Antihypertensives Flashcards
1
Q
Furosemide
Class
A
Loop Diuretic
2
Q
Furosemide
MOA
A
Inhibits Cl portion of Na/K/2Cl cotransporter in tALH –> dec Na, Ca, and H2O reabsorption –> resultant K loss
3
Q
Furosemide
Uses
A
Crisis edema (pulmonary, CHF, cirrhosis)
Hypercalcemia
Drug tox/OD
Severe HTN (with CHF/Cirrhosis)
4
Q
Furosemide
Impt SE
A
Hypokalemia Hypomagnesemia Hypercalcinuria Nephrocalcinosis Ototoxicity (esp w Aminoglycoside)
5
Q
Furosemide
Other SE
A
HyperGlycemia HyperLipidemia HyperUricemia Hyponatremia/magnesia Gout Photosensitivity Drug interactions Erectile dysfunction
6
Q
Furosemide
Misc
A
Avoid NSAIDs, take before salty meals, reduce salt intake, useful in pts with renal insufficiency (GFR < 30-40)
7
Q
Hydrochlorothiazide
Class
A
Thiazide Diuretic
8
Q
Hydrochlorothiazide
MOA
A
Inhibits the Cl portion of the NaCl cotransporter in the early DCT –> Decreased Na and H2O reabsorption, Increase Ca reabsorption –> resultant K loss
9
Q
Hydrochlorothiazide
Uses
A
HTN (intravascular contraction) Chronic Edema (cardiac insufficiency) Idiopathic Hypercalciuria (stones) Nephrogenic Diabetes Insipidous
10
Q
Hydrochlorothiazide
HENN - Uses
A
HTN
Edema
Nephrolithiasis
Nephrogenic Diabetes Insipidous
11
Q
Hydrochlorothiazide
Impt SE
A
Hypokalemia
Hypomagnesemia
Contraction alkalosis
Inc BUN/Cr
12
Q
Hydrochlorothiazide
Other SE
A
HyperGlycemia HyperLipidemia HyperUricemia HyperCalcemia HypOnatremia/magnesia Gout Photosensitivity Impotence Drug Interactions
13
Q
Hydrochlorothiazide
Miscellaneous
A
Avoid NSAIDs and Bile sequestrants;
Ineffective if GFR < 30
14
Q
Chlorthalidone
Class
A
Thiazide-Like Diuretic
15
Q
Chlorthalidone
MOA
A
Inhibits the Cl portion of the NaCl cotransporter in the early DCT –> Dec Na and H2O reabsorption, Inc Ca reabsorption –> resultant K loss
16
Q
Chlorthalidone
Uses
A
Reduce Stroke Risk & CHF Events HTN (intravasc contraction) Chronic Edema (cardiac) Idiopathic Hypercalciuria (stones) Nephrogenic Diabetes Insipidous
17
Q
Chlorthalidone
HENN + 2 - Uses
A
HTN Edema Nephrolithiasis Nephrogenic Diabetes Insipidous \+ Reduce Stroke risk and CHF events
18
Q
Chlorthalidone
Impt SE
A
Hypokalemia
Hypomagnesemia
Contraction Alkalosis
Inc BUN/Cr
19
Q
Chlorthalidone
Other SE
A
HyperGlycemia HyperLipidemia HyperUricemia HyperCalcemia HypOnatremia/magnesia Gout Photosensivity Impotence Drug interactions
20
Q
Chlorthalidone
Misc
A
Avoid NSAIDs and Bile sequestrants;
Ineffective if GFR <30
21
Q
Metolazone
Class
A
Thiazide-Like Diuretic
22
Q
Metolazone
MOA
A
Inhibits Cl portion of the NaCl cotransporter in early DCT –> Dec Na and H2O reabsorption, Inc Ca reabsorption –> resultant K loss
23
Q
Metolazone
Uses (HENN)
A
HTN (intravasc. cont.) Chronic Edema Idiopathic Hypercalciuria (stones) Nephrogenic Diabetes Insipidous
24
Q
Metolazone
Impt SE
A
Hypokalemia
Hypomagnesemia
Contraction Alkalosis
Inc BUN/Cr
25
Metolazone
| Other SE
```
HyperGlycemia
HyperLipidemia
HyperUricemia
HyperCalcemia
HypInatremia/magnesia
Gout
Photosensitivity
Impotence
Drug Interactions
```
26
Metolazone
| Misc
Avoid NSAIDs and Bile Sequestrants,
| Ineffective if GFR < 30
27
Amiloride
| Class
Renal ENaC Inhibitor
| K-sparing
28
Amiloride
| MOA
Blocks Na channel and Na/H antiporter in late DCT and CD --> Dec K and DCT acid secretion, Inc Ca absorption
29
Amiloride
| Uses
```
Combined with other diuretics to prevent hypokalemia;
Edema;
Idiopathic Hypercalciuria (stones);
Lithium-induced Polyuria/Toxicity;
Liddle Syndrome;
Mucocilliary Clearance
```
30
Amiloride
| Impt SE
