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Cardio Drugs > Antihypertensive > Flashcards

Antihypertensive Flashcards

1
Q

Thiazide, Hydrochlorothiazide, Chlorothialidone Type & indication

A

Often combined with BB’s, ACEI’s, ARBS, central-actors in fixed dose combinations for treatment of HTN

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2
Q

Thiazide, Hydrochlorothiazide, Chlorothialidone Contraindication

A

severe renal or cardiac insufficiency, hypokalemia, pregnancy

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3
Q

Thiazide, Hydrochlorothiazide, Chlorothialidone MOA

A

initial effect due to volume contraction, long term effect due to decreased peripheral resistance (prostaglandin)

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4
Q

Thiazide, Hydrochlorothiazide, Chlorothialidone Drug Action/Pd

A

Thiazide, K+ wasting, Ca2+ saver. Inhibits Na+ reabsorption-Inhibits Na/Cl cotransporter in distal tubule. Not as strong because most Na has already been pumped. Protective against kidney stones.

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5
Q

Thiazide, Hydrochlorothiazide, Chlorothialidone Adverse Effects

A

hyponatremia, hyperglycemia (watch diabetics), Increased LDL/HDL, Hypokalemia, Hyperuricemia, Impotence

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6
Q

Thiazide, Hydrochlorothiazide, Chlorothialidone Drug interactions

A

No NSAIDS (PG mechanism), No BB’s if diabetic or lipidy-worsen hyperlipidemia and hyperglycemia, No Digoxin or Quinidine or Steroids. No Carbamazapine/Chlorpropamide or Anticoagulants (prone to clots).

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7
Q

Thiazide, Hydrochlorothiazide, Chlorothialidone Notes

A

watch renal insufficiency w/thiazides.

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8
Q

Drug Name

A

Loop, Furosemide (Lasix)

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9
Q

Furosemide (Lasix) Type & indication

A

Loop Diuretic

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10
Q

Furosemide (Lasix) Contraindication

A

diabetics (if on sulfonylureas will get hyperglycemic), watch heart patients (interaction w/B-Block, Digoxin and Quinidine), no renal insufficiency (will potentiate hyperkalemia), hyperuricemia (can lead to GOUT)

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11
Q

Furosemide (Lasix) Drug Action/Pd

A

K+ wasting, Ca/Mg wasting, hypokalemia. Inhibits Na/K/Cl- transporter in loop of henle. Remember that Ca and Mg are linked to the K+ situation in loop of henle.

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12
Q

Furosemide (Lasix) Adverse Effects

A

Dehydation/hyponatremia, hypokalemia (K+ wasting), Impaired Diabetes Control, Increased LDL/HDL, OTOTOXICITY, hypomagnesemia, hypocalcemia.

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13
Q

Furosemide (Lasix) Drug interactions

A

No NSAIDs, No BB’s, No Digoxin or Quinidine or Steroids. No Aminoglycosides or Anticoagulants (increased bleed).

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14
Q

Spironolactone, Eplerenone Contraindication

A

hyperkalemia or in patients that can have a state causing hyperkalemia (diabetes, myeloma, renal dx, renal insuff)

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15
Q

Spironolactone, Eplerenone Drug Action/Pd

A

Aldo-R inhibitor, K+ Sparing. Collecting Tubule. Gets into cell via basolateral (blood) side-no transporter needed.

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16
Q

Spironolactone, Eplerenone Adverse Effects

A

Hyperkalemic metabolic acidosis (due to sparing of H+.) Gynecomastia, antiandrogenic effects (but not w/newer eplerenone)

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17
Q

Spironolactone, Eplerenone Drug interactions

A

No NSAIDS, ACE inhibitors or ARB’s (further mess with Aldosterone system), Don’t combine with RAS inhibitors

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18
Q

Spironolactone, Eplerenone Notes

A

note that man-boobs and anti-androgenic effects are only for older spironolactone.

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19
Q

Nifedipine Type & indication

A

Calcium channel blocker; good for ischemic heart disease (angina), chronic pulmonary disease, diabetes due to limited side effects.

