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Anti-Hypertensives Flashcards

1
Q

When is an antihypertensive indicated?

A

Sustained systolic BP over 140

Sustained diastolic BP over 90

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2
Q

Why is hypertension a “silent killer”?

A

Pts are asymptomatic, and heart is struggling. It eventually thickens and causes further problems

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3
Q

What two things control arterial blood pressure?

A

Cardiac Output

Peripheral resistance

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4
Q

What are the 7 antihypertensive drug subclasses?

A 
ACE-inhibitors
Angiotensin II receptor blockers
Ca Channel blockers
Alpha-blockers
Beta-blockers
Diuretics
Other
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5
Q

Name 5 ACE inhibitors

A 
Lisinopril
Benazepril
Captopril
Enalapril
Quinapril
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6
Q

What is the common suffice for ACE-inhibitors?

A

-pril

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7
Q

What is the MOA of lisinopril?

A

ACE-inhibitor

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8
Q

How does an ACE-inhibitor act on the body?

A

Suppresses RAA system and simultaneously inhibits bradykinin degradation

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9
Q

What are the common adverse effects of lisinopril (ACE-inhibitors)

A 
Photophobia
Reduced vision
Headache
Hypotension
Conjunctivitis
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10
Q

What are the distinguishing adverse effects of ACE-inhibitors?

A

Cough

Taste disturbances

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11
Q

What are the serious adverse hypersensitivity effects of Lisinopril?

A

Angioedema

Eyelid edema

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12
Q

What are the serious ocular adverse effects of Lisinopril?

A

Blur
Dry eye
Conjunctival or retinal hemes
Diplopia

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13
Q

ACE-inhibitors have important interactions with which two drugs?

A

Acetaminophen

Cyclosporin

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14
Q

What does the interaction of Lisinopril and Acetaminophen do?

A

Inhibits renal prostaglandins and antagonizes the therapy

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15
Q

What does the interaction of ACE-inhibitors and Cyclosporin do?

A

Induces renal toxicity causing hyperkalemia created by suppressed aldosterone release from the adrenal cortex

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16
Q

Lisinopril has one disease in which caution is required. Which disease is it?

A

Sjogren’s syndrome

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17
Q

The suffix -sartan belongs to what group of drugs?

A

Angiotensin II receptor blockers - for HTN

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18
Q

What are the two angiotensin II receptor blockers?

A

Valsartan

Condesartan

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19
Q

What are the indications for an angioensin II receptor blocker?

A

HTN
Congestive heart failure
Post myocardial infarction

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20
Q

What is the MOA for an ARB?

A

Selective antagonist of angiotensin II receptor

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21
Q

What are the common adverse effects of Valsartan?

A

Headache

Dizziness

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22
Q

What are the hypersensitivity reactions of ARBs?

A

Angioedema

Vasculitis

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23
Q

What are the two drugs that have important interactions with Valsartan?

A

NSAIDs

Cyclosporine

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24
Q

What happens when Valsartan interacts with NSAIDs?

A

Antagonism

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25
Q

What happens when ARBs interact with Cyclosporin?

A

Hyperkalemia

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26
Q

What is hyperkalemia?

A

High blood potassium

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27
Q

What does hyperkalemia do to the body?

A

Can cause abnormal heart rhythms and even heart attack

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28
Q

What is the one disease that ACE-inhibitors don’t help?

A

Angina

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29
Q

What is the most common drug for HTN?

A

ACE-inhibitors because it helps so many concomitant disease factors, as well

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30
Q

Why is it believe that patients on ACE-inhibitors develop a cough?

A

Bradykinin accumulation

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31
Q

ACE-inhibitors affect metabolism of both ___ and ___.

A

Polypeptides

Eicosanoids

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32
Q

Angioedema can be mistaken for what?

A

Preseptal cellulitis

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33
Q

How do Aceteaminophen and Aspirin interfere with lisinopril?

A

They bind to cyclooxygenase and will impari production of key prostaglandins

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34
Q

If an NSIAD is added to ACE-inhibtor therapy, what may occur?

A

Elevation of BP

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35
Q

What do ACE-inhibitors inhibit?

