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NAPLEX: CVD > HTN: Medications > Flashcards

HTN: Medications Flashcards

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1
Q

Thiazide Diuretics: MOA

A

Blocks Na+/Cl- symporter (DCT)

Prevents Na+ reabsorption –> shifts osmotic balance in renal filtrate

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2
Q

Thiazide Diuretics (5)

[CCHIM]

A 
Chlorothiazide (Diuril)
Chlorthalidone (Thalitone)
Hydrocholorthiazide (Microzide)
Indapamide (--)
Metolazone (Zaroxolyn)
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3
Q

Thiazide: Primary Side Effects (7)

A
  1. ) Hypokalemia (muscle cramps)
  2. ) Hypomagnesmia
  3. ) Hyponatremia
  4. ) Hypercalcemia**
  5. ) Hyperuricemia
  6. ) Hyperglycemia
  7. ) Photosensitivity

**Take in morning (nocturia)

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4
Q

Thiazide: Monitoring Parameters (5)

A
  1. ) BP
  2. ) Electrolytes
  3. ) BUN/SrCr Levels
  4. ) Blood Glucose
  5. ) Uric Acid levels
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5
Q

Chlorothiazide

A

Brand: Diuril
Generic: Chlorothiazide
Class: Thiazide Diuretic (TZD)
Dose: 500-2000mg/day

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6
Q

Chlorthalidone

A

Brand: Thalitone
Generic: Chlorthalidone
Class: Thiazide Diuretic (TZD)
Dose: 12.5-100mg/day

Top 200

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7
Q

Hydrochlorothiazide (HCTZ)

A

Brand: Microzide
Generic: HCTZ
Class: Thiazide Diuretic (TZD)
Dose: 12.5-50mg/day

Top 200

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8
Q

Indapamide

A

Brand: —
Generic: Indapamide
Class: Thiazide Diuretic (TZD)
Dose: 1.25-5mg/day

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9
Q

Metolazone

A 
Brand: Zaroxolyn
Generic: Metolazone
Class: Thiazide Diuretic (TZD)
Dose: 2.5-5mg/day
Other: Can be used in 30mL/min patients

Top 200

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10
Q

Loop Diuretics: MOA (2)

A
  1. ) Inhibit Na+ reabsorption in ASCENDING Loop of Henle
    * *blocks Na+/K+/2Cl- symporter**
  2. ) Decreases PRELOAD
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11
Q

Loop Diuretics (3)

[BFT]

A

Bumetanide (—)
Furosemide (Lasix)
Torsemide (Demadex)

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12
Q

Loop Diuretics: Contraindiation (1) + Key Drug Interactions (4)

A

1.) Sulfa Allergy

  1. ) Increase Li toxicity risk
  2. ) Increase OTOTOXICITY risk with aminoglycosides
  3. ) Decrease DIABETES medication efficacy (SLGTs?)
  4. ) NSAIDs decrease effects
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13
Q

Loop Diuretics: Primary Side Effects (8)

A
  1. ) Hypocalcemia***
  2. ) Hypokalemia
  3. ) Hypomagnesmia
  4. ) Hyponatremia
  5. ) Hyperglycemia
  6. ) Hyperuricemia
  7. ) Metabolic alkalosis **
  8. ) Azotemia (high nitrogen wastes in blood) **

(** vs TZDs)

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14
Q

Loop Diuretics: Monitoring (8)

A
  1. ) BP
  2. ) Electrolyte levels
  3. ) SrCl/BUN
  4. ) Blood Glucose
  5. ) Uric acids
  6. ) Jugular venous pressure (JVP)
  7. ) Urine output
  8. ) Weight (~0.5-1kg drop in first day)
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15
Q

Bumetanide

A

Brand: –
Generic: Bumetanide
Class: Loop
Dose: 0.5-10mg/day

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16
Q

Furosemide

A 
Brand: Lasix
Generic: Furosemide
Class: Loop
Dose: 20-600mg/day 
PO = 2x IV dose

Top 200

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17
Q

Torsemide

A

Brand: Demadex
Generic: Torsemide
Class: Loop
Dose: 10-200mg/day

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18
Q

Potassium-Sparing Diuretics (2) + Doses

[AT]

A

Amloride (–) [5-10mg/day]

Triamterene (Dyrenium) [50-100mg/day]

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19
Q

Potassium-Sparing Diuretics: Contraindications (2) + Drug Interactions (5)

A
  1. ) HyperKALEMIA
  2. ) CKD

Hyperkalemia Risking Meds

  1. ) K-supplements
  2. ) ACEis
  3. ) ARBs
  4. ) ARAs
  5. ) NSAIDs
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20
Q

Potassium-Sparing Diuretics: Primary Side Effects (1)

A

Hyperkalemia

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21
Q

Potassium-Sparing Diuretics: Key Monitoring (3)

A
  1. ) BP
  2. ) Potassium Levels
  3. ) BUN/Sr
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22
Q

Aldosterone Receptor Antagonists (ARAs) (2)

A
  1. ) Spironolactone (Aldactone)

2. ) Eplerenone (Inspra)

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23
Q

ARAs: Monitoring (5)

A
  1. ) Hyperkalemia
  2. ) Metabolic Acidosis (in cirrhotic patients)
  3. ) Altered clearance of salicylates and glycosides
  4. ) Diarrhea
  5. ) CYP3A4 inhibitors (eplerenone)
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24
Q

ARA: Mechanism

A

Block mineralcorticoid receptors –> prevent expression of aldosterone-induced proteins (AIPs)

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25
Aldosterone Receptor Activation Induced Effects (8)
1. ) Activation of Na+-channels 2. ) Removal of Na+ channels from membrane (ENaC) inhibition 3. ) De novo Na+-channel synthesis 4. ) Activation of membrane-bound Na/K-ATPase 5. ) Redistribution of Na/K-ATPase channels to membrane 6. ) De novo Na/K-ATPase-channel synthesis 7. ) Tight junction permeability changes 8. ) Increased mitochondrial production
26
SGK1 Mechanism + Related HTN Disease
Activated by aldosterone Inhibits Nedd4-2 phosphorylation (UBQ ligase) **Nedd4-2 phosphorylates and internalizes ENaC Liddle Syndrome (mutated Nedd4-2 binding domain on ENaC)
27
Beta Blocker: MOA ()
- Reduced cardiac output (CO) | - Negative ionotrope + chronotrope
28
Cardioselective BBs (6) [BAMBAN]
``` Betaxolol Acebutolol Metoprolol Bisprolol Atenolol Nebivolol ```
29
Cardioselective BBs: MOA
Blocks beta adrenergic receptors (b1 > b2) | -Loss of cardioselectivity @ high doses
30
Intrinsic sympathomimetic activity (ISA) BBs [CAPP]
Carvedilol Acebutolol Pindolol Propranolol
31
BB: Lipophillic (6) + Primary Side Effect CLPPMN
``` Carvedilol Labetalol Propranolol Pindolol Metoprolol Nebivolol ``` More likely to cause CNS side effects (i.e. fatigue)
32
BB: Hydrophillic A
Atenolol
33
Acebutolol
Brand: Sectral Generic: Acebutolol Class: Cardioselective BB Dose: 200-1,200mg/day
34
Atenolol
Brand: Tenormin Generic: Atenolol Class: Cardioselective BB Dose: 25-100mg/day
35
Betaxolol
Brand: Kerlone Generic: Betaxolol Class: Cardioselective BB Dose: 5-20mg/day
36
Bisoprolol
Brand: Zebeta Generic: Bisprolol Class: Cardioselective BB Dose: 2.5-20mg/day
37
Metoprolol Tartrate
Brand: Lopressor Generic: Metoprolol Tartrate Class: Cardioselective BB Dose: 25-400mg/day (BID dosing)
38
Metoprolol Succinate
Brand: Toprol XL Generic: Metoprolol Succinate Class: Cardioselective BB Dose: 25-400mg/day (QD Dosing)
39
Nebivolol
Brand: Bystolic Generic: Nebivolol Class: Cardioselective BB Dose: 5-40mg/day
40
Carvedilol IR
Brand: Coreg Generic: Carvedilol IR Class: Nonselective BB Dose: 12.5-50mg/day (BID)
41
Carvedilol CR
Brand: Coreg CR Generic: Carvedilol CR Class: Nonselective BB Dose: 20-80mg (QD)
42
Labetalol
Brand: Trandate Generic: Labetalol Class: Nonselective BB Dose: 200-2,400mg/day
43
Nadolol
Brand: Corgard Generic: Nadolol Class: Nonselective BB Dose: 20-320mg/day
44
Pindolol
Brand: -- Generic: Pindolol Class: Nonselective BB Dose: 5-60mg/day
45
Propranolol
Brand: Inderal Generic: Propranolol Class: Nonselective BB Dose: 80-640mg/day IR (BID-TID) + ER (QD)
46
Timolol
Brand: -- Generic: Timolol Class: Nonselective BB Dose: 20-60mg/day
47
Cardioselective BB: Primary Side Effects (9)
1. ) Bradycardia/Heart block 2. ) HF exacerbation 3. ) Bronchospasm 4. ) Cold extremities 5. ) Fatigue 6. ) Decreased exercise tolerance 7. ) Depression (lipophilllc) 8. ) Glucose intolerance 9. ) Marked hypoglycemia (DM patients) [same as nonselective]
48
Cardioselective BB: Contraindications + Drug Interactions
≥ 2nd Degree Heart Block HF (EXCEPT bisoprolol and metoprolol succinate) *avoid abrupt discontinuation (titration required)
49
Cardioselective BB: Monitoring Parameters (4)
1. ) BP 2. ) HR 3. ) S/S HF 4. ) Blood Glucose (DM patients)
50
Nonselective BB: Primary Side Effects
1. ) Bradycardia/Heart block 2. ) HF exacerbation 3. ) Bronchospasm 4. ) Cold extremities 5. ) Fatigue 6. ) Decreased exercise tolerance 7. ) Depression (lipophilllc) 8. ) Glucose intolerance 9. ) Marked hypoglycemia (DM patients) [same as selective]
51
Nonselective BB: Contraindications + Drug Interactions
- ≥ 2nd degree heart block (w/o pacemaker) | - HF (except carvedilol)
52
Nonselective BB: Monitoring Parameters
1. ) BP 2. ) HR 3. ) S/S HF 4. ) Blood Glucose (DM patients)
53
Combination Products: Tenoretic
Atenolol/chlorthalidone
54
Combination Products: Ziac
Bisoprolol/HCTZ
55
Combination Products: Corzide
Nadolol/Bendroflumethiazide
56
Combination Products: Inderide
Propranolol/HCTZ
57
Combination Products: Lopressor HCT
Metoprolol Tartrate/HCTZ
58
Combination Products: Dutoprol
Metoprolol Succinate/HCTZ
59
ACEi (10) Meds BCEFLMPQRT
1. ) Benazepril (Lotensin) 2. ) Captopril (Capoten) 3. ) Enalapril (Vasotec) 4. ) Fosinopril (--) 5. ) Lisinopril (Prinivil, Zestril) 6. ) Moexipril (Univasc) 7. ) Perindopril (Aceon) 8. ) Quinapril (Accupril) 9. ) Ramipril (Atlace) 10. ) Trandolapril (Mavik)
60
ACEi: Contraindications (4)
1. ) Pregnancy 2. ) Hx: Angioedema or previous failure 3. ) Hyperkalemia 4. ) Bilateral artery stenosis
61
ACEi: Primary Side Effects (4)
1. ) Hyperkalemia 2. ) Renal insufficiency 3. ) Cough (DRY) 4. ) Angioedema
62
ACEi: Monitoring (3)
1. ) BP 2. ) BUN/SCr 3. ) Potassium
63
Benazepril
Brand: Lotensin Generic: Benazepril Class: ACEi Dosing: 4-50mg/day
64
Captopril
Brand: Capoten Generic: Captopril Class: ACEi Dosing: 12.5-450mg/day -Shortest duration of action
65
Enalapril
Brand: Vasotec Generic: Enalapril Class: ACEI Dosing: 2.5-40mg/day -Oral (Epaned) and Injectable (Enalaprilat) preparations available
66
Fosinopril
Brand: -- Generic: Fosinopril Class: ACEi Dosing: 5-80mg/day
67
Lisinopril
Brand: Zestril, Prinivil Generic: Lisinopril Class: ACEi Dosing: 2.5-40mg/day
68
Moexipril
Brand: Univasc Generic: Moexipril Class: ACEi Dosing: 3.75-30mg/day
69
Perindopril
Brand: Aceon Generic: Perindopril Class: ACEi Dosing: 4-16mg/day
70
Quinapril
Brand: Accupril Generic: Quinapril Class: ACEI Dosing: 10-80mg/day
71
Ramipril
Brand: Atlace Generic: Ramipril Class: ACEi Dosing: 1.25-20mg/day
72
Trandolapril
Brand: Mavik Generic: Trandolapril Class: ACEi Dosing: 0.5-4mg/day
