1 - Anti-Hypertensives Flashcards
what are the 4 ACE inhibitor drugs?
lisinopril, benazepril, captopril, and enalapril
What is the mechanism of action for ACE Inhibitors?
Renin Angiotensin Aldosterone (RAA) system inhibitor - blocks the conversion of angiotension1 to angiotension2
results in elevated levels of bradykinin
What is the main distinguishing two side effects of an ACE Inhibitors/Lisinopril?
Cough with no phlegm (non productive) and Taste disturbance
what hypersensitivity side effect is seen with ACE inhibitors/Lisinopril?
angioedema (looks like preceptal cellulitis) and eyelid edema
What are the most common side effects of an ACE Inhibitors/Lisinopril?
photosensitivity, reduced vision, headache, hypotension and conjunctivitis (also retinal hemorrhages and diplopia)
What 2 drugs will inhibit renal prostaglandins and antagonize therapy with Lisinopril?
Acetaminophen and ASA
What major drug is known to cause renal toxicity and exacerbate hyperkalemia when combined with Lisinopril?
Cyclosporine
What major disease should you watch out for when using Lisinopril?
Sjogren’s Syndrome
What are the 2 Angiotensin 2 Receptor Blockers?
ValSARTAN and CandeSARTAN
What type of drugs are used for someone post MI?
Angiotensin 2 Receptor Blockers and Beta Blocker
what are the hypersensitivity reactions seen with valsartan?
Angioedema and Vasculitis
What are the 2 major contraindications for Valsartan?
NSAID’s (antagonism) and Cyclosporine (hyperkalemia)
What type of Anti-Hypertensive drug group works directly on the walls of the heart? What is the mechanism of action?
Calcium Channel Blockers (Amlodipine,Diltiazem and Veraprimil)
Mechanism - Inhibits trans membrane Ca++ current into VSM»_space; cardiac muscle
Name 3 ocular issues when using Amlodipine?
Conjunctivitis, Diplopia and Pain
what are the common side effects for amlodipine?
Headache, Dizziness
What is the most common contraindication of Anti-Hypertensives?
Cyclosporine - It can induce renal toxicity, suppress metabolism
What will occur if a pt. is taking a amlodipine and Dexamethosone?
Enhancement of metabolism will occur and diminish the results of amlodipine
What two types of Glaucoma drugs are contraindicated with Amlodipine?
Alpha 2 agonists and Beta Blockers
both are additive
what are the indications for amlodipine?
hypertension and coronary artery disease (CAD)
what is the alpha blocker anti-hypertensive?
Terazosin
What are two common indications of Terazosin?
HTN and BPH (Benign Prostatic Hypertrophy)
What is the mechanism of action for Terazosin?
Antagonizes peripheral alpha 1 adrenergic receptors
what are the common side effects for terazosin?
headache, dizziness, pain and paresthesia
What is the distinguishing side effect for Terazosin?
Intraoperative floppy iris syndrome
When a pt. takes Terazosin, what will happen if they take a sympathomimetic?
reduced effect of BP lowering
What are the 3 types of beta blockers?
Metoprolol, Propranolol and Atenolol
what are the indications for metoprolol?
hypertension, angina pectoris and post MI
What is the mechanism of action for metoprolol?
selective competitive antagonism of beta1 receptors = reduces systolic BP and CO via negative inotropic and chronotropic effects
central acting inhibition of sympathetic outflow and suppression of renin activity
What Anti-hypertensive drug has a side effect of depression and short term memory loss?
Metoprolol
What are the number 1 health threats in men and women?
Heart problems
what are the common ocular side effects for metoprolol?
increased migranious scotomata, reduced IOP, glaucoma progression and exacerbation of myasthenia gravis
What is the mechanism of action for Furosemide?
inhibits re-absorption of NaCl at proximal/distal convoluted tubule and loop of Henle
what are the common side effects for furosemide?
Blurred vision, hypotension, pruritus (allergy based)
What is a contraindication/caution when using furosemide or hydrocholorthiazide?
Sulfonamide allergies
What major ocular adverse effect can occur when using hydrocholorthiazide?
Angle Closure Glaucoma
what happens if you take CAIs with hydrochlorothiazide?
synergy or additive = used to treat an acute angle closure in clinic *monitor BP - patient may faint
what are the indications for spirolactone?
hypertension, CHF, hyperaldosteronism, and hypokalemia
What is the mechanism of action for Spironolactone?
Antagonize aldosterone receotors in distal tubule. This will cause loss of water, sodium and have high amounts of potassium retension
What diuretic will could cause, as adverse affect, gynecomastia and menstrual irregularities?
Spironolactone (steroid side effects are seen)
What will occur when NSAID’s and Spironolactone are interacted?
reduced BP lowering
what is the mechanism of action for clonidine?
Stimulation of central and spinal alpha 2 adrenergic receptors (presynaptic and post junctional)
Note: It is a Central Acting Alpha Agonist
what is a serious side effect seen with clonidine?
