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Pharm > Antihypertensives > Flashcards

Antihypertensives Flashcards

1
Q

Furosemide

Class

A

Loop Diuretic

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2
Q

Furosemide

MOA

A

Inhibits Cl portion of Na/K/2Cl cotransporter in tALH –> dec Na, Ca, and H2O reabsorption –> resultant K loss

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3
Q

Furosemide

Uses

A

Crisis edema (pulmonary, CHF, cirrhosis)
Hypercalcemia
Drug tox/OD
Severe HTN (with CHF/Cirrhosis)

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4
Q

Furosemide

Impt SE

A 
Hypokalemia
Hypomagnesemia
Hypercalcinuria
Nephrocalcinosis
Ototoxicity (esp w Aminoglycoside)
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5
Q

Furosemide

Other SE

A 
HyperGlycemia
HyperLipidemia
HyperUricemia
Hyponatremia/magnesia
Gout
Photosensitivity
Drug interactions
Erectile dysfunction
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6
Q

Furosemide

Misc

A

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

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7
Q

Hydrochlorothiazide

Class

A

Thiazide Diuretic

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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

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9
Q

Hydrochlorothiazide

Uses

A 
HTN (intravascular contraction)
Chronic Edema (cardiac insufficiency)
Idiopathic Hypercalciuria (stones)
Nephrogenic Diabetes Insipidous
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10
Q

Hydrochlorothiazide

HENN - Uses

A

HTN
Edema
Nephrolithiasis
Nephrogenic Diabetes Insipidous

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11
Q

Hydrochlorothiazide

Impt SE

A

Hypokalemia
Hypomagnesemia
Contraction alkalosis
Inc BