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Pharm 225A > AntiHypertensives > Flashcards

AntiHypertensives Flashcards

1
Q

MOA of Thiazide Diuretics

A
  • increase the excretion of Na+ and water by blocking Na+ reabsorption
  • decreases blood volume and arterial resistance
  • # 1 drug choice in most cases
  • for HTN or edema
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2
Q

Hydrochlorothiazide

A
  • aka HCTZ, thiazide diuretic
  • blocks Na+ reabsorption in early segment of distal convoluted tubule
  • PO only
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3
Q

Chlorthalidone

A
  • thiazide diuretic
  • 1.5-2 times more potent as HCTZ
  • PO only
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4
Q

Adverse effects of thiazide diuretics

A
  • hyponatremia/dehydration
  • hypokalemia
  • hyperuricemia
  • hyperglycemia
  • hyperlipidemia
  • photosensitivity
  • contraindicated if sulfa-allergy or CKD
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5
Q

MOA of Loop Diuretics

A
  • inhibit co-transport of Na+/K+/2Cl- –> increases Na+ and K+ excretion
  • more diuresis than thiazides, shorter duration
  • for HTN or edema
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6
Q

Furosemide

A
  • Loop Diuretic
  • most freq. prescribed of this class
  • prevents passive reabsorption of water –> profound diuresis
  • PO or IV
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7
Q

Bumetanide

A
  • Loop diuretic
  • more potent than Furosemide
  • PO or IV
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8
Q

Adverse Effects of Loop Diuretics

A
  • Orthostatic hypotension
  • electrolyte imbalance (hyponatremia, dehydration)
  • hypokalemia
  • hyperuricemia
  • hyperglycemia
  • hyperlipidemia
  • photosensitivity
  • ototoxicity ( esp. in IV route)
  • contraindicated if sulfa-allergy
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9
Q

MoA of Potassium sparing diuretics

A
  • less potent than thiazides and loop diuretics
  • provide modest increase in urine production with less potassium excretion
  • meds often coupled with HCTZ
  • for HTN or edema
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10
Q

Amiloride

A
  • Potassium Sparing diuretic
  • MoA: directly blocks Na+/K+ pump; prevents Na+ reabsorption and K+ secretion in collecting tubule
  • PO only
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11
Q

Triamtrene

A
  • Potassium Sparing diuretic
  • directly blocks Na+/K+ pump
  • mild diuresis; excretes Na+, prevents secretion of K+
  • PO only
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12
Q

Spironolactone or Eplerenone

A
  • Potassium sparing Diuretics
  • aldosterone antagonist to work in collecting duct –> Na+ excretion, K+ reabsorption
  • PO only
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13
Q

Adverse Effects of potassium sparing diuretics

A
  • hyperkalemia (esp if in combo with ACE, ARB, or K+ supplement)
  • contraindicated in patients with CKD or hyperkalemia
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14
Q

Adverse effects specific to spironolactone

A
  • gynecomastia in males
  • abnormal vaginal bleeding
  • BBW: tumorigenic
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15
Q

MoA of ACE Inhibitors

A
  • inhibit angiotensin I converting enzyme –> block formation of angiotensin II –> decreased angiotensin II levels
  • inhibit bradykinin degradation –> increased bradykinin levels in lung (cough)
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16
Q

Enalapril or Lisinopril

A
  • ACE inhibitors
  • Enalapril –> PO or IV
  • Lisinopril –> PO
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17
Q

Adverse Effects of ACE inhibitors

A
  • BBW: injury/death to developing fetus
  • first dose hypotension (abrupt drop of angiotensin II
  • dry cough (bronchial/laryngeal irritation)
  • Hyperkalemia
  • Angioedema (increased permeability of capillaries, esp if IV)
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18
Q

Indications of ACE inhibitors

A
  • HTN
  • MI
  • prevention of MI, stroke, and death in patients at high risk of CVD
  • CHF
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19
Q

MoA of ARBs

A
  • bind to angiotensin II receptor subtype –> block action of angiotensin II
  • relaxes smooth muscle and promotes vasodilation
  • decreases aldosterone release and increases renal Na+/water excretion
  • alternate to ACEs
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20
Q

