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Pharm 2 module 2 > Antihypertensives > Flashcards

Antihypertensives Flashcards

1
Q

What are cardiac output and peripheral vascular resistance controlled by

A

Baroreflexes
&
Renin-angiotensis aldosterone system (RAAS)

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2
Q

What are the different types of hypertension

A

Essential
Malignant
Resistant
Pulmonary
Pseudo
White coat / office
Isolated systolic

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3
Q

What is the general MOA of diuretics

A

Increase water and sodium excretion to lower blood volume which in turn will decrease BP

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4
Q

What are end stage complication of uncontrolled HTN

A

Heart disease
Heart failure
Stroke
CKD

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5
Q

What are the categories of antihypertensive drugs

A

Diuretics
ACE inhibitos
ARBs
Ca2+ blockers
Beta blockers
Alpha blockers

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6
Q

What are the different categories of diuretics

A

Distal tubule
K-Sparing
Loop diuretics
Carbon anhydrase inhibitor
Osmotic

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7
Q

What drugs make up distal tubule diuretics (Thiazides)

A

Hydrochlorothiazide
Chlorthalidone
Metolazone
Indapamide

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8
Q

What is the MOA of thiazide diuretics

A

Inhibit Na+ and Cl- reabsorption in the distal tubule resulting in increase urine output

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9
Q

What is the indication of use for hydrochlorothiazide

A

Starting agent for HTN, Chronic edema, Idiopathic hypercalcinuria

*treats CaOx stones in Meneires disease and nephrogenic diabetes insidious

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10
Q

What are the pharmacokinetics of hydrochlorothiazide

A

Oral (onset 2 hours)
Absorbed rapidly and eliminated mostly unchanged

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11
Q

What are the adverse effects of hydrochlorothiazide

A

Increased digitalis / lithium toxicity

Hypokalemia if given w/ corticosteroids / ACTH

Orthostatic hypotension with EToH/ Barbituates/ narcotis

Contraindicated in gout

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12
Q

Which type of diuretic can be paired with thiazide or loop diuretics

A

Potassium sparing to mitigate potassium wasting

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13
Q

What is the indication for chlorthalidone

A

HTN, HF, hypercalciuria, Diabetes

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14
Q

Which thiazide is available IV

A

Chlorthalidone

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15
Q

What is the pharmacokinetics of chlorthalidone

A

Oral / IV
Long 1/2t and low bioavailability
excreted in urine unchanged

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16
Q

What are the side effects of chlorthalidone, metolazone, and indapamide

A

Hyponatremia, hypochloremia, hypotensions, hypokalemia

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17
Q

What is the indication for metolazone

A

Additive treatment to loop diuretics for tx of edema in HF

10x more potent that HCTZ

Safe in renal insufficiency

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18
Q

What is the indication for indapamide

A

HTN in decompensated HF
**Not commonly used

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19
Q

What are the pharmacokinetics of indapamide

A

Oral
Hepatic metabolism and renal excretion
*AKA excreted in urine and bile

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20
Q

Which drugs make up loop diuretics

A

Furosemide
Bumetanide
Torsemide

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21
Q

What is the MOA of loop diuretics

A

Inhibits Cl- and Na+ reabsorption = prevention of passive reabsorption of water

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22
Q

Which loop diuretic is most common

A

Furosemide

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23
Q

Which loop diuretic is preferred in patients with low GFR and in hypertensive emergencies

A

Furosemide

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24
Q

What is the indication for furosemide

A

Needing to move large volumes of fluid
->HF, Decamp. Cirrhosis, acute pulm. edema

Hypercalcemia
*Can combine with thiazide

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25
Q

What are the pharmacokinetics of furosemide

A

Oral
Diuresis begins 60min post admin and lasts 8 hours

Hepatic metabolism nd renal excretion

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26
Q

Which drugs will inhibit furosemide

A

Probenecid
indomethacin

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27
Q

What drug interaction will loop diuretics have

A

Digoxin
K+ sparing diuretics
Lithium
NSAIDS

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28
Q

Which patients do you need to use extra caution with in regards to loop diuretics

