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U4 Drug table > Antihypertensives > Flashcards

Antihypertensives Flashcards

1
Q

What is the class for Furosemide (Lasix)

A

Loop diuretic

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2
Q

What is the mechanism for Furosemide (Lasix)

A

Inhibits Cl portion of Na-K-2Cl cotransporter in luminal membrane at medullary and cortical (proximal) talH –> decreased Ca++ and Na+ (and water) reabsorption, resultant K+ loss

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3
Q

What are the therapeutics for Furosemide (Lasix)

A

Crisis edema (pulmonary, CHF, cirrhosis), hypercalcemia, drug toxicity/OD; severe hypertension in setting of CHF or cirrhosis

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4
Q

What are the important side effects for Furosemide (Lasix)

A

Hypokalemia/hypomagnesemia, hypercalcinuria, nephrocalcinosis, ototoxicity (esp. w/aminoglycoside)

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5
Q

What are the other side effects for Furosemide (Lasix)

A

Hyper -glycemia, -lipidemia, -uricemia; hypo -magnesia, -natremia; gout, photosensitivity, drug interactions; erectile dysfunction

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6
Q

What are the miscellaneous for Furosemide (Lasix)

A

avoid NSAIDs, take before salty meals, reduce salt intake; useful in patients with renal insufficiency (GFR < 30-40)

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7
Q

What is the class for Hydrochlorothiazide (Microzide)

A

Thiazide diuretic

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8
Q

What is the mechanism for Hydrochlorothiazide (Microzide)

A

Inhibits the Cl portion of the Na-Cl cotransporter in the luminal membrane at the early distal tubule –> decreased Na+ (and water) reabsorption, increased Ca++ reabsorption, resultant K+ loss

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9
Q

What are the therapeutics for Hydrochlorothiazide (Microzide)

A

HTN (intravascular contraction), chronic edema (cardiac insufficiency), idiopathic hypercalciuria (stones), nephrogenic diabetes insipidus

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10
Q

What are the important side effects for Hydrochlorothiazide (Microzide)

A

Hypokalemia/hypomagnesemia, contraction alkalosis, increased BUN & creatinine

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11
Q

What are the other side effects for Hydrochlorothiazide (Microzide)

A

Hyper -glycemia, -lipidemia, -uricemia, -calcemia; hypo -magnesia, -natremia; gout, photosensitivity, impotence, drug interactions

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12
Q

What are the miscellaneous for Hydrochlorothiazide (Microzide)

A

avoid NSAIDs, bile sequestrants; ineffective if GFR <30

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13
Q

What is the class for Chlorthalidone (Thalitone)

A

Thiazide-like diuretic

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14
Q

What is the mechanism for Chlorthalidone (Thalitone)

A

Inhibits the Cl portion of the Na-Cl cotransporter in the luminal membrane at the early distal tubule –> decreased Na+ (and water) reabsorption, increased Ca++ reabsorption, resultant K+ loss

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15
Q

What are the therapeutics for Chlorthalidone (Thalitone)

A

Reduce stroke risk, CHF events; HTN (intravascular contraction), chronic edema (cardiac insufficiency), idiopathic hypercalciuria (stones), nephrogenic diabetes insipidus

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16
Q

What are the important side effects for Chlorthalidone (Thalitone)

A

Hypokalemia/hypomagnesemia, contraction alkalosis, increased BUN & creatinine

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17
Q

What are the other side effects for Chlorthalidone (Thalitone)

A

Hyper -glycemia, -lipidemia, -uricemia, -calcemia; hypo -magnesia, -natremia; gout, photosensitivity, impotence, drug interactions

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18
Q

What are the miscellaneous for Chlorthalidone (Thalitone)

A

avoid NSAIDs, bile sequestrants; ineffective if GFR <30

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19
Q

What is the class for Metolazone (Zaroxolyn)

A

Thiazide-like diuretic

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20
Q

What is the mechanism for Metolazone (Zaroxolyn)

A

Inhibits the Cl portion of the Na-Cl cotransporter in the luminal membrane at the early distal tubule –> decreased Na+ (and water) reabsorption, increased Ca++ reabsorption, resultant K+ loss

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21
Q

What are the therapeutics for Metolazone (Zaroxolyn)

A

HTN (intravascular contraction), chronic edema (cardiac insufficiency), idiopathic hypercalciuria (stones), nephrogenic diabetes insipidus

