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Pharmacology > Anti-Hypertensive Drugs > Flashcards

Anti-Hypertensive Drugs Flashcards

1
Q

ACE Inhibitors Indication

A
  1. first line for HTN in patients with CHF or DM

2. post-MI

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2
Q

ACE Inhibitors MOA

A
  1. blocks conversion of angiotensin I to angiotensin II –> less vasoconstriction
  2. increases bradykinin levels in order to vasodilate
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3
Q

ACE Inhibitors Examples

A
  1. Lisinopril (prinivil/zestril)
  2. Benazepril (lotensin)
  3. Quinapril (accupril)
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4
Q

ACE Inhibitors CI

A
  1. Pregnancy, category D
  2. Renal artery stenosis
  3. caution with renal impairment
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5
Q

ACE Inhibitors SE

A
  1. DRY COUGH (due to bradykinins)
  2. Hyperkalemia!!!
  3. Hypotension
  4. Renal dysfunction
  5. Angioedema!!!
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6
Q

Benefits of ACE Inhibitors in diabetic patients

A
  1. delays onset of diabetic neuropathy

2. renal protection

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7
Q

ACE Inhibitors special considerations

A
  1. they decreases absorption of antacids (pepcid, zantac) - separate time of dosing
  2. check K and creatinine levels (CMP or BMP)
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8
Q

ARBs MOA

A

blocks angiotensin II’s binding/effects on blood vessels –> decreases vasoconstriction, increases vasodilation

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9
Q

ARBs Indications

A

HTN, second line for CHF patients if cannot tolerate

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10
Q

ARBs CI

A
  1. pregnancy, category D

2. renal artery stenosis?

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11
Q

ARBs SE

A
  1. dizziness, hypotension
  2. hyperkalemia
  3. renal failure
  4. angioedema (less than ACE)
    but overall well tolerated
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12
Q

ARBs Examples

A
  1. Losartan (cozaar)
  2. Valsartan (Diovan)
  3. Irbesartan (Avapro) - stronger than losartan

Candesartan used for BP and headache

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13
Q

Beta Blockers MOA

A

bind beta adrenoceptors and block binding of NE and E which inhibits sympathetic effects –> slow HR and decrease BP

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14
Q

3 types of Beta Blockers

A
  1. Cardioselective - affect beta 1 on heart only
  2. Non-selective - affect beta 1 and beta 2 (lungs) equally
  3. Mixed alpha and beta
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15
Q

Cardioselective Beta Blockers examples

A
  1. metoprolol (lopressor/toprol)

2. atenolol (tenormin)

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16
Q

Non-selective Beta Blockers examples

A
  1. propranolol (inderal)

2. nadolol

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17
Q

mixed alpha and beta blockers example

A
  1. carvedilol/coreg (use for stable CHF)

2. labetalol (use in pregnancy, preeclampsia)

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18
Q

Beta Blockers Cardiac Indications

A
  1. CHRONIC CHF
  2. A fib/A flutter/other tachyarrhythmias
  3. angina
  4. HTN (3rd line)
  5. post-MI (decreases O2 requirement)
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19
Q

Beta Blockers Non-cardiac indications

A
  1. migraine prophylaxis
  2. anxiety, public speaking
  3. tremors
  4. timolol (nonselective) –> glaucoma
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20
Q

Beta Blockers CI

A
  1. Asthmatics, COPD for non-selective
  2. 2nd/3rd degree heart block
  3. bradycardia
  4. sick sinus syndrome
  5. ACUTE heart failure
  6. severe hypotension
  7. caution with diabetics!
  8. Raynauds
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21
Q

Beta Blockers S/E

A
  1. Hypotension
  2. asthma/bronchoconstriction
  3. Raynauds
  4. impotence
  5. fatigue (MC)
  6. MASK SYMPTOMS OF HYPOGLYCEMIA
  7. insomnia
  8. depression
  9. nightmares
  10. increased triglycerides, decreased HDL - monitor lipids
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22
Q

Calcium Channel blockers types

A
  1. Dihydropyridines

2. Non-dihydropyridines

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23
Q

Dihydropyridines examples

A
  1. amlodipine/norsac

2. nifedipine/procardia

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24
Q

What medication is good for African Americans

A

Calcium Channel blockers - Dihydropyridines

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25
Q

Dihydropyridines indications

A
  1. HTN
  2. diastolic heart failure
  3. prevention/tx of coronary spasms (prinzmetal angina, cocaine induced MI)
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26
Q

Dihydropyridines CI

A
  1. pregnancy
  2. conditions that worsen with tachycardia (CAD, aortic stenosis, mitral stenosis)
  3. Do not take with grapefruit juice
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27
Q

Dihydropyridines SE

A
  1. flushing
  2. dizziness
  3. headache - cerebral vasodilation
  4. tachycardia
  5. constipation
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28
Q

Non-Dihydropyridines examples

A
  1. Diltiazem/cardizem

2. verapamil

29
Q

Non-Dihydropyridines effects

A

decrease BP and SLOW HR

  • decreases vascular permeability
  • decreases cardiac contractility/conduction
30
Q

Non-Dihydropyridines indications

A
  1. great tx for A fib/A flutter
  2. SVT
  3. Stable angina
  4. HTN
31
Q

Non-Dihydropyridines CI

A
  1. Wolff-Parkinson-White Syndrome
  2. Hypotension
  3. acute CHF
  4. AV blocks
32
Q

Non-Dihydropyridines SE

A
  1. bradycardia
  2. worsened HF
  3. hypotension
  4. constipation (MC)
33
Q

calcium channel blocker MOA

A

block L-type calcium channels on cardiac myocytes –> inhibit contraction of smooth muscle

  • these channels also located on skeletal muscles, neurons, vascular smooth muscle, uterus –> coronary vasodilation, increased myocardial oxygen delivery
34
Q

Types of diuretics

A
  1. Thiazides
  2. Potassium sparing diuretics
  3. LOOP diuretics
35
Q

Thiazides MOA

A

enhance excretion of Na and Cl in urine, water also excreted, decreased blood volume

36
Q

Thiazide Example

A

Hydrochlorothiazide (HCTZ)

37
Q

Potassium sparing diuretic example

A

Triamterene

38
Q

Potassium sparing diuretic MOA

A

increases Na excretion but not K excretion because it blocks the exchange of Na and K –> increased secretion of water

39
Q

Diuretic SE

A
  1. thirst, dry mouth
  2. increased urination
  3. hypotension
  4. weakness
  5. dizziness
  6. tachycardia
  7. GI disturbances
40
Q

Potassium sparing diuretic CI

A
  1. electrolyte imbalances
41
Q

LOOP diuretics examples

A
  1. furosemide/lasix

2. bumetanide/bumex

42
Q

How long does lasix work for?

43
Q

LOOP diuretics MOA

A

inhibit reabsorption of sodium at loop of henle in nephron

44
Q

What medication can you give a person with altitude sickness?

A

acetazolamide (carbonic anhydrase inhibitor)

45
Q

Alpha Blockers MOA

A

bind to alpha adrenoreceptors to relax muscles that are surrounding arteries, cause dilation and decrease BP

46
Q

mixed alpha and beta blockers MOA

A

vasodilation in periphery and decreases HR

47
Q

Aldosterone receptor blockers example

A

Spironolactone/Aldactone

48
Q

Aldosterone receptor blockers MOA

A

block aldosterone receptors, inhibit Na resaborption

49
Q

What can spironolactone also be used for?

50
Q

Nitrates example

A

nitroglycerine

51
Q

Nitroglycerine MOA

A

dilates coronary arteries to increases coronary blood flow, increase oxygen supple and decrease oxygen demand of heart

52
Q

Nitrates Indications

A
  1. stable angina - tx and prevention (sublingual)
  2. unstable angina/MI (IV)
  3. hypertensive emergency
53
Q

Acute MI treatmetn

A
  1. morphine for pain
  2. oxygen
  3. nitroglycerine - vasodilation and increases O2 to heart
  4. aspirin (325 mg)
54
Q

Nitrates CI

A
  1. hypotension
  2. cannot co-administer with PDE-5 inhibitors (viagra/sildenafil, cialis, levitra)
  3. closed angle glaucoma & other conditions with increased intracranial pressure
  4. PERICARDIAL TAMPONADE
  5. hx of syncope/syncopal episodes/pre-syncope (ie. aortic stenosis)
55
Q

Nitrates SE

A
  1. headache
  2. flushing
  3. orthostatic hypotension
56
Q

Risk Factors for HTN

A
  1. obesity
  2. stress/anxiety
  3. excessive alcohol
  4. excessive salt
  5. family history
  6. diabetes
  7. tobacco use
  8. African American
57
Q

ACE inhibitor clearance

A

kidney - dose adjustment

58
Q

what is a benefit of ACE inhibitors?

A

intermediate duration of action and once daily dosing (except captopril)

59
Q

what medications should you avoid in African Americans?

A

ACE inhibitors and ARBs (not as effective, higher risk of angioedema)

60
Q

half life and dosing of ARBs

A

12-24 hrs, once daily dosing

61
Q

patient education for stopping beta blockers

A

Cannot abruptly stop them because rebound effect - palpitations, sweating

62
Q

difference between dihydropyridines and non-dihydropyridines

A
  1. dihydropyridines: predominantly vasodilator, neutral/increased effects on vascular permeability
  2. Non-dihydropyridines: reduce vascular permeability and affect cardiac contractility and conduction
63
Q

carbonic anhydrase inhibitors MOA

A

increase excretion of Na, K, bicarbonate, water

64
Q

Loop diuretic indications

65
Q

dosing of HCTZ

A

12.5-50 mg

66
Q

dosing of triamterene

67
Q

combination treatment dosing

A

HCTZ + Triamterene 25mg/37.5mg or 50mg/75mg

68
Q

spironolactone dosing

Pharmacology (27 decks)

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