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clinical pharm y5 > antihypertensive drug therapy > Flashcards

antihypertensive drug therapy Flashcards

1
Q

what are the goals of antihypertensive treatment

A

Treating SBP and DBP to targets that are <140/90 mmHg
Patients with diabetes or renal disease, the BP goal is <130/80 mmHg
primary focus should be on attaining the SBP goal. To reduce cardiovascular and renal morbidity and mortality

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2
Q

non pharm treatment of hypertension

A

Physical activity.: at least 30 mins moderate exercise most days of the week . reduce sendentary acttivities.
DASH(Dietary Approach to Stop Hypertension): as effective as a single medication.
Rich in fruits and veg
Low fat and dairy
Reduce sodium -2.4 g sodium. 6g sodium chloride
Reduction of alcohol- 2 drinks of per day men, 1 drink a day for women and lightweight men
Weight loss: bmi between 18.5-24.9kg/m2. Smaller portion sizes. Reduction in frequency
Stress reduction: e.g. transcendental meditaion
Tobacco cessation

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3
Q

what are the 8 Rules of pharmacological antihypertensive treatment

A

+ reach therapeutic dose in 2-3 weeks.
+ The dose should be increased in 4-5 days.
+ The optimal dose is reached after 4 weeks;
+ If there is no effect of antihypertensive treatment dose is increased to maximum therapeutic dose by “titration” (ie balance between the amount of antihypertensive effect and side effects of each drug).
+ Systematic and continuous treatment, which is consistent with the stage course and comorbidity;
+ Optimal dosing and optimal dose regimen;
+ In symptomatic hypertension treat the cause;
+ The patient should be informed about all the risks of treatment.

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4
Q

what causes treatment failure in antihypertensive treatment

A

Bad compliance i.e. patients do not participate in the treatment;
Improper selected drug or drug combination;
The dosage is not an individual, according to ADRs.

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5
Q

what factors must you consider when choosing the antihypertensive drug

A 
age
race
pregnancy
dyslipidemia 
renal failure
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6
Q

antihypertensive rx for over 60 yrs

A

monotherapy prefer - diuretics, calcium channel blocker

α- blockers in combination therapy.

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7
Q

antihypertensive rx for under 60 yrs

A

Monotherapy: beta blockers,
Combo: acei and hydralazine (vasodilator)

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8
Q

what drugs do nigga’s respond well to

A

diuretics and CCB like old people

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9
Q

which drugs are commonly used to treat hypertension in pregnancy

A

prazosin( alpha 1 blocker) methyldopa (alpha 1 competitive drug and pro drug)

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10
Q

which anti hypertensive drugs are contraindicated in dyslipidemia

A
  1. Thiazide and loop diuretics (increase the cholesterol and triglyceride levels)
  2. Non selective beta blockers (pindolol is an exception that decreases cholesterol levls d/2 sympathomimetic activity)
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11
Q

how does thiazide and loop diuretucs worsen dyslipidemia

A

ncreases TAG lvls -> increased cholesterol levels in pt’s w/ metabolic disorder

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12
Q

how do non selective beta blockers worsen dyslipidemia

A

increase TAG lvls->cholesterol in pt’s w/ metabolic disorder,

b3 inhibition causes decreased lipolysis in the liver leading to tag build up

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13
Q

which beta blockers can be used in renal failure
Piss
On
Bitches

A

Propranolol, Oxprenolol, Bisoprolol as they are metabolized in the liver.

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14
Q

betablockers CONTRAINDICATED in renal failure

A

Atenolol, Acebutolol (excreted in active form in the urine).
If this is the only option for treatment dose adjustment is required according to creatinine clearance. When creatinine clearance below 30 ml / min. reduction in the dose of pindolol and celiprolol is needed.

