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CVS-PHARMA > Antihypertensives > Flashcards

Antihypertensives Flashcards

1
Q

Diuretics can be used in three concomitant diseases for HTN. What are the conditions?

A

Diabetes (though thiazide causing hyperglycemia)
Recurrent stroke
Heart failure

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2
Q

What should we monitor if a patient is on diuretics?

A

Serum electrolytes

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3
Q

How does thiazide decrease blood pressure?

A

By decreasing blood volume and decreasing peripheral resistance

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4
Q

How can thiazide be given to a patient?

A

We can give it as an initial therapy

Also, they can be used as combination w/ others

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5
Q

When thiazide are not effective?

A

If there is kidney failure

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6
Q

What is the maximum GFR value for thiazide to be ineffective?

A

If GFR is less than 30mL/min/m2 then it’s ineffective

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7
Q

What thiazide is effective even in renal failure?

A

metolazone

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8
Q

Side effect of thiazide is

Hypokalemia/Hyperkalemia?

A

Hypokalemia

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9
Q

Side effect of thiazide is _____________ (hyperuricemia/hypoglycemia)

A

hyperuricemia (and hyperglycemia too)

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10
Q

If there is renal failure then what kind of diuretics can be given to that patient?

A

Loop diuretics

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11
Q

Loop diuretics cause decreased ____________ and increased ___________ (renal blood flow/renal vascular resistance/peripheral resistance)

A

decreased renal vascular resistance

increased renal blood flow

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12
Q

Loop diuretics cause hypokalemia and __________ (increase/decrease) calcium content in the URINE.

A

increase

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13
Q

__________ are for tx of HTN and useful in diabetes and stable ischemic heart disease

A

CCBs

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14
Q

High doses of short acting CCB leads to excessive vasodilation and marked reflex cardiac stimulation so HIGH RISK OF ______________

A

MI

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15
Q

What are the three types of CCBs?

A

Diphenylalkylamines
Benzothiazepines
Dihydropyridines

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16
Q

Example of Diphenylalkylamines

A

Verapamil

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17
Q

Verapamil has effect on _____________ (vascular smooth muscle/cardiac muscle/both)

A

both

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18
Q

Verapamil is used for tx of four things. Name them?

A

Angina
Supraventricular tachyarrythmias
Cluster headaches
Migraine

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19
Q

Example of Benzothiazepines.

A

Diltiazem

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20
Q

Diltiazem has less effect on the _________ (heart/vascular smooth muscles/both) than verapamil has.

A

heart

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21
Q

Benzothiazepine has a ___________ (less negative/more negative) inotropic effect.

A

less negative

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22
Q

Examples of dihydropyridines?

A 
Nifedipine
Amlodipine
Felodipine
Isradipine
Nicardipine
Nisoldipine
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23
Q

Dihydropyridines have less effect on the _________ (heart/vascular smooth muscles/both)

A

heart

Its good for HTN

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24
Q

Dihydropyridines show little interaction for specific drugs. Name the drugs?

A

Digoxin

Warfarin

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25
Q

Loop diuretics are commonly used to manage symptoms of ___________ and ____________

A

heart failure and edema

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26
Q

Amiloride, spironolactone, eplerenone and triamterene are ________________ diuretics

A

potassium sparing

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27
Q

Spironolactone and eplerenone are __________________ (aldosterone receptor antagonist/inhibitors of epithelial sodium transport at the late distal and collecting ducts)

A

aldosterone receptor antagonist

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28
Q

Amiloride and triamterene are __________________ (aldosterone receptor antagonist/inhibitors of epithelial sodium transport at the late distal and collecting ducts)

A

Inhibitors of epithelial sodium transport at the late distal and collecting ducts

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29
Q

____________ (amiloride/spironolactone) has the additional benefit of diminishing the cardiac remodeling that occurs in heart failure

A

spironolactone

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30
Q

____________ (amiloride/spironolactone) also has affinity for androgen and progesterone receptors

A

spironolactone

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31
Q

What are the endocrine related adverse effects of spironolactone?

A

gynecomastia and dysmenorrhea

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32
Q

________________ are sometimes used in combination with loop diuretics and thiazides to reduce the amount of potassium loss induced by these diuretics.

A

Potassium-sparing diuretics

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33
Q

Name three conditions in which we can use beta blockers for treating HTN,

A

Stable ischemic heart disease
Previous MI
Heart failure

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34
Q

The prototype β-blocker is ____________, which acts at both β1 and β2 receptors

A

propranolol

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35
Q

How do B-Blockers work?