Losartan or Valsartan

A
  • ARBs
  • both PO only
  • Losartan 1st choice for this class
  • higher cost, reserved for patients who develop cough with ACE inhibitors
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21
Q

Indications of ARBs

A
  • HTN
  • MI
  • CHF
  • Prevention of stroke in patients with high risk of CVD
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22
Q

Adverse effects of ARBs

A
  • BBW: can cause injury/death to developing fetus
  • no problems with cough
  • hyperkalemia
  • hypotension
  • angioedema (rare)
  • acute renal insufficiency
  • additive hypotensive effects when in combo with other antihypertensives
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23
Q

ACE inhibior/ARB warning

A
  • start with smallest dose possible due to hypotension risk
  • may cause hyperkalemia in CKD patients or patients on other K+ sparing meds
  • absolutely contraindicated in pregnancy
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24
Q

MoA of Renin inhibitor

A
  • Inhibits angiotensinogen to angiotensin I conversion
  • does not block bradykinin breakdown (less cough than ACE-Is)
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25
Q

Aliskiren

A
  • Renin inhibitor; inhibits angiotensinogen to angiotensin I conversion
  • can be used alone or in combo with other antihypertensives
  • PO
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26
Q

adverse effects of Renin inhibitors

A
  • orthostatic hypotension
  • hyperkalemia
  • angioedema
  • BBW: injury/death to developing fetus
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27
Q

MoA of all types of CCBs

A
  • inhibit influx of calcium via the voltage-dependent calcium channels in vascular smooth muscle
  • relaxation of peripheral vasculature –> peripheral vasodilation
  • each agent produces different degrees of systemic/coronary arterial vasodilation
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28
Q

Dihydropyridines

A
  • CCBs that act primarily on artieroles
  • end in (-dipine)
  • ex. Nifedipine, Amlodipine, Clevidipine
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29
Q

Nifedipine

A
  • dihydropyridine CCB, acts on arterioles
  • the 1st choice of drug for this class
  • more potent
  • PO
30
Q

Amlodipine

A
  • dihydropyridine CCB, acts on arterioles
  • more potent
  • PO
31
Q

Clevidipine

A
  • dihydropyridine CCB, acts on arterioles
  • IV only
32
Q

Non-dihydropyridines

A
  • CCBs that act on arterioles and on the heart
  • inhibit influx of calcium via voltage-dependent calcium channels in vascular smooth muscle AND in th heart
  • decrease HR, AV conduction, and force of contraction
33
Q

Verapamil

A
  • Non-dihydropyridine CCB; acts on artieroles AND heart
  • PO or IV
34
Q

Diltiazem

A
  • Non-dihydropyridine CCB; acts on artieroles AND heart
  • PO or IV
35
Q

adverse effects of CCBs (dihydropyridines)

A
  • dizziness, headache, flushing
  • reflex tachycardia (avoided by using B-blocker in combo)
  • peripheral edema
  • gingival hyperplasia
36
Q

adverse effects of CCBs (non-dihydropyridines)

A
  • peripheral edema
  • headache
  • gingival hyperplasia
  • CV effects (bradycardia, AV block, decrease myocardial contractility, hypotension)
  • constipation
37
Q

indications of CCBs

A
  • HTN
  • Angina pectoris (dihydro)
  • cardiac dysrhythmias (non-dihydro)
38
Q

MoA of B-Blockers

A
  • competitively antagonize the response of catecholamines mediated by beta-receptors
  • decreased heart contractility and HR
  • decreased cardiac output and peripheral resistance
  • decreased renin release and blood volume
39
Q

Selective B1 blockers

A
  • greater tendency to occupy B1 receptors in the heart rather than B2 in the lungs
  • AtBM –> Atenolol, Bisoprolol, Metoprolol
40
Q

Metoprolol

A
  • Selective B1 blocker
  • PO
41
Q

Atenolol

A
  • Selective B1 blocker
  • PO
42
Q

Bisoprolol

A
  • Selective B1 blocker
  • PO
43
Q

Non-selective B1 and B2 blockers

A
  • most adverse effects on lungs
  • ex. propranolol
44
Q

Propranolol

A

-Non-selective B1 and B2 blocker
- PO, IV
- prototype for this class of drugs

45
Q

Nebivolol

A
  • B1 selective with Nitric oxide dependent vasodilation
  • PO
46
Q

Partial agonist B blockers

A
  • have intrinsic sympathomimetic activity –> prevents bronchoconstriction and other B-blocking actions
  • ability to maintain satisfactory HR
  • ex. Acebutolol
47
Q

