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Systemic Pharmacology_Dr. McNaughton > 1. Hypertension > Flashcards

1. Hypertension Flashcards

1
Q

Sustained systolic BP of >___ mmHg or sustained diastolic BP >___mmHg

A

140, 90

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2
Q

African Americans are at __times greater risk than whites.

A

4

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3
Q

Complications of hypertension include.

A

stroke, congestive heart failure (CHF), MI, renal failure

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4
Q

what are the antihypertensive drug subclasses?

A
  1. ACE-inhibitors –> Lisinopril [Zextril, Prinivil]
  2. Angiotensin 2 Receptor blockers –> Valsartan [Diovan]
  3. Calcium Channel Blockers –> Amlodapine [Norvasc]
  4. Alpha-blockers –> Terazosin [Hytrin]
  5. Beta- blockers –> Metoprolol [Lopressor, Toprol-XL]
  6. Diuretics–> Furosemide [Lasix]
  7. Other –> Clonidine [Catapres, Duraclon]
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5
Q

What are the concomitant diseases we can use hypertension medicines to treat?

A
  1. high-risk angina pectoris
  2. diabetes
  3. recurrent stroke
  4. heart failure
  5. previous myocardial infarction
  6. chronic renal disease
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6
Q

What is the most common drug that’s use to treat concomitant diseases?

A

ACE inhibitors

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7
Q

What is the least common drug that’s use to treat concomitant diseases?

A

Diuretics

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8
Q

What are the ACE inhibitors?

A

Lisinopril [Zestril®, Prinivil®] (most common)
Benazepril [Lotensin®]
Captopril [Capoten®]
Enalapril [Vasotec®]

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9
Q

Linsinopril is indicated for ______, ______, and ______.

A

hypertension, CHF, Acute MI

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10
Q

T/F The mechanism of action of Lisinopril is to suppress renin angiotensin aldosterone system and simultaneously activates bradykinin degradation.

A

False. it suppresses RAA system and inhibits bradykinin degradation

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11
Q

What are the adverse side effects of Lisinopril?

A

Common: photosensitivity, reduced vision, headache, hypotension, conjunctivitis
Distinguishing: cough, taste disturbances

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12
Q

What are the more serious adverse effects of Lisinopril?

A

Hypersensitivity: angioedema*, eyelid edema
Ocular: blur, dry eyes, conjunctival or retinal hemes#, diplopia

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13
Q

angioedema may look like what?

A

preceptal cellulitis

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14
Q

Drug interactions between Lisinopril with Acetaminophone and ASA will inhibit ________ and _______.

A

renal prostaglandins, antagonize therapy

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15
Q

Drug interactions between Lisinopril with Cyclosporine will induce renal toxicity, which will exacerbate ________ created by suppressed _________ release from adrenal cortex.

A

hyperkalemia, aldosterone

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16
Q

Cyclosporine is use to treat ______ and ______ for transplants.

A

dry eye, immunesupressants

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17
Q

Can hyperkalemia affect the heart?

A

Yes.

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18
Q

What connective tissue disease should be caution when taking Lisinopril?

A

Sjogren’s syndrome

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19
Q

What are the Angiotensin 2 receptor blockers?

A

Valsartan [Diovan®] “most common”

Candesartan [Atacand®]

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20
Q

Valsartan is indicated for ________, _______ and ______.

A

hypertension, CHF (40-160mg bid), and Post MI (80-320mg qd)

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21
Q

Which anti-hypertensive meds can cause angioedema?

A

lisinopril, Valsartan and Clonidine

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22
Q

Which anti-hypertensive meds can cause steven-johnson syndrome?

A

Furosemide and Hydrochlorothazide

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23
Q

Which anti-hypertensive meds can cause intraoperative flobby iris syndrome?

A

Terazosin. Beware of cataract surgery.

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24
Q

Which anti-hypertensive meds can cause intraoperative flobby iris syndrome?

A

Terazosin

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25
Q

Which anti-hypertensive meds can cause dry eye?

A

Lisinopril causes blur dry eyes conjunctival or retinal hemes
Metoprolol causes dry eye syndrome due to decrease tear secretion, which causes visual disturbances

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26
Q

Which anti-hypertensive meds can cause glaucoma?

A

Metoprolol causes glaucoma progression

Hydrochlorothiazide causes angle closure glaucoma

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27
Q

Which anti-hypertensive meds can cause Lupus erythematosus?