A

The conversion of angiotensin I to angiotensin II

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36
Q

When it comes to dosing an ARB, which requires a higher dose, HTN or CHF?

A

HTN

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37
Q

Why does Valsartan cause headaches?

A

It changes vascular tone

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38
Q

What causes the dizziness associated with ARBs?

A

Lower BP and reduced perfusion to CNS

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39
Q

The interaction of Vlasartan and NSAIDs does what?

A

Inhibits diuretic prostaglandin synthesis

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40
Q

Ca is the key ion for what?

A

Muscle contraction

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41
Q

How do Ca channel blockers reduce BP?

A

They block the Ca channels in the blood vessels, inhibiting contraction and reducing BP

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42
Q

What are the four Ca channel blockers?

A

Amlodipin
Nifedipine
Diltiazem
Verapamil

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43
Q

What are the indication for Amlodipine?

A

HTN

Coronary Artery Disease

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44
Q

What is the MOA of a Ca channel blocker?

A

Inhibits the trans-membrane CA++ current into vascular smooth muscle (cardiac)

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45
Q

What are the common adverse effects of Amlodipine?

A

Headache

Dizziness

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46
Q

What are the ocular adverse effects of amlodipine?

A

Conjunctivitis
Diplopia
Pain

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47
Q

What are the drugs that interact with Amlodipine?

A

Dexamethasone
Cyclosporine, erythromycins, azoles
Ophthalmic Alpha-2 agonists
ophthalmic beta-blockers

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48
Q

What happens in the dexamethasone/Ca channel blocker interaction?

A

Enhances the metabolism of the Ca channel blocker

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49
Q

What happens in the cyclosporine/erythromycin/azole and Amlodipine interaction?

A

They suppress the metabolism of amlodipine, causing an elevation of the drug, increasing the possibility of the side effects

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50
Q

What happens in an ophthalmic alpha-2 agonist and amlodipine interaction?

A

Additive effect, causing excessive BP lowering, dizziness, and hypotension

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51
Q

What occurs in an ophthalmic beta-blocker and amlodipine interaction?

A

Additive effect, causing excessive BP lowering

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52
Q

Alpha-2 agonists shut down which pathway?

A

Sympathetic

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53
Q

What do alpha-1 do?

A

Regulates vascular tone throughout the body

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54
Q

What happens when alpha-1 is stimulated?

A

Vasoconstriction

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55
Q

What is the one alpha blocker for HTN?

A

Terazosin [hytrin]

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56
Q

What are the indications for Terazosin?

A

HTN

Benign prostatic hyperplasia

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57
Q

When is Terazosin supposed to be taken?

A

Before bed

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58
Q

What is the MOA of Terazosin?

A

Antagonizes peripheral alpha-1 adrenergic receptors

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59
Q

What are the common adverse effects of Alpha blockers?

A

Headache
Dizziness
Pain
Paresthesia

60
Q

What is the distinguishing adverse effect of Terazosin?

A

Floppy iris syndrome

61
Q

If a patient is on Terazosin, is it safe to dilate them? Why or why not?

A

Not really. They don’t dilate well.

62
Q

What are the two drug types that Alpha blockers interact with?

A

Sympathomimetics

Beta-blockers

63
Q

What happens in the terazosin and sympathomimetic drug interaction?

A

Reduces the amount of BP lowering

64
Q

What is a common sympathomimetic that we might see?

A

Phenylephrine (visine) - Phenyl tries to stimulate alpha-1 receptors

65
Q

What happens in the Alpha blocker and beta-blocker drug interaction?

A

Enhanced BP lowering

66
Q

Patients on Terazosin are cautioned with what?

A

Cataract surgery or retinal surgery

67
Q

The suffix -olol goes on what kind of drugs?

A

Beta blockers

68
Q

What are the three beta blockers?

A

Metoprolol
Atenolol
Propranolol

69
Q

What are the indications for metoprolol?

A

HTN
Angina
Post myocardial infarction

70
Q

Which of the anti-HTN drugs is hemodynamically stable?

A

Metoprolol

71
Q

What is the MOA of beta-blockers?

A

Selective competitive antagonism of Beta-1 receptors (reduces systolic BP and CO)
Central acting inhibition of sympathetic outflow
Suppression of renin activity

72
Q

What are the common adverse effect of Metoprolol?

A

Visual disturbances
Decreased tear secretion
Headache

73
Q

What are the distinguishing adverse effects of metoprolol?

A

Depression

Short Term Memory loss

74
Q

What are the ocular adverse effects of Metoprolol?

A 
Increased migrainous scotomata
Reduced IOP
Glaucoma progression
Corneal anesthesia
Exacerbation of myasthenia gravis
75
Q

The adverse effects of metoprolol can mimic what eye problem?

A

Herpes keratitis

76
Q

Why does metoprolol cause dry eye?

A

It numbs the cornea, so you don’t blink as much

77
Q

Is metoprolol a sympathomimetic or a sympatholytic?

A

Sympatholytic

78
Q

What is a sympatholytic?

A

A drug that inhibits the postganglionic functioning of the sympathetic nervous system

79
Q

What is the effect of an ophthalmic alpha-2 agonist interaction with metoprolol?

A

Additive effect

80
Q

What is the effect of an ophthalmic beta-blocker interaction with metoprolol?

81
Q

What is the effect of pilocarpine with metoprolol interactions?

82
Q

What kind of drug is pilocarpine?

A

Parasympathomimetic

83
Q

What is the effect of an NSAID interaction with metoprolol?

A

Antagonistic

84
Q

What is the effect of an ophthalmic decongestant reaction with metoprolol?

A

Antagonisti

85
Q

What three drugs interact with Metoprolol to cause an additive effect?

A

Ophthalmic Alpha-2 agonists
Ophthalmic beta-blockers
Pilocarpine

86
Q

What two drugs interact with Metoprolol to cause an antagonistic effect?

A

NSAIDs

Ophthalmic decongestants

87
Q

What receptor does cocaine block?

A

Reuptake receptors for NE

88
Q

What is the suffix for diuretics?

A

-ide and tone

89
Q

Which diuretic is contraindicated for people with sulfa allergies?

A

Furosemide

90
Q

What are the three diuretics used for HTN?

A

Furosemide
Hydrochlorothiazide
Spironolactone

91
Q

What are the indications for Furosemide?

A

Hypertension
Acute pulmonary edema
Hypercalcemia

92
Q

How does furosemide help with hypercalcemia?

A

Enhances urinary output of calcium

93
Q

What do diuretics inhibit?

A

Reabsorption of calcium (I think)

94
Q

What two ions does furosemide deplete?

A

Ca++ and K+

95
Q

What is the MOA of diuretics?

A

Inhibits reabsorption of NaCl at the proximal/distal convoluted tubule and loop of henle

96
Q

To whom are loop diuretics prescribed?

A

Patients with impaired renal function

97
Q

How do loop diuretics enhance renal blood flow?

A

By increasing prostaglandin production

98
Q

What are the common adverse effects of Furosemide?

A

Blurred vision
Hypotension
Puritis

99
Q

What is puritis?

100
Q

What are the potential hypersensitivity reactions from Furosemide?

A

Steven’s Johnson syndrome

Erythemia multiforme

101
Q

What adverse effects can furosemide have on the cardiovascular system?

A

Decrease K+

Vasculitis

102
Q

If furosemide depletes too much K+, that can be a problem for which organ?

103
Q

What effect occurs when Furosemide interacts with Aminoglycosides?

A

Additive nephrotoxicity

104
Q

What effect occurs when Furosemide interacts with NSAIDs?

A

Induced ototoxicity and antagonism

105
Q

What effect occurs when Diuretics interact with Carbonic Anhydrase Inhibitors?

A

Prolonged QT interval

106
Q

What effect occurs when diuretics interact with erythromycins?

A

Prolonged QT interval

107
Q

If you do a DFE and not anemia and the patient reports being on a HTN drug, which drug is most likely?

A

Diuretic - Furosemide

108
Q

Why is the drug interaction effect of prolonging the QT interval bad?

A

It is potentially life threatening

109
Q

Which patients require caution with Furosemide?

