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
2
Q
What should we monitor if a patient is on diuretics?
A
Serum electrolytes
3
Q
How does thiazide decrease blood pressure?
A
By decreasing blood volume and decreasing peripheral resistance
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
5
Q
When thiazide are not effective?
A
If there is kidney failure
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
7
Q
What thiazide is effective even in renal failure?
A
metolazone
8
Q
Side effect of thiazide is
Hypokalemia/Hyperkalemia?
A
Hypokalemia
9
Q
Side effect of thiazide is _____________ (hyperuricemia/hypoglycemia)
A
hyperuricemia (and hyperglycemia too)
10
Q
If there is renal failure then what kind of diuretics can be given to that patient?
A
Loop diuretics
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
12
Q
Loop diuretics cause hypokalemia and __________ (increase/decrease) calcium content in the URINE.
A
increase
13
Q
__________ are for tx of HTN and useful in diabetes and stable ischemic heart disease
A
CCBs
14
Q
High doses of short acting CCB leads to excessive vasodilation and marked reflex cardiac stimulation so HIGH RISK OF ______________
A
MI
15
Q
What are the three types of CCBs?
A
Diphenylalkylamines
Benzothiazepines
Dihydropyridines
16
Q
Example of Diphenylalkylamines
A
Verapamil
17
Q
Verapamil has effect on _____________ (vascular smooth muscle/cardiac muscle/both)
A
both
18
Q
Verapamil is used for tx of four things. Name them?
A
Angina
Supraventricular tachyarrythmias
Cluster headaches
Migraine
19
Q
Example of Benzothiazepines.
A
Diltiazem
20
Q
Diltiazem has less effect on the _________ (heart/vascular smooth muscles/both) than verapamil has.
A
heart
21
Q
Benzothiazepine has a ___________ (less negative/more negative) inotropic effect.
A
less negative
22
Q
Examples of dihydropyridines?
A
Nifedipine Amlodipine Felodipine Isradipine Nicardipine Nisoldipine
23
Q
Dihydropyridines have less effect on the _________ (heart/vascular smooth muscles/both)
A
heart
Its good for HTN
24
Q
Dihydropyridines show little interaction for specific drugs. Name the drugs?
A
Digoxin
Warfarin
25
Loop diuretics are commonly used to manage symptoms of ___________ and ____________
heart failure and edema
26
Amiloride, spironolactone, eplerenone and triamterene are ________________ diuretics
potassium sparing
27
Spironolactone and eplerenone are __________________ (aldosterone receptor antagonist/inhibitors of epithelial sodium transport at the late distal and collecting ducts)
aldosterone receptor antagonist
28
Amiloride and triamterene are __________________ (aldosterone receptor antagonist/inhibitors of epithelial sodium transport at the late distal and collecting ducts)
Inhibitors of epithelial sodium transport at the late distal and collecting ducts
29
____________ (amiloride/spironolactone) has the additional benefit of diminishing the cardiac remodeling that occurs in heart failure
spironolactone
30
____________ (amiloride/spironolactone) also has affinity for androgen and progesterone receptors
spironolactone
31
What are the endocrine related adverse effects of spironolactone?
gynecomastia and dysmenorrhea
32
________________ are sometimes used in combination with loop diuretics and thiazides to reduce the amount of potassium loss induced by these diuretics.
Potassium-sparing diuretics
33
Name three conditions in which we can use beta blockers for treating HTN,
Stable ischemic heart disease
Previous MI
Heart failure
34
The prototype β-blocker is ____________, which acts at both β1 and β2 receptors
propranolol
35
How do B-Blockers work?
They reduce cardiac output and inhibit renin release by acting on B1 receptors on heart and kidneys
36
Name the selective blockers of β1 receptors
Metoprolol
Atenolol
Nebivolol
37
___________ is a selective blocker of β1 receptors, which also increases the production of nitric oxide, leading to vasodilation.
Nebivolol
38
The ____________ β-blockers are contraindicated in patients with asthma due to their blockade of β2
-mediated bronchodilation
nonselective
39
The selective β-blockers may be administered cautiously to hypertensive patients who also have ___________
asthma
40
β-Blockers should be used cautiously in the treatment of patients with ______________ and peripheral vascular disease
acute heart failure
41
In what conditions, beta blocker usage is discouraged?
Asthma
Second- and third-degree heart block
Severe peripheral vascular disease
42
Can we give beta blocker to a patient who has concomitant heart disease (atrial fibrillation)?
Yes
43
Oral β-blockers may take several _________ (minutes/hours/weeks) to develop their full effects
weeks
44
The β-blockers may __________(decrease/increase) libido and _______ (treat/cause) erectile dysfunction
decrease
| cause
45
Noncardioselective B-blockers can ____________ (increase/decrease) HDL and _____________ (increase/decrease) triglycerides
decrease HDL
| increase triglycerides
46
What are the symptoms of abrupt withdrawl of beta blockers?
Severe hypertension
Angina
Myocardial infarction
Even sudden death in patients with ischemic heart disease
47
What are the adverse effects of beta blockers?