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22
Q

What are the important side effects for Metolazone (Zaroxolyn)

A

Hypokalemia/hypomagnesemia, contraction alkalosis, increased BUN & creatinine

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23
Q

What are the other side effects for Metolazone (Zaroxolyn)

A

Hyper -glycemia, -lipidemia, -uricemia, -calcemia; hypo -magnesia, -natremia; gout, photosensitivity, impotence, drug interactions

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24
Q

What are the miscellaneous for Metolazone (Zaroxolyn)

A

avoid NSAIDs, bile sequestrants; ineffective if GFR <30

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25
Q

What is the class for Amiloride (Midamor)

A

Renal ENaC inhibitor

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26
Q

What is the mechanism for Amiloride (Midamor)

A

Blocks Na channel and Na/H antiporter in lumenal membrane at the late distal tubule and collecting duct –> decreased K+ secretion and distal tubule acid secretion, increased Ca++ absorption

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27
Q

What are the therapeutics for Amiloride (Midamor)

A

Combination with other diuretics to prevent hypokalemia; edema, idiopathic hypercalciuria (stones); lithium-induced polyuria & toxicity, Liddle syndrome, mucocilliary clearance

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28
Q

What are the important side effects for Amiloride (Midamor)

A

Hyperkalemia in patients with renal failure or on ACE inhibitors

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29
Q

What are the miscellaneous for Amiloride (Midamor)

A

Contraindicated in patients with renal failure (hyperkalemia), ACEi/ARB use; FeNa = 2%

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30
Q

What is the class for Spironolactone (Aldactone)

A

Aldosterone receptor antagonist

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31
Q

What is the mechanism for Spironolactone (Aldactone)

A

Competes for aldosterone receptor, inhibiting mRNA transcription and translation –> decreased Na and K channels, decreased number and activity of Na-K-ATPase pumps in the late distal tubule and collecting duct –> decreased K+ secretion, distal tubule acid secretion

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32
Q

What are the therapeutics for Spironolactone (Aldactone)

A

Reduction in CHF mortality (30% in NYHA class III and IV); combination with other diuretics to prevent hypokalemia; edema; primary and secondary aldosteronism; hypertension; anti-testosterone agent

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33
Q

What are the important side effects for Spironolactone (Aldactone)

A

Hyperkalemia in patients with renal failure or on ACE inhibitors; male patients may have gynecomastia, erectile dysfunction, and loss of libido; female patients may have amenorrhea, breast soreness, and oligomenorrhea

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34
Q

What are the miscellaneous for Spironolactone (Aldactone)

A

Contraindicated in patients with renal failure (hyperkalemia); FeNa = 2%; requires a salt-restricted diet; only drug not requiring tubular lumen access

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35
Q

What is the class for Eplerenone (Inspra)

A

Potassium-sparing diuretic

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36
Q

What is the mechanism for Eplerenone (Inspra)

A

Block alodesterone; inhibits sodium reabsorption in distal tubule

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37
Q

What are the therapeutics for Eplerenone (Inspra)

A

Reduction in CHF mortality (30% in NYHA class III and IV); combination with other diuretics to prevent hypokalemia; edema; primary and secondary aldosteronism; hypertension; anti-testosterone agent

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38
Q

What are the important side effects for Eplerenone (Inspra)

A

Hyperkalemia; much lower incidence of gynecomastia and mennorhagia

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39
Q

What are the miscellaneous for Eplerenone (Inspra)

A

Caution in renal failure, ACEi or ARB use, and in diabetics

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40
Q

What is the class for Captopril (Capoten)

A

short-acting ACE-I (vasodilators)

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41
Q

What is the mechanism for Captopril (Capoten)

A

Blocks endothelial ACE from converting angiotensin I to angiotensin II (potent vasoconstrictor); as a side effect, also prevents breakdown of bradykinin (potent vasodilator)

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42
Q

What are the therapeutics for Captopril (Capoten)

A

CHF, left ventricular hypertrophy, post-MI (prevents left ventricular remodeling)

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43
Q

What are the important side effects for Captopril (Capoten)

A

Dry cough, angioedema, inhibits renal autoregulation, hypotension

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44
Q

What are the miscellaneous for Captopril (Capoten)

A

Short-acting; contraindicated in pregnancy, renal artery stenosis, hyperkalemia, and prior angioedema (no ARB allowed, either); caution in renal failure; reduces incidence of future CAD events, may reduce risk of diabetes