A

People with hypersensitivity to sulfonamides

110
Q

If depletion of Ca and K is not desired, which Diuretic is used?

A

HCTZ - hydrochlorothiazide

111
Q

When in hydrochlorothiazide indicated?

A

Hypertension
Peripheral edema
Congestive heart failure
Osteoporosis

112
Q

Between HCTZ and Furosemide, which one is Ca depleting?

A

Furosemide

113
Q

What is the MOA of HCTZ?

A

Inhibits NaCl reabsorption at the distal convoluted tubule

114
Q

What are the common adverse effects of HCTZ?

A

Photosensitivity

Headache

115
Q

What hypersensitivity reactions are possible with HCTZ?

A

Erythema multiforme

Steven’s-Johnson syndrome

116
Q

What hematological adverse effects are possible with HCTZ?

A

Anemia
Leukopenia
Thrombocytopenia

117
Q

What are the potential ocular adverse effects of HCTZ?

A

Angle closure glaucoma

118
Q

What is thrombocytopenia?

A

Reduction in thrombocytes

119
Q

What do thrombocytes do?

A

Reduce platelets

120
Q

What may thrombocytopenia cause?

A

Low platelet count and hemorrhaging

121
Q

What is the effect of CAI interactions with HCTZ?

A

Synergy - they both cause a reduction in fluid production

122
Q

What is the effect os NSAID interactions with HCTZ?

A

Antagonistic

123
Q

What is the effect of erythromycin interaction with HCTZ?

A

QT prolongation

124
Q

When should caution be taken when prescribing HCTZ?

A

Hypersensitivity to sulfonamides

125
Q

What are the indications for Sprionolactone?

A

HTN
Congestive heart failure
Hyperaldosteronism
Hypokalemia

126
Q

What kind of drug is Spironolactone?

127
Q

Spironolactone is a ___ sparing drug.

128
Q

What unique relationship does Sprionolactone have?

A

Hyperaldosteronism

129
Q

If a patient with hyperaldosteronism is put on spironolactone, what may occur?

A

BP may increase, instead of decrease, because they are putting out too much aldosterone

130
Q

What is the MOA for spironolactone?

A

Antagonizes the aldosterone receptors in the distal convoluted tubule (kidney), resulting in Na/water loss and K retention

131
Q

What are the common adverse effects of Spironolactone?

132
Q

What are the distinguishing adverse effects of Spironolactone?

A

Gynecomastia

Menstrual irregularities

133
Q

What occurs when Sprionolactone interacts with cyclosporine?

A

Hyperkalemia - additive effect

134
Q

What occurs when spironolactone interacts with NSAIDs?

A

Decreases the amount of BP lowering (antagonistic)

135
Q

What are the two “other” HTN drugs?

A

Clonidine

Hydrolzine

136
Q

What are the indications for Clonidine?

A

HTN

Severe cancer-related pain

137
Q

Which drug can be given via epidural injection?

138
Q

What is the MOA for Clonidine?

A

Stimulates the central and spinal alpha-2 adrenergic receptors (presynaptic and post-junstional

139
Q

What are the serious adverse effects of Clonidine?

A

Angioedema

140
Q

What is the effect of the interaction between antihistamines or opioids and Clonidine?

A

Enhanced CNS depression (agonistic)

141
Q

What is the effect of the interaction between ophthalmic beta-blockers and Clonidine?

A

Antagonistic

142
Q

What is the effect of the interaction between ophthalmic decongestants and Clonidine?

A

Antagonistic

143
Q

What is the effect of the interaction of ophthalmic alpha-2 agonists and clonidine?

144
Q

Clonidine inhibits ___ activity.

A

Sympathetic

145
Q

What are the indications for Hydralazine?

A

Hypertension
Congestive heart failure
HTN crisis

146
Q

What is the MOA for Hydralazine?

A

Directly dilates peripheral vessels via hyperpolarization of vascular smooth muscle, which inhibits CA++ influx (depolarization

147
Q

What are the common adverse effects of Hydralazine?

A

Headache

Lupus erythematosus

Systemic Pharm (15 decks)

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