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Anti-HTN Flashcards

1
Q

What anti-HTN drugs are included in the Diuretics class?

A

Thiazide: Indapamide
Loop
Potassium sparing

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2
Q

What anti-HTN drugs are included in the Sympathetic Nervous System Drugs - 𝛼2 agonist class?

A

Clonidine, Methyldopa

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3
Q

What anti-HTN drugs are included in the Sympathetic Nervous System Drugs - 𝛼1 blocker class?

A

Prazosin

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4
Q

What anti-HTN drugs are included in the Sympathetic Nervous System Drugs - Β-blockers class?

A

Propranolol, Nebivolol (-olol)

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5
Q

What anti-HTN drugs are included in the Sympathetic Nervous System Drugs - Combined 𝛼1-β blockers class?

A

Carvedilol, Labetalol

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6
Q

What anti-HTN drugs are included in the Vasodilators - Drugs acting though NO class?

A

Hydralazine, Sodium Nitroprusside

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7
Q

What anti-HTN drugs are included in the Vasodilators - D1 agonist class?

A

Fenoldopam

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8
Q

What anti-HTN drugs are included in the Vasodilators - Calcium channel blockers class?

A

Nifedipine, Amlodipine (-dipine), Diltiazam, Verapamil

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9
Q

What anti-HTN drugs are included in the Inhibitors of RAS - ACE-I class?

A

Enalapril, Lisinopril

-pril

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10
Q

What anti-HTN drugs are included in the Inhibitors of RAS - ARBs class?

A

Losartan, Valsartan

-artan

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11
Q

What condition leads to an increased incidence of renal failure, coronary disease, HF, and stroke?

A

HTN

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12
Q

If a pt is considered stage 1 HTN (SBP 130-139 or DBP 80-89), how many drugs should be used?

A

1

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13
Q

If a pt is considered stage 2 HTN (SBP ≥ 140 or DBP ≥ 90), how many drugs should be used?

A

2

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14
Q

What is considered first line of HTN treatment?

A

Lifestyle modifications

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15
Q

What is the most common cause of failure of antihypertensive treatment?

A

Non-compliance

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16
Q

How much does the efficacy in decreased BP differ between anti-HTN drugs?

A

Very little

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17
Q

Should BP lowering be gradual or abrupt?

A

Gradual without compromising vital organs

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18
Q

What is the effect of combining drugs from different groups for treatment of HTN?

A

Increases efficacy and may decrease toxicity

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19
Q

Thiazide diuretics (Indapamide) is a direct vasodilator used in the treatment of mild to moderate HTN and lowers BP by how much?

A

10-15 mmHg

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20
Q

What are notable SE’s of diuretics with respect to HTN tx?

A

Reduced glucose tolerance
Increased plasma lipid concentration
avoided w lower doses

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21
Q

What is one of the initial recommended drugs for HTN treatment that acts by counteracting Na+ and H2O retention?

A

Thiazides

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22
Q

What populations are thiazide diuretics more effective in?

A

African Americans, elderly

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23
Q

What drug class has the following MOAs?

  • ↓ BP by reducing sympathetic vasomotor tone
  • Adrenergic receptor action
  • Interruption of efferent sympathetic pathway
  • Activate baroreflexes to cause Na+ and H2O retention
  • Best when combined w diuretic
A

Sympatholytics

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24
Q

The following is the MOA for what drugs?

Stimulation of medullary alpha2 adrenergic receptors leading to decreased peripheral sympathetic nerve activity

A

Clonidine, Methyldopa

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25
Q

What drug used to treat HTN is safe in pregnancy?

A

Methyldopa

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26
Q

What drugs have the following therapeutic effects?

- ↓ sympathetic outflow/ renin secretion leading to ↓ BP

A

Clonidine, Methyldopa

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27
Q

Does Clonidine or Methyldopa decrease HR and CO more?

A

Clonidine

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28
Q

What are the adverse effects of centrally acting sympatholytics? (4)

A

Sedation/ CNS effects
Xerostomia
ED
Hemolytic anemia/ + Coombs test (Methyldopa)

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29
Q

Why are centrally acting sympatholytics not recommended for monotherapy?

A

CNS effects (only if refractory pts)

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30
Q

What can be caused by sudden withdrawal of clonidine?

A

Hypertensive crisis

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31
Q

What is the MOA of Prazosin?

