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Kaplan Pharm: Cardiac and Renal > Antihypertensives > Flashcards

Antihypertensives Flashcards

1
Q

What are the 1st line drugs recommended for antihypertensive medication?

A

thiazides
ACEIs and ARBs
long acting CCBs

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2
Q

Why do ACEIs cause a symptom of dry cough in a patient?

A

Because ACE is responsible for breaking down bradykinin which can cause inflammatory response

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3
Q

What is the stem to remember ACEIs?

A

prils

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4
Q

Name the commonly tested drugs considered ACEIs.

A

lisinopril
captopril

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5
Q

What are the common ARBs?

A

losartan

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6
Q

What is the major stem to remember ARBs?

A

sartans

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7
Q

What is the major renin inhibitor we discussed?

A

aliskrien

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8
Q

Does the renin inhibitor alkiskrien interfere with bradykinin breakdown?

A

no it does not interfere with bradykinin degradation

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9
Q

What are the uses of ACE, ARBs, and renin inhibitors?

A

mild to moderate HTN (all)
Protective diabetic nephropathy (ACEI/ARBs)
CHF (ACE/ARBs)

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10
Q

What are the side effects of of ACEIs, ARBs, and renin inhibitors?

A

dry cough (ACEIs)
hyperkalemia
acute renal failure in renal artery stenosis
angioedema (mostly ACEIs)

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11
Q

ACE, ARBs and renin inhibitors are contraindicated in what patients?

A

pregnancy

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12
Q

How can ACEIs and ARBs be beneficial in diabetic nephropathies?

A

PGs dilate afferent arterioles whereas Ang II constrict efferent arterioles

Therefore NSAIDS constrict the afferent arterioles whereas ACEIs and ARBs dilate the efferent arteriole

This decreases the amount of fluid filtered, dec. GFR and dec workload and dec. proteinuria

Why the y are used in diabetics patients to control BP and save kidneys because of this decreased workload on the heart

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13
Q

Why are ACEIs and ARBs not beneficial when one has bilateral renal a. stenosis?

A

There is already afferent arteriole constriction a decreased GFR so the ACE and ARBs will further decrease the GFR that Ang II was trying to maintain. Last thing you want is to work against the Ang II which is preventing complete failure of renal system

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14
Q

CCBs block L-type Ca2+ channels in what organs?

A

in the heart or BV

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15
Q

Which CCBs mainly lead to decreased CO?

A

verapamil and diltiazem

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16
Q

Which CCBs lead to decreased TPR?

A

all CCBs

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17
Q

What is a stem to remember most of the CCBs? (dihydropyridines)

A

“dipines” dihydropyrdine family

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18
Q

What is the prototype dihydropyridine?

A

nifedipine

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19
Q

In order of what drugs work on heart to BV name which CCBS have most selectivity?

A

verapamil mostly heart
diltiazem (intermediate) heart and BV
“dipines” mostly BV

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20
Q

Which vasodilators specifically act on arterioles?

A

CCBs, hydralazine, K+ channel openers

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21
Q

What is a major venodilator we discussed in this chapter?

A

nitrates

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22
Q

Orthostatic (postural) hypotension results from venular dilation (not arteriolar) and mainly results from what?

A

a1 blockade or decreased sympathetic tone

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23
Q

What are the major uses of CCBs?

A

HTN (all drugs)
Angina (all drugs)
antiarrythmics (verapamil, diltiazem)

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24
Q

What are the side effects of using CCBs?

A

reflex tachycardia (dipines)

gingival hyperplasia (dipines)

constipation (verapamil)

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25
Q

Why can B blockers be dangerous for use of a person with hypoglycemia?

A

can cause masking in diabetics because it blocks tremors and palpitations so there is no warning sign for them other then possibly getting sweaty because that doesn’t work on β or α.

26
Q

What groups of people should you use beta blockers in with caution?

A

asthma
vasospastic disorders
diabetics

27
Q

What are other drugs that can be used for HTN that alter sympathetic activity?

A

beta blockers,
alpha 1 blockers like prazosin, doxazosin, terazosin,
and alpha 2 agonists clonidine and methyldopa

28
Q

What is the indication for using beta blockers for HTN?

A

not 1st line but good for hypertensive patients with selective comorbidities such as stable angina, CHF, and post-MI

29
Q

Some major side effects of Beta blockers?

A

CVS depression
fatigue
sexual dysfunction
inc. LDLs and TGs

30
Q

What are the side effects of alpha 1 blockers?

A

1st dose syncope (dizziness),
orthostatic hypotension,
urinary incontinence

31
Q

What are the advantages of using alpha 1 blockers on metabolic function?