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45
Q

What is the class for Lisinopril (Prinivil); Benazepril (Lotensin); Quinapril (Accupril); Ramipril (Altace)

A

long-acting ACE-I (vasodilators)

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46
Q

What is the mechanism for Lisinopril (Prinivil); Benazepril (Lotensin); Quinapril (Accupril); Ramipril (Altace)

A

Blocks endothelial ACE from converting angiotensin I to angiotensin II (potent vasoconstrictor); as a side effect, also prevents breakdown of bradykinin (potent vasodilator)

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47
Q

What are the therapeutics for Lisinopril (Prinivil); Benazepril (Lotensin); Quinapril (Accupril); Ramipril (Altace)

A

CHF, left ventricular hypertrophy, post-MI (prevents left ventricular remodeling)

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48
Q

What are the important side effects for Lisinopril (Prinivil); Benazepril (Lotensin); Quinapril (Accupril); Ramipril (Altace)

A

Dry cough, angioedema, decreased renal function, hypotension

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49
Q

What are the miscellaneous for Lisinopril (Prinivil); Benazepril (Lotensin); Quinapril (Accupril); Ramipril (Altace)

A

Long-acting; contraindicated in pregnancy, renal artery stenosis, hyperkalemia, and prior angioedema (no ARB allowed, either); caution in renal failure; reduces incidence of future CAD events; may reduce risk of diabetes

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50
Q

What is the class for Enalapril (Vasotec)

A

ACE-I (vasodilators)

51
Q

What is the mechanism for Enalapril (Vasotec)

A

Blocks endothelial ACE from converting angiotensin I to angiotensin II (potent vasoconstrictor); as a side effect, also prevents breakdown of bradykinin (potent vasodilator)

52
Q

What are the therapeutics for Enalapril (Vasotec)

A

CHF, left ventricular hypertrophy, post-MI (prevents left ventricular remodeling)

53
Q

What are the important side effects for Enalapril (Vasotec)

A

Dry cough, angioedema, decreased renal function, hypotension

54
Q

What are the miscellaneous for Enalapril (Vasotec)

A

Metabolized to enalaprilat, a more active metabolite;contraindicated in pregnancy, renal artery stenosis, hyperkalemia, and prior angioedema (no ARB allowed, either); caution in renal failure; reduces incidence of future CAD events; may reduce risk of diabetes

55
Q

What is the class for Losartan (Cozaar); Valsartan (Diovan); Irbesartan (Avapro)

A

Angiotensin II Recepter Blockers

56
Q

What is the mechanism for Losartan (Cozaar); Valsartan (Diovan); Irbesartan (Avapro)

A

Competitive inhibition of angiotensin II in vascular endothelium

57
Q

What are the therapeutics for Losartan (Cozaar); Valsartan (Diovan); Irbesartan (Avapro)

A

Fall in peripheral vascular resistance, w/little change in HR or CO; same uses as ACE-I

58
Q

What are the important side effects for Losartan (Cozaar); Valsartan (Diovan); Irbesartan (Avapro)

A

Angioedema, decreased renal function, hypotension; dry cough less frequent than with ACE-I

59
Q

What are the miscellaneous for Losartan (Cozaar); Valsartan (Diovan); Irbesartan (Avapro)

A

Contraindicated in pregnancy, renal artery stenosis, hyperkalemia, and prior angioedema (no ARB allowed, either); caution in renal failure

60
Q

What is the class for Aliskiren (Tekturna)

A

Renin inhibitor

61
Q

What is the mechanism for Aliskiren (Tekturna)

A

Renin inhibitor

62
Q

What are the therapeutics for Aliskiren (Tekturna)

A

Not very effective

63
Q

What is the class for Diltiazem (Cardizem); Verapamil (Calan)

A

Non-dihydropyridine Calcium channel blockers

64
Q

What is the mechanism for Diltiazem (Cardizem); Verapamil (Calan)

A

Interact with L-type voltage gated plasma membrane Ca channel –> decreased calcium entry into vascular smooth muscle cell, preventing contraction; causes decreased contractility, firing rate of aberrant pacemaker sites, and conduction velocity; prolongs repolarization in SA node and AV node (–> decreases HR); less vasodilation

65
Q

What are the therapeutics for Diltiazem (Cardizem); Verapamil (Calan)