A

They reduce cardiac output and inhibit renin release by acting on B1 receptors on heart and kidneys

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36
Q

Name the selective blockers of β1 receptors

A

Metoprolol
Atenolol
Nebivolol

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37
Q

___________ is a selective blocker of β1 receptors, which also increases the production of nitric oxide, leading to vasodilation.

A

Nebivolol

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38
Q

The ____________ β-blockers are contraindicated in patients with asthma due to their blockade of β2
-mediated bronchodilation

A

nonselective

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39
Q

The selective β-blockers may be administered cautiously to hypertensive patients who also have ___________

A

asthma

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40
Q

β-Blockers should be used cautiously in the treatment of patients with ______________ and peripheral vascular disease

A

acute heart failure

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41
Q

In what conditions, beta blocker usage is discouraged?

A

Asthma
Second- and third-degree heart block
Severe peripheral vascular disease

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42
Q

Can we give beta blocker to a patient who has concomitant heart disease (atrial fibrillation)?

A

Yes

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43
Q

Oral β-blockers may take several _________ (minutes/hours/weeks) to develop their full effects

A

weeks

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44
Q

The β-blockers may __________(decrease/increase) libido and _______ (treat/cause) erectile dysfunction

A

decrease

cause

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45
Q

Noncardioselective B-blockers can ____________ (increase/decrease) HDL and _____________ (increase/decrease) triglycerides

A

decrease HDL

increase triglycerides

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46
Q

What are the symptoms of abrupt withdrawl of beta blockers?

A

Severe hypertension
Angina
Myocardial infarction
Even sudden death in patients with ischemic heart disease

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47
Q

What are the adverse effects of beta blockers?

A 
hypotension
bradycardia
insomnia
sexual dysfunction
fatigue
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48
Q

In what diseases we can use ACE inhibitors for the treatment of HTN?

A 
Stable ischemic heart disease
Diabetes
Recent MI
Heart failure
Recurrent stroke
Chronic kidney disease
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49
Q

ACE inhibitors reduce _________ (preload/afterload/ both preload and afterload), thereby decreasing workload on the heart.

A

both preload and afterload

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50
Q

How does ACE Inhibitors work?

A
  1. Decrease Angiotensin II (potent vasoconstrictor)
  2. Decrease Aldosterone release (increases salt and water retention)
  3. Increase bradykinin levels by inhibiting ACE (bradykinin stimulate NO and prostacyclin production, now they both produce vasodilation)
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51
Q

___________ slow the progression of diabetic nephropathy

A

ACE inhibitors

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52
Q

___________ decrease albuminuria

A

ACE inhibitors

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53
Q

Why use ACE inhibitors for a patient with diabetic nephropathy?

A

ACEIs slows the progression of diabetic nephropathy and decrease albuminuria

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54
Q

What are the cardiovascular therapeutic uses of ACEIs?

A 
HTN w/ or w/o chronic kidney disease
Heart failure
After MI to reduce ventricular remodelling
Systolic failure
Patients at risk of CAD
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55
Q

All ACEIs except captopril and lisinopril are __________ (prodrug/drug)

A

prodrug

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56
Q

___________ is the only ACE inhibitor that is not eliminated primarily by the kidneys

A

Fosinopril

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57
Q

____________ is the only drug in ACEIs available intravenously.

A

Enalaprilat

58
Q

The dry cough, induced by ACEIs which occurs in up to 10% of patients, is thought to be due to ____________ in the pulmonary tree

A

Increased bradykinin and substance P

59
Q

Dry cough induced by ACEIs is more common in ___________ (men/women)

A

women

60
Q

Dry cough induced by ACEIs is ____________ (reversible/irreversible) when discontinued

A

reversible

61
Q

What is the name of the condition in which swelling of the lips, face and cheeks occurs, due to increased bradykinin levels induced by class of drugs?

A

Angioedema

Drugs = ACEIs

62
Q

When on ACEIs, potassium supplements and potassium-sparing diuretics should be used with caution due to the risk of ______________

A

hyperkalemia

63
Q

What should we monitor if ACEIs are being given to a patient?

A 
Serum potassium
Serum creatinine (particularly in renal disease)
64
Q

An increase in serum creatinine of up to _____ above baseline is acceptable and by itself does not warrant discontinuation of ACEIs.

A

30%

65
Q

ACEIs _______ (can/cannot) be used in pregnant women.

A

cannot

66
Q

What are adverse effects on ACEIs in a nutshell?

A 
Altered taste
Hypotension
Skin rash
Hyperkalemia
Angioedema
Dry cough
67
Q

Mnemonic for adverse effects of ACEIs.

