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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
Aliskiren
- Renin inhibitor; inhibits angiotensinogen to angiotensin I conversion - can be used alone or in combo with other antihypertensives - PO
26
adverse effects of Renin inhibitors
- orthostatic hypotension - hyperkalemia - angioedema - BBW: injury/death to developing fetus
27
MoA of all types of CCBs
- 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
28
Dihydropyridines
- CCBs that act primarily on artieroles - end in (-dipine) - ex. Nifedipine, Amlodipine, Clevidipine
29
Nifedipine
- dihydropyridine CCB, acts on arterioles - the 1st choice of drug for this class - more potent - PO
30
Amlodipine
- dihydropyridine CCB, acts on arterioles - more potent - PO
31
Clevidipine
- dihydropyridine CCB, acts on arterioles - IV only
32
Non-dihydropyridines
- 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
Verapamil
- Non-dihydropyridine CCB; acts on artieroles AND heart - PO or IV
34
Diltiazem
- Non-dihydropyridine CCB; acts on artieroles AND heart - PO or IV
35
adverse effects of CCBs (dihydropyridines)
- dizziness, headache, flushing - reflex tachycardia (avoided by using B-blocker in combo) - peripheral edema - gingival hyperplasia
36
adverse effects of CCBs (non-dihydropyridines)
- peripheral edema - headache - gingival hyperplasia - CV effects (bradycardia, AV block, decrease myocardial contractility, hypotension) - constipation
37
indications of CCBs
- HTN - Angina pectoris (dihydro) - cardiac dysrhythmias (non-dihydro)
38
MoA of B-Blockers
- 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
Selective B1 blockers
- greater tendency to occupy B1 receptors in the heart rather than B2 in the lungs - AtBM --> Atenolol, Bisoprolol, Metoprolol
40
Metoprolol
- Selective B1 blocker - PO
41
Atenolol
- Selective B1 blocker - PO
42
Bisoprolol
- Selective B1 blocker - PO
43
Non-selective B1 and B2 blockers
- most adverse effects on lungs - ex. propranolol
44
Propranolol
-Non-selective B1 and B2 blocker - PO, IV - prototype for this class of drugs
45
Nebivolol
- B1 selective with Nitric oxide dependent vasodilation - PO
46
Partial agonist B blockers
- have intrinsic sympathomimetic activity --> prevents bronchoconstriction and other B-blocking actions - ability to maintain satisfactory HR - ex. Acebutolol
47
Acebutolol
- Partial agonist B blocker - depresses HR less than other B blockers - PO
48
Nonselective B blockage drugs with A blockade
- 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
Carvedilol
- Nonselective B blockage drugs with A blockade - PO
50
Labetolol
- Nonselective B blockage drugs with A blockade - alternative med for chronic HTN in pregnancy - PO, IV
51
Indications of B blockers
- HTN - Angina - MI - Antiarrhythmics - Migraine - Glaucoma
52
Adverse effects of B blockers
- bradycardia, AV block, worsening HF - induce/worsen bronchospasm (Asthma, some COPD) - sexual impairment - depression, fatigue, nightmares, confusion, hallucinations - hyperglycemia, hyperTGemia - allergy to propranolol
53
BBW of b blockers
- abrupt d/c may cause rebound HTN or unstable angina, MI, and death in patients with high CAD
54
MoA of alpha 1 blockers
- 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
Terazosin
- Alpha 1 blocker - PO
56
Tamsulosin
- Alpha 1 blocker - selective for prostate smooth muscle vs vascular smooth muscle - PO
57
indications for A1 blockers
- HTN - BPH
58
adverse effects of A1 blockers
- CV: reflex tachy and ortho hypotension - salt and water retention - blurred vision - nasal congestion - erectile dysfunction
59
MoA of A2 agonist
- 2nd line agents - selective activation of A2 receptors in the CNS --> vasodilation, reduce HR and cardiac output
60
Methyldopa
- A2 agonist - drug of choice for chronic HTN in pregnancy - PO
61
Clonidine
- 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
Indications for A2 agonists
- HTN - ADHD - Pain (clonidine)
63
adverse effects of A2 agonists
- CNS depression --> drowsiness - dry mouth - Rebound HTN --> large jump in BP occurring to abrupt clonidine withdrawal (requires slow weaning)
64
MoA of Direct Arteriolar Vasodilators
- selective dilation of arterioles (not veins) - produce peripheral vasodilation --> decreased peripheral resistance - increase HR/myocardial contractility by baroreceptor activation
65
Hydralyzine
- Direct Arteriolar Vasodilator - PO or (IV in hypertensive emergencies) - used prior to labor in pre-eclampsia
66
Minoxidil
- Direct Arteriolar Vasodilator - not first choice drug (pericardial effusion side effects), only used for pts who do not respond to first line - PO
67
adverse effects of arteriolar vasodilators
- reflex tachycardia - vascular headache - Lupus-like syndrome (hydralazine) Specific to Minoxidil --> pericardial effusion (BBW); Hirsutism
68
drugs used in chronic HTN in pregnancy
- methyldopa - labetolol
69
Drugs for hypertensice emergency
- nitroglycerin - hydralyzine - labetolol - clevidipine
70

Pharm 225A (7 decks)

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