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M3 Pharm B2 > Anti-hypertensives (Cardio and Renal 1) > Flashcards

Anti-hypertensives (Cardio and Renal 1) Flashcards

1
Q

6 Types of Heart Drugs

A
  1. Anti-hypertensives
  2. Anti-arrhythmias
  3. Anti-anginal drugs
  4. Drugs used in MI
  5. Drugs used in heart failure
  6. Anti-hyperlipidemic drugs
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2
Q

10 Types of Anti-Hypertensives

A
  1. Diuretics
  2. Angiotensin Converting Enzyme Inhibitors (ACE Inhibitors or ACEI)
  3. Angiotensin Receptors Blockers (ARB)
  4. Beta Blockers (BB
  5. Calcium Channel Blockers (CCB)
  6. Alpha 2 Agonist
  7. Adrenergic Neuronal Blocking Drugs
  8. Alpha Blockers
  9. Direct Acting Vasodilators
  10. Renin Inhibitors: Aliskiren
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3
Q

Which classes of Anti-hypertensive drugs have proven to decrease mortality from heart disease (3)?

A
  1. Beta Blockers
  2. ACE Inhibitors
  3. Thiazide Diuretics
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4
Q

What’s hypertension?

A

Elevated systolic, diastolic, or BOTH.

Normal: 120/80

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5
Q

When are anti-hypertensives indicated? Stage I Hypertension

A

Stage I Hypertension

Diastolic = 90-99

Recommended: Thiazide diuretic

Consider: ACEI, ARB, BB, or CCB

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6
Q

When are anti-hypertensives indicated? Stage II Hypertension

A

Diastolic = >100

Recommended: *Two-drug combination (Stage II, 2-drug combo)
e.g. Thiazide diuretics + ACEI OR Thiazide diuretics + ARB + BB + CCB

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7
Q

Pre-Hypertension

A

Diastolic = 80-89

Recommended: Life style modification -* weight reduction, moderate alcohol, regulary exercise, reduced sodium, *smoking cessation

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8
Q

If patient presents with hypertension + medical condition, then what’s the approach?

A

Hypertension + (Compelling indications)

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9
Q

Hypertension and angina pectoris

A

BB, CCB

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10
Q

Hypertension and BPH

A

Alpha blocker

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11
Q

Hypertension and diabetes

A

ACE Inhibitors, ARB

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12
Q

Hypertension and heart failure

A

ACE Inhibitors, ARB, BB

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13
Q

Hypertension in patient AFTER having MI

A

BB

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14
Q

Hypertension and hyperlipidemia

A

Alpha blocker, CCB

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15
Q

Refractory Hypertension

A

Hypertension that is not responding to combination therapy

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16
Q

Drug choice for pregnant female with Pre-Eclampsia (high BP)

A

Labetalol

Consider: Hydralazine- Nifedipine-Nitroglycerin

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17
Q

Mechanisms affecting BP: Formulas

A

BP = CO x TPR

CO = SV x HR

BP = SV x HR x TPR

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18
Q

Mechanisms affecting BP: Increased SV (Edema, increased renin-angiotensin activity)

A

Rx: Diueretics, ACE Inhibitors

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19
Q

Mechanisms affecting BP: Increased HR (due to decreased vagal tone and increased sympathetic tone)

A

Rx: BB

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20
Q

Mechanisms affecting BP: Increased peripheral resistance (Increased sympathetic tone)

A

Rx: Alpha 2 agonist
Alpha Blockers
CCB
Direct acting vasodilators

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21
Q
  1. Diuretics: Types (5)
A
  1. Thiazides diuretics (Early distal tubule)
  2. Loop diuretics (Thick Ascending Limb of Loop)
  3. Osmotic diuretics (Proximal tubules, Loop of Henle, and Collecting duct)
  4. Carbonic Anhydrase inhibitors (Proximal tubules)
  5. Potassium-sparing diuretics (Late distal tubule, and collecting duct)
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22
Q
  1. Diuretics: Thiazides
A

Rx: Chlorothiazide, Hydrochlorothiazide, *Chlorthalidone, **Indapamide *Metalozone

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23
Q
  1. Diuretics: Thiazides - MOA *(4)
A

Inhibit Na/Cl cotransport

Increase excretion of: Na+, K+, Cl+, Mg+, and HCO3

Decrease excretion of: Ca, uric acid

*Reduces symptoms of both central and nephrogenic diabetes insipidus by persistent extracellular volume depletion AND decreased GFR

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24
Q
  1. Diuretics: Thiazides - Side Effects
A