ASH HAD COUGH

A 
Altered taste
Skin rash
Hypotension
Hyperkalemia
Angioedema
Dry Cough
68
Q 
Which of the following antihypertensive drugs would you expect to cause a decrease in afterload?
Hydralazine
Methyldopa
Nitroglycerin
Amlodipine
Labetalol
A

Hydralazine

69
Q

A CCB ___________ is not safe to use during pregnancy.

A

Verapamil

70
Q

The four drugs:????, are the mainstay treatments of hypertension during pregnancy.

A

Hydralazine
Labetalol
Methyldopa
Nifedipine

71
Q

___________is an irreversible non-selective covalent alpha blocker.

A

Phenoxybenzamine

72
Q

_________ and _____________ are competitive alpha 1 blockers.

A

Terazosin and prazosin

73
Q

____________ action is reversed within 4 hours of action.

A

Phentolamine

74
Q

Losartan and Irbestan are __________

A

Angiotensin receptor blockers

75
Q

ARBs block the ______ receptor

A

AT1

76
Q

What are the effects of ARBs?

A

Produce arteriolar and venous dilation (lower peripheral resistance)
Block aldosterone secretion (decreasing salt and water retention)

77
Q

ARBs do not _______ (increase/decrease) bradykinin levels

A

Increase

78
Q

What are the concomitant diseases in which ARBs can be used?

A 
Stable ischemic heart disease
Diabetes
Recurrent stroke
Heart failure
Chronic kidney disease
79
Q

Risks of cough and angioedema are ___________ (decreased/increased) with ARBs

A

Decreased

80
Q

ACE Inhibitors and ____________ should not be combined due to similar adverse effects

A

Angiotensin receptor blocker

81
Q

ARBs _______ (should/shouldn’t) be used in pregnant women

A

Should not

82
Q

____________ is a selective renin inhibitor

A

Aliskiren

83
Q

Aliskiren should not be combined with ____________ in the treatment of hypertension.

A

an ACE inhibitor or ARB

84
Q

Aliskiren can cause ___________, especially at higher doses

A

diarrhea

85
Q

Aliskiren _______ (should/shouldn’t) be used in pregnant women

A

should not

86
Q

Aliskiren also causes cough and angioedema but ________(less/more) often than ACE inhibitors

A

less

87
Q

Aliskiren is metabolized by __________ and is subject to many drug interactions

A

CYP3A4

88
Q

Verapamil has ___________ effect on the coronary dilation

A

moderate

89
Q

Nifedipine and Diltiazem has __________ effect on coronary dilation

A

high

90
Q

Nifedipine has ________ effect on AV conduction

A

little

91
Q

Verapamil and diltiazem __________ (increased/decreased) AV conduction

A

decreased

92
Q

What is the frequency of adverse effects for nifedipine?

A

18%

93
Q

What is the frequency of adverse effects for verapamil?

A

9%

94
Q

What is the frequency of adverse effects for diltiazem?

A

2%

95
Q

Calcium channel blockers do not dilate _______ (veins/arterioles)

A

veins

96
Q

Diltiazem and verapamil are used in the treatment of _____________ (atrioventricular block/atrial fibrillation)

A

atrial fibrillation

97
Q

___________ (CCBs/ACEIs) have short half-lives (3 to 8 hours) following an oral dose

A

CCBs

98
Q

A CCB ____________ has a very long half-life.

A

Amlodipine

99
Q

_______________ and ___________ are common dose-dependent side effects of verapamil

A

First degree Atrioventricular block

Constipation

100
Q

Why should be Verapamil and diltiazem avoided in patients with heart failure or with atrioventricular block?

A

Due to negative inotropic (force of cardiac muscle contraction) and dromotropic (velocity of conduction) effects.

101
Q

What are the side effects of nifedipine?

A

Hypotension (Dizziness, fatigue, headache)
Flushing
Peripheral edema
Gingival hyperplasia

102
Q

α-Adrenergic blockers used in the treatment of hypertension include ___________, ____________ and ___________

A

prazosin
doxazosin
terazosin

103
Q

Prazosin is a ________ (competetive/noncompetetive) blockers of α1-adrenoceptors

A

competetive

104
Q

How do alpha adrenoceptor blockers reduce blood pressure and peripheral vascular resistance?

A

They cause relaxation of both arterial and

venous smooth muscle

105
Q

____________ cause only minimal changes in cardiac output, renal blood flow, and glomerular filtration rate

A

Alpha adrenoceptor blockers

106
Q

What are the adverse effects of alpha adrenoceptor blockers?

