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Pharmacology 2 > 1 - Antihypertensives > Flashcards

1 - Antihypertensives Flashcards

1
Q

What are the categories of hypertension and what’s involved in each category?

A
  • Essential Hypertension (Primary or Idiopathic)
    • 85-90% of all cases
  • Secondary Hypertension
    • Endocrine or renal system disease
    • Drugs - NSAIDS, birth control, decongestants, tricyclic antidepressents
  • Malignant Hypertension
    • BP very high or rapidly rises
    • Retinal and renal damage
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2
Q

What are the blood pressure guidelines?

A
  • Normal <120 / <80
  • Prehyptertension 120-139 / 80-89
  • Stage 1 hypertension 140-159 / 90-99
  • Stage 2 hypertension 160+ / 100+
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3
Q

What are the 3 basic methods used to obtain the overall goal of decreasing blood pressure?

A
  • Reduce peripheral resistance
  • Reduce cardiac output
  • Decrease blood volume
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4
Q

How do diuretics work?

A
  • Increase the rate of urine formation
  • Most block the kidney tubular reabsorption of Na+
  • Most diuretics are excreted by kidney tubular secretion
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5
Q

What are the major classes of diuretics?

A
  • Thiazides
  • Loop
  • Potassium sparing
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6
Q

What was the first class of diuretics, that are also not on the market anymore?

A

Mercurials

They all start with “mer…”

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7
Q

What is the first choice agent for hypertension and congestive heart failure?

A

Thiazides (Benzothiazides)

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8
Q

What are the most commonly prescribed diuretics?

A

Thiazides

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9
Q

What are the common preparations of a thiazide diuretics?

A
  • “HCTZ” Hydrochlorothiazide (Microzide)
  • Chlorothiazide (Diuril)
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10
Q

What are the adverse effects of thiazide diuretics?

A
  • Hypokalemia - is sodium intake increases, the potassium loss is exacerbated
  • Elevated cholesterol
  • Hyperglycemia
  • Sexyal dysfunction
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11
Q

Thiazides are not good for patients with _________ or patients with __________ or lipids.

A
  • Diabetes (elevated glucose)
  • High cholesterol
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12
Q

What type of diuretic causes a major loss of volume?

A

Loop Diuretics

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13
Q

What is the drug of choice (diuretic) for serious edema?

A

Loop (high Ceiling) Diuretic

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14
Q

Why are Loop Diuretics potentially toxic?

A
  • Major rapid loss of sodium and potassium = serious electrolyte imbalances may result
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15
Q

All loop diuretics are _______ to some degree (causing hearing loss/deafness)?

A

Ototoxic

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16
Q

What are the common preparations of Loop Diuretics?

A
  • Lasix (furosemide) - most common
  • Edecrin (ethacrynic acid)
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17
Q

What is Lichenoid Drug Reaction?

A

White splotchey drug reaction observed with Thiazide and Loop Diuretics

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18
Q

What are Potassium-sparing Diuretics? And what are the common preparations?

A

They block the effect of aldosterone, and prevent the usual loss of K+

  • spironolactone (Aldactone)
  • triamterene (Dyrenium)
  • eplerenone (Inspra)
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19
Q

What are the adverse effects of Potassium-sparing diuretics?

A
  • Hyperkalemia
  • Gynecomastia
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20
Q

What are Carbonic Anhydrase Inhibitors primarily used for?

A
  • Glaucoma, and therapy for congestive heart failure

acetazolamide - Diamox - common prep

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21
Q

What diuretics are filtered but not reabsorbed, and used in emergencies when a decrease in blood volume is needed?

A

Osmotic Diuretics

22
Q

What type of diuretic is used in emergency rooms to treat hypochloremic states or metabolic alkalosis?

A

Acidifying agents - Ammonium Chloride

23
Q

How do Xanthines work?

A
  • Inhibit ADH - increases bloodflow and decreases reabsorption of water in collecting duct
24
Q

Rank the following diuretics by degree of potency (most to least):

Potassium Sparing

Carbonic Anhydrase inhibitors

Loop

Thiazides

A
  1. Loop
  2. Thiazides
  3. Carbonic anhydrase inhibitors
  4. Potassium-sparing
25
Q

What are some dental considerations dealing with diuretics?

A
  • Xerostomia
  • Apthous stomatitis
  • Lichenoid drug reaction
  • Use of NSAIDS for >3 weeks can decrease effectiveness of diuretics
26
Q

What can patients take to counter the loss of potassium while taking diuretics?

A

Potassium Salts -

The supplements have “K” in the name (K-Tab, Klor-Con)

27
Q

How do Beta-blockers work?

