Therapeutics of Hypertension 3 Flashcards
(25 cards)
Angiotensin Inhibitors
- ACE-i: inhibits conversion from ___ to ___
- ARBs: block effects of ___ by binding to ___
- renin inhibitors: inhibits converion of ___ to ___
- angiotensin I to angiotension II
- angiotensin II by binding to target receptors
- angiotensinogen to angiotensin I
ACE-i
- ___ line treatment for HTN
- additional benefit with history of ___ with proteinuria, ___ , post MI, and___
- good option for PM dosing to ensure BP ___ overnight
- HTN effects by ___, reduced ___, and increased ___
- first
- DM, FH, CKD
- dipping
- vasodilation, PVR, diuresis
ACE-i
AE:
- angiodema
- ___ (up to 20%)
- ___kalemia
- acute ___ failure w/severe bilateral ___ artery ___
Contraindications
- history of ___ on an ACE-i
- concominant use of ___ in patients with diabetes
- pregnancy/breastfeeding
- cough
- hyperkalemia
- renal, renal, stenosis
- angiodema
- aliskiren
ACE-i Frequency
- benazepril, enalapril, moexipril, quinapril, and ramapril are taken ___ or ___ daily
- fosinopril, lisinopril, perindopril, and trandolapril are all taken ___ daily
- captopril is taken ___ or ___ daily
- once, twice
- once
- twice, thrice
ARBs
- ___ line treatment option for HTN
- often “back-up” if an ACE-i isn’t tolerated for other indications
- doesn’t block ___ breakdown = less ___
- can use with history of ___ due to ACE-i
- good option for PM dosing to ensure BP ___ overnight
- HTN effects by ___, reduced ___, and increased ___
- first
- bradykinin, cough
- angiodema
- dipping
- vasodilation, PVR, diuresis
ARBs
AE
- angiodema
- ___kalemia
- acute ___ failure with severe bilateral ___ artery ___
Contraindications
- history of ___ on an ARB
- concomitant use of ___ in patients with diabetes
- pregnancy/breastfeeding
- hyperkalemia
- renal, renal, stenosis
- angiodema
- aliskiren
ARB Frequency
- azilsartan, candesartan, irbesartan, olmesartan, telmisartan, valsartan are all taken ___ daily
- eprosartan and losartan are taken __ or ___ daily
- once
- once, twice
ACE-i/ARB Monitoring
Check ___ and ___ function at baseline
- check BMP within ___ week for elderly
- in low risk patients with K < ___ mEq/L can wait ___ - ___ weeks before initial assessment
- follow up every ___ - __ months
- consider holding or reducing dose if K > ___ mEq/L or SCr increase > ___ %
K , renal
- 1
- 4.5, 3-4
- 6-12
- 5.5, 30%
Direct Renin Inhibitors
Aliskiren
- ___ first line for HTN
- very expensive and no better than ACE-i/ARBs
- doesnt block ___ breakdown = less ___ than ACE-i
- avoid in ___
- concomintant use with an ACE-I or ARB is contraindicated in patients with ___
- NOT
- bradykinin, cough
- pregnancy
- diabetes
Direct Renin Inhibitor Frequency, Monitoring, and AE
frequency: ___ daily
Monitoring: ___ , ___ , and ___
AE
- diarrhea
- ___ effects
- dizziness
- headache
- ___kalemia
- ___ insufficiency
- ___ hypotension
- once
- K, BUN, SCr
- musculoskeletal
- hyperkalemia
- renal
- orthostatic
Angiotensin Inhibitor Clinical Pearls
- discuss ___ methods with women of childbearing age
- do not ___ drug classes due to risk of adverse effects
- assess patients risk for ___ (CKD, other meds)
- educate patient on dietary sources or ___ (bananas, seasoning, etc)
- ___ often preferred over other first-line agents in the presence of other compelling indications
- contraceptive
- combine
- hyperkalemia
- K
- ACE-i/ARBs
CCBs
___ line for HTN
- inhibit influx of ___ across cardiac and smooth muscle cell membranes leading to coronary and peripheral ___
Subclasses:
