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pharm > Antihypertensive Meds > Flashcards

Antihypertensive Meds Flashcards

1
Q

What is the definition of stage I hypertension?

A

SBP btw 140-159

DBP btw 90-99

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2
Q

What is the definition of stage 2 hypertension?

A

SBP over 160; DBP over 100

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3
Q

What are the 5 potential targets for antihypertensive therapy?

A
  1. Heart (decr. contractility and HR)
  2. Arteries/arterioles (decr. TPR)
  3. Veins (incr. capacitance, decr. preload)
  4. Kidneys (decr. fluid)
  5. CNS (regulatory systems)
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4
Q

What class of drug is frequently the first line antihypertensive drug?

A

thiazide diuretic

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5
Q

What is the general treatment goal for hypertension? What if the pt is diabetic?

A

goal: 140/90

diabetic goal: 130/90

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6
Q

Diuretics: what do they all have in common? advantages?

A

all promote Na and H2O loss
good for elderly, those w chronic renal failure and CHF
good for combo therapy
inexpensive

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7
Q

What is a prototypical loop diuretic?

A

lasix/furosimide

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8
Q

How do loop diuretics work?

A

inhibition of the Na-K-2Cl cotransporter in the thick ascending limb (the countercurrent multiplier. this keeps more fluid in the tubule –> more water lost in urine
most are short acting
remember, example of loop diuretic is lasix/furosimide

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9
Q

How do thiazide diuretics work?

A

inhibit the Na-Cl cotransporter in the distal convoluted tubule. promotes sodium loss. relatively long duration.

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10
Q

What do diuretics of the collecting tubule do?

A

aka potassium-sparing diuretics

act on the principal cells of the late DCT, collecting tubule and collecting duct.

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11
Q

What are the three key side effects of loop diuretics?

A

hyperuricemia
impaired glucose tolerance
ototoxicity

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12
Q

What are four main side effects of thiazide diuretics?

A

hypercalcemia
hyperuricemia
imparied glucose tolerance
pancreatitis

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13
Q

What are two side effects of potassium sparing/colleting tubule diuretics?

A

hyperkalemia and gynecomastia

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14
Q

describe the renin/angiotensin cascade.

A

angiotensinogen converted to angiotensin I by renin from juxtoglomerular cells in kindey that detect low bp.
angiotensin I converted to angiotensin II by ACE (angiotensin converting enzyme)
angiotensin II
angiotensin II is a potent chemical that raises bp. these effects are mediated by angiotensin II receptors.

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15
Q

What are the main effects of ACE inhibitors?

A

decr. angiotensin II-mediated vasoconstriction and resistance. little effect on heart (angiotensin II generated by methods that don’t use ACE)

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16
Q

What are some long-term effects of ACE inhibitors?

A

decr. NE release from peripheral nerves
incr. bradykinin
decr. aldo secretion (less Na and water retention)
incr. renal blood flow (and are sometimes renal protective)
incr. vasodilatory prostaglandins

17
Q

What is the suffix for an ACE inhibitor drug?

A

-pril

18
Q

What are some benefits of ACE inhibitors and ARBs?

A

BP reduction, less LV hypertrophy, less afterload for pts with CHF, good for remodeling after MI, slower progression of DM nephropathy

19
Q

What are two side effects sometimes seen with ACE inhibitors?

A

dry cough

angioedema

20
Q

What are the main contraindications for ACE inhibitors and ARBs?

A

PREGNANCY

major renal problems (renal artery stenosis, severe renal insufficiency)

21
Q

What are ARBs?

A

stand for angiotensin receptor blockers

the are competitive antagonists of angiotensin II at AT1 receptors.

22
Q

What is the deal with non-selective alpha blockers? What is the main example? How are they used?

A

PBZ (pnehoxybenzamine) is the main non-selective alpha blocker
it is a noncompetitive oral drug
lots of side effects: basically only used for phenochromocytoma

23
Q

What is the deal with selective alpha 1 blockers? side effects?

A

like other classes, they do reduce bp. may also help with cholesterol profile, incr. insulin sensitivity
side effects: very rapid first dose response. can cause syncope, ED

24
Q

What are the four net effects of beta blockers?

A
  1. decr. contractility
  2. decr. HR
  3. decr. renin/angiotensin/aldo
  4. decr. cardiac output
25
Q

What is the suffix for a beta blocker?

A

-olol

26
Q

What are potential benefits of beta blockers? Drawbacks?

A

benefits: may help with migranes, tremors, situational anxiety, alcohol withdrawal
drawbacks: fatigue, depression, erectile dysfunction

27
Q

What are some beneficial properites of beta blockers?

A

antiarrhytmia
helps with PVC
decr Vfib and sudden cardiac death after MI
anti-angina

28
Q

What are some adverse effects of beta blockers?

A

CHF?
Heart block, rebound hypertension, hypoglycemia in DM, asthma, fatigue, ED, depression, glucose intolerance, worse lipid profile

29
Q

What are CCBs?

A 
calcium channel blockers
inhibit entry of calcium thru channels
relatively selective (for L type Ca channels, which let in Ca in smooth/cardiac muscle over T type which control nodal deopl)
inhibit vascular smooth muscle contraction--> vasodilation, decr. rate/contractility
30
Q

What are the electrophysiological effects of CCBs (slope of diastolic depol, threshold potential for AP, AP amplitude, duration of AP, AV node refractory period)

A 
slope: decr. 
threshold potential: incr.
AP amplitude: decr.
duration of AP: decr.
AV node refractory period: incr.
31
Q

What are some other uses of CCBs? Drawbacks?

A 
angina
arrhythmias (class IV)

drawback: worsens CHF, hypotension, bradycardia, constipation, pedal edema, fatigue,

32
Q

What is clonidine (class, type)? Side effects

A

alpha2 agonist.
centrally acting.
side effects often prohibitive: fatigue, dry mouth, rebound hyertension with non-compliance, constipation

33
Q

What is the only antihypertensive that is approved for use in pregnant women? Class?

A

alpha methyl DOPA

centrally acting antihypertensive

34
Q

What is hydralazine (class)? What are the 2 biggest side effects?

A

direct vasodilator

may elicit reflex hypertension, SLE-like side effect (lupus)

35
Q

What is minoxidil (class/bullet point MOA)? Sides?

A

direct vasodilator: K channel opener

sides: LV hypertrophy, hair growth (main ingrediant in rogaine)

36
Q

What is the suffix for an ARB?

A

“sartan”

36
Q

What is the use of sodium nitropursside? Main side effect/concern?

A

immediate onset short duration IV antihypertensive

main concern is cyanide toxicity

37
Q

What is the suffix for specific alpha blockers?

A

“azosin”

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