A

Patients with sulfa allergies

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29
Q

What are some common adverse effects with furosemide

A

Hyponatremia, hypochloremia, dehydration, ototoxicity, hyperglycemia

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30
Q

What is the most potent loop diuretic

A

Bumetanide

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31
Q

What is the indication for bumetanide

A

Edema caused by HF
CKD
Cirrhosis
hypercalcemia

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32
Q

What are the pharmacokinetics of bumetanide

A

Oral
Onset 30-60min
Duration 4-6 hours

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33
Q

What are some adverse effects of bumetanide

A

Dehydration
severe myalgias

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34
Q

What is the indication of torsemide

A

Edema caused by HF
CKD
Cirrhosis
Hypertension
Hypercalcemia

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35
Q

What are some adverse reactions to torsemide

A

Dehydration
ototoxicity
headache
dizziness

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36
Q

What are the K+ sparing diuretics

A

Spironolactone
Eplerenone
Amiloride
Triamterene
Acetazolamide
Mannitol

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37
Q

What is the MOA of K+ sparing diuretics

A

inhibits K+ secretion and influence sodium excretion

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38
Q

What is the indication for spironolactone

A

HTN
Edema in HF
Ascites
nephrotic syndrome
hyperaldosteronism

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39
Q

What is spironolactone often prescribed with

A

Thiazide/loop diuretics to counteract K+ wasting effect

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40
Q

Which K+ sparing meds are aldosterone antagonists

A

Spironolactone
eplerenone

41
Q

What are the pharmacokinetics of spironolactone

A

Oral
Effects can take up to 48hours to set in

42
Q

What are the adverse effects of spironolactone

A

Gynecomastia
hyperkalemia
risk of digitalis toxicity when coadministered

43
Q

What is the indication for eplerenone

A

Edema in HF
Resistant HTN
primary Hyperaldosteronism

44
Q

What are the indications for amiloride

A

3rd / 4th line to tx HTN, HF

May correct polyuria/polydipsia due to lithium induced nephrogenic diabetes insipidus

45
Q

What is the MOA of Amiloride

A

Inhibit K+ loss by direct blockade of Na+/K+ exchange in the distal nephron

46
Q

What are the adverse reactions with amiloride

A

Hyperkalemia
Vomiting
Leg cramps
Dizziness
*Glucose intolerance in diabetics

47
Q

What is the indication for triamterene

A

HTN
Edema
alone or in combo

48
Q

What are the pharmacokinetics of triamterene

A

Oral
Initial response develops within hours

49
Q

What are the adverse reactions of triamterene

A

Blue urine
Hyperkalemia
leg cramps
dizziness

50
Q

What is the indication of Acetazolamide

A

Chronic open angle glaucoma
prophylaxis of altitude sickness

51
Q

What is the MOA for Acetazolamide

A

Inhibits carbonic anhydrase which promotes renal excretion of Na+/K+, bicarb, and water

52
Q

What are the pharmacokinetics of acetazolamide

A

Oral / IV
Eliminated renally

53
Q

What are the adverse reactions of acetazolamide

A

Metabolic acidosis
renal stones
Hyperammonemia in cirrhotic patients
NO IN SULFA ALLERGIES

54
Q

What are osmotic diuretic drugs

A

Mannitol

55
Q

What is the indication of mannitol

A

Maintains urine flow following acute toxic ingestion of substances capable of producing acute renal failure (Lithium excretion)

Reduction in ICP

Glaucoma TX

56
Q

What is the MOA of mannitol

A

Incr concentration of filtrates in the kidney and blocks reabsorption of water

57
Q

What are the pharmacokinetics of mannitol

A

IV
Onset 30-60 min and lasts 6-8 hours

*safe in pregnancy

58
Q

What are the side effects of mannitol

A

HA
Nausea
dizziness
polydipsia
dehydration
confusion
chest pain

59
Q

Why can thiazides not be used in the treatment of hypercalcemia

A

Thiazides can exacerbate hypercalcemia by increasing tubular calcium resorption

60
Q

Which drugs are ACE inhibitors

A

Captopril
Enalapril
Lisinopril

61
Q

What are the indications of use for ACE inhibitors

A

Treatment of:
HTN
DM
Stroke
MI
HF
CKD
*preferred in patients with diabetic neuropathy

62
Q

What is the MOA of ACE inhibitors

A

inhibits ACE which reduces levels of angiotensin 2, suppress aldosterone excretion, decrease peripheral resistance and increase sodium and water retention

63
Q

What are some contraindications with ACE inhibitors

A

Contra in pregnancy
-Interactions w diuretics, antihypertensives, drugs that raise K+ levels, lithium, NSAIDS

64
Q

What is the pharmacokinetics of captopril

A

oral 2-3x/day

dose adjust in kidney disease

65
Q

What are the adverse effect is captopril

A

First dose hypotension, cough, hyperkalemia, renal failure, angioedema, neutropenia, proteinuria