- dihydropyridines - more ___
- non-dyhydropyridines - more negative ___ effects
overall similar effect on BP
First
- Ca
- vasodilation
- vasodilation
- inotropic
Dihydropyridine CCBs
patient populations with additional benefit
- ___ syndrome
- ___ with isolated ___ HTN
More potent ___ than non-dihydropyridines
- leads to baroreceptor-mediated ___
- no effect on ___ node conduction
Avoid short-acting dihydropyridines ( ___ and ___ )
- Reynaud’s
- elderly, systolic
- vasodilators
- tachycardia
- AV
- IR nifedipine, nicardipine
dihydropyridine CCBs
AE:
reflex ___ , ___, dizziness, headache, peripheral ___ (dose related), gingival hyperplasia
Warnings
- increased risk of ___ / ___ in pts with obstructive coronary disease due to reflex ___
Drug interactions
- ___ juice
- ___ enzyme inducers/inhibitors
- tachycardia, flushing, edema
- angina/MI, tachycardia
- grapefruit
- CYP3A4
Dihydropyridine CCB frequency
- amlodipine, felodipine, isradipine SR, nifedipine LA, nisoldipine are all taken ___ daily
- isradipine and nicardipine SR are taken ___ daily
___ and ___ do not have negative ionotropic effects
- once
- twice
amlodipine, felodipine
Non-dihydropyrindins CCBs
patient populations with additional benefit
- supraventricular tachyarrhythmias ( ___ )
- pts with ___ who cannot tolerate a ___
Slows ___ node conduction and decreases in ___
- negative ___ effects
___ formulations preferred for HTN
- Afib
- angina, beta blocker
- AV, HR
- ionotropic
- ER
Non-dihydropyrindins CCBs Frequency
diltiazem ER and verapamil ER are both taken ___ or ___ daily
- many formulations available and start/max doses differ by product
- not AB rated as interchangeable/equipotent due to differences in ___ mechanisms and ___
once, twice
- release, bioavailability
Non-dihydropyrindines CCBs Frequency
AE:
- ___cardia, headache, dizziness, ___ node block, ___ HF, gingival hyperplasia, ___ (dose related: verapamil ___ diltiazem)
Drug interactions:
- concomitant use of ___
- ___ juice
- ___ enzyme inducers/inhibitors
Contraindications
- ___ block
- ___ ventricular dysfunction
- bradycardia, AV, systolic, consipation, >
- beta blockers
- grapefruit juice
- CYP3A4
- heart
- left
CCB Clinical Pearls
- ___ routine lab monitoring required
- check for drug interactions
- CCBs are ___ line for HTN
- peripheral __ is dose-dependent
- ___ formulations are preferred
- non-dihydropyridine CCB formulations are not ___
- if a CCB is needed in the setting of HF, choose ___
- no
- first
- edema
- ER
- interchangeable
- amlodipine
Beta-Blockers
- NOT ___ line for HTN unless compelling indication is present
- examples or compelling indications include ___ and ___
patient populations with additional benefit
- ___ , tremors, ___, thyrotoxicosis
- decreases HR + force of contraction = decrease in __
- avoid abrumpt ___
- first
- HF, CAD
- tachyarrhyrhmias, migraines
- CO
- cessation
B- blockers
Cardioselective
- atenolol, betaxolol, bisoprolol, metoprolol succinate, nebivolol* are taken ___ daily
- metoprolol tartrate are taken ___ daily
*nebivolol has nitric oxide induced ___
once
twice
vasodilation
B-blockers frequency
non-selective
- Nadolol and propranolol LA are taken ___ daily
- propranolol IR is taken ___ daily
- avoid in ___ airway disease
- once
- twice
- bronchospastic
B-blockers
intrinsic sympathoimetic activity
- acebutolol and
pindolol are taken ___ daily
- penbutolol is taken ___ daily
- avoid in ___ and ___
- twice
- once
- HF, IHD
B-blockers
mixed alpha/beta
- carvedilol and labetalol are taken ___ daily
twice
