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Pharm block 4 hemostasis and cardiac > Anti-hypertensive drugs > Flashcards

Anti-hypertensive drugs Flashcards

1
Q

what are the stages of hypertension

A

normal 160 or >100

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2
Q

8 classes of drugs that can be used to treat HTN

A

*Diuretics
*Calcium Channel Blockers (CCBs)
Centrally-acting Agents
Alpha Adrenergic Blockers
Beta Adrenergic Blockers (BBs)
Vasodilators
*Angiotensin Converting Enzyme inhibitors (ACEIs)
*Angiotensin Receptor Blockers (ARBs)

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3
Q

what are the 4 sites of action for HTN drugs

A
  1. arterioles (resistance)
  2. venules (capacitance)
  3. Heart (pump output)
  4. Kidneys (volume)
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4
Q

when is diuretics use

A

*Drugs of choice in uncomplicated hypertension

Effective for mild-moderate hypertension combined with lifestyle modifications

Generics most economical choice

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5
Q

Thiazide diuretics MOA and examples

A

Hydrochlorothiazide, Chlorthalidone
Mode of Action (MOA) – inhibits Na+/Cl co-transporter

Initial volume contraction
later decreased in peripheral resistance (prostaglandin)
Mild Na+ excretory effect

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6
Q

Thiazide Diuretics side effects

A

Hyponatremia
Hyperglycemia
Increased LDL/HDL
Hypokalemia

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7
Q

mechanism of hypokalemia and metabolic alkalosis with thiazide diurects

A

Low plasma Na+ stimulates aldosterone -acts in collecting duct cells

Increased delivery of Na+ to collecting duct cells increases Na+ diffusion

K+ loss from principal cells and H+ loss from intercalated cells due to resulting neg. charge on lumen side

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8
Q

good drug combinations with thiazide diuretics

A

Combined with BBs, ACEIs, ARBs and centrally acting anti- hypertensive

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9
Q

drug interactions with thiazide diuretics

A 
NSAIDS
Beta Blockers (can use but be cautious)
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10
Q

contraindications for thiazide diurectics

A

Hypokalemia and pregnancy (as a new therapy)

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11
Q

thiazide diurectis are less effective in which pts

A

pts with renal insufficiency

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12
Q

Loop diurectics MOA and example

A

furosemide (lasix)

MOA – blocks Na+/K+/Cl co-transporter, causes venous dilation via prostaglandins

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13
Q

side effects of loop diurectics

A 
Dehydration/hyponatremia
Hypokalemia
Impaired diabetes control
Increased LDL/HDL
Ototoxicity
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14
Q

loop diurectics drug interactions

A

NSAIDS

Aminoglycosides (increased ototoxicity)

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15
Q

Potassium Sparing Diuretics examples

A

spironolactone and eplerenone, triamterene, amiloride

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16
Q

Potassium Sparing diuretics MOA

A

Aldosterone receptor blocker – combine with diuretics, not used for monotherapy of HT**

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17
Q

side effects of Potassium sparing diuretics

A

hyperkalemia

gynecomastia (spironolactone)

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18
Q

drug interactions of K+ sparing diuretics

A

NSAIDS
ACE inhibitors
ARBs

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19
Q

contraindications for K+ sparing diuretics

A

RAS inhibitors (ACEI and ARB)

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20
Q

Potassium sparing diuretics are commonly given with

A

thiazide and loop diuretics to prevent hypokalemia (excretion of K+)

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21
Q

Calcium channel blockers MOA

A

All reduce vascular resistance by reducing calcium influx in VSM
Non-dihydropyridines also reduce pacemaker potentials, AV node conduction, and contractility

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22
Q

what are the 3 Ca channel blockers

A

Nifedipine
Diltiazem
Verapamil

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23
Q

side effects of Nifedipine

A

(dihydropyridine) acute tachycardia and peripheral edema

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24
Q

side effects of diltiazem

A

(non-dihydropyridine) bradycardia

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25
Q

side effects of verapamil

A

(non-dihydropyridine)
constipation
bradycardia

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26
Q

Non-dihydropyridines Ca Channel blockers are contraindicated in which pts

A

pts with conduction disterbances

or in uncompensated heart failure (cardiogenic shock)

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27
Q

Clonidine and Guanfacine MOA

A

α2-adrenergic receptor agonist in medullary cardiovascular center decreases sympathetic outflow from CNS

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28
Q

Clonidine side effects and drug interactions

A

SE: sedation (12-35%), dry mouth (25-40%), bradycardia, dermatitis

Caution pt about missing doses withdraw slowly to prevent rebound hypertension

Drug interactions : CNS depressants

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29
Q

advantages of Guanfacine over clonidine

A

longer half life and less risk of rebound

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30
Q

Methyldopa MOA

A

converted to methylnorepinephrine
α2-adrenergic receptor agonist (same MOA as clonidine)
Competes with L-DOPA for DOPA decarboxylase (inhibits dopamine production) (do not give to someone with parkinsons)

31
Q

Methyldopa side effects and drug interactions

A

drug interactions levodopa, SE: sedation

32
Q

Methyldopa clinical use

A

anti-hypertensive during pregnancy

33
Q

Reserpine MOA

A

blocks VMAT vesicular transporter, prevents storage of NE centrally and peripherally.

