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Cardiology > Anti-HTN Drugs > Flashcards

Anti-HTN Drugs Flashcards

1
Q

Prehypertension SBP and DBP?

A

SBP 120-139 or DBP 80-89

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2
Q

Stage 1 HTN

A

SBP 140-159 or DBP 90-99

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3
Q

Stage 2 HTN

A

SBP >160 or DBP >100

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4
Q

alpha 1 blockers

A

Prazocin, Doxazocin, Terazocin

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5
Q

Beta blockers (non-specific)

A

Propanolol, carvedilol, pindolol, timolol

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6
Q

B1 specific blockers

A

Metoprolol, atenolol, bisoprolol, nebivolol

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7
Q

Third generation b1 specific blockers

A

bisoprolol, nebivolol

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8
Q

ACE inhibitors

A

Captopril, Lisinopril, Enalapril, Ramipril

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9
Q

AR blockers

A

Losartan, valsartan, irbesartan, telmisartan, candesartan

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10
Q

Renin inhibitor

A

aliskerin

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11
Q

L-type Ca channel blocker- Phenylalkylamine

A

Verapamil

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12
Q

L-type Ca channel blocker- Benzothiazepine

A

Diltiazem

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13
Q

L-type Ca channel blockers- Dihydropyridine

A

Amoldipine, nifedipine, nicardipine, nimodipine

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14
Q

Centrally acting alpha-2a agonists

A

clonidine, guanabens, gaunfacine, methyldopa

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15
Q

Direct vasodilators

A

Minoxidil, sodium nitroprusside, diazoxide, fenoldopam

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16
Q

site of action for alpha-1 blockers

A

arteries and veins

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17
Q

effects of alpha-1 blockers

A

decrease TPR, reduce BP, relieve BPH symptoms. Also increase HDL, lower LDL, and has a beneficial effect on insulin resistance

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18
Q

side effects of alpha-1 blockers

A

first-dose hypotension (particularly with Prazosin; give at bedtime)

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19
Q

orthostatic hypertension is a problem with?

A

alpha antagonist, Prazosin

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20
Q

B blockers with ISA (Intrinsic Sympathomimetic activity)?

A

Timolol and Pindolol (aka Timon and Pumba have Simba)

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21
Q

B blockers with MSA (membrane stabilizing activity)?

A

Propanolol, metoprolol pindolol

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22
Q

B blocker that prevents LDL oxidation and uptake in the coronary arteries?

A

Carvedilol

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23
Q

B blocker that has antioxidant capability and promotes NO-mediated vasodilation

A

Nebivolol

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24
Q

B blockers with Cardioselectivity

A

Metoprolol and bisoprolol

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25
Q

Effects of BB with no ISA?

A

decrease HR, decrease contractility, decrease CO, block B1-AR in juxtaglom. app. thereby inhibiting renin release

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26
Q

BB with no ISA useful in what patients?

A

high renin hypertension (also work well in hypertensive patients with normal-low renin)

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27
Q

B blockers effective therapy in what grades of HTN?

A

All grades

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28
Q

Get an additive effect when combining BB with?

A

diuretic

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29
Q

Associated with definite mortality benefits?

A

bisoprolol

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30
Q

Mixed alpha 1 and beta antagonist?

A

Labetalol and Carvedilol

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31
Q

labetalol uses?

A

IV for hypertensive emergencies. Pheochromocytoma and preeclampsia

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32
Q

BB that protects membranse from lipid peroxidation?

A

Carvedilol

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33
Q

Clinical use of 3rd gen b-blockers

A

CHF and HTN

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34
Q

Why are 3rd gen BB better for CHF and HTN?

A
  1. reduce bp more than other b-blockers because of additional alpha blockade (carvedilol labetalol) and N.O. (nebivolol) 2. reduce HR less than other b blockers, decreased mortality and morbidity in CHF patients 3. Not associated with changes in lipids and glucose, preferred in metabolic syndrome
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35
Q

Drug for open angle glaucoma?

A

Timolol

36
Q

Timolol MOA?

A

reduces production of aqueus humor

37
Q

BB has a compelling indication for?

A

HTN patients with hyperthyroidism and migraines

38
Q

Drugs that can worsen peripheral arterial insufficiency (cold)?

A

1st and 2nd generation BB

39
Q

Side-effects of 1st and 2nd gen BB

A
  1. bradycardia, 2. bronchospasm (okay with COPD, no asthma) 3. bad dreams, 4. block glycogenolysis, delay recovery from hypoglycemia in T1D, 5. block HSL in adipocytes, increase LDL, increase triglycerides, decrease HDL
40
Q

Abrupt withdrawal of BB causes

A

tachycardia due to upregulation of b receptors in the heart (should taper off)

41
Q

ACE converts?

A

Ang I to Ang II, and degrades bradykinin. Also decreases secretion of aldosterone

42
Q

Drug that directly blocks renin activity

A

aliskerin

43
Q

Effect of captopril

A

increases synthesis of renal prostaglandins (delays progression of renal disease in diabetics, renoprotective)

44
Q

ACE inhibitor effect on baroreceptors?

