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Heart Pharm > Antihypertensive Drugs > Flashcards

Antihypertensive Drugs Flashcards

1
Q

Pre-Hypertensive

A

120-139

80-89

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2
Q

Stage 1

A

140-159

90-99

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3
Q

Stage 2

A

> 160

>100

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4
Q

Old people treatment initiated at?

A

150/90

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5
Q

What are the first line drugs of choice for hypertension?

A
  1. Diuretics
  2. Calcium Channel Blockers
  3. ACEI
  4. Angiotensin receptor blockers

ACE DIR CALLS ANGI

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6
Q

What is the drug of choice for uncomplicated hypertension?

A

Diuretics

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7
Q 
Thiazide Diuretics 
Drug
MOA
SE 
Drug Interactions 
Contraindications
A

Hydrochlorothiazide. Chlorthalidone

MOA
Inhibits Na/Cl cotransporter in distal convoluted tubule
-initial volume contraction
-later decreased peripheral resistance (prostaglandin)
-mild Na excretory effect

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8
Q

Thiazide Diuretics
SE
Drug Interactions
Contraindications

A

SE

  1. Hyponatremia
  2. Hypokalemia
  3. Metabolic Alkalosis
  4. Hyperglycemia
  5. Hyperlipidemia
  6. Hyperuricemia
  7. Hypercalcemia

Drug Interactions

  1. NSAIDs
  2. Beta Blockers-similar side effects

Contraindications
1. Hypokalemia

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9
Q

Loop Diuretics
Drug
MOA

A

Furosemide

  1. blocks NA/K/Cl cotransporter
  2. venous dilation via prostaglandins
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10
Q

Loop Diuretics
SE
Drug Interactions

A

OH DANG

  1. ototoxicity
  2. hypokalemia
  3. Dehydration/hyponatremia
  4. Allergy
  5. Nephritis
  6. Gout
    - Impaired Diabetes control
    - Increased LDL/HDL

Drug Interactions

  1. NSAIDS
  2. Aminoglycosides
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11
Q

Potassium Sparing Diuretics
Drug
MOA

A

Spironolactone
Eplerenone
Triamterene
Amiloride

Aldosterone receptor blocker-combined with diuretics-NOT USED IN MONOTHERAPY of HT

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12
Q

Potassium Sparing
SE
Drug Interactions
Contraindications

A

SE

  1. Hyperkalemia
  2. Gynecomastia (spirono)

Drug Interactions

  1. NSAiDs
  2. ACE inhibitors and ARB

Contraindications
1. Renin angiotensin inhibitors

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13
Q

Calcium Channel Blockers

MOA

A

All reduce vascular resistance by reducing calcium influx in vascular smooth muscle

Non-dihydropyridines also reduce pacemaker potentials, AV node conduction, and contractility

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14
Q

Nifedipine

SE

A

Dihydropyridine
-limited effect on pacemaker or conduction

SE

  1. acute tachycardia
  2. peripheral edema
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15
Q

Diltiazem

A

Non-dihydropyridine
-reduces pacemaker and conduction currents

SE
1. Bradycardia

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16
Q

Verapimil

A

Non-dihydropyridine
-more pronounced reduction of currents

SE

  1. Bradycardia
  2. Constipation
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17
Q

What are non-dihydropyridines contraindicated in?

A

Contraindication

  1. pts with conduction disturbances
  2. with caution in patients given beta blockers

-avoid use of short acting CCBs for chronic hypertension

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18
Q

What do sympatholytic drugs do?

A

Reduce sympathetic-mediated vasoconstriction, CO, and renin release

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19
Q

Clonidine
MOA
SE

A

-second line for hypertension
Alpha 2 Agonist
–>decrease sympathetic outflow from CNS

SE

  1. sedation
  2. dry mouth
  3. dermatitis

CNS depressant

Need slow withdraw to prevent rebound hypertension

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20
Q

What can you give that has less chance of rebound than clonidine?

A

Guanfacine

  • has longer half life
  • second line for hypertension
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21
Q 
Methyldopa
What is it used for?
MOA
Drug interactions
SE
A

Anti-hypertensive PREGNANCY!