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15
Q

Antihypertensives for ventricular dysfunction, CHF, DB,

A

ACE inhibitors
Arbs
Ra

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16
Q

when are CCB used to treat hypertension

A

only when bb, ace i and diuretics fail
in the eldernly
in niggas

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17
Q

why are diuretics not used as first line treatment

A

complication risk isn’t proportional to BP reduction

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18
Q

ADR’S of thiazide diuretics

A 
Gi disturbed
Hypokalemia
Hypochloremic alkalosis	
Hypercalcemia
Hypercholesterolemia
Hyperglycemia
Hyperuricemia
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19
Q

Indapamide adr

A

Hypercalcemia
Hypercholesterolemia
Hyperglycemia
Reduced hypokalemia compared to others

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20
Q

when are weak diuretics used ( spironolactone and triamterene)

A

Used in combo w/ stronger diuretics

Potassium saving- can cause hyperkalemia

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21
Q

Spironolactone adr’s

A

Gastrointestinal reactions;
gynecomastia; impotence; amenorrhea; hirsutism.
Contraindicated in kidney failure, because of the danger of hyperkalemia.

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22
Q

Triamterene adrs

A

Reduced platelets and leukocytes;
Increases uric acid
leads to megaloblastic anemia.
Contraindicated in liver and kidney failure

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23
Q

which alpha blocker causes regression of left ventricular hypertrophy

A

prazosin

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24
Q

oral bioavaialbitly of prazosin

A

60% and is not affected by food

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25
Q

why must prazosizin be administered w/ a loading dose of 0.5mg before bed

A

it may cause orthostatic hypotension

26
Q

how is prazozin dosed

A

treatment is continued at 0.5 mg per 12 hours, and can reach up to 20 mg of 4 doses.

27
Q

which alpha blocker is used in pregnancy, liver and kidney failure

A

prazosin

28
Q

alpha blocker also used in BPH

A

prazosin

29
Q

clonidine adr’s

copy cat n benz

A 
Constipation,
dry mouth, 
 Depression,
 impotence, 
AV block,
 withdrawal syndrome that occurs with hypertensive crisis. 
 Treatment 2 times 1 tablet, 0.3 mg.  
Not be used during pregnancy.
30
Q

alpha methly dopa and pregnancy

A

1.5 - 4 g. daily dose

improves renal perfusion and the perfusion of the uterus.
No teratogenic effects.
In liver and kidney failure requiring dose reduction.
It can be used to 4000 mg daily metoprolol combined with dopegyt.

31
Q

mother adr of alpha methyl dopa

A

sleepiness, decreased performance,

liver and blood damage, hemolytic anemia, reduced number of leukocytes and eosinophils

32
Q

fetus adr of alpha methyl dopa

A

liver and blood damage.

33
Q

which antihypertensive drugs can be used in pregnancy

A

labetalol: 1200 mg
prazosin:2.5 mg daily dose.
alpha methyl dopa

34
Q

contraindicated antihypertensives in pregnancy
Children
Dont
Cry

A

diuretics – can lead to miscarriage,
CCBs,
clonidine.

35
Q

what group are beta blockers most effective in

A

hypertension over 40 years w/ elevated renin activity, at high pulse amplitude,
hypertension with tachycardia at rest.

36
Q

what group do beta blockers have reduces effect

A

smokers d/2 fast metabolism

37
Q

fat sol bb

A

good absorption after oral administration and metabolized in the liver thus contraindicated in liver failure

38
Q

examples of fat soluble bb

A

Propranolol and metoprolol

39
Q

water sol bb (atenolol)

A

eliminated in urine and contraindicated in renal failure

40
Q

adr’s of bb

A

Bradycardia, AV block, heart failure;
bronchospasm;
Increasing peripheral vascular resistance;
hypoglycemia; Fat soluble BB lead to nightmares;
Impotence.
During hard braking, develops withdrawal syndrome that occurs angina pectoris (ishaemic) crises.

They should not be combined with Verapamil(ccb) because of the danger of bradycardia and development of heart failure.

41
Q

first choice CCB in hypertension

A

Amlodipine

Felodipine

42
Q

nifedipine retard dose

A

2 times / 24 hours
(over 98% bound to plasma proteins)
only ccb used in pregnancy

43
Q

Verapamil retard dose

A

1 time for 24 hours. have antiarrhythmic effect. Negative Inotropic, chronotropic, Dromotropic action.

