HTN Pharm Flashcards by Niko McCauley

adverse effects verapamil

flushing

headaches

negative ionotropes (worse of Ca blockers)

constipation (worse of Ca blockers)

reduced av conduction (worse of Ca blockers)

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neronal and ganglionic blockers

guanethadine

guandadrel

reserpine

trimethapan (ganglionic)

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adverse effects B blockers

glucose intolerance, masked hypoglycemia

bradycardia, dizziness,

increased TGs, decreased HDL

Depression, fatigue, sleep disturbance

reduced CO

impotence

exercise intolerance

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direct renin inhibitor

aliskiren

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adverse effects, aliskerin

orthostatic hypotension

hyperkalemia

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combine reserpine and guanethidine wiht ___ to avoid water retention

thiazide diuretic

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selective alpha 1 blockers

prozosin

terazosin

doxazosin

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reflexive effect of direct arterial vasodilators that can be counteracted with beta blockers

reduced pressure > compensatory increaesed sympathetic flow - HR increase, renin increase

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ACE inhibitors

Captopril

Elanopril

Lisinopril

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Direct Arterial Vasodilators

Hydralazine

Minoxidil

diazoxide

nitroprusside

fenoldopam

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Ca channel blockers

Nifedipine

Diltiazem

Verapamil

Amlodipine

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action of a1/a2 blokcers (phenoxybenzamine, phentolamine)

inhibit smooth muscle catecholamine uptake in peripheral vasculature

vasodilation

lowered BP

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central a2 agonists

clonidine

gunabenz

a-methyldopa

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sympathetic impact on lung

bronchodilation (beta2)

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ACE distribution

prmarily endothelial cells

blood vessels major site of angitotensin II production

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monitor __ and ___ within 4 weeks of ACE inhibitor regiment

K and SCr

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impact of selective alpha1 blockers (terasozin, dozazosin, prazosin)

smaller increase in heartrate than nonselective

do not stimulate renin release

do not block alpha 2 receptors - allows NE inhibition at autoreceptor

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ACE inhibitors

captopril

enalapril

lisinopril

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most effect demographics, beta blockers / mize blockers

better in young adults (older adults, combine with diuretics)

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central a2 agonists

cliinidine

guanabenz

a metyhl dopa

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JNC8 reccomentdation for AA

CCB or thiazide

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symptoms hypertensive emergency

encepoaplopathy

intracranial hemorrhage

acute LV failure with pul edema

dissecting oartic aneurism

unstable angia

ecamplsia

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Beta blocker action at B1 receptors

heart kidney

stimulate HR, contractility, renin release

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adverse effects, diltiazem

flushing

headaches

negative ionotrope

edema

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beta blocker efficacy is dependent upon ___ status

renin status (not effective for low renin HTN)

changes in JNC8

no lifestyle reccommendations Racial, CKD, diabetic subgroups

side effect NO donors (nitroprusside)

cyanide buildup (especially if Kidney failure

Ca channel blockers

Diltiazem (non-dihydro) Verapamil (non-dihydro) Amlodipine Nifedipine

beta 1 blockers

metropolol atenonolol

sympathetic impact on arterioles

constriction (skin, viscera) alpha 1 dilation (skeletal muscle, liver) beta 2

beta 1 blockers

metropolol atenolol

alpha 1/2 blockers

phenoxybenzamine phentolamine

adverse effects reserpine and guanethidine (neuronal blockers)

sedation, depression increased gastric acid (reserpine decreased CO sodium water retntion diarrhea bradycardia

sympathetic impact on heart

contractility and HR (beta 1)

beta blocker actiona t beta 2 receptors

lugn liver pancreas, arterolal smooth muscle bronchodilation and vasodilation mediate insulin secretion and glycogenolysis

JNC8 reccommendation for DM

Thiazide CCB ACEi ARB

new JNC BP goals for under 60 years, over 60

\>60 150/90

aldosterone antagonists

sprinolactone eplerenone

RAS system inhibitors

aliskiren losartan captopril enalapril lisinopril

impact aldosterone antagonists

inhibit renal effect of aldosterone (Na and water retention) and extra renal effects (fibrosis, inflammation)

At1 receptor action

vasoconstriction vascular prolif aldosterone secretion cardiac myocyte proliferation increased sympathetic tone

first line drugs JNC8(vs 7)

7 = Thiazide diuretics 8 = Thiazide CCB ACE inhibitor ARB

adverse effects direct arterial dilators

sodium/water retention tachycardia, angina Hyrdralazine - lupus like syndrome minoxidil - hair growth

when beta1 selectivity is lost at high doses of B1 blockers antenolol and metropolol, may exacerpate

bronchospastic disease

action ACE inhibitiors

block bradykinin degredations stimulate sythesis of vasodilation substances like prostaglandin E2 and prostacyclin prevent or reggress LVH

dihydropyridines vs non-dihyrdropyridines

dihydropyidines don't alter av conduction (no HR depression) so no baroreceptor mediated reflex tachycardia

adverse effects central a2 agonsits

na/water retention discontinued = rebound HTN depression, dizziness clonidine - anticholinergic methyldopa - hepatitis, hemolytic anemia

alpha 1/2 blockers

phenoxybenzamine phentolamine

ARB

losartan

Cardioselective beta blockers receptor effects

metropolol and atenolol inhibit b1 receptors at low to moderate dose inhibit beta2 at higher dose (selective, not specific)

adverse effects nifedipine

flushing headaches edema refractoryness

neuronal ganglionic blockers

guanethidine guandadrel reserpine trimethapan (ganglionic)

alpha 1 blocker first dose effect

orthostatic hypotension tranisent dizziness, fainteness, palpitations, syncope withing 1-3 hours of first dose reflex tachy 1st dose before sleep to minimize

impact aliskerin

renin inhibition does not black bradykinin breakdown - less cough than ace inhibition

impact central a2 agonists (clonidine, guanabenz, amethyldopa)

reduce sympathetic outflow from vasomotor center increasse vagal tone

aldosterone antagonists

spironolactone eplerenone

sympathetic action on the kidney

increased renin (alpha-1, beta-1)

diuretics

hydrochlorothiazide fursemide amiloride

hypertesnive crisis level

180/120

ACE / ARB precautions

acute kidney failure if: severe bilateral artery stenosis (or solitary kindey stenosis) contraindicated in pregnancy

mixed Beta blockers

Propanolol (B1/B2) Labetalol (B1/B2/a1)

adverse effects diuretics

Electrolyte distubance hyperglycemia hypotension/orthstasis lipid abnromalities phosensitivity ototoxicity hyperuriciemia, gout flare

JNC8 reccommendation for CKD

ACEi or ARB

AT2 receptor action

vasodilation antiproliferation apoptosis

adverse effects ACE inhibitors

cough angioedema hyperkalemia (esp if CKD or DM) neurropenia, agrnulocytosis, proteinuria, glomerulonephritis, acute renal fialure

RAS inhibitors

aliskiren losartan captopril enalpril lisinopril

selective alpha 1 blockers

prazosin terzosin doxazosin

Direct Arterial Vasodilators

Hydralazine Minoxidil diazoxide nitroprusside fenoldopam

adverse effects angiotensin II receptor blocker ARBs

orthostatic hypotension renal insufficiency hyperkalemia

HTN Pharm Flashcards

(69 cards)