Hyperkalemia in pts with renal failure or on an ACEI
31
Amiloride
| Misc
Contraindicated in pts with renal failure (hyperkalemia) and ACEI/ARB use;
FeNa = 2%
32
Spironolactone
| Class
Aldosterone Receptor Blocker
| K sparing
33
Spironolactone
| MOA
Competes for aldosterone receptor and inhibits mRNA transcription and translation --> Dec Na and K channels and a Dec in Na/K/ATPase pump activity in late DCT and CD --> Dec K secretion, DCT acid secretion
34
Spironolactone
| Uses
Reduction in CHF mortality (30% in Class III and IV);
Combined with other diuretics to prevent hypokalemia;
Edema;
Primary and Secondary Aldosteronism;
HTN;
Anti-testosterone Agent
35
Spironolactone
| HELP - Uses
cHf
Edema
Low K
Primary/Secondary aldosteronism
36
Spironolactone
| Impt SE
Hyperkalemia in pts with renal failure or on ACEI;
Gynecomastia;
Erectile Dysfunction/Loss of libido;
Amenorrhea/Oligomenorrhea/breast soreness in women
37
Spironolactone
| Misc
Contraindicated in pts with renal failure (hyperkalemia);
Requires a salt restricted diet;
FeNa = 2%;
Only drug not requiring tubular lumen access
38
Eplerenone
| Class
K-sparing Diuretic
39
Eplerenone
| MOA
Block aldosterone;
| Inhibits Na reabsorption in DCT
40
Eplerenone
| Uses
Reduction in CHF mortality (30% in Class III and IV);
Combined with other diuretics to prevent hypokalemia;
Edema;
Primary/Secondary Aldosteronism;
HTN;
Anti-testosterone Agent
41
Eplerenone
| Impt SE
Hyperkalemia in pts with renal failure or on an ACEI;
Gynecomastia;
Erectile Dysfunction/loss of libido;
Amenorrhea/Oligomenorrhea/Breast soreness in women
42
Eplerenone
| Misc
Contraindicated in pts with renal failure (hyperkalemia);
Requires a salt restricted diet;
FeNa = 2%;
Only drug not requiring tubular lumen access
43
What are the names of the ACE Inhibitors (vasodilators)?
(6 of them)
(CLBQRE)
```
Captopril (SA)
Lisinopril (LA)
Benazepril (LA)
Quinapril (LA)
Ramipril (LA)
Enalapril
```
44
Which ACEI is short acting?
Captopril
45
What is the MOA for the ACEIs?
Block endothelial ACE from converting Angio I to Angio II (potent vasoconstrictor);
As a SE, it also prevents breakdown of bradykinin (potent vasodilator)
46
What are the long acting ACEIs?
Lisinopril
Benazepril
Quinapril
Ramipril
47
ACEI Uses
CHF
LV Hypertrophy
Post-MI (prevents LV remodeling)
48
What are the SEs of ACEIs?
```
Dry cough
Angioedema
Hypotension
Dec Renal function in most
(Except Captopril inhibits renal autoregulation)
```
49
ACEIs
| Contraindications
Pregnancy
Renal artery stenosis
Prior angioedema
Use caution in renal failure
50
ACEIs
| Misc
Reduces incidence of future CAD events and may reduce risk of diabetes
51
Enalapril
| Specific Misc
Metabolized to enalaprilat (a more active metabolite)
52
Name the three Angiotensin II Receptor Blockers (ARBs)
| LVI
Losartan
Valsartan
Irbesartan
53
ARBs MOA
| Losartan, Valsartan, Irbesartan
Competitive inhibition of Angio II in vascular endothelium
54
ARBs Uses
| Losartan, Valsartan, Irbesartan
Fall in peripheral vascular resistance, with little change in HR or CO; same uses as ACEIs
(CHF, LVH, Post-MI to prevent LV remodeling)
55
ARBs
| SEs
Angioedema
Decrease renal function
Hypotension
Dry cough less frequent
56
ARB
| Contraindications
```
-Same as ACEI
Pregnancy
Renal Artery Stenosis
Hyperkalemia
Prior Angioedema
Caution in Renal Failure
```
57
Aliskiren
| Class & MOA
Renin Inhibitor
| Not very effective
58
Name the 4 Ca channel blockers used to treat HTN:
| DVAN
Diltiazem
Verapamil
Amlodipine
Nifedipine
59
The Ca Channel blockers are divided into 2 groups, and they are...