A

Hydralazine

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28
Q

Which anti-hypertensive meds can cause gynecomastia and menstrual irregularities?

A

Spronolactone

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29
Q

Which anti-hypertensive meds can cause depression and short term memory loss?

A

Metoprolol

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30
Q

Which anti-hypertensive meds can cause an increase IOP, glaucoma progression and exacerbate myastenia gravis?

A

Metoprolol

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31
Q

Which anti-hypertensive meds can cause conjunctivitis?

A

Lisinopril and Amlodipine

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32
Q

Drug interactions between Valsartan and NSAIDs?

A

antagonism.

NSAIDs increases BP by blocking PG production. this antagonistic to Valsartan (lower BP).

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33
Q

Drug interactions between Valsartan and Cyclosporine?

A

Hyperkalemia

34
Q

What are the Calcium Channel Blockers?

A

Amlodipine [Norvasc®] “most common”
Diltiazem [Cardizem®]
Verapamil [Calan®, Isoptin®]

35
Q

Coronary artery disease is an indication in which anti-hypertensive drug?

A

Amlodipine (Calcium Channel blockers)

36
Q

How does Calcium Channel Blockers work?

A

It works on the musculature of the blood vessel walls. it inhibits trans membrane Ca2+ current into vascular smooth muscle.. more than cardiac muscle.

37
Q

Which drug increases the metabolism of Amlodipine?

a. Cyclosprine
b. azoles
c. Dexamethasone
d. Ophthalmic Alpha-2 agonists

A

C. Dexamethasone.

decreases the level of amlodipine.

38
Q

Which drug supresses the metabolism of Amlodipine?

A

Cyclosporine, erythromycins and azoles

39
Q

Which drugs are additive to Amlodipine when given together?

A

Ophthalmic Alpha-2 agonist

Ophthalmic Beta-blockers

40
Q

Terazosin [Hytrin] is which class of antihypertensive drugs?

A

Alpha blockers

41
Q

Benign Prostatic Hypertrophy (BPH) is an indication of which anti-hypertensive drug?

a. Lisinopril (ACE inhibitor)
b. Amlodipine (Calcium channel blockers)
c. Valsartan (Angiotensin 2 receptor blockers)
d. Terazosin (Alpha blockers)

A

d. Terazosin

42
Q

If you are to prescribe patient with Terazosin to treat hypertension, what is the dosing you would give?

A

[1-5mg] 1 tab qhs

43
Q

T/F Terazosin is antagonizes peripheral alpha-2 adrenergic receptors.

A

False. alpha-1 adrenergic receptors

44
Q

What is the drug interactions when taken Terazosin and sympathomimetics together?

A

reduced BP lowering

45
Q

What is the drug interactions when taken Terazosin and Beta-blockers together?

A

enhanced BP lowering

46
Q

Paresthesia (irregularity blood flow to the extremities) is an adverse effect of which medication?

A

Terazosin (Alpha blockers)

47
Q

Paresthesia (irregularity blood flow to the extremities) is an adverse effect of which medication?

A

Terazosin (Alpha blockers)

48
Q

Which drug has an indication for hypertension, angina pectoris and post MI?

A

Metroprolol (Beta blockers)

49
Q

What is the dosing for Metroprolol?

A

50 to 200mg bid

50
Q

Metoprolol competitve antagonists beta 1 receptors by reducing systolic BP and CO via _________ and _______ effects.

A

negative inotropic, chronotropic

51
Q

Metroprolol act by supression of _______ activity.

52
Q

T/F Metoprolol increases tear secretion.

A

False.

decreases tear secretion. It leads to dry eye syndrome

53
Q

Drug interactions between Metoprolol with opthalmic Alpha 2 Agonists, Opthalmic Beta blockers or Pilocarpine will result in a what reaction?

54
Q

Drug interactions between Metoprolol with NSAIDs and Ophthalmic decongestants will result in a what reaction?

A

Antagonistic

55
Q

Drug interactions between Metoprolol with NSAIDs and Ophthalmic decongestants will result in a what reaction?

A

Antagonistic

56
Q

Alpha 2 receptors have feedback inhibitions on ____ in the pre-synaptic nerve terminal to block the vesicles to fuse with membrane to release _______ contents into the synaptic cleft.

A

Ca2+, Norepinephrine

57
Q

Alpha 2 receptors have feedback inhibitions on ____ in the pre-synaptic nerve terminal to block the vesicles to fuse with membrane to release _______ contents into the synaptic cleft.