73
ACEi: MOA
``` Inhibit ACE (angiotensin I --> II conversion) Decrease in aldosterone production Inhibit Bradykinin breakdown (cough source) ```
74
ARBs (8)
``` Azilsartan (Edarbi) Candesartan (Atacand) Eprosartan (Teveten) Irbesartan (Avapro) Losartan (Cozaar) Olmesartan (Benicar) Telmisartan (Micardis) Valsartan (Diovan) ```
75
ARB: MOA
Inhibit angiotensin II binding with AT1 receptors Reduction in aldosterone production NO EFFECTS ON BRADYKININ
76
ARB: Contraindications (4)
1. ) Pregnancy 2. ) Hx: Angioedema or previous failure 3. ) Hyperkalemia 4. ) Bilateral artery stenosis
77
ARB: Drug Interactions
Hyperkalemia risk with combinations (ACEi, supplements, etc.) Increases lithium toxicity risk
78
Azilsartan
Brand: Edarbi Generic: Azilsartan Class: ARB Dosing: 40-80 mg/day
79
Candesartan
Brand: Atacand Generic: Candesartan Class: ARB Dosing: 4-32mg/day
80
Eprosartan
Brand: Teveten Generic: Eprosartan Class: ARB Dosing: 400-800mg/day
81
Irbesartan
Brand: Avapro Generic: Irbesartan Class: ARB Dosing: 75-300mg/day
82
Losartan
Brand: Cozaar Generic: Losartan Class: ARB Dosing: 25-100mg/day
83
Olmesartan
Brand: Benicar Generic: Olmesartan Class: ARB Dosing: 20-40mg/day
84
Telminsartan
Brand: Micardis Generic: Telminsartan Class: ARB Dosing: 20-80mg/day
85
Valsartan
Brand: Diovan Generic: Valsartan Class: ARB Dosing: 80-320mg/day
86
DRI (1) + MOA
Direct Renin Inhibitor Aliskiren (Tekturna) Blocks angiotensinogen --> angiotensin I conversion via Renin
87
DRI: Contraindications (4)
1. ) Pregnancy 2. ) Hx angioedema with ACEis/ARBs 3. ) Hyperkalemia 4. ) Bilateral renal artery stenosis
88
DRI: Drug Interactions
Hyperkalemia risk with other drugs (ACEs, ARBs, etc.) Avoid taking with HIGH FAT DM/Renal Impairment Avoid with furosemide (decrease effects), itraconazole/cyclosporine (increase effects)
89
DRI: Side Effects (4)
1. ) Headache 2. ) Dizziness 3. ) Diarrhea 4. ) Hyperkalemia/renal insufficiency
90
DRI: Key Monitoring (3)
1. ) BP 2. ) BUN/SrCr 3. ) Potassium Levels
91
Aliskiren Combo Products (3):
1. ) Aliskiren/amlodipine (Tekamlo) 2. ) Aliskiren/amlodipine/HCTZ (amturnide) 3. ) Aliskiren/HCTZ (Tekturna HCT)
92
DHP CCB: MOA
Block L-type channels in vascular smooth muscle Specific/selective to vascular tissues (POTENT) NO alterations to cardiac conductivity NO cardiac conduction alterations
93
Non-DHP CCB: MOA
Block L-type channels in vascular smooth muscle Less peripheral dilation Negative chronotropic effects
94
DHP CCB (6)
``` Amlodipine (Norvasc) Felodipine (Plendil) Nicardipine (--) Nifedipine (Procardia, Nifedical, etc.) Nisoldipine (Sular) ```
95
Non-DHP CCB (2)
Diltiazem (Cardizem) | Verapamil (Calan)
96
DHP CCB: Contraindications + Drug Interactions
None CYP3A4 substrate (inhibitors increase, inducers decrease)
97
DHP CCB: Side Effects (6)
``` Reflex tachycardia Headache Flushing Peripheral edema Gingival hyperplasia HF exacerbation (NOT AMLODIPINE + FELODIPINE) ```
98
DHP CCB: Monitoring
BP HR Heart Failure S/Sx
99
Non-DHP CCB: Contraindications + Drug Interactions
≥ 2nd Degree Heart Block Systolic HF CYP3A4 interactions Use with other negative choronotropes Increase digoxin toxicity Increase CYP3A4 substrate toxicity
100
Non-DHP CCB: Side Effects (5)
1. ) Bradycardia/Heart block 2. ) Constipation 3. ) Peripheral edema 4. ) Gingival hyperplasia 5. ) HF exacerbation
