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Anti-hypertensive drugs Flashcards

1
Q

HCTZ: How does it work?

A

Blocks reuptake of Na and Cl after filtration. Causes a decrease in TPR

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2
Q

By how much does HCTZ lower BP?

A

10-15 mm

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3
Q

What competing drug is slightly more effective than HCTZ and in the same class?

A

chlorthalidone

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4
Q

What is the oral fraction of HCTZ?

A

70%

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5
Q

How is HCTZ excreted? In what form?

A

Excreted unchanged in the urine

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6
Q

What is the route of administration for HCTZ?

A

Oral

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7
Q

What is the onset, peak, and duration of HCTZ?

A

2,5,10

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8
Q

What are the toxic effects of HCTZ?

A

K and Mg depletion, Na and CL depletion
Metabolic alkalosis
Volume depletion
worsens hyperuricemia (gout)

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9
Q

What pregnancy class is HCTZ?

A

Class D. Would not want to give it to pregnant women unless it were a last choice.

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10
Q

Which populations would you worry about giving HCTZ to?

A

Pregnant women, geriatric pts (more side effects) and pts with reduced GFR

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11
Q

What should you monitor in a pt on HCTZ?

A

BP, weight, edema, K, Mg, BUN, creatinine

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12
Q

What is lisinopril used for?

A

Treatment of HTN, CHF, management of MI

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13
Q

What therapeutic class is lisinopril in?

A

ACE inhibitor. Prevents vasoconstriction and aldosterone release from Angiotensin II

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14
Q

What is the onset, peak, and duration of lisinopril?

A

1 hr, 6 hr, 24 hr

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15
Q

What are the toxicities of lisinopril?

A

orthostatic hypotension; reduces GFR (be careful in pts with renal stenosis), angioedema, cough, acute renal failure.

Can have hyperkalemia if KCl is given.

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16
Q

Which pts would you want to be careful giving lisinopril to?

A

Pts who are already on diuretics or have aortic stenosis. Also, pts with renal stenosis.

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17
Q

What pregnancy category is lisinopril in?

A

Category C/D because it can cause abnormal cartilage development

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18
Q

What would you need to monitor with lisinopril?

A

BP, weight, edema, K, BUN, and creatinine

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19
Q

What are some toxicities with lisinopril?

A

Orthostatic hypotension, renal effects, angioedema, cough

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20
Q

What are some interactions with lisinopril?

A

Additive, NSAIDS interfere with drug, Hypercalcemia with KCL administration

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21
Q

What are some special considerations with lisinopril?

A

Abnormal cartilage development, renal stenosis, aortic stenosis, discontinue diuretics before starting, preserves renal function in renal failure

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22
Q

What can lisinopril be used to treat?

A

HTN, CHF, preserves renal function in renal failure, preserves LV after MI and during acute management

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23
Q

What therapeutic class is Losartan in?

A

ARB

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24
Q

How does Losartan work?

A

Blocks binding of ATII to the ATI receptor. Decreases vasoconstriction and aldosterone release

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25
Pharmacokinetics of losartan
Effects at 6hrs, long half life, extensive 1st pass metabolism (make sure they are sitting down!). Active metabolite is 40x more potent
26
Losartan toxicity problems
Dizziness, orthostatic hypotension, worsening of renal failure
27
What pregnancy class is Losartan?
Pregnancy C/D
28
What are some special considerations with losartan?
Caution with pts on diuretics, renal artery stenosis, mitral/aortic stenosis
29
What do you need to monitor with Losartan?
BP, weight, Edema, Electrolytes, BUN, creatinine
30
What therapeutic class is nitroprusside in?
Direct vasodilator
31
How does nitroprusside work?
Direct effect on vascular smooth muscle, with BOTH VENO and VASO constriction. Releases both CN and NO.
32
What is the route of administration with nitroprusside?
IV
33
How long does it take for nitroprusside to work?
Within minutes
34
How is nitroprusside metabolized?
Conversion of CN- to SCN in the liver
35
Nitroprusside toxicities:
Excessive hypotension, CN/SCN accumulation, headache, decreased perfusion to the brain
36
What are some interactions with nitroprusside?
Additive effects with other anti-HTNs
37
What are some special considerations with Nitroprusside?
It requires a central line, so must be given in the ICU. NOT GIVEN CHRONICALLY.
38
Which patient population must you be cautious in giving nitroprusside to?
Pts with high intracranial pressure
39
What do you need to monitor with nitroprusside?
BP, HR, metabolic acid, arterial line
40
What therapeutic class does hydralazine belong to?
Vasodilator
41
What else is hydralazine used to treat aside from HTN? What other anti-hypertensive can be used for this purpose?
CHF. Lisinopril can also be used for CHF.
42
How does hydralazine work?
Direct vasodilator that induces the arterial endothelium to produce NO. Mostly VASODILATION NOT VENODILATION.
43
How is hydralazine metabolized?
Metabolized in the GI/Liver.
44
How is hydralazine administered? What is the onset time with each?
Administered orally or through IV. Oral: 30 min. IV: 10 min.
45
How long do the effects of hydralazine last?
2-6 hrs
46
What are the potential toxic effects of hydralazine?
Hypotension, drug-induced lupus
47
What are the drug interactions of hydralazine?
Additive with other anti-HTNs
48
Which pts would you be cautious in giving hydralazine to?
Pts with renal disease, prior stroke, angina, CAD
49
What are some special considerations with hydralazine?
Never given as a monotherapy. Concerns with edema and reflex tachycardia
50
What do you need to monitor with Hydralazine?
BP, edema, weight, BUN, creatinine, lupus, angina
51
What therapeutic class does Verapamil belong too?
CCB
52
What can verapamil be used to treat aside from HTN?
angina, arrhythmias
53
How does verapamil work?
Inhibits calcium channels to dilate peripheral arterioles. Decreases inotropy, afterload, and also reduces coronary artery spasms
54
How is verapamil metabolized?
By the liver and kidney.
55
What are the routes of administration with Verapamil? What is the onset for each?
Oral (2 hr), IV (1-5 min)
56
What is the half life of verapamil?
6-12 hrs
57
Verapamil toxicity
hypotension, AV block, worsen CHF, bradycardia
58
What are verapamil interactions?
Additive, toxicity when combined with beta blockers
59
What are some special considerations with verapamil?
Pts with renal and hepatic disease will want to decrease dose because it is broken down through the kidneys and liver.
60
What pregnancy class is verapamil in?
Pregnancy class C
61
What do you want to monitor with verapamil?
BP, weight, edema

Pharm drugs HC (3 decks)

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