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20
Q

Nifedipine Contraindication

A

liver failure (metabolism-pk), severe heart failure (need vasoconstriction to perfuse organs)

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21
Q

Nifedipine MOA

A

dihydropyridine

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22
Q

Nifedipine Drug Action/Pd

A

more selective action on vessels, least action on heart (is a dihydropyridine)

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23
Q

Nifedipine Adverse Effects

A

acute tachycardia (reflex to the vasodilation and decreased cardiac return), peripheral edema (arterioles dilate more than veins so fluid goes out of capillaries instead of into higher-pressure veins), flushing (sympa activation), headache (decreased return)

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24
Q

Nifedipine Notes

A

(Not the heart one) Dr. Samarel Sez: most cardiologists use diltiazem for treatment of angina b/c middle vasodilatory effects (hi vasodilation can lead to reflex tachy) and intermediate action in inotropy and chronotropy.

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25
Q

Diltiazem Type & indication

A

Calcium channel blocker; good for ischemic heart disease (angina), chronic pulmonary disease, diabetes due to limited side effects.

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26
Q

Diltiazem Contraindication

A

liver failure (metabolism), severe heart failure (need vasoconstriction to perfuse organs), negative inotropic effect could cause ischemia

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27
Q

Diltiazem MOA

A

non-dihydropyridine-has effects on AV node and contractility

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28
Q

Diltiazem Drug Action/Pd

A

intermediate action on vessels and heart. Blocks activated/inactivated Ca channels primarily in heart (use-dependent). Slows AV nodal conductions & increases refractoriness.

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29
Q

Diltiazem Adverse Effects

A

bradycardia (AV node), dizziness & headache (hypotensive effect from vasodilation), edema

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30
Q

Diltiazem Drug interactions

A

note that SHORT acting CCB’s cannot be used in patients with coronary ischemia (CAD) b/c they can have a heart attack!!

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31
Q

Diltiazem Notes

A

(D middle of the road) Dr. Samarel Sez: most cardiologists use diltiazem for treatment of angina b/c middle vasodilatory effects (hi vasodilation can lead to reflex tachy) and intermediate action in inotropy and chronotropy.

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32
Q

Verapamil Type & indication

A

Calcium channel blocker; good for ischemic heart disease (angina), chronic pulmonary disease, diabetes due to limited side effects.

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33
Q

Verapamil Contraindication

A

liver failure (metabolism), severe heart failure (need vasoconstriction to perfuse organs), negative inotropic effect could cause ischemia

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34
Q

Verapamil MOA

A

non-dihydropyridine-has effects on AV node and contractility

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35
Q

Verapamil Drug Action/Pd

A

more effect on heart than vessels, Blocks activated/inactivated Ca channels primarily in heart (use-dependent). Slows AV nodal conductions & increases refractoriness.

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36
Q

Verapamil Adverse Effects

A

constipation, bradycardia (AV node, reduced CO b/c of Ca block), dizziness & headache and edema

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37
Q

Verapamil Drug interactions

A

watch cardiac acting non-dihydropyridines in pts w/BB’s because they can get SEVERE BRADYCARDIA!

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38
Q

Verapamil Notes

A

(Very cardiac active) Dr. Samarel Sez: most cardiologists use diltiazem for treatment of angina b/c middle vasodilatory effects (hi vasodilation can lead to reflex tachy) and intermediate action in inotropy and chronotropy.

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39
Q

Clonidine Type & indication

A

sympathetic-induced HYPERTENSION

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40
Q

Clonidine

A

A2 agonist (but remember alpha-2 is hooked up to Gi) acute increase in BP initially (peripherally) and then reduced BP (centrally); has actions on vasculature & chol/adr nerve terminals

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41
Q

Clonidine Drug Action/Pd

A

A2 Agonist. Decreases sympathetic outflow from CNS

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42
Q

Clonidine Adverse Effects

A

side effects do with blocking sympathetics: sedation (12-35%), dry mouth (25-40%), bradycardia, dermatitis

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43
Q

Clonidine Drug interactions

A

CNS Depressants like barbituates, benzos, opioid analgesics… (because Clonidine causes some CNS depression.

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44
Q

Clonidine Notes

A

Caution patient about missing doses–withdrawal should be done slowly to prevent rebound hypertension. Major compensatory response is salt retention.

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45
Q

Methyldopa Type & indication

A

Hypertension in PREGNANCY (drug of choice)

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46
Q

Methyldopa Contraindication

A

Liver failure, or treatment with MAOI’s or L-Dopa for Parkinson’s

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47
Q

Methyldopa MOA

A

same MOA as A2 agonist Clonidine.