```
hypotension
bradycardia
insomnia
sexual dysfunction
fatigue
```
48
In what diseases we can use ACE inhibitors for the treatment of HTN?
```
Stable ischemic heart disease
Diabetes
Recent MI
Heart failure
Recurrent stroke
Chronic kidney disease
```
49
ACE inhibitors reduce _________ (preload/afterload/ both preload and afterload), thereby decreasing workload on the heart.
both preload and afterload
50
How does ACE Inhibitors work?
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)
51
___________ slow the progression of diabetic nephropathy
ACE inhibitors
52
___________ decrease albuminuria
ACE inhibitors
53
Why use ACE inhibitors for a patient with diabetic nephropathy?
ACEIs slows the progression of diabetic nephropathy and decrease albuminuria
54
What are the cardiovascular therapeutic uses of ACEIs?
```
HTN w/ or w/o chronic kidney disease
Heart failure
After MI to reduce ventricular remodelling
Systolic failure
Patients at risk of CAD
```
55
All ACEIs except captopril and lisinopril are __________ (prodrug/drug)
prodrug
56
___________ is the only ACE inhibitor that is not eliminated primarily by the kidneys
Fosinopril
57
____________ is the only drug in ACEIs available intravenously.
Enalaprilat
58
The dry cough, induced by ACEIs which occurs in up to 10% of patients, is thought to be due to ____________ in the pulmonary tree
Increased bradykinin and substance P
59
Dry cough induced by ACEIs is more common in ___________ (men/women)
women
60
Dry cough induced by ACEIs is ____________ (reversible/irreversible) when discontinued
reversible
61
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?
Angioedema
| Drugs = ACEIs
62
When on ACEIs, potassium supplements and potassium-sparing diuretics should be used with caution due to the risk of ______________
hyperkalemia
63
What should we monitor if ACEIs are being given to a patient?
```
Serum potassium
Serum creatinine (particularly in renal disease)
```
64
An increase in serum creatinine of up to _____ above baseline is acceptable and by itself does not warrant discontinuation of ACEIs.
30%
65
ACEIs _______ (can/cannot) be used in pregnant women.
cannot
66
What are adverse effects on ACEIs in a nutshell?
```
Altered taste
Hypotension
Skin rash
Hyperkalemia
Angioedema
Dry cough
```
67
Mnemonic for adverse effects of ACEIs.
| ASH HAD COUGH
```
Altered taste
Skin rash
Hypotension
Hyperkalemia
Angioedema
Dry Cough
```
68
```
Which of the following antihypertensive drugs would you expect to cause a decrease in afterload?
Hydralazine
Methyldopa
Nitroglycerin
Amlodipine
Labetalol
```
Hydralazine
69
A CCB ___________ is not safe to use during pregnancy.
Verapamil
70
The four drugs:????, are the mainstay treatments of hypertension during pregnancy.
Hydralazine
Labetalol
Methyldopa
Nifedipine
71
___________is an irreversible non-selective covalent alpha blocker.
Phenoxybenzamine
72
_________ and _____________ are competitive alpha 1 blockers.
Terazosin and prazosin
73
____________ action is reversed within 4 hours of action.
Phentolamine
74
Losartan and Irbestan are __________
Angiotensin receptor blockers
75
ARBs block the ______ receptor
AT1
76
What are the effects of ARBs?
Produce arteriolar and venous dilation (lower peripheral resistance)
Block aldosterone secretion (decreasing salt and water retention)
77
ARBs do not _______ (increase/decrease) bradykinin levels
Increase
78
What are the concomitant diseases in which ARBs can be used?
```
Stable ischemic heart disease
Diabetes
Recurrent stroke
Heart failure
Chronic kidney disease
```
79
Risks of cough and angioedema are ___________ (decreased/increased) with ARBs
Decreased
80
ACE Inhibitors and ____________ should not be combined due to similar adverse effects
Angiotensin receptor blocker
81
ARBs _______ (should/shouldn’t) be used in pregnant women
Should not
82
____________ is a selective renin inhibitor
Aliskiren
83
Aliskiren should not be combined with ____________ in the treatment of hypertension.
an ACE inhibitor or ARB
84
Aliskiren can cause ___________, especially at higher doses
diarrhea
85
Aliskiren _______ (should/shouldn’t) be used in pregnant women
should not
86
Aliskiren also causes cough and angioedema but ________(less/more) often than ACE inhibitors
less
87
Aliskiren is metabolized by __________ and is subject to many drug interactions
CYP3A4
88
Verapamil has ___________ effect on the coronary dilation
moderate
89
Nifedipine and Diltiazem has __________ effect on coronary dilation
high
90
Nifedipine has ________ effect on AV conduction
little
91
Verapamil and diltiazem __________ (increased/decreased) AV conduction
decreased
92
What is the frequency of adverse effects for nifedipine?
18%
93
What is the frequency of adverse effects for verapamil?