66
Q

What are the adverse effects from enalapril

A

First dose hypotension, cough, hyperkalemia, renal failure, angioedema, proteinuria

67
Q

What are the pharmacokinetics of enalapril

A

Oral (pro-drug) / IV
Dose adjust in kidney disease

68
Q

What are the adverse effects of lisinopril

A

First dose hypotension, cough, hyperkalemia, renal failure, angioedema, neutropenia, proteinuria

69
Q

What are symptoms of severe hypercalcemia

A

Neuromuscular effects
GI effects
Renal effects
CV effects

70
Q

What is the safest and most effective treatment of hypercalcemic crisis

A

Saline rehydration
Furosemide diuresis

71
Q

What is nephrogenic diabetes insipidus

A

Where kidneys have partial or complete resistance to effects of antidiuretic hormone (vasopressin)
-polyuria / polydipsia are signs

72
Q

What is the main goal while treating nephrogenic DI

A

Proper fluid intake and reduction in urine output

73
Q

What drugs can be used to help treat nephrogenic DI

A

HCTZ -> corrects hypernatremia

*Sometimes in conjunction with amiloride to help body maintain K+ level

74
Q

What drug classes make up the renin-angiotensin aldosterone system (RAAS)

A

ACE inhibitors (ACEi)
Angiotensin receptor blockers (ARBs)
Aldosterone antagonists

75
Q

Where is Renin released from

A

Kidneys

76
Q

What is the main MOA of ACEi

A

Angiotensin converting enzyme (ACE) is released from the lungs and converts angiotensin 1 into angiotensin 2

angiotensin 2 then stimulates vasoconstriction and causes the adrenals to release aldosterone

Aldosterone then causes the kidneys to increase reabsorption of N+ and Cl- = increase BP

77
Q

Why are ACEi preferred in patients with diabetic nephropathy

A

B/c glucose levels are not effected and drugs are renoprotective

78
Q

Which drugs are in the ARBs class

A

Losarten
Valsartan
Candesartan
Olmesartan

79
Q

What is the MOA for ARBs

A

-Blocks angiotensin II receptors in blood vessels, adrenals, and other tissues, dilation of arterioles and veins

80
Q

What is the indication for Losartan

A

HTN
Stroke prevention
diabetic neuropathy
reduces uric acid levels

81
Q

What was the first ARB approved for HF

A

Valsartan

82
Q

What is the indication for olmesartan

A

HTN (mean BP reduction)

83
Q

What is the indication for Candestartan

A

HTN
HF

84
Q

What is the pharmacokinetics of Losartan

A

Oral 1x daily
Extensive first pass metabolism

85
Q

What is the pharmacokinetics of valsartan

A

Oral
2x daily

86
Q

What are the pharmacokinetics of candesartan and olmesartan

A

oral
1x daily dosing

87
Q

What are the adverse effects / contraindications of losartan, valartan, candesartan

A

Angioedema, renal failure, dry cough, rash, altered taste
-Drug interactions: additive effect w antihypertensive drugs
-Contra in 2nd and 3rd trimesters of pregnancy

88
Q

What is the adverse reaction and contraindication of olmesartan

A

Drug interactions: additive effect w antihypertensive drugs
-Contra in 2nd and 3rd trimesters of pregnancy

89
Q

What drug is a renin inhibitor

A

Aliskiren

90
Q

What is the MOA of Aliskiren

A

Inhibits renin by binding to it, preventing the cleavage of angiotensinogen

, acting early in the RAAS

91
Q

What is the indication for aliskiren

A

HTN
*side effects make it less favorable

92
Q

What are the side effects / contraindications of aliskiren

A

Diarrhea
Cough
Angioedema

*contraindicated in pregnancy

93
Q

What are the pharmacokinetics of aliskiren

A

Oral
CYP metabolism
Bioavailability low, becomes lower with high fat meal

1/2t 24 hours

94
Q

What are the endothelia antagonists

A

Ambrisentan
Bosentan

95
Q

What is the MOA of ambrisentan

A

Slectively blocks type A endothelin receptors

96
Q

What is the indication for ambrisentan

A

PAH
Improve exercise, delay clinical worsening
*Can be used in combo with tadalafil

97
Q

What is the indication for bosentan

A

PAH
Decrease digital ulcerations in patients with scleroderma

98
Q

What are the adverse effects of Ambrisentan

A

Edema
nasal congestion
palpitations
abdominal pain
constipation

Pharm 2 module 2 (4 decks)

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