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48
Q

Methyldopa Drug Action/Pd

A

Prodrug which is converted to active form-is ALPHA 2 agonist

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49
Q

Methyldopa Adverse Effects

A

sedation, nightmares, movement disorders, hyperprolactinemia, Hemolytic Anemia (rare 1-5%)

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50
Q

Methyldopa Drug interactions

A

MAOI’s b/c drug competes w/Nepi for transport into vesicles, leading to Nepi buildup in cytoplasm and expulsion of Nepi into body, negating effects. L-dopa (parkinsons) b/c drug causes increased dopamine degredation.

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52
Q

Reserpine Type & indication

A

HTN-often combined with diuretics to use therapeutically b/c at low dose you don’t have depression side effect.

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53
Q

Reserpine Contraindication

A

DO NOT use as a MONOTHERAPY (alone).

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54
Q

Reserpine MOA

A

leaves monoamines susceptible to degredation by MAO

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55
Q

Reserpine Drug Action/Pd

A

PREsynaptic inhibition of Ntmission, indirect acting adrenergic blocking agent. Inhibits VMAT uptake of monoamines

56
Q

Reserpine Adverse Effects

A

depression (not at lower doses), nasal congestion, bradycardia, sedation, diarrhea.

57
Q

Reserpine Drug interactions

A

CNS depressants (sleeping meds especially) or MAOI’s

58
Q

Reserpine Notes

A

note that dopamine is transported into vesicles, and this is the step that is blocked

59
Q

Phentolamine Type & indication

A

Pheochromocytoma ; catecholamine extravasation (to save tissue from ischemia and death if NE/Epi is out of veins)

60
Q

Phentolamine Contraindication

A

pts with poor cardiac blood flow or CAD (due to reflex tachycardia)

61
Q

Phentolamine MOA

A

non-selective alpha antagonist (A1 & A2)

62
Q

Phentolamine Adverse Effects

A

orthostatic hypotension, reflex tachy (can give B-Blocker to prevent from happening), nasal congestion (due to vasodilation of nasal vessels), decreases LDL & HDL

63
Q

Phentolamine Notes

A

hypotensive side effects lessen after 1st dose

64
Q

Prazosin Type & indication

A

Hypertension, selective A1 antagonist

65
Q

Prazosin MOA

A

selective alpha-1 antagonist

66
Q

Prazosin Drug Action/Pd

A

less reflex tachycardia b/c less A2 effects when compared to non-specifics, also large initial drop in blood pressure (pts level out). Does not impair exercise tolerance.

67
Q

Prazosin Adverse Effects

A

orthostatic hypotension (syncopy), decreases LDL & HDL

68
Q

Prazosin Notes

A

hypotensive side effects lessen after 1st dose

69
Q

Propranolol, Nadolol Type & indication

A

Propranolol-mild to moderate HTN, is lipophilic, sometimes used with vasodilators. Nadolol-longer 1/2 life, better compliance, hydrophilic

70
Q

Propranolol, Nadolol Contraindication

A

bradycardia or heart block; cardiogenic shock or heart failure, asthmatics or diabetics

71
Q

Propranolol, Nadolol MOA

A

NONSELECTIVE BETA BLOCKERS (B1 & B2 block). (Propranolol is also a Type II anti-arrythmic.)

72
Q

Propranolol, Nadolol Drug Action/Pd

A

Anti-HTN actions: decrease HR & contractility, decrease renin release; decrease sympathetic activation. Also inhibit aqueous humor production. Bronchospasm (inhibit B2)! Diabetics- decreased response to epi (liver B2)-don’t respond to hypoglycemia!

73
Q

Propranolol, Nadolol Adverse Effects

A

lipophilic drug Propranolol-Chronic Fatigue, also insomnia, nightmares. Both have Bradycardia, increased triglycerides, decreased HDL’s, increased airway resistance (B2)

74
Q

Propranolol, Nadolol Drug interactions

A

CCB’s (due to doubling up of reduced contracility and conduction)

75
Q

Propranolol, Nadolol Notes

A

Nadolol has longer 1/2 life (20-24hr) so has once-daily dosing advantage over prototype propranolol.