9%
94
What is the frequency of adverse effects for diltiazem?
2%
95
Calcium channel blockers do not dilate _______ (veins/arterioles)
veins
96
Diltiazem and verapamil are used in the treatment of _____________ (atrioventricular block/atrial fibrillation)
atrial fibrillation
97
___________ (CCBs/ACEIs) have short half-lives (3 to 8 hours) following an oral dose
CCBs
98
A CCB ____________ has a very long half-life.
Amlodipine
99
_______________ and ___________ are common dose-dependent side effects of verapamil
First degree Atrioventricular block
| Constipation
100
Why should be Verapamil and diltiazem avoided in patients with heart failure or with atrioventricular block?
Due to negative inotropic (force of cardiac muscle contraction) and dromotropic (velocity of conduction) effects.
101
What are the side effects of nifedipine?
Hypotension (Dizziness, fatigue, headache)
Flushing
Peripheral edema
Gingival hyperplasia
102
α-Adrenergic blockers used in the treatment of hypertension include ___________, ____________ and ___________
prazosin
doxazosin
terazosin
103
Prazosin is a ________ (competetive/noncompetetive) blockers of α1-adrenoceptors
competetive
104
How do alpha adrenoceptor blockers reduce blood pressure and peripheral vascular resistance?
They cause relaxation of both arterial and
| venous smooth muscle
105
____________ cause only minimal changes in cardiac output, renal blood flow, and glomerular filtration rate
Alpha adrenoceptor blockers
106
What are the adverse effects of alpha adrenoceptor blockers?
Reflex tachycardia
| Postural hypotension
107
Alpha blockers are used for the tx of _____________
refractory hypertension
108
α1-blockers with greater selectivity for the prostate are used in the treatment of _______________.
Benign prostatic hyperplasia
109
Labetalol and carvedilol block _______________ receptors
α1, β1, and β2
110
Carvedilol is indicated in the treatment of _________ and ____________.
heart failure
| hypertension
111
Labetalol is used in the management of ______________ and hypertensive emergencies
gestational diabetes
112
Labetalol and carvedilol are _______________ agent
a/b adrenoceptors
113
What are the centrally acting adrenoceptors?
clonidine
| methyldopa
114
Clonidine acts centrally as an ___________ to produce inhibition of sympathetic vasomotor centers, decreasing sympathetic outflow to the periphery
α2 agonist
115
______________ occurs following abrupt withdrawal of clonidine
Rebound hypertension
116
____________ is used primarily for the treatment of hypertension that has not responded adequately to
treatment with two or more drugs
clonidine
117
Why is clonidine useful in the treatment of hypertension complicated by renal disease?
Clonidine does not decrease renal blood flow or glomerular filtration
118
What are the adverse effects of clonidine?
```
sedation
constipation
dry mouth
drowsiness
hypotension
confusion
```
119
Route of administration of clonidine?
orally
| transdermal patch
120
Excretion of clonidine is mainly through _________
kidneys
121
Methyldopa is an α2 agonist that is converted to __________________ centrally to diminish
adrenergic outflow from the CNS
methylnorepinephrine
122
Methyldopa ______ (can/cannot) be used in pregnancy
can
123
The most common side effects of methyldopa are __________ and ______________
sedation and drowsiness
124
___________ (Hydralazine/Captopril) is an accepted medication for controlling blood pressure in pregnancy-induced hypertension
Hydralazine
125
Name the direct-acting smooth muscle relaxants that can be used in pregnancy.
Hydralazine
| Minoxidil
126
Hydralazine and minoxidil produce vasodilation by acting on ________ and arterioles (arteries/veins)
arteries
127
What are the effects of hydralazine and minoxidil?
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
What are the adverse effects of hydralazine
```
headache
tachycardia
nausea
sweating
arrhythmia
precipitation of angina (due to reflex stimulation of the heart)
```
129
A _______-like syndrome can occur with high dosages, but it is reversible upon discontinuation of the hydralazine
lupus
130
Minoxidil treatment causes ______________
hypertrichosis
131
What is hypertrichosis?
the growth of body hair
132
____________ is used topically to treat male pattern baldness
Minoxidil
133
The undesirable effects of hydralazine/minoxidil can be prevented by concomitant use of other drugs _________ and ____________
diuretics
| B-blockers
134
What are the some adverse effects of hydralazine?
```
Headache
Palpitations
Tachycardia
Angina
Nausea
```
135
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)
180
| 120
136
A severe elevation in blood pressure without evidence of target organ damage is considered a ____________
hypertensive urgency
137
Hypertensive emergencies require timely blood pressure reduction with treatment administered _____________ to prevent or limit target organ damage
intravenously
138
What are the drugs used for hypertensive emergency?
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
__________________ is defined as blood pressure that remains elevated (above goal) despite administration of an optimal three-drug regimen that includes a diuretic
Resistant hypertension
140
What are the causes of resistant hypertension?
```
Poor compliance
Excessive ethanol intake
Concomitant conditions
concomitant medications
Insufficient dose
```