44
Q

pharmacokinetics of CCB

A

High intestinal absorption of 80 to 90%;

First pass effect;

45
Q

which ccb is contraindicated in pregnancy and lactation

A

nifedipine

46
Q

vasodilators used in hypertension

A

Nitroprusside sodium
Diazoxide
Hydralazine

47
Q

adr’s of sodium nitroprusside

A

Signs of cyanide poisoning - headache, dizziness, psychotic reactions, muscle cramps, reflex tachycardia, increased plasma renin activity.

48
Q

diazoxide

A

Hyperglycemia; 2. Retention of sodium and water; 3. Hyperuricemia; 4. Angina attack.

49
Q

Hydralazine

A

Tachycardia; 2. Bleeding from the gastrointestinal tract; 3. Dizziness; 4. Nausea, diarrhea; 5. Occurrence of lupus erythematosus (LE) cells.

50
Q

benefits of ace inhibitors in hypertension

A

Lead to regression of myocardial hypertrophy after 3-4 months of treatment.

Inhibit proliferation of vascular intima and thus inhibit
atherogenesis.

In patients with diabetes have nephroprotective effect.

Reduce the incidence of strokes and heart attacks in patients with hypertension.

Improve quality of life and extend the life of hypertensive patients.

51
Q

why aren’t ace inhibitors mixed with potassium sparing diuretics

A

hyperkalemia

52
Q

why aren’t ace inhibitors mixed w/ neuroleptics

A

orthostatic hypotension is a common side effect of atypical antipsychotics. caused by anticholinergic or alpha-1 adrenoceptor blockage. Alpha-1 adrenoceptors cause vasoconstriction in certain vascular beds. The blockade of these receptors leads to vasodilation which causes blood pressure to declin

53
Q

effect of ace inhibitors on omeprazole

A

reduces it’s bioavailability

54
Q

Classification of β-blockers

A 
Selective (cardioselective)β1-blockers
⦁	Metoprolol
⦁	Atenolol
⦁	Bisoprolol
Nonselective β1 + β2 blockers
⦁	Propranolol
⦁	Pindolol
⦁	Oxprenolol
Nonselective α1 + β blockers (β blocker w/ vasodialtor effect)
⦁	Carvedilol
55
Q

Classification of diuretics

A 
Thiazide diuretics and analogs:
⦁	Hydrochlorothiazide
⦁	Clopamide
⦁	Indapamide
Loop diuretics:
⦁	Furosemide
potassium sparing
-spironolactone
Combinations:
⦁	Triampurcompositum
56
Q

Calcium channel blockers/antagonists

A 
Dihydropyridines
⦁	I genereation: Nifedipine 
⦁	II generation: Felodipine 
⦁	III generation: Amlodipine
Non-dihydropyridines
⦁	Diltiazem(Diltiazem; Dilzem) 
⦁	Verapamil
57
Q

Classification of ACE Inchibitors

A 
Direct
⦁	Captopril (Capoten) 
⦁	Lisinopril (Diroton) 
Indirect(precursors, prilates):
⦁	Enalapril
⦁	Perindopril 
⦁	Ramipril
58
Q

Classification of ARBs & RA

A 
Angiotensin Receptor Blockers (ARB, sartans) 
⦁	Losartan .
⦁	Valsartan
Renin Inhibitors(RI)
⦁	Аliskiren
59
Q

Classification of Indirect Adrenomymetics

A 
Central alpha2 agonists:
⦁	Clonidine 
⦁	α-Methyldopa 
Indirect:
⦁	Reserpine
60
Q

Classification of α-blockers

A

⦁ Prazosine
⦁ Doxazosin
Classification of Antihypertensive Vasodilators
⦁ Diazoxide
⦁ Nitroprusside
Classification of Imidazoline II-Receptor Agonist Drugs
⦁ Moxonidine
⦁ Rilmenidine
⦁ Used only for co-medication, not as monotherapy!

clinical pharm y5 (22 decks)

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