A
  • Decrease cardiac output
  • Decrease renin secretion
  • Reduce plasma volume and venous return
  • Decrease sympathetic outflow from CNS
  • Reduce peripheral resistance
28
Q

How can you classify a beta-blocker by it’s name?

A
  • Beta-blockers end in “…olol”
  • A-M are Cardioselective
  • N-Z are Non-cardioselective
    • Exceptions to this rule are usually meds for glaucoma
29
Q

What are the contraindications to beta-blockers?

A
  • Congestive heart failure - already decreased cardiac outpute
  • Asthma
  • Heart block
  • Diabetes
30
Q

What blockers produce peripheral vasodilation in arterioles and venules, decreasing peripheral vascular resistance?

A

Alpha 1 - Blockers

31
Q

What are alpha-1 blockers used for?

A
  • To improve urination in men with enlarged prostate and those with bladder problems
    • BPH
    • Old men!
32
Q

What are some common preparations of Alpha-1 blockers?

A
  • End in “…osin”
  • doxazosin (Cardura)
  • prazosin (Minipress)
  • *tamsulosin (Flomax) - teratogenic** with side effect of severe orthostatic hypotension
33
Q

What drug prevents conversion of angiotensin I to angiotensin II (a potent vasoconstrictor)?

A

ACE inhibitors

34
Q

What is the mechanism of action for ACE inhibitors?

A
  • Decrease secretion of aldosterone which decreases sodium and water retention
  • Vasodilation and decreased blood volume lower blood pressue
35
Q

What are some common ACE inhibitors?

A
  • End in “…pril”
  • enalapril (Vasotec)
  • lisinopril (Prinivil, Zestril) - biggest seller
  • benzepril (lotensin)
  • captopril (Capoten)
  • fosinopril (Monopril)
36
Q

What are some common side effects of ACE inhibitors?

A
  • Chronic dry cough - mediated by increased bradykinin release in bronchial tree
  • Angioneurotic edema with first dose - which is why the first dose should be taken at physicians office
37
Q

What are ARBs?

A

Angiotensin Receptor Blockers

  • Blocks vasoconstriction and aldosterone-secreting effects of angiotensin II
  • Increase in plasma renin level causing vasodilation, decreased sodium and water retention
  • Which leads to reduction in blood pressure
38
Q

What are some common preparations of ARBs?

A

End in “…sartan”

  • losartan (Cozaar)
  • valsartan (Diovan)
  • candesartan (Atacand)
39
Q

What is a Renin Inhibitor?

A

A new drug class for hypertension

  • Binds to renin which then reduces levels of angiotensin I, angiotensin II, and aldosterone
40
Q

What are calcium channel blockers used for?

A
  • Hypertension
  • Angina
  • Arrhythmias
41
Q

What are the common preparations of Calcium Channel Blockers?

A
  • verapamil (Calan) - major effect on heart
  • nifedipine (Procardia) - blood vessels
  • amlodipine (Norvasc) - #1 in US sales
42
Q

What calcium channel blocker is associated with the greatest numner of cases of gingival hyperplasia?

A

nifedipine (Procardia)

43
Q

What is an important alpha 2 agonist and what does it act on?

A
  • clonidine (Catapres) - alpha2 agonist - decreases sympathetic outflow from CNS
    • Xerostomia, parotid gland swelling, dysguesia
44
Q

What type of drug blocks granular uptake and storage (depletion) of norepinephrine = decreases sympathetic activity due to a lack of neurotransmitter supply?

A

Catecholamine Release Blockers

45
Q

What are the common preps and characteristics of Catecholamine Release Blockers?

A
  • reserpine (Serpasil) - decreased BP via depletion of NE and dopamine, crosses BBB (schizophrenia treatment)
  • guanethidine (Ismelin) - uncouples action potential from exocytotic release of the transmitter (blocks AP)
46
Q

What are Catecholamine Release Blockers contraindicated in?

A

Patients with peptic ulcers (increased HCl secretion)

47
Q

What is the safe cardiac dose of epinephrine?

A

0.04 mg - always take BP prior to injection of local anesthetics

48
Q

Use of NSAIDS for longer than 3 weeks may decrease the effectiveness of some ________. ________ and __________?

A
  • Diuretics
  • Beta blockers
  • ACE inhibitors
49
Q

What are the common treatments for stage 1 hypertension?

A
  • Thiazide diuretics for most
  • May consider ACEI, ARB, BB, CCB
50
Q

What are common treatments for stage 2 hypertension?

A
  • 2 drug combination for most
  • Thiazide diuretic with ACEI, ARB, BB, CCB
51
Q

What are common drugs used for compelling indications of hypertension?

A
  • Diuretics
  • ACEI
  • ARB
  • BB
  • CCB

Pharmacology 2 (21 decks)

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