure, HYPERALDOSTERONISM, K+ wasting of other diuretics Don't - Liver disease, hyperkalemia, metabolic acidosis, renal insufficiency
50
What's special about MR antagonist drugs?
NOT acting on the luminal side, unlike other diuretics
51
Don't combine K+ sparing diuretics with what?
Beta blockers, NSAIDs, or ACE inhibitors
52
Function of Na+ channel blockers
Same as MR antagonists
53
When to use mannitol?
Maintain or increase urine volume, decrease IOP, decreased ICP
54
When to use desmopressin?
- Pituitary D.I. - Polyuria, polydipsia - Hypernatremia - Nocternal pissing
55
Conivaptan - Treats? - Function?
ADH antagonist - Treats SIADH, HF, hyponatremia - V1a and V2 antagonist
56
Drug combo to treat hypokalemia
K+ sparing + other diuretic
57
Function of ACE inhibitors
Prevent Ang II, increase bradykinin --> decrease PVR
58
When to use ACE inhibitors? When NOT to use ACE inhibitors?
Use - HTN, nephropathy, HF, LV dysfunction, AMI, prophylaxis of cardiac events Don't - PREGNANCY, hypotension, cough, ANGIOEDEMA, acute renal failure
59
Don't combine ACE inhibitors with what drugs?
K+ sparing or NSAIDs
60
Function of ARBs Side effect differences compared to ACE inhibitors? When not to use?
Same as ACE inhibitors EXCEPT no bradykinin increase and no AT2 receptor block - Less cough, less angioedema Don't - PREGNANCY, non-DM renal disease, w/ K+ sparing drugs
61
Function of Clonidine? Use when?
Alpha-2 agonist --> decreased SNS --> decreased renin LAST RESORT
62
Function of Propranolol on RAAS?
Decreased renin via Beta-1 antagonism on JG cells
63
Aliskiren: Use when? Don't use when?
Use - w/ increased renin via ACEI, ARB, diuretics Don't - PREGNANCY, renal insufficiency

Renal 2 (11 decks)

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