A

Hypertension, anti-anginal (chronotropic effects –> decreased myocardial oxygen demand), SVT (class IV anti-arrhythymic)

66
Q

What are the important side effects for Diltiazem (Cardizem); Verapamil (Calan)

A

Leg edema, bradycardia, AV nodal blockade, hypotension, worsening heart failure

67
Q

What are the other side effects for Diltiazem (Cardizem); Verapamil (Calan)

A

Constipation (most common), headache, flushing

68
Q

What are the miscellaneous for Diltiazem (Cardizem); Verapamil (Calan)

A

Contraindicated in overt decompensated heart failure, bradycardia, sinus node dysfunction, high-degree AV block

69
Q

What is the class for Amlodipine (Norvasc); Nifedipine (Procardia)

A

Dihydropyridine Calcium channel blockers

70
Q

What is the mechanism for Amlodipine (Norvasc); Nifedipine (Procardia)

A

Interact with L-type voltage gated plasma membrane Ca channel –> decreased calcium entry into vascular smooth muscle cell, preventing contraction; causes dilation of epicardial coronary arteries, arteriolar resistance arteries; less heart-specific activity

71
Q

What are the therapeutics for Amlodipine (Norvasc); Nifedipine (Procardia)

A

Hypertension, Raynauds, angina (3rd choice drug)

72
Q

What are the important side effects for Amlodipine (Norvasc); Nifedipine (Procardia)

A

Leg edema (less than 1st generation), heart failure, AV nodal blockade, reflex tachycardia (lipophilic agents gain entry to brain and depress vasomotor center, rapidly dropping BP; this causes more reflex sympathetic activation (leading to adverse CV effects); long-acting agents are less lipophilic, and will cause less sympathetic activation and initial fall in BP)

73
Q

What are the other side effects for Amlodipine (Norvasc); Nifedipine (Procardia)

A

Constipation (most common), headache, flushing

74
Q

What are the miscellaneous for Amlodipine (Norvasc); Nifedipine (Procardia)

A

Contraindicated in overt decompensated heart failure, bradycardia, sinus node dysfunction, high-degree AV block

75
Q

What is the class for Propranolol (Inderal)

A

Nonselective ?-blocker

76
Q

What is the mechanism for Propranolol (Inderal)

A

Nonselective ?-blocker; primarily reduces cardiac output

77
Q

What are the important side effects for Propranolol (Inderal)

A

Bronchospasm, bradycardia (negative chronotrope), CHF (negative ionotrope), masking of hypoglycemia symptoms

78
Q

What are the other side effects for Propranolol (Inderal)

A

Decreased exercise capacity, depression (crosses BBB), worsening symptoms of peripheral vascular disease

79
Q

What is the class for Metoprolol (Lopressor); Atenolol (Tenormin)

A

?1-selective blocker

80
Q

What is the mechanism for Metoprolol (Lopressor); Atenolol (Tenormin)

A

Moderately selective ?1 blockade

81
Q

What are the important side effects for Metoprolol (Lopressor); Atenolol (Tenormin)

A

Less likely to have bronchospasm, hypoglycemic awareness, and depression

82
Q

What is the class for Bisoprolol (Zebeta); Nadolol (Corgard)

A

?1-selective blocker

83
Q

What is the mechanism for Bisoprolol (Zebeta); Nadolol (Corgard)

A

Moderately selective ?1 blockade

84
Q

What are the important side effects for Bisoprolol (Zebeta); Nadolol (Corgard)

A

Less likely to have bronchospasm, hypoglycemic awareness, and depression

85
Q

What are the miscellaneous for Bisoprolol (Zebeta); Nadolol (Corgard)

A

Longer-acting than other beta-blockers

86
Q

What is the class for Labetolol (Trandate)

A

Combined ?? blocker

87
Q

What is the mechanism for Labetolol (Trandate)

A

?1 blockade with vasodilatory effects

88
Q

What are the therapeutics for Labetolol (Trandate)

A

Hypertensive urgency

89
Q

What is the class for Carvedilol (Coreg)

A

Combined ?? blocker

90
Q

What is the mechanism for Carvedilol (Coreg)

A

?1 blockade with vasodilatory effects

91
Q

What are the therapeutics for Carvedilol (Coreg)

A

Acute coronary syndrome, CHF

92
Q

What is the class for Esmolol (Brevibloc)