A

Specifically blocks alpha1 adrenergic receptors

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32
Q

What drug has the following indications/ therapeutic effects?
Reduce NE vasoconstriction to dilate arteries/ veins
↓ peripheral resistance = ↓ BP
Do not adversely affect plasma lipids
Beneficial in BPH

A

Prazosin

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33
Q

With what class of drugs is the “first dose phenomenon” evident? (postural hypotension)

A

Alpha1- adrenergic antagonists

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34
Q

Besides postural hypotension, what other adverse effects are seen with alpha1- adrenergic antagonists?

A

Na+ and water retention

Reflex tachycardia

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35
Q

What drug class decreases BP by blocking beta-adrenergic receptors in the heart to reduce CO, in the kidneys to reduce renin secretion, and in the CNS to reduce sympathetic vasomotor tone?

A

Beta-blockers (propranolol)

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36
Q

What drug class is combined with other drugs to counteract reflex tachycardia and increase renin secretion?

A

Beta-blockers (propranolol)

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37
Q

What drug class is no longer recommended for monotherapy of HTN?

A

Beta blockers

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38
Q

What is the preferred drug for pts with angina, post MI, migraine, and HF?

A

Beta blockers

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39
Q

What is the least preferred drug for pts with high physical activity, African heritage, asthma, DM, hypercholesterolemia, and PVD?

A

Beta blockers

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40
Q

What beta blocker leads to increase NO = direct vasodilation = decreased ED?

A

Nebivolol

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41
Q

What are the main c/i’s for Beta blockers? (4)

A

DM
Severe (end stage) HF
Heart block
Asthma

42
Q

Sudden withdrawal of Beta blockers may lead to what?

A

Undesirable CV outcomes

43
Q

Beta specific drugs fall into what category?

study tip

44
Q

Beta non-specific drugs fall into what category?

study tip

45
Q

In what pt population should you avoid use of combined alpha and beta blocker?

A

Asthmatics (bronchoconstriction)

46
Q

What adverse effect does Labetalol have?

A

Hepatotoxicity (EM use only)

47
Q

Sodium nitroprusside relaxes what in addition to arterial smooth muscle?

48
Q

Which vasodilators are used IV for emergencies?

A

Nitroprusside, fenoldopam, some CCBs

49
Q

What class of drugs works best in combo w other drugs to oppose compensatory responses and have diminished effects with time?

A

Vasodilators

50
Q

Which vasodilators are used for chronic oral treatment?

A

Hydralazine

51
Q

The following sxs may accompany what primary sx with vasodilators?

  • Reflex tachycardia and ↑ myocardial contraction
  • ↑ renin secretion
  • Fluid retention
  • HAs, flushing
  • Palpitations, dizziness
A

Hypotension

52
Q

What is the drug of last choice for the treatment HTN?

A

Hydralazine

53
Q

What drug dilates arterioles but not veins, is used in chronic therapy of severe HTN, combined with other agents only?

A

Hydralazine

54
Q

What drug is used in severe HTN or hypertensive emergencies in pregnancy (compelling indication)?

A

Hydralazine

55
Q

What is the primary adverse effect seen w Hydralazine?

A

SLE in slow acetylators

56
Q

What is the primary adverse effect seen w Hydralazine?

A

SLE in slow acetylators

57
Q

What drug rapidly lowers BP and is used for emergency hypertensive situations?

A

Sodium nitroprusside

58
Q

What drug is metabolized by the liver rapidly to thiocyanate and is given by IV infusion only?

A

Sodium nitroprusside

59
Q

What is the primary adverse effect of Sodium nitroprusside?

A

Cyanide accumulation

60
Q

What is the indication for Fenoldopam?

A

Emergency hypertensive situations

61
Q

How is Fenoldopam given?

A 
IV administration
(also has short half life)
62
Q

What do all CCBs end with? (name wise)

A

“-dipine”

63
Q

What class of drugs are orally active and bind to L-type channels in the myocardium and vascular smooth muscle?

64
Q

What tissue is most sensitive to CCBs although it will exert effects on all tissues that depend on calcium for normal resting tone and contraction?

A

Vascular smooth muscle

65
Q

What class of drugs is one of the first choices for hypertensive therapy?

66
Q 
The following are major cardiac effects for what class of drugs? 
↓ contractility = neg inotropic
↓ impulse generation in the SA node = neg chronotropic
↓ AV node conduction = neg dromotropic
67
Q

Which CCB has the greatest effects on vascular smooth muscle?