used with diuretics for mild and moderate hypertension

34
Q

Reserpine side effects

A

depression (crosses BBB), nasal congestion

35
Q

Alpha Adrenergic Receptor Antagonists examples and MOA

A

Phenoxybenzamine, Prazosin, terazosis and doxazosin

block α-adrenergic-mediated vasoconstriction at receptor

36
Q

Phenoxybenzamine use and side effect

A

phenoxybenzamine is non-selective, primarily used in pheochromocytoma, SE- tachycardia

37
Q

prazosin, terazosis, doxazosin MOA and side effects

A

selective α1-adrenergic antagonist,
less tachycardia than direct vasodilators, hypotension w/ 1st dose
terazosin and doxazosin have longer half lifes

38
Q

Beta-Adrenergic Antagonists MOA

A

MOA – decreased cardiac contractility and CO, decreased renin secretion and thus decreased Angiotensin II production

39
Q

Non selective Beta-Adrenergic Antagonists

A

Propranolol
Nadolol (longer half-life)
Pindolol (partial agonist, less bradycardia)
Carvedilol (alpha receptor antagonist, vasodilator)

40
Q

cardioselective/B1-selective B-Blockers

A

Metoprolol (lipophilic)
Atenolol
Labetolol (lipophilic)

41
Q

side effects of Beta Blockers

A 
Bradycardia
Increased triglycerides
Decreased HDLs
Hyperglycemia
Impaired exercise tolerance

Non-selective
Increased airway resistance

Lipophilic
Insomnia
chronic fatigue

42
Q

Drug Interactions with Beta blockers

A

CCBs (reduced contractility and conduction)

43
Q

contraindications for beta blockers

A

Cardiogenic Shock
Sinus bradycardia
Asthma
Severe heart failure

44
Q

Beta blocker consideration in pts with diabetes

A

Can mask and prolong insulin-induced hypoglycemia

45
Q

Vasodilators examples and MOA

A

Hydralazine
Minoxidil
Nitroprusside

vasodilation of small vessels, primarily arterioles

46
Q

when do you use vasodilators such as Hydralazine

Minoxidil, and Nitroprusside?

A

drug resistant hypertension and emergencies

47
Q

Nitroprusside side effect

A

cyanide poisoning

48
Q

Hydralazine and Minoxidil

A

tachycardia, angina aggravation, fluid retention, NSAIDS can reduce effectiveness

49
Q

ACEI MOA

A

blocks production of Angiotensin II and Ang II-mediated- vasoconstriction

50
Q

ACEI examples

A

Captopril (short half life)
Enalapril (converted to active metabolite, longer half-life)
Lisiniopril

51
Q

ACEI side effects

A

hyperkalemia, rash, dry cough, angioedema (0.2%)

52
Q

ACEI drug interactions

A

Exacerbates hyperkalemic effect of K+ sparing drugs (no aldosterone = decreased K+ excretion)

53
Q

ACEI contraindications

A

pregnancy, bilateral renal stenosis

54
Q

benefits of ACEI

A

Prolongs survival in pts with HF or LV dysfunction after MI

Preserves renal function in diabetic patients

55
Q

*Angiotensin II Receptor Blockers (ARBs) example

A

Losartan

56
Q

Side effect of ARB

A

hyperkalemia (no aldosterone = decreased K+ excretion)

57
Q

contraindications of ARBs

A

Pregnancy

58
Q

Drug interactions of ARBs

A

K+ sparing drugs

59
Q

with ARBs it is better to use them with what other type of drug rather than increase their dose

A

diuretics

60
Q

thiazide diuretics work well with which other types of drugs for hypertension control

A

K+ sparing diuretics and BB

61
Q

K+ sparing diurects work well with which other types of drugs for hypertension control

A

thiazide or loop diuretics

62
Q

Calcium channel blockers work well with what other class of drug

A

ACEI

63
Q

ACEI cause hyperkalemia when used with what other durg

A

K+ sparing diuretics

64
Q

why would you not combine ACEI and ARBs in diabetics

A

no advantage and increases risk of hyperkalemia

65
Q

what is the first choice drug in diabetic patients?

A

ACEIs - delay loss of renal function

CCBs (few effects on carb metabolism)

66
Q

What is the first choice drug in heart failure patients

A

ACEI (reduce mortality) combination with diuretics for congestion

67
Q

what are best choices for MI pts

A

ACEI (reduce remodeling) and BB (reduce arrhythmia and remolding)

68
Q

what drugs must be avoided in pregnancy

A

ACEI and ARBs and BB (inhibit renin)

69
Q

what is the drug of choice in pregnancy

A

methyldopa

70
Q

which drugs are less effective in african americans

A

BB, ACEI (but work well when combined with diuretics)

71
Q

which drugs are most efficacious in African americans

A

monotherapy with diuretics (CCB are best)

72
Q

what considerations should be take for elderly patients

A

smaller doses with small increments
simple regimens
monitor side effects closely

73
Q

what drugs should be avoided in pts with obstructive airway disease

A

avoid BB

Pharm block 4 hemostasis and cardiac (12 decks)

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