A

?1-selective blocker

93
Q

What are the therapeutics for Esmolol (Brevibloc)

A

AV nodal blockade in unstable patients

94
Q

What are the miscellaneous for Esmolol (Brevibloc)

A

Short half-life

95
Q

What is the class for Terazosin (Hytrin); Doxazosin (Cardura)

A

?1-adrenergic receptor antagonist

96
Q

What is the mechanism for Terazosin (Hytrin); Doxazosin (Cardura)

A

Blocks post-synaptic ?1-adrenergic receptor antagonist on vascular smooth muscle

97
Q

What are the therapeutics for Terazosin (Hytrin); Doxazosin (Cardura)

A

BPH; second-tier meds (use when other condition around, not for isolated hypertension)

98
Q

What are the important side effects for Terazosin (Hytrin); Doxazosin (Cardura)

A

Orthostatic hypotension, fluid retention, worsening angina (secondary to reflex tachycardia)

99
Q

What is the class for Clonidine (Catapres)

A

Central ?2-agonist

100
Q

What is the mechanism for Clonidine (Catapres)

A

Stimulation of central ?2a adrenergic receptors –> reduction in sympathetic outflow from vasomotor systems in brainstem; inhibition of renin release (secondary to decreased sympathetic tone)

101
Q

What are the important side effects for Clonidine (Catapres)

A

Rebound HTN if abruptly stopped; moderate orthostatic hypotension

102
Q

What are the other side effects for Clonidine (Catapres)

A

Sedation, dry mouth, fatigue, depression

103
Q

What is the class for ?-methyldopa (Aldomet)

A

Central ?2-agonist

104
Q

What is the mechanism for ?-methyldopa (Aldomet)

A

Stimulation of central ?2a adrenergic receptors –> reduction in sympathetic outflow from vasomotor systems in brainstem; inhibition of renin release (secondary to decreased sympathetic tone)

105
Q

What are the therapeutics for ?-methyldopa (Aldomet)

A

Hypertension of pregnancy (only)

106
Q

What are the important side effects for ?-methyldopa (Aldomet)

A

Rebound HTN if abruptly stopped; moderate orthostatic hypotension

107
Q

What are the other side effects for ?-methyldopa (Aldomet)

A

Sedation, dry mouth, fatigue, depression

108
Q

What are the miscellaneous for ?-methyldopa (Aldomet)

A

Takes place of dopa, so less NE (also, methyl-NE activates ?2)

109
Q

What is the class for Reserpine (Serpalan)

A

Ganglion blocking agent (adrenergic neuron blocking agent)

110
Q

What is the mechanism for Reserpine (Serpalan)

A

Blocks transport of NE, DA, and 5HIAA into storage granules in PNS and CNS –> less neurotransmitter available when nerves are stimulated

111
Q

What are the therapeutics for Reserpine (Serpalan)

A

Decrease cardiac output and systemic vascular resistance

112
Q

What are the important side effects for Reserpine (Serpalan)

A

Sedation, mental depression, Parkinsonism symptoms

113
Q

What is the class for Hydralazine (Apresoline)

A

Direct (vasodilators)

114
Q

What is the mechanism for Hydralazine (Apresoline)

A

Relax smooth muscle of peripheral arterioles

115
Q

What are the therapeutics for Hydralazine (Apresoline)

A

Hypertensive urgency; patients with BOTH advanced CHF and hypertension

116
Q

What are the important side effects for Hydralazine (Apresoline)

A

Drug-induced lupus

117
Q

What are the other side effects for Hydralazine (Apresoline)

A

reflex tachycardia

118
Q

What are the miscellaneous for Hydralazine (Apresoline)

A

Serves as an antioxidant, preventing oxidation of NO

119
Q

What is the class for Minoxidil (Loniten)

A

Direct (vasodilators)

120
Q

What is the mechanism for Minoxidil (Loniten)

A

Relax smooth muscle of peripheral arterioles

121
Q

What are the therapeutics for Minoxidil (Loniten)

A

Refractory hypertension; hair loss

122
Q

What are the important side effects for Minoxidil (Loniten)

A

Pericardial effusion; hirsutism

123
Q

What are the other side effects for Minoxidil (Loniten)

A

reflex tachycardia

124
Q

What are the miscellaneous for Minoxidil (Loniten)

A

Smooth muscle relaxation by opening cardiovascular ATP-sensitive potassium channels

U4 Drug table (7 decks)

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