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Pharm Unit 4 by Hans Kim > anti HTN > Flashcards

anti HTN Flashcards

1
Q

what are the 4 basic types of anti HTN meds?

A
  1. diuretics –> decrease intravascular volume
  2. angiotensin blockers –> inhibit production or action of angiotensin II (potent vasoconstrictor) thereby reducing peripheral vascular resistance
  3. direct vasodilators
  4. sympathoplegic agents (beta blockers, alpha blockers)
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2
Q

what is the mech of high potency loop diuretics?

A

competitively inhibit Na+K+Cl- transporter in the proximal ascending tubule

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3
Q

what it the low medium potency diuretics?

A

thiazide diuretics –> inhibits Na+/Cl- in the distal ascending loop

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4
Q

what is the low potency diuretics?

A

potassium sparing diuretics –> inhibit Na+ reabsorption in the distal tubule

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5
Q

what is the most appropriate for most mild moderate hypertensive?

A

thiazide

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6
Q

what is the clinical application of loop diuretics?

A
  1. necessary for severe HTN

2. in the setting of CHF or Cirrhosis, and with renal insufficiency GFR < 30-40

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7
Q

when is appropriate to use potassium sparing diuretics?

A

appropriate in combination with above 2 to help prevent hypokalemia

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8
Q

what do you need to be cautious of when using loop and thiazide diuretics?

A
  1. hypokalemia & hypomagnesemia (both can contribute to cardiac arrythmias)
  2. impaired glucose tolerance
  3. increased lipids
  4. increased uric acid
  5. erectile dysfunction
  6. volume depletion
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9
Q

side effects of potassium sparing diuretics?

A
  1. gynecomastia (spironolactone)
  2. menstrual irregularities, menorrhagia and nipple tenderness
  3. hyperkalemia
  4. especially in setting of …
    1) renal failure
    2) diabetes
    3) use of ACE inhibitors or ARB’s
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10
Q

two major biologic effects of diuretics?

A
  1. volume depletion by enhanced excretion of sodium and water –> initially causes BP drop and a drop in cardiac output
  2. over time CO returns to normal
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11
Q

name of loop diuretics?

A

furosemide

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12
Q

names of thiazides?

A

hydrochlorothiazide, chlorthalidone, indapamide, metolazone (in order of increasing potency)

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13
Q

names of potassium sparing diuretics?

A
  1. spironolactone
  2. triamterene
  3. amiloride
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14
Q

what are the 4 major causes of secondary HTN?

A
  1. renal –> chronic kidney dz (due to high volume and high renin states)
  2. drugs –> ETOH, oral contraceptive, NSAIDs
  3. endocrine –> pheochromocytoma, Cushing
  4. pulmonary –> obstructive sleep apnea
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15
Q

what is a common 2nd cause of HTN which is due to endocrine problem?

A

hypo/hyperthyroidism

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16
Q

what are the two important parameters that result in end organ dz?

A
  1. extent of BP

2. duration of HTN

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17
Q

what are the unique side effects of thiazide diuretics?

A
  1. hyperuricemia –> can develop to Gout
  2. hyperglycemia
  3. hyperlipidemia
  4. hypercalcemia
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18
Q

what are the unique side effects of loop diuretics?

A
  1. hypokalemia and acidosis
  2. hypocalcemia (loop lose Ca2+)
  3. ototoxicity with aminoglycoside
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19
Q

what is the advantage is of using K+ sparing?

A

b/c both loop (high potency) and thiazide (medium potency) lead to hypokalemia, thus you may want to add K+ sparing, when pt is too hypokalemic

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20
Q

when is thiazides most appropriate to use?

A

mild to moderate hypertensive

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21
Q

when is loop diuretics necessary?

A

for severe HTN in setting of CHF or cirrhosis, and with renal insufficiency GFR < 30-40 (normal GFR is about 100)

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22
Q

when your GFR goes down from 100 (normal) to 30, what needs to be done?

A

thiazide (medium potency) does not work any more, thus need to change it to loop

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23
Q

K+ sparing diuretics are appropriate in

A

combination with thiazides and loop to help prevent hypokalemia

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24
Q

what are the side effects of loop and thiazide?

A
  1. hypokalemia, hypomagnesemia (both can contriube to cardiac arrythmias)
  2. impaired glucose tolerance
  3. increased lipids
  4. increased uric acid
  5. erectile dysfunction
  6. volume depletion
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25
Q

what is the mech of ACE inhibitors?

A

Mechanism is blocking endothelial ACE from
converting Angiotensin I to Angiotensin II. Also
inhibits the breakdown of bradykinin which is a
potent vasodilator.

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26
Q

spironolactone is a competitive antagonist for

A

aldosterone

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27
Q

mech for Angiotensin Receptor Blockers?

A

competitive receptor binding of angiotensin II to vascular endothelium (angiotensin II is very potent vasoconstrictor)

28
Q

what is the name of the short acting ACEI?

A

captopril

29
Q

what are the 4 names of the longer acting ACEI?