76
Q

Pindolol Type & indication

A

HYPERTENSION, especially if sympathetic activity is too high

77
Q

Pindolol Contraindication

A

bradycardia or heart block; cardiogenic shock or heart failure, asthmatics or diabetics

78
Q

Pindolol MOA

A

PARTIAL AGONIST, less bradycardia & lipid abnormalities than other B-Blocker types

79
Q

Pindolol Drug Action/Pd

A

decrease heart rate & contractility and overall CO (B1), decrease renin release (less vasoconstriction via R-A-A system); decrease sympathetic activation.

80
Q

Pindolol Adverse Effects

A

slightly lipophilic so may see Chronic fatigue, insomnia, nightmares.

81
Q

Pindolol Drug interactions

A

CCB’s (due to doubling up of reduced contracility and conduction)

82
Q

Pindolol Notes

A

Beneficial when sympathetic activity is too high

83
Q

Sympatholytic Drugs:

A

idea is to decrease sympathetic mediated vasoconstriction (alphas), CO and Renin Release (Betas), (l) after name means lipophilic for B-Blockers, BB’s less effect in blacks or elderly

84
Q

Metoprolol (l) Atenolol Type & indication

A

ANTI-HTN: HYPERTENSION, ANGINA, Arrythmias

85
Q

Metoprolol (l) Atenolol Contraindication

A

bradycardia or heart block; cardiogenic shock or heart failure, asthmatics or diabetics*

86
Q

Metoprolol (l) Atenolol MOA

A

Selective B1 BLOCKERS “cardioselective”, (these two are also used as Type II anti-arrythmic)

87
Q

Metoprolol (l) Atenolol Drug Action/Pd

A

decrease heart rate & contractility and overall CO (B1), decrease renin release (less vasoconstriction via R-A-A system); decrease sympathetic activation. *Little effect on liver or lung so may be okay for diabetics or asthmatics.

88
Q

Metoprolol (l) Atenolol Adverse Effects

A

less respiratory side effects b/c of cardioselectivity (B1), do have bradycardia, increased triglys

89
Q

Metoprolol (l) Atenolol Drug interactions

A

CCB’s (due to doubling up of reduced contracility and conduction)

90
Q

Labetolol (l) Type & indication

A

ANTI HTN: mild to severe HTN, used for Pheochromocytoma

91
Q

Labetolol (l) Contraindication

A

bradycardia or heart block; cardiogenic shock or heart failure, asthmatics or diabetics

92
Q

Labetolol (l) Drug Action/Pd

A

B-Blocker with A-Blocker activity

93
Q

Labetolol (l) Adverse Effects

A

Due to alpha blocking, get more incidence of orthostatic hypotension (block of baroreceptor alpha response), same lipophilic effcts as above (fatigue)

94
Q

Carvedilol (l) Type & indication

A

ANTI-HTN: mild to severe HTN, also used post-MI and for heart failure

95
Q

Carvedilol (l) Contraindication

A

bradycardia or heart block; cardiogenic shock or heart failure, asthmatics or diabetics

96
Q

Carvedilol (l) Drug Action/Pd

A

B-Blocker with A-Blocker activity

97
Q

Carvedilol (l) Adverse Effects

A

Due to alpha blocking, get more incidence of orthostatic hypotension (block of baroreceptor alpha response), same lipophilic effcts as above (fatigue)

98
Q

Hydralazine Type & indication

A

Vasodilation of small vessels, particularly arterioles: drug resistant HTN and emergencies

99
Q

Hydralazine Contraindication

A

Severe angina or known CAD (see “Coronary steal”)

100
Q

Hydralazine MOA

A

vasodilate arterioles

101
Q

Hydralazine Drug Action/Pd

A

orally effective

102
Q

Hydralazine Adverse Effects

A

tachycardia, angina aggrevation, fluid retention, nausea, vomiting, sweating flushing, lupus-like symptoms

103
Q

Hydralazine Drug interactions

A

NSAID’s (can reduce effectiveness)

104
Q

Hydralazine Notes

A

remember from Dr. Samarel’s lecture that drugs that work primarily on arterioles can produce coronary steal!