Acebutolol

A
  • Partial agonist B blocker
  • depresses HR less than other B blockers
  • PO
48
Q

Nonselective B blockage drugs with A blockade

A
  • alpha blockade –> promotes vasodilation (but also orthostatic hypotension)
  • B blockade on heart –> decreased HR and contractility
  • B blockade on juxtaglomerular cells –> suppresses release of renin
  • ex. Carvedilol, Labetolol
49
Q

Carvedilol

A
  • Nonselective B blockage drugs with A blockade
  • PO
50
Q

Labetolol

A
  • Nonselective B blockage drugs with A blockade
  • alternative med for chronic HTN in pregnancy
  • PO, IV
51
Q

Indications of B blockers

A
  • HTN
  • Angina
  • MI
  • Antiarrhythmics
  • Migraine
  • Glaucoma
52
Q

Adverse effects of B blockers

A
  • bradycardia, AV block, worsening HF
  • induce/worsen bronchospasm (Asthma, some COPD)
  • sexual impairment
  • depression, fatigue, nightmares, confusion, hallucinations
  • hyperglycemia, hyperTGemia
  • allergy to propranolol
53
Q

BBW of b blockers

A
  • abrupt d/c may cause rebound HTN or unstable angina, MI, and death in patients with high CAD
54
Q

MoA of alpha 1 blockers

A
  • blocks A1 receptors (competitive antagonists) –> competes with norepinephrine and epinephrine on vascular smooth muscle and prevents vasoconstriction
  • dilation of arterioles
  • reduce prostatic symptoms in men
55
Q

Terazosin

A
  • Alpha 1 blocker
  • PO
56
Q

Tamsulosin

A
  • Alpha 1 blocker
  • selective for prostate smooth muscle vs vascular smooth muscle
  • PO
57
Q

indications for A1 blockers

58
Q

adverse effects of A1 blockers

A
  • CV: reflex tachy and ortho hypotension
  • salt and water retention
  • blurred vision
  • nasal congestion
  • erectile dysfunction
59
Q

MoA of A2 agonist

A
  • 2nd line agents
  • selective activation of A2 receptors in the CNS –> vasodilation, reduce HR and cardiac output
60
Q

Methyldopa

A
  • A2 agonist
  • drug of choice for chronic HTN in pregnancy
  • PO
61
Q

Clonidine

A
  • A2 agonist
  • used in resistant HTN (2nd and 3rd line agent, high side effects)
  • adjunct therapy in cancer pain
  • off label use for opioid/alc withdrawal symptoms, nicotine dependence, PMS
  • PO
62
Q

Indications for A2 agonists

A
  • HTN
  • ADHD
  • Pain (clonidine)
63
Q

adverse effects of A2 agonists

A
  • CNS depression –> drowsiness
  • dry mouth
  • Rebound HTN –> large jump in BP occurring to abrupt clonidine withdrawal (requires slow weaning)
64
Q

MoA of Direct Arteriolar Vasodilators

A
  • selective dilation of arterioles (not veins)
  • produce peripheral vasodilation –> decreased peripheral resistance
  • increase HR/myocardial contractility by baroreceptor activation
65
Q

Hydralyzine

A
  • Direct Arteriolar Vasodilator
  • PO or (IV in hypertensive emergencies)
  • used prior to labor in pre-eclampsia
66
Q

Minoxidil

A
  • Direct Arteriolar Vasodilator
  • not first choice drug (pericardial effusion side effects), only used for pts who do not respond to first line
  • PO
67
Q

adverse effects of arteriolar vasodilators

A
  • reflex tachycardia
  • vascular headache
  • Lupus-like syndrome (hydralazine)

Specific to Minoxidil –> pericardial effusion (BBW); Hirsutism

68
Q

drugs used in chronic HTN in pregnancy

A
  • methyldopa
  • labetolol
69
Q

Drugs for hypertensice emergency

A
  • nitroglycerin
  • hydralyzine
  • labetolol
  • clevidipine

Pharm 225A (7 decks)

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