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Cardio > Anti-HTN drugs > Flashcards

Anti-HTN drugs Flashcards

1
Q

3 factors that determine BP

A

CO, SVR, blood volume

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2
Q

overall diuretic mech

A

inhibit reuptake of Na+ and thus water- water follows sodium

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3
Q

targets for the three main diuretics

A

loop- loop of henle
thiazides- distal tubule
K+ sparing- collecting duct

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4
Q

loop diuretics moa

A

inhibit Na/K/2Cl transporter in loop of henle, reduce Na reuptake (also K+ reuptake)

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5
Q

loop examples

A

furosemide, torsemide

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6
Q

loop adverse effects

A

hypokalemia and alkalosis- extracellular Na+ is traded for intracellular H+ downstream of targeted transporter, more Na+ w/ diuretic effect

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7
Q

thiazide moa

A

inhibit Na/Cl symporter in DCT

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8
Q

thiazide examples and adverse effects

A

hydrochlorothiazide, chlortalidone

hypokalemia and alkalois (same mech as loop)

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9
Q

K+ sparing moa

A

inhibit ENaC (epithelial Na channel) in collecting duct either directly (triamterene) or indirectly thru antagonizing aldosterone receptor (spironolacotne and eplerenone) which normally upregulates ENaC

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10
Q

K+ sparing adverse effects

A

gynecomastia- male breast enlargement in spironolactone (similar to estradiol) but not with eplerenone

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11
Q

interaction of diuretics and NSAIDs

A

NSAIDs inhibit glucoronidation of aldosterone (more ENaC) and thus more water retention, and inhibit PGE2 vasodilation

NSAIDs raise blood pressure, can blunt the effects of diuretics

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12
Q

why hypokalemia in loop/thiazide diuretics?

A

increased extracellular Na+from upstream drives loss of K+ in collecting duct

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13
Q

hypokalemia CV relevance

A

can cause hyperpolarization and delayed repolarization (long QT) which can cause arrhythmias

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14
Q

types of vasodilator drugs

A

hydralazine, K+ channel opening (diazoxide), Ca++ blockers (amlodipine, etc)

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15
Q

differentiate DHP and non-DHP Ca++ blockers

A

DHP (amlodipine and nifedipine) act mainly on vascular smooth muscle (SVR) while non DHP act on both vascular SM and cardiac tissue (verapamil and diltiazem)

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16
Q

Ca blockers moa

A

inhibit Ca influx channels, reduce strength of SM contraciton

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17
Q

Ca blockers adverse effects

A

drug-induced gingival enlargement

18
Q

Ca blockers and pregnancy

A

nifedipine is drug of choice from this class

19
Q

goal of anti-angiotensin drugs

A

reduce vasoconstriction and water retention

20
Q

ACE inhib moa

A

inhibit ACE, conversion of angiotensin I to angiotensin II

ACE also breaks down bradykinin, these drugs cause accumulation

21
Q

ARB inhib moa

A

inhibit angiotensin receptor at vessels and kidneys (prevent constriction and aldo release)

22
Q

ACE inhib examples

A

captopril, lisinopril

23
Q

ARB examples

A

losartan, valsartan

24
Q

toxicities of ACEi and ARBs

A

dry cough, angioedema (from excess bradykinin causing endothelial leakage, worse in african americans)

hyperkalemia and risk of arrhythmias

25
Q

ACEi and ARBs in pregnancy

A

teratogenic in first trimester, cause fetal hypotension and renal failure in second 2 trimesters

26
Q

goal of sympatholytics

A

reduce BP by inhibiting SNS

27
Q

why prefer B blockers to vasodilators?

A

B blockers less likely to induce reflex tachycardia

28
Q

a2 agonist example and moa

A

clonidine and methyldopa- inhibit SNS from the CNS, reinforcing NE negative feedback loop on the presynaptic receptor

29
Q

Beta blockers moa

A

inhibit B1 receptors- reduce HR and contractility

30
Q

a1 inhibs moa

A

block a1 and inhibit VSM contraction

31
Q

B blockers for HF?

A

yes, documented to decrease mortality

32
Q

B blocker toxicities

A

can both raise and lower blood sugar (careful with diabetics)

exacerbate asthma/COPD (when non selective for B1)

33
Q

a1 examples

A

prazosin, terazosin, doxazosin

34
Q

a1 toxicities

A

fist dose causes orthostatic Hypotension (esp w/ prazosin)

35
Q

HTN drug of choice during pregnancy?

A

methyldopa, a2 agonist

36
Q

which drugs for HTN and angina?

A

B blockers and Ca blockers

37
Q

drugs for HTN and diabetes/nephropathy?

A

ACEi or ARBs

38
Q

drugs for HTN and HF

A

diuretics, ACEi/ARBs, B blockers, hydralazine and nitrates

39
Q

drugs for HTN and BPH?

A

a1 antagonists

40
Q

threshold for HTN tx?

A

greater than or equal to 140/90

or 130/80 and CVD, CKD, DM, high CVD risk

41
Q

first line HTN agents

A

thiazides, Ca blockers, ARBs, ACEi

can combine any except ACEi and ARBs

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