Angioedema
what happens if you take ophthalmic beta-blockers and decongestants with clonidine?
antagonistic effect
**beta blockers should be BP lowering but they enhance sympathomimetic activity at alpha1 receptors
What is the mechanism of action for hydralazine?
Directly dilates peripheral vessels via hyperpolarization of vascular smooth muscle which thus inhibits Ca++ influx (depolarization)
what are the side effects for hydralazine?
headaches and Lupus erythematosus
What is a important drug interaction with hydralazine?
NSAID’s (antagonistic = these raise BP)
What is the mechanism of action for Hydrocholorthiazide?
Inhibits reabsorption of NaCl at distal convoluted tubule
What is the mechanism of action for beta blockers?
Antagonism of B1 receptor reducing systolic BP and CO. Suppression of Renin activity
What Anti-hypertensive drug has a side effect of depression and short term memory loss?
Beta-Blockers (Meopholol, Propranolol and Atenolol)
What is the mechanism of action for Furosemide?
Specifically, Cl- binding is inhibited
Inhibition reabsorption of NaCl at the both proximal/distal tubules and loop of henle of the kidneys
What is the most common ocular adverse effect of furosemide?
Blurred vision
What durietic drug is contraindication when NSAID’s are given?
ALL HAVE Contraindication
What is the mechanism of action for Hydrocholorthiazide?
Inhibits reabsorption of NaCl at distal convoluted tubule
What major ocular adverse effect can occur when using hydrocholorthiazide?
Angle Closure Glaucoma
What are the 3 types of drug contraindications when using hydrocholorthiazide?
CAI’s, NSAID’s and Erythromycins
Which of the diuretics does potassium sparing?
a. hydrocholorthiazide
b. spironolactone
c. furosemide
b. Spironolactone
What is the mechanism of action for Spironolactone?
Antagonize aldosterone receotors in distal tubule. This will cause loss of water, sodium and have high amounts of potassium
What will occur when NSAID’s and Spironolactone are interacted?
reduced BP lowering
Clonidine is used for severe cancer related pain and as a hypertensive drug. What is the mechanism of action?
Stimulation of central and spinal alpha 2 adrenergic receptors (presynaptic and post junctional)
Note: It is a Central Acting Alpha Agonist
What is a serious adverse of Clonidine?
Angioedema
What is the mechanism of action for hydralazine?
Directly dilates peripheral vessels via hyperpolarization of vascular smooth muscle which thus inhibits Ca++ influx (depolarization)
What is a major adverse effect of hydralazine?
Lupus erythematosus
What is a important drug interaction with hydralazine?
NSAID’s
what happens if you take terazosin with a systemic beta-blocker?
it is additive - enhances BP lowering
what is the caution for terazosin?
cataract surgery - due to intraoperative floppy iris syndrome
what are the common side effects for metoprolol?
visual disturbances, decreased tear production (dry eye syndrome) and headaches
what happens if you take metoprolol with ophthalmic alpha2 agonists or beta blockers?
there is an additive effect
what happens if you take metoprolol with pilocarpine?
there is an additive effect - cholinergic agents produce additive effects on cardiac conduction
what happens if you take metoprolol with NSAIDs or ophthalmic decongestants?
antagonistic effect
what are the 3 diuretics used to treat hypertension?
furosemide, hydrochlorothiazide, and spironolactone
what is the indication for furosemide?
hypertension, acute pulmonary edema and hypercalcemia
what is the pharmacology for furosemide?
high ceiling/loop diuretic = Ca2+ and K+ depleting
what are the hypersensitivity reactions are seen with furosemide?
stevens johnson syndrome and erythema multiforme
what is the cardiovascular side effect seen with furosemide?
decreased potassium and vasculitis
what is the hematology side effect seen with furosemide?
anemia
what happens if you take furosemide with aminoglycosides?
additive - nephrotoxicity
what happens if you take CAIs or erythromycins with furosemide?
prolong QT interval = life threatening
what are the indications for hydrochlorothiazide?
hypertension, peripheral edema, CHF, and osteoporosis
what are the hypersensitivity reactions seen with hydrochlorothiazide?
erythemia multiforme and stevens johnson syndrome
what are the hematology side effects seen with hydrochlorothiazide?
anemia, leukopenia, and thrombocytopenia
what happens if you take NSAIDs with hydrochlorothiazide?
antagonistic effect (NSAIDs raise BP)
what happens if you take erythromycins with hydrochlorothiazide?
prolonged QT interval
what happens if you take spironolactone with cyclosporine?
hyperkalemia may result
what are the indications for clonidine?
hypertension and severe cancer related pain
what is the pharmacology for clonidine?
antihypertensive = central acting alpha agonist
analgesic
what happens if you take clonidine and antihistamines or opioids?
enhanced CNS depression
what happens if you take clonidine with ophthalmic alpha 2 agonists?
additive effect
what are the indications for hydralazine?
hypertension, CHF, and hypertensive crisis
what is the pharmacology for hydralazine?
antihypertensive = vasodilator