A

Verapamil < Diltiazem < Nifedipine

68
Q

Which CCB has the greatest effects on cardiac muscle?

A

Verapamil > Diltiazem > Nifedipine

69
Q

Due to the differences in tissue selectivity of CCBs, the drugs have opposite effects on HR. Which increases HR? Which decreases HR?

A

Nifedipine ↑ HR

Verapamil ↓ HR

70
Q

Which CCB is recommended for HTN in pregnancy?

A

Nifedipine

71
Q

How are CCBs excreted?

72
Q

Which CCB is most likely to produce reflex tachycardia?

A

Nifedipine

highest vasodilation = marked hypotension = reflex tachycardia

73
Q

Which CCB has the greatest effects on vasodilation and reflex tachycardia?

A

Verapamil < Diltiazem < Nifedipine

74
Q

Which CCB has the greatest effects on depressed SA and AV node function?

A

Verapamil > Diltiazem > Nifedipine

75
Q

Verapamil and diltiazem are c/i’d and dihydropyridines used cautiously in pts with what?

76
Q

Which CCBs cause the most vascular SEs?

reflex tachycardia, HA, flushing, dizziness, peripheral edema

A

Dihydropyridines

77
Q

What is the most common SE of Verapamil?

A

Constipation

78
Q

Which anti hypertensive drugs lower BP without compromising the heart, brain, or kidneys?

A

ACE Inhibitors

79
Q

What drug class is one of the first choices for hypertensive mono therapy (mild-mod HTN) and definitive DOC for treatment of hypertensives with: DM, CKD, HF?

A

ACE Inhibitors

80
Q

Which drug class for anti hypertensives enhance antihypertensive efficacy of diuretic drugs and balance the adverse effects of diuretics?

A

ACE Inhibitors

81
Q

ACE inhibitors are DOC for what specific condition (even without HTN)?

A

CKD + particularly indicated for diabetic nephropathy

82
Q

What drug class used to treat HTN has the following adverse effects?

  • Orthostatic hypotension and dizziness (severe if hypovolemic)
  • Dry, hacking, non-productive cough
  • Angioneurotic edema
  • Acute renal failure if bilateral renal artery stenosis
A

ACE Inhibitors

83
Q

What are the 2 most important c/i’s with ACE inhibitor treatment?

A

Pregnancy

Combo w NSAIDS

84
Q

Which drug class to treat HTN block AT1 receptors selectively without affecting AT2 receptors?

85
Q

All effects (good and bad) of ARBs are similar to ACE inhibitors except what?

A

Cough and angioedema

86
Q

What are the most preferred drugs in pregnancy? (HTN)

A

Methyldopa, labetalol, nifedipine

87
Q

What are the least preferred drugs in pregnancy? (HTN)

A

ACE inhibitors, ARB

88
Q

What are the most preferred drugs in pts with angina pectoris? (HTN)

89
Q

What are the least preferred drugs in pts with angina pectoris? (HTN)

A

Hydralazine, minoxidil

90
Q

What are the most preferred drugs in pts post MI/ w clinical CAD? (HTN)

A

ACE inhibitors/ ARB, BB

91
Q

What are the most preferred drugs in HF? (HTN)

A

ACEI/ ARB + BB + diuretic + aldosterone antagonist

92
Q

What are the least preferred drugs in HF? (HTN)

93
Q

What are the most preferred drugs in pts for recurrent stroke prevention? (HTN)

A

Diuretic, ACEI, ARB

94
Q

What are the most preferred drugs in pts w CKD? (HTN)

95
Q

What are the most preferred drugs in pts w T2DM? (HTN)

A

ACEI/ ARB, CCB

96
Q

What are the least preferred drugs in pts w T2DM? (HTN)

A

Diuretic, BB

97
Q

What are the most preferred drugs in pts w asthma? (HTN)

98
Q

What are the least preferred drugs in pts w asthma? (HTN)

99
Q

What are the most preferred drugs in pts w BPH? (HTN)

A

alpha-blocker

100
Q

What are the most preferred drugs in pts with migraine HA? (HTN)

101
Q

What are the most preferred drugs in pts w osteoporosis? (HTN)

102
Q

Gingival hyperplasia is an adverse effect of which CCB class?

A

“-dipines”

Pharm II (13 decks)

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