A
  1. lisinopril
  2. benazepril
  3. quinapril
  4. ramipril
30
Q

what is unique about enalapril?

A

Enalapril is ACEI that is converted to enalaprilat which is a more active metabolie

31
Q

All ARBs end with

A

-sartans

32
Q

what are the 3 names of ARBs?

A
  1. losartan
  2. valsartan
  3. irbesartan
33
Q

what are the side effects of ACEIs and ARBs?

A
  1. cough (only ACEI not ARBs)
  2. hypotension
  3. decreased renal function
  4. rarely angioedema
34
Q

ACEIs and ARBs are contraindicated in

A
  1. renal artery stenosis
  2. hyperkalemia
  3. caution in renal failure
  4. pregnancy
35
Q

in pts with chronic renal dz, ACE inhibitors can cause

A

acute renal failure in renal artery stenosis

36
Q

Volume depleted states and vasodilators

raise levels of

A

renin and angiotensin thereby supporting the role of combined drug combinations Thiazides + ACEI/ARB drugs or amlodipine + ACEI/ARBʼs.

37
Q

ACEI/ARBʼs benefit …

A

– chronic kidney disease and proteinuria.
– Congestive heart failure
– LV remodeling post MI
– Left ventricular hypertrophy
– May reduce risk of diabetes in patients at risk

38
Q

what is the name of renin inhibitor?

A

aliskirin

39
Q

what are the 2 types of Ca2+ channel blockers?

A
  1. dihydropyridines

2. non-dihydropyridines

40
Q

what are the 2 drugs that belong to dihydropyridines?

A
  1. amlodipine

2. nifedipine

41
Q

what are the 2 drugs that belong to non-dihydropyridines?

A
  1. verapamil

2. diltiazem

42
Q

Dihydropyridines (amlodipine, nifedipine) can cause a

A

reflex tachycardia and may worsen angina by

increasing oxygen demand

43
Q

Non-dihydropyridines (verapamil, diltiazem) decrease

A 
heart rate (chronotropic benefit) thus decreasing
myocardial oxygen demand
44
Q

does dihydropyridines affect heart rate?

A

no

45
Q

what is a characeteristics of verapamil?

A

a potent negative ionotropic –> decrease contractality

46
Q

does amlodipine affect contractality?

A

no

47
Q

what type of particular Ca2+ blockers are contraindicated to heart failure?

A

non-dihydropyridines (verapamil, diltiazem)

48
Q

short acting CCB’s worsen all these side effects including higher likelihood of HTN, therefore

A

use long acting CCB’s

49
Q

what is the mech of CCB?

A

inhibit contraction of vascular smooth muscles by blocking Ca entry into cell leading to reduced systemic vascular resistance

50
Q

what are the mech of beta blockers?

A
  1. reduced cardiac output (primary reason for BP lowering)
  2. inhibit renin release
  3. reduced NE release from neurons
  4. decrease central vasomotor activity –> less sympathetic tone
51
Q

what are the side effects of propranolol (bothe b1 and b2 blockers)

A
  1. bronchospasm
  2. bradycardia (negative chronotrope)
  3. CHF (negative inotrope)
  4. mast symptoms of hypoglycemia in diabetics
  5. can cross BBB and can cause depression
  6. worsening symptoms of peripheral vascular dz
52
Q

what are the 2 moderately selective BB?

A
  1. metoprolol
  2. atenolol
    - -> cardioselective in that it blocks B1 and very little B2 activity
53
Q

what are the advantages of using metoprolol and atenolol?

A

less likely to cause bronchospasm and problems with hypoglycemic awareness and depression

54
Q

what are the 3 potent antihypertensive BB?

A
  1. carvedilol
  2. labetalol
  3. esmolol
55
Q

what is the drug that uses for its short half life and used mostly for AV nodal blocking in unstable patients?

A

esmolol

56
Q

BB that are Potent antihypertensives often used in ICU
and CCUʼs for BP control for hypertensive
urgency

A

(labetolol) or acute coronary

syndromes or CHF (carvedilol).

57
Q

what are the 2 vasodilators?

A
  1. hydralazine

2. minoxidil

58
Q

what are the mech of hydralazine and minoxidil?

A

relax smooth muscles of peripheral arterioles

59
Q

what vasodilator is used for refractory HTN (and topically for men with hair loss)?

A

minoxidil = rogaine

60
Q

what is used IV in ICU’s for acute HTN urgency or in setting of chronic CHF for selective pts with both HTN and advanced CHF

A

hydralazine

61
Q

Alpha methyl dopa still

A

used in pregnancy

62
Q

ALLHAT –

A

head to head comparison of
Chlorthalidone, amlodipine, lisinopril and
doxasosin for primary prevention

63
Q

• ACCOMPLISH –

A
  1. combination therapy in patients at risk for cardiovascular events.
  2. Benzapril + amlodipine vs benzapril +
    thiazide diurectic
64
Q

if you are obese (volume overload) with HTN, what drug would you give?

A

clovaridol ???

65
Q

in general the DIC for HTN are

A

ACE inhibitors

Pharm Unit 4 by Hans Kim (15 decks)

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