105
Q

Minoxidil Type & indication

A

Vasodilation of small vessels, particularly arterioles: drug resistant HTN

106
Q

Minoxidil Contraindication

A

Severe angina or known CAD (see “Coronary steal”)

107
Q

Minoxidil MOA

A

vasodilate arterioles

108
Q

Minoxidil Drug Action/Pd

A

orally effective

109
Q

Minoxidil Adverse Effects

A

tachycardia, angina aggrevation, fluid retention, hypertrichosis (extra body hair), nausea, vomiting, sweating flushing, lupus-like symptoms

110
Q

Minoxidil Notes

A

remember from Dr. Samarel’s lecture that drugs that work primarily on arterioles can produce coronary steal!

111
Q

Nitroprusside Type & indication

A

Vasodilation of small vessels, particularly arterioles: emergencies

112
Q

Nitroprusside MOA

A

arteriole & venous dilation; endothelium independent.

113
Q

Nitroprusside Drug Action/Pd

A

immediate onset, brief duration. Can produce prompt vasodilation (w/reflex tachy) and can reduce BP in all pts, regardless of cause of HTN!

114
Q

Nitroprusside Adverse Effects

A

nausea, vomiting, muscle twitch, cyanide poisioning

115
Q

Nitroprusside Notes

A

you don’t give it orally b/c that converts it to cyanide!

116
Q

Losartan Type & indication

A

Angiotensin R Blocker (ARB’s): non-peptide antagonist of ATII receptor

117
Q

Losartan Contraindication

A

no ARB’s in pregnancy-renal damage to fetus (Dr. Fareed)

118
Q

Losartan MOA

A

blocks renin-angiotensin-aldosterone system to lower BP

119
Q

Losartan Adverse Effects

A

hyperkalemia. Less effective (just like ACEI’s) in salt-sensitive blacks.

120
Q

Losartan Drug interactions

A

liver metabolism, so decrease dose if liver problem or hypovolumic

121
Q

Losartan Notes

A

Better results with diuretic combo rather than increased dose!

122
Q

Drug Name

A

Captopril

123
Q

Captopril Type & indication

A

ACEI’s are Less effective in black patients you racist! ACEI’s: Reduces mortality post-MI and in HF pts, Reduces remodeling of heart post MI. Preserves renal function in diabetics

124
Q

Captopril Contraindication

A

no ACE inhibitors in pregnancy due to renal damage of fetus (Dr. Fareed), bilateral renal stenosis

125
Q

Captopril Drug Action/Pd

A

short t 1/2, need multiple daily doses, has active metabolites

126
Q

Captopril Adverse Effects

A

hyperkalemia, dry cough, rash, angioedema (rare!). Risk of hyperkalemia if using K+ sparing drugs!

127
Q

Captopril Drug interactions

A

ACE is also a kininase, so when you block it, you see increased bradykinin, which is a vasodilator and is thought to be what causes cough in people.

128
Q

Enalapril Type & indication

A

ACEI’s are Less effective in black patients you racist! ACEI’s: Reduces mortality post-MI and in HF pts, Reduces remodeling of heart post MI. Preserves renal function in diabetics

129
Q

Enalapril Contraindication

A

no ACE inhibitors in pregnancy due to renal damage of fetus (Dr. Fareed), bilateral renal stenosis

130
Q

Enalapril Drug Action/Pd

A

prodrug that gets converted to active metabolite, longer 1/2 life, can dose 1-2x per day

132
Q

Enalapril Drug interactions

A

Note you really want to give ACEI’s to post-MI, HF or Diabetics. BB’s also good post-MI. Remember that AT-II is a potent cardiomyocyte growth factor (hypertrophy) and fibroblast mitogen factor (hyperplasia)– ACEI prevents cardiac remodeling!!

133
Q

Lisinopril Type & indication

A

ACEI’s are Less effective in black patients you racist! ACEI’s: Reduces mortality post-MI and in HF pts, Reduces remodeling of heart post MI. Preserves renal function in diabetics

134
Q

Lisinopril Contraindication

A

no ACE inhibitors in pregnancy due to renal damage of fetus (Dr. Fareed), bilateral renal stenosis

135
Q

Lisinopril Drug Action/Pd

A

more predictable onset and duration of action, has long 1/2 life for 1x dosing

136
Q

Lisinopril Drug interactions

A

Note you really want to give ACEI’s to post-MI, HF or Diabetics. BB’s also good post-MI. Remember that AT-II is a potent cardiomyocyte growth factor (hypertrophy) and fibroblast mitogen factor (hyperplasia)– ACEI prevents cardiac remodeling!!

Cardio Drugs (7 decks)

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