Non-dihydropyridine
| Dihydropyridine
60
Name the two Non-Dihydropyridine CCBs
Diltiazem
| Verapamil
61
Name the two Dihydropyridine CCBs
Amlodipine
| Nifedipine
62
Non-Dihydropyridine CCBs
MOA
(Diltiazem, Verapamil)
Interact with L-type voltage gated plasma membrane Ca Channel --> decreases Ca entry into vascular smooth muscle cell --> prevents contraction;
Causes dec contractility, dec firing rate of aberrant pacemaker sites, dec conduction velocity;
Prolongs repolarization in SA and AV Nodes (Dec HR);
Less Vasodilation vs dihydropyridines
63
Dihydropyridine CCBs
MOA
(Amlodipine, Nifedipine)
Basically same as the Non-dihyropyridine CCBs but with less heart-specific activity and more vasodilation:
"Interacts with L-type voltage gated plasma membrane Ca channel --> dec Ca entry into smooth muscle cell --> prevents contraction;
Causes dilation of epicardial coronary arteries, arteriolar resistance arteries
64
Non-Dihydropyridine CCBs
Uses
(Diltiazem, Verapamil)
HTN
Angina (chronotropic effects causing dec myocardial O2 demand)
SVT (Class IV anti-arrhythmic)
65
Dihydropyridine CCBs
Uses
(Amlodipine, Nifedipine)
HTN
Raynauds
Angina (3rd choice drug)
66
Non-Dihyrdopyridine CCBs
| Impt SE
```
Leg Edema
Bradycardia
AV Nodal blockade
Hypotension
Worsening HF
```
67
Dihydropyridine CCBs
| Impt SE
Leg Edema ( More reflex sympathetic activation; long-acting agents are less lipophilic thus less symp activation)
68
CCB (all 4)
Other SE
(Diltiazem, Verapamil, Amlodipine, Nefidipine)
Constipation (most com)
Headache
Flushing
69
CCB (all 4)
Contraindications
(Diltiazem, Verapamil, Amlodipine, Nefidipine)
Decompensated HF
Bradycardia
Sinus Node Dysfunction
High-degree AV block
70
What Beta blockers are used to treat HTN? (8)
| PMAEBNLC
```
Propranolol
Metoprolol
Atenolol
Esmolol
Bisoprolol
Nadolol
Labetolol
Carvedilol
```
71
Which of the 8 Beta blockers is non-selective?
Propranolol
| primarily reduces CO
72
Propranolol
| Impt SE
Bronchospasm
Bradycardia (neg chronotrope)
CHF (neg ionotrope)
Masking of Hypoglycemia Sxs
73
Propranolol
| Other SE
Decreased exercise capacity
Depresses (crosses BBB)
Worsening Sxs of Peripheral Vasc Dz
74
Which Beta blockers are B1 selective?
```
Metoprolol
Atenolol
Esmolol (short half-life)
Bisoprolol
Nadolol
```
75
B1 selective blockers
Impt SE
(Minus Esmolol)
(Metoprolol, Atenolol, Bisoprolol, Nadolol)
-Less likely to have bronchospasm
Hypoglycemic awareness
Depression
76
Which B1-selective blockers are longer-acting than the other beta blockers?
Bisoprolol & Nadolol
77
Esmolol
| Uses
AV Nodal blockade in unstable pts (short half-life)
78
Which antihypertensive drugs are Combined Alpha/Beta blockers
Labetolol
| Carvedilol
79
Labetolol & Carvedilol
| MOA
B1 blockade with vasodilatory effects
80
Labetolol
| Uses
Hypertensive urgency
81
Carvedilol
| Uses
Acute coronary syndrome
| CHF
82
Terazosin & Doxazosin
| Class
Alpha-1 adrenergic receptor antagonist
83
Terazosin & Doxazosin
| MOA
Block post-synaptic Alpha-1 receptor on vascular smooth muscle
84
Terazosin & Doxazosin
| Uses
BPH (not so much anymore)
| Second tier meds (use when there is a combo of things going on, not for isolated HTN)
85
Terazosin & Doxazosin
| Impt SE
```
Orthostatic Hypotension
Fluid Retention
Worsening Angina (secondary to reflex tachycardia)
```
86
Clonidine & Methyldopa
| Class
Central Alpha-2 Agonists
87
Clonidine & Methyldopa
| MOA
Stimulation of Alpha-2 receptors causing dec sympathetic outflow from vasomotor systems in brainstem;
Inhibition of Renin release (secondary to dec symp tone)
88
What is the only use of Methyldopa in HTN?
HTN of Pregnancy
89
Clonidine & Methyldopa
| Impt SE
Rebound HTN if abruptly stopped;
| Moderate Orthostatic Hypotension
90
Clonidine & Methyldopa
| Other SE
Sedation
Dry mouth
Fatigue
Depression
91
Methyldopa
| Misc
Takes place of dopamine (so less NE);
| Methyl-NE also activates Alpha-2
92
Hydralazine
| Class
Direct vasodilator
93
Hydralazine
| MOA
Relaxes smooth muscle of peripheral arterioles
94
Hydralazine
| Uses
Hypertensive urgency;
| Pts with BOTH Advanced CHF and HTN
95
Hyrdralazine
| Impt SE
Drug-induced Lupus
96
Hydralazine
| Other SE
Reflex Tachycardia
97
Hydralazine
| Misc
Serves as an antioxidant, preventing the oxidation of NO