A

none (and no postural hypotension)

45
Q

what converts angiotensinogen to Ang 1

A

Renin

46
Q

difference between ang 1 and ang 2

A

ang 1 has 1-10 AAs, ang 2 has two less (1-8 AAs) Chymase cleaves the two

47
Q

What are the various Ang 2 effects?

A

Cardiac/Vasc hypertrophy, systemic vasoconstriction, increased blood volume, Renal sodium and Fluid retention

48
Q

Only way to treat CHF?

A

dilate the vasculature (achievable through ACE-I)

49
Q

Most common side effect of ACE-I

A

Cough (potentially bradykinin related)

50
Q

Side effects of ACE-I

A
  1. hypotension, in hypovolemic or Na-depleted patients 2. hyperkalemia, esp with renal insufficiency 3. Dry cough (bradykinin stretch receptors in the trachea 4. angioedema (secondary to inhibited bradykinin degradation) 5. Fetotoxicity (contra in 2nd/3rd trimester)
51
Q

MOA of ARB

A

selectively block AT II type 1 receptors

52
Q

Effect of ARBs

A

vasodilation, increase Na and h20 excretion. Thus they decrease TPR, plasma volume, CO, and BP

53
Q

Pro-drug ARB

A

Losartan

54
Q

MOA of Losartan

A

competitive antagonist of thromboxane A2 receptor, attenuates platelet aggregation

55
Q

Unique effect of Losartan

A

increases uric acid urinary excretion

56
Q

ARB drugs with no uric acid or CYP enzyme effects, yet have fetotoxicity risk

A

Irbesartan, valsartan, telmisartan (not renally excreted)

57
Q

CCB contraindicated for someone with Wolf-Parkinson-White

A

Verapamil

58
Q

3 classes of CCBs

A

Phenylalkylamines, benzothiazepines, dihydropyridines

59
Q

CCB selective for myocardium, less effective vasodilator

A

verapamil

60
Q

CCB intermediate-selective for vascular Ca channels

A

diltiazem

61
Q

CCB selectively blocks L-type Ca channels in blood vessels

A

dihydropyridines

62
Q

Dihydropyridines used for

A

HTN, as the decrease SVR and arterial pressure

63
Q

How do DihydroP CCBs decrease BP

A

by relaxing arteriolar smooth muscle and decrease PVR

64
Q

DihydroP CCBs are more effect in what type of patient

A

those with low renin: the elderly and African Americans. Also preferred in older subjects with systolic hypertension

65
Q

Actions of clonidine, guanfacine, guanabenz

A

agonist of postsyn a2 in the rostral ventrolateral medulla (RVLM), decrease PVR and HR

66
Q

Clonidine uses

A

analgesic (releases endogenous opiates), ADHD, HTN tertiary (not 1st or 2nd line therapy)

67
Q

Which a2 agonist lowers cholesterol in plasma

A

guanabenz

68
Q

Clonidine withdrawal associated with

A

hypertension

69
Q

Hydralazine actions

A

arteriolar (not veins) smooth muscle relaxers (triggers reflex sympathetic stimulation)

70
Q

side effects of hydralazine

A

pronounced tachycardia and hemolytic anemia

71
Q

Selective d1 partial agonist, that is useful in septic shock

A

fenoldopam

72
Q

Relaxes smooth muscle via opening K channels. Has hirsutism side effect

A

Minoxidil

73
Q

Minoxidil uses

A

IV hypertensive emergencies, preeclampsia (generally used with BB and diuretics)

74
Q

Afterload is…

A

aortic pressure that must be overcome by the Left ventricle

75
Q

MOA of Nitroprusside

A

pro-drug, froms NO (stimulates smooth muscles guanyl cyclase), increases cGMP, causes relaxation

76
Q

Effects of Nitroprusside

A

dilates both arteries and veins, reduces TPR and increases veinous pooling, decrease CO in normal subjects. Short half life. Use in patients with angina/MI

77
Q

Best tolerated drugs for the monotherapy of HTN

A

Diuretics and ACE-Is

78
Q

Patients who particularly require a diuretic for BP control

A

patients with edematous conditions (HF and renal insuf) Also, those with volume dependent hypertension (low renin)

79
Q

Inability to respond to thiazides indicates

A

a problem with Na ingestion or excretion

80
Q

Major advantage for B blockers

A

secondary protection in CAD … particularly useful in hypertensives with tachycardia, high CO, and/or high renin

81
Q

How long should BB be tapered over (in discontinuation)

A

10-14 days

82
Q

What is the standard BB chosen to be used with ACE-Is and diuretics

A

Bisoprolol (3rd gen)

83
Q

what drug preserves renal function in patients with non-diabetic nephropathies?

A

captopril

84
Q

What drug should be avoided in patients with hyperkalemia

A

ACE-I

85
Q

What should the initial HTN agent be for patients with Diabetes

A

ACE-I

Cardiology (14 decks)

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