A

good lipid profile inc. HDL, dec. LDL

32
Q

What are some uses of alpha 2 agonists?

A

mild to moderate HTN
Opiate withdrawal (clonidine)
hypertensive management in pregnancy (methyldopa)

33
Q

What are the side effects of alpha 2 agonist?

A
  • positive Coombs test (methyldopa) (rarely hemolytic anemia though)
  • CNS depression (fatigue) (both)
  • edema (both) compensation for dec. in BP
  • May get rebound HTN if abruptly stop because of upreg of sympathetic activity while they were blocked.
34
Q

What are some drug interactions that need to be remembered for alpha 2 agonists?

A

TCAs which dec. the antihypertensive effects of alpha 2 agonists

the antihypertensive effects oppose each other

35
Q

What are the direct acting vasodilators that can be used as antihypertensives that directly act through NO?

A

hydralazine
nitroprusside

36
Q

What are the direct acting drugs that open potassium channels that act as vasodilators and can be used as antihypertensives?

A

minoxidil and diazoxide

37
Q

Chronic (preexisting) HTN in pregnancy is often treated with what drugs?

A

methyldopa or labetalol

38
Q

New-onset HTN in pregnancy or preeclampsia is treated with what drugs?

A

labetalol or hydralazine

39
Q

Which drugs are recommended for treating cyanide poisoning? Explain the MOA

A

hydroxocobalamin and sodium thiosulfate

the cobalt molecule in hydroxocobalamin binds cyanide-forming cyanocobalamin, which is readily excreted in the urine.

40
Q

Difference between hydralazine and nitroprusside?

A

hydralazine decreases TPR via arteriolar dilation while nitroprusside dec. TPR via dilation of both arterioles and venules?

41
Q

Use for hydralazine?

A

moderate to severe HTN
preeclampsia

42
Q

S/E of hydralazine?

A

SLE-like syndrome in slow acetylators (would see (+)ANA and (+) antihistones (this histones means drug induced)
edema
reflex tachycardia

43
Q

Use of nitroprusside?

A

hypertensive emergencies via IV

44
Q

S/E nitroprusside?

A

cyanide toxicity

45
Q

MOA of minoxidil and diazoxide?

A

opens K+ channels causing hyper polarization of vascular smooth muscle results in arteriolar vasodilation

46
Q

What are the uses for minoxidil and diazoxide?

A

insulinoma (diazoxide)
severe hypertension ( minoxidil)
baldness (topical minoxidil)

47
Q

What are the S/E for minoxidil and diazoxide?

A
  • hypertrichosis (excessive hair growth any part of the body for males and females)
  • hyperglycemia (dec. insulin release (diazoxside))
  • edema
  • reflex tachycardia
48
Q

What drugs should be avoided when you have dyslipidemias?

A

avoid beta blockers and thiazides

49
Q

Can fenoldopam cause reflex tachycardia?

A

yes

50
Q

What are the strategies for the treatment of pulmonary HTN? Name the drugs indicated for treatment

A

drugs with vasodilator effects

Bosentan
Prostacyclin (PGI2) analogs: Epoprostenol
Sildenafil

51
Q

MOA of Bosentan?

A

an ET -A receptor antagonist

ET1 endothelin 1 is a powerful vasoconstrictor through ET-A and B receptors

52
Q

S/E of Bosentan?

A

those associated with vasodilation (headache, flushing, hypotension)

53
Q

What is Bosentan contraindicated in?

A

pregnancy

54
Q

Prostacyclin PGI2 analogue used for primary pulmonary HTN?

A

Epoprostenol

55
Q

MOA of sildenafil for pulmonary HTN treatment?

A
  • inhibits type V PDE
  • increases cGMP
  • Causes pulmonary artery relaxation
  • decreases pulmonary HTN
56
Q

Most suitable antihypertensive drugs for treatment of angina?

A

beta blockers, CCBs

57
Q

Most suitable antihypertensive drugs for treatment of diabetes?

A

ACEIs, ARBs

58
Q

Most suitable antihypertensive drugs for treatment of heart failure?

A

ACEIs, ARBs, beta blockers

59
Q

Most suitable antihypertensive drugs for treatment of post-MIs?

A

beta blockers

60
Q

Most suitable antihypertensive drugs for treatment of BPH?

A

alpha blockers

61
Q

Most suitable antihypertensive drugs for treatment of dyslipidemias?

A

alpha blockers, CCBs, ACEIs/ARBs

62
Q

Most suitable antihypertensive drugs for treatment of chronic kidney disease?

A

ACEIs, ARBs

Kaplan Pharm: Cardiac and Renal (6 decks)

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