101
Non-DHP CCB: Monitoring
BP HR Heart Failure S/Sx
102
Amlodipine
Brand: Norvasc Generic: Amlodipine Class: DHP CCB Dosing: 2.5-10mg/day
103
Felodipine
Brand: Plendil Generic: Felodipine Class: DHP CCB Dosing: 2.5-20mg/day
104
Isradipine
Brand: -- Generic: Isradipine Class: DHP CCB Dosing: 5-10mg/day
105
Nicardipine
Brand: Cardene Generic: Nicardipine Class: DHP CCB Dosing: 60-120mg/day (BID-TID)
106
Nifedipine
Brand: Adalat, Procardia Generic: Nifedipine Class: DHP CCB Dosing: 30-180mg/day
107
Nisoldipine
Brand: Sular Generic: Nisoldipine Class: DHP CCB Dosing: 10-40mg/day
108
Diltiazem
Brand: Cardizem Generic: Diltiazem Class: Non-DHP CCB Dosing: 120-540mg/day
109
Verapamil
Brand: Calan Generic: Verapamil Class: Non-DHP CCB Dosing: 120-360mg/day
110
Alpha1-Receptor Antagonists: MOA
Block a1 receptors in peripheral blood vessels (both arterial and venous) --> dilation
111
Alpha1-Receptor Antagonists: Contraindications + Drug Interactions
Not in combination with PDE-5 inhibitors (hypotension risk)
112
Alpha1-Receptor Antagonists: Monitoring
BP | HR
113
Alpha1-Receptor Antagonists: Side Effects (5)
1. ) Orthostatic hypotension 2. ) Reflex tachycardia 3. ) Peripheral Edema 4. ) Headache 5. ) Drowsiness Take at bedtime to avoid orthostatic hypotension
114
Doxazosin
Brand: Cardura Generic: Doxazosin Class: Alpha1-Receptor Antagonists Dosing: 1-16mg/day
115
Prazosin
Brand: Minipress Generic: Prazosin Class: Dosing: 1-20mg/day
116
Terazosin
Brand: ---- Generic: Terazosin Class: Dosing: 1-20mg/day
117
Central Alpha2 Receptor Agonist: MOA
Stimulate a2 brain receptors --> decrease sympathetic outflow [lower norepinephrine release] --> lower HR/BP
118
Central Alpha2 Receptor Agonist: Monitoring
BP HR LFTs (methyldopa) Tapering required (2w)
119
Central Alpha2 Receptor Agonist: Contraindications + Drug Interactions
Methyldopa (liver disease) Other negative chronotropes (i.e. digoxin, verapamil, etc.)
120
Central Alpha2 Receptor Agonist: Side Effects (7)
1. ) Sedation 2. ) Orthostatic hypotension 3. ) Depression 4. ) Peripheral edema 5. ) Dry mouth 6. ) Bradycardia 7. ) Hepatitis (methyldopa)
121
Clonidine
Brand: Catapres Generic: Clonidine Class: Central Alpha2 Receptor Agonist Dosing: 0.2-2.4mg/day Epidural injection available (pain) Transdermal available (0.1-0.3mg QW) **treatment needs to overlap with oral therapy**
122
Methyldopa
Brand: --- Generic: Methyldopa Class: Central Alpha2 Receptor Agonist Dosing: 250-1000mg/day Safe in pregnant HIV patients
123
Direct Vasodilator: MOA
Increase cGMP --> aterial vasodilation
124
Direct Vasodilator: Side Effects
``` Reflex tachycardia Orthostatic hypotension Peripheral edema Lupus-like syndrome (hydralazine) Hirsutism (minoxidil) ```
125
Direct Vasodilator: Contraindications + Drug interactions
Acute MI Aortic Dissection None
126
Direct Vasodilator: Monitoring
BP HR S/Sx Lupus (chest pain, joint pain, fever, rash)
127
Hydralazine
Brand: --- Generic: Hydralazine Class: Direct vasodilator Dosing: 25-300mg/day Injection available
128
Minoxodil
Brand: --- Generic: Minoxodil Class: Direct vasodilator Dosing: 2.5-100mg/day LAST LINE THERAPY DUE TO SIDE EFFECTS (Hirsutism) Topical and solution/foam available

NAPLEX: CVD (2 decks)

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