A

Reflex tachycardia

Postural hypotension

107
Q

Alpha blockers are used for the tx of _____________

A

refractory hypertension

108
Q

α1-blockers with greater selectivity for the prostate are used in the treatment of _______________.

A

Benign prostatic hyperplasia

109
Q

Labetalol and carvedilol block _______________ receptors

A

α1, β1, and β2

110
Q

Carvedilol is indicated in the treatment of _________ and ____________.

A

heart failure

hypertension

111
Q

Labetalol is used in the management of ______________ and hypertensive emergencies

A

gestational diabetes

112
Q

Labetalol and carvedilol are _______________ agent

A

a/b adrenoceptors

113
Q

What are the centrally acting adrenoceptors?

A

clonidine

methyldopa

114
Q

Clonidine acts centrally as an ___________ to produce inhibition of sympathetic vasomotor centers, decreasing sympathetic outflow to the periphery

A

α2 agonist

115
Q

______________ occurs following abrupt withdrawal of clonidine

A

Rebound hypertension

116
Q

____________ is used primarily for the treatment of hypertension that has not responded adequately to
treatment with two or more drugs

A

clonidine

117
Q

Why is clonidine useful in the treatment of hypertension complicated by renal disease?

A

Clonidine does not decrease renal blood flow or glomerular filtration

118
Q

What are the adverse effects of clonidine?

A 
sedation
constipation
dry mouth
drowsiness
hypotension
confusion
119
Q

Route of administration of clonidine?

A

orally

transdermal patch

120
Q

Excretion of clonidine is mainly through _________

A

kidneys

121
Q

Methyldopa is an α2 agonist that is converted to __________________ centrally to diminish
adrenergic outflow from the CNS

A

methylnorepinephrine

122
Q

Methyldopa ______ (can/cannot) be used in pregnancy

A

can

123
Q

The most common side effects of methyldopa are __________ and ______________

A

sedation and drowsiness

124
Q

___________ (Hydralazine/Captopril) is an accepted medication for controlling blood pressure in pregnancy-induced hypertension

A

Hydralazine

125
Q

Name the direct-acting smooth muscle relaxants that can be used in pregnancy.

A

Hydralazine

Minoxidil

126
Q

Hydralazine and minoxidil produce vasodilation by acting on ________ and arterioles (arteries/veins)

A

arteries

127
Q

What are the effects of hydralazine and minoxidil?

A

Decrease peripheral vascular resistance
Produce reflex stimulation of the heart resulting in increased myocardial contractility, heart rate, and oxygen consumption
Increase plasma renin concentration,
resulting in sodium and water retention

128
Q

What are the adverse effects of hydralazine

A 
headache
tachycardia
nausea
sweating
arrhythmia
precipitation of angina (due to reflex stimulation of the heart)
129
Q

A _______-like syndrome can occur with high dosages, but it is reversible upon discontinuation of the hydralazine

A

lupus

130
Q

Minoxidil treatment causes ______________

A

hypertrichosis

131
Q

What is hypertrichosis?

A

the growth of body hair

132
Q

____________ is used topically to treat male pattern baldness

A

Minoxidil

133
Q

The undesirable effects of hydralazine/minoxidil can be prevented by concomitant use of other drugs _________ and ____________

A

diuretics

B-blockers

134
Q

What are the some adverse effects of hydralazine?

A 
Headache
Palpitations
Tachycardia
Angina
Nausea
135
Q

Hypertensive emergency is a life-threatening situation characterized by severe elevations in blood pressure (systolic greater than ____ mm Hg or diastolic greater than ____ mm Hg) with evidence of impending or progressive target organ damage (for example, stroke, myocardial infarction)

A

180

120

136
Q

A severe elevation in blood pressure without evidence of target organ damage is considered a ____________

A

hypertensive urgency

137
Q

Hypertensive emergencies require timely blood pressure reduction with treatment administered _____________ to prevent or limit target organ damage

A

intravenously

138
Q

What are the drugs used for hypertensive emergency?

A

Calcium channel blockers (nicardipine and clevidipine), Nitric oxide vasodilators (nitroprusside and nitroglycerin)
Adrenergic receptor antagonists (phentolamine, esmolol, and labetalol)
The vasodilator hydralazine
The dopamine agonist fenoldopam

139
Q

__________________ is defined as blood pressure that remains elevated (above goal) despite administration of an optimal three-drug regimen that includes a diuretic

A

Resistant hypertension

140
Q

What are the causes of resistant hypertension?

A 
Poor compliance
Excessive ethanol intake
Concomitant conditions
concomitant medications
Insufficient dose

CVS-PHARMA (5 decks)

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