Alpha 2 agonist
-competes with L-DOPA for DOPA decarboxylase

Drug Interactions
Levodopa

SIde effects
1. Sedation

22
Q

Reserpine
Combined with?
SE
Drug interactions

A

-used for resistant hypertension
blocks VMAP vesicular transport

Combined with diuretics
-used for mild and moderate hypertension

SE

  1. Depression
  2. Nasal Congestion

Drug interactions

  1. CNS depressant
  2. If given with MOAi could have reversal and lead to hypertensive crisis
23
Q

Alpha antagonist

A

block vasoconstriction

24
Q

Phenoxybenzamine

A

Non-selective
Used in Pheochromocytoma

SE
Tachycardia

25
Q

Prazosin

A

Second line for chronic hypotension
Selective alpha1 antagonist
-less tachycardia than direct vasoconstrictors
-doesnt impair exercise tolerance

terazosin and doxazosin have longer half lives

SE
1. Hypotension (1st dose)

26
Q

Beta Antagonists MOA

A

decreased cardiac contractility and CO, decreased renin secretion

27
Q

Propranolol
Type
Indication
Lipophilic

A

Non selective

  1. Hypertension with angina, MI, or arrhythmia
  2. used as adjunct to prevent tachycardia with vasodilators

Lipophilic

28
Q 
Nadolol
Type 
Indication 
HL
Lipophilic
A

Non Selective

  1. Long-term angina, hypertension

Longer half life* 1/day

Not Lipophilic

29
Q

Pindolol
Type
Indication
Lipophilic

A

Non Selective
Partial agonist

  1. Chronic Hypertension
    - Less brady than other beta blockers *

Slightly Lipophilic

30
Q

Metoprolol
Type
Indication
Lipophilic

A

B1 Selective

  1. Hypertension, Long term angina

somewhat lipophilic

31
Q

Atenolol
Type
Indication
Lipophilic

A

B-1 Selective

  1. Chronic Hypertension

Not Lipophilic

32
Q

Labetalol
Type
Indication
Lipophilic

A

Mixed alpha/beta antagonist

  1. Chronic hypertension

Lipophilic

33
Q

Carvedilol
Type
Indication
Lipophilic

A

Mixed alpha/beta receptor blocker and NO generator

  1. Chronic Hypertension and CHF
  2. Vasodilator-NO

Somewhat lipophilic

34
Q

Which beta blockers are not lipophilic?

A

Atenolol and Nadolol

35
Q

What are SE/contraindications/drug interactions of Beta blocker?

A
  1. Bradycardia
  2. Increased Triglycerides
  3. Decreased HDLs
  4. Hyperglycemia
  5. Impaired Exercise tolerance

Contraindications

  1. Cardiogenic shock
  2. sinus brady
  3. asthma
  4. severe heart failure

Drug interactions
1.CCB(reduced contractility and conduction)

Non selective
-increased airway resistance

Lipophilic

  1. insomnia
  2. chronic fatigue
36
Q

Vasodilators

MOA

A

vasodilation of primary arterioles

37
Q

Hydralazine
Indication
SE

A

resistant hypertension
pregnancy induced hypertension

SE

  1. tachy
  2. angina aggravation
  3. fluid retention
  4. NSAIDs can reduce effectiveness
38
Q

Minoxidil

Indication

A

Resistant hypertension

39
Q

Nitroprusside

A

Emergencies
Acute Hypertensive Crisis

SE
1. Cyanide poisoning

40
Q 
ACEi 
MOA
SE
Drug Interactions
Contraindications
A

Blocks production of Angiotensin 2

  • *Prolongs survival in pts with HF or LV dysfunction after MI
  • *Preserves renal function in diabetic patients

SE

  1. hyperkalemia
  2. dry cough
  3. angioedema

Drug Interactions
1. Exacerbates hyperkalemic effect of k sparing

Contraindication
1. pregnancy-bilateral renal stenosis

41
Q

Captopril

A

short HL-requires multiple doses

42
Q

Enalapril

A

converted to active metabolite

longer HL 1-2/day

43
Q

Lisinopril

A

1/day dosing

44
Q

Angiotensin 2 Receptor Blockers MOA

A

Mediate Vasoconstriction and sodium retention

45
Q

Losartan

A

Select AT1 receptor antagonist

SE
Hyperkalemia

Contraindications
Pregnancy

Drug interaction
K sparing diuretics

46
Q

What are three good combos?

A
  1. Thiazide or Loop with K sparing
  2. Thiazide with BB
  3. CCB with ACEI
47
Q

If someone has diabetes what do you give them?

A

ACEI

CCBs have few effects on carb metabolism

48
Q

If someone has heart failure what do you give them?

A

ACEI + Diuretic

49
Q

If someone has MI what do you give them?

A

ACEI-reduce remodeling

BB-reduce arrhythmia and remodeling

50
Q

What should you give African American pts?

A

Monotherapy with diuretics or CCBs most efficacious

Heart Pharm (14 decks)

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