A

Ca2+, Norepinephrine

58
Q

What are the Diuretics drugs?

A

Furosemide [Lasix®] “most common”
Hydrochlorothiazide (HCTZ) [Microzide®]
Spironolactone [Aldactone®]

59
Q

Hypertension, Acute Pulmonary Edema and Hypercalcemia is indication for which anti-hypertensive drug?

A

Furosemide

60
Q

What is the dosing of Furosemide (Diuretics) when taken for hypertension?

A

10-40mg bid

61
Q

T/F Furosemide is a High ceiling/Loop diuretic (Ca2+ and K+ depleting).

62
Q

T/F Furosemide is a High ceiling/Loop diuretic (Ca2+ and K+ depleting).

63
Q

Drug interactions of Aminoglycosides in the presence of Furosemide will result in?

A

additive nephrotoxicity

64
Q

Drug interactions of NSAIDs in the presence of Furosemide will result in?

A

induced ototoxicity and antagonistic effect on BP

65
Q

Drug interactions of Carbonic Anhydrase Inhibitors or Erythromycins in the presence of Furosemide will result in?

A

prolong QT interval. CAI acts at the proximal convoluted tubules of the kidney. They have a different effect on electrolytes, which causes QT prolongation.

66
Q

Drug interactions of Carbonic Anhydrase Inhibitors or Erythromycins in the presence of Furosemide will result in?

A

prolong QT interval (sluggish cardiac beat and pulse).

Life threatening.

67
Q

Drug interactions of Carbonic Anhydrase Inhibitors or Erythromycins in the presence of Furosemide will result in?

A

prolong QT interval (sluggish cardiac beat and pulse).

Life threatening.

68
Q

Can you take Furosemide and Sulfonimides together?

A

NO. Patients who are on sulfonamides should not be on these drugs. Sulfa allergies are also counter-intercator on carbonic anhydrase inhibitors. (CAI)

69
Q

Can you take Furosemide and Sulfonimides together?

A

NO. Patients who are on sulfonamides should not be on these drugs. Sulfa allergies are also counter-intercator on carbonic anhydrase inhibitors. (CAI)

70
Q

Thiazide Diuretics have _______ sparing properties.

A

Calcium, which it’s an indicator for osteoporosis.

71
Q

Spironolactone diuretics have _________ spring properties.

72
Q

Spironolactone diuretics is an indication for?

A

hypertension, CHF, Hyperaldosteronism and hypokalemia

73
Q

How does Spironolactone work on the kidney to retain potasium?

A

It antagonizes aldosterone receptors in distal convoluted tubule resulting in sodium/water loss and potassium retention.

74
Q

How does Spironolactone work on the kidney to retain potassium?

A

It antagonizes aldosterone receptors in distal convoluted tubule resulting in sodium/water loss and potassium retention.

75
Q

Clonidine stimulate which adrenergic receptors?

A

central and spinal alpha 2 receptors.

76
Q

What happens if you add antihistamines or opiods in the presence of clonidine?

A

enhanced CNS depression

77
Q

What happens if you add antihistamines or opiods in the presence of clonidine?

A

enhanced CNS depression

78
Q

Why does Opthalmic Beta blockers have an antagonistic effect in the presence of Clonidine?

A

Norepinephrine that has been released into the synaptic cleft can’t bind to Beta receptors because of Beta blockers and can’t bind to alpha 2 receptors as well because of Clonidine is an alpha 2 agonist. The only sites NE can bind to are alpha 1 receptors, hence, it increases BP.

79
Q

Why does Opthalmic Beta blockers have an antagonistic effect in the presence of Clonidine?

A

Norepinephrine that has been released into the synaptic cleft can’t bind to Beta receptors because of Beta blockers and can’t bind to alpha 2 receptors as well because of Clonidine is an alpha 2 agonist. The only sites NE can bind to are alpha 1 receptors, hence, it increases BP.

80
Q

Which drug has an indication for hypertensive crisis?

A

Hydralazine (other diuretics)

81
Q

How does Hydralazine work?

A

It works directly dilate peripheral vessels via hyperpolarization of vascular smooth muscle which inhibits Ca2+ influx (depolarization).

82
Q

What is the drug interaction of NSAIDs in the presence of Hydralazine?

A

antagonistic.

Systemic Pharmacology_Dr. McNaughton (12 decks)

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