Hypo everything except calcium –> hyper alchemical and hyperuricemia

Metabolic Alkalosis

Increase plasma cholesterol and TGs (except **indapamide)

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25
1. Diuretics: Loop Diuretics
Rx: Furosemide, Bumetanide, Torsemide, Ethacrynic acid
26
1. Diuretics: Loop Diuretics - MOA
Inhibit Na+/K+ dicholride cotransport system Increase excretion of Na, K, Mg, Cl, HCO3, Ca
27
1. Diuretics: Loop Diuretics - Side effects
Buzzword: Ototoxicity HYPO EVERYTHING Metabolic alkalosis
28
1. Diuretics: Loop Diuretics - Drug Interactions
Loop diuretic + Antibiotic (aminoglycosides) ----> Increased risk for ototoxicity
29
1. Diuretics: Osmotic Diuretics
Rx: Mannitol and Urea
30
1. Diuretics: Osmotic Diuretics - MOA
Increase the osmotic pressure in the proximal tubule --> inhibition of reabsorption of water and electrolytes
31
1. Diuretics: Osmotic Diuretics - *Indications
*Increase intra-cranial and intra-ocular pressure Acute renal failure
32
1. Diuretics: Carbonic Anydrase Inhibitors
Rx. Acetazolamide, Dorzolamide
33
1. Diuretics: Carbonic Anydrase Inhibitors - MOA
Increase excretion of Na+, K+, and HCO3
34
1. Diuretics: Carbonic Anydrase Inhibitors - Side Effects
Hyperchloremic metabolic acidosis (normal anion gap acidosis), hypokalemia
35
1. Diuretics: Carbonic Anydrase Inhibitors - Indications
Rx of glaucoma, and overdose of acidic drugs Why?
36
1. Diuretics: Potassium-Sparing Diuretics
Rx: Spironolactone (Aldosterone Antagonist) Amiloride Triamterene
37
1. Diuretics: Potassium-Sparing Diuretics MOA
Block Na+ reabsorption | Block K+ secretion (spare K+)
38
1. Diuretics: Potassium-Sparing Diuretics - Side Effects
*Hyperkalemia, metabolic acidosis Nephrolithiasis (triamterene) Decreased libido (spironolactone)
39
1. Diuretics: Potassium-Sparing Diuretics - Eplerenone (New)
Similar to spironolactone with less side effects
40
1. Diuretics: Potassium-Sparing Diuretics - Indications 1
*Spironolactone + ACEI increased survival in heart failure **Spironolactone has an anti-androgenic effect: rx for hirsutism
41
1. Diuretics: Potassium-Sparing Diuretics - Indications 2
Amiloride used as rx for Nephrogenic DI caused by lithium What drug is used for rx for Nephrogenic DI? (Thiazides to excrete water and Na, check slide 26 to confirm)
42
2. ACE Inhibitors: Buzzword
Drugs ending with "pril" - 7 Captopril Enalapril --> IV for hypertensive emergency (Diastolic above 120 and Systolic above 200 WITH SYMPTOMS) Lisinopril Fosinopril --> no dose adjustment in renal failure Benazepril Quinapril Ramapril
43
2. ACE Inhibitors: MOA
Inhibit ACE (thus no AT II, and also inhibits inactivation of bradykinin --> so, bradykinin is still active and can cause vasodilation) Side effect: Dry cough
44
What drugs are the best for hypertension in diabetes?
ACE Inhibitors because diabetic patients tend to get nephropathy. ACE Inhibitors slow down renal damage
45
2. ACE Inhibitors: Contraindications
HYPERkalemia and acute renal failure (proteinuria)
46
2. ACE Inhibitors: Contraindicated During Pregnancy
Contraindicated in 2nd and 3rd trimester --> leads to fetopathy Also, oligohydramnios, IUGR, hypocalvaria, and renal failure
47
3. ARB (AT II Receptor Blockers)
Buzzword: Drugs ending in "sartan" Losartan Valsartan Candesartan Irbesartan *NO DRY COUGH because no bradykinin involved
48
3. ARB (AT II Receptor Blockers) : MOA (*2)
Block AT II (type I, at AT-1 receptors) ---> reducing vasconstriction *Increases ability of kidney to excrete sodium when plasma renin is 3-4x higher than normal
49
3. ARB (AT II Receptor Blockers): Adverse Reactions
Acute renal failure Contraindicated in pregnancy
50
4. Beta Blockers (BB)
Buzz word: Drugs ending in "olol" Propranolol ---> Hyperthyroidism Atenolol - Selective B1-blocker Metoprolol - Selective B1-blocker Bisoprolol - Selective B1-blocker Labetalol - Selective alpha and non-selective B blocker
51
4. Beta Blockers (BB): Third Generation (2)
Nebivolol - Selective B1 blocker with antioxidant properties Carvedilol - Third generation alpha and beta blocker
52
4. Beta Blockers (BB): Indications (4)
1. Coronary Artery Disease 2. Tachy-arrhythmia 3. Migraine headaches 4. Anxiety
53
4. Beta Blockers (BB): Contraindications
Asthma, heart attack
54
4. Beta Blockers (BB): Adverse Effects
Bronchospasm, fatigue, glucose intolerance
55
4. Beta Blockers (BB): Cautions (2)
1. Mask signs of hypoglycemia 2. Abrupt withdrawal can cause hypertension Upregulation of # of receptors
56
5. ***CCB
Drugs ending in "dipine: Amlodipine - Most commonly prescribied Nifedipine Isradipine Feldopine Nicardipine Buzz word: Dihydropyridinees (peripheral tissues, dilate) ***Exception Non-hydropyridines (heart): Diltiazem and Verapamil Works for hypertension and arrhythmias
57
5. CCB: MOA
Block the L-type Ca2+ channels
58
5. CCB: Dihydro-pyridines
Buzzword: Reflex tachycardia, flushing, ankle edema
59
5. CCB: Non-dihydropyridines
Buzzword: Decrease cardiac contractility, possible AV block
60
5. CCB: Indications (3)
Angina pectoris Peripheral vascular disease Tachy-arrhythmia
61
5. CCB: Nimodipine is approved for?
Acute subarachnoid hemorrhage | Prevents post hemorrhagic vasospasm
62
Who respond to CCBs well?
African Americans and elderly
63
6. Alpha 2 Agonist: Clonidine
Mild to moderate hypertension (patches cause less side effects) Side effects: Edema, rebound hypertension after sudden withdrawal
64
6. Alpha 2 Agonist: Alpha Methyldopa
Mild to moderate hypertension Side effects: + Coombs test --> hemolytic anemia Safe in pregnancy and renal dysfunction
65
7. Adrenergic Neuronal Blocking Drugs: Guanethidine
Binds to storage vesicles and inhibit release of NE Side effects: Fluid retention Contraindicated with antidepressants
66
7. Adrenergic Neuronal Blocking Drugs: Reserpine
Binds to storage vesicles and destroys them Causes depletion of NE, DA, and serotonin Side effects: Psychotic depression and suicide
67
8. Alpha Blockers: Rx and Use
"Dox Pra Tera" Rx: Doxazocin, Prazocin, Terazocin Lower BP and used for BPH
68
8. Alpha Blockers: Side Effects
First dose of syncope, orthostatic hypotension
69
8. Alpha Blockers: What happens when women cough, sneeze, or try to lift weights?
Incontinence because of the alpha blockade effect on the bladder and sphincter
70
9. Direct Acting Vasodilators: Hydralazine (*4)
Relaxes arteriolar smooth muscle Side effects: Reflex tachycardia, palpitations (use a BB) Buzz word: SLE like syndrome and hemolytic anemia Not used alone as an anti-hypertensive drug because its tolerance to the anti-hypertensive action develops early due to counter regulatory mechanism
71
9. Direct Acting Vasodilators: Sodium Nitroprusside
Dilate both resistance and capacitance vessels Long term side effects: accumulation of cyanide and thiocyanate Buzzword: Choice for hypertensive crisis (IV)
72
9. Direct Acting Vasodilators: Minoxidil
Prodrug which after sulfation appears to activate K+ channels Side effects: Hypertrichosis (abnormal hair growth) Buzzword: Rogaine (topically for baldness)
73
9. Direct Acting Vasodilators: Diazoxide
Activates K+ channels causing relaxation of smooth muscle Side effects: Hyperglycemia (decrease insulin release from B cells) AND Hypertrichosis IV Rx of hypertensive emergencies Used to tx insulinoma Sulfonylureas (oral hypoglycemics) work n the same type of K+ channel but close them
74
9. Direct Acting Vasodilators: Fenoldopam
Side effects: Headache and nausea
75
10. Renin Inhibitor
Aliskiren
76
What are the 4 drugs for hypertensive emergency with symptoms?
Enalapril (ACEI) Labetolol (BB) Sodium Nitroprusside (Direct Acting Vasodilator) Diazoxide (Direct Acting Vasodilator)

M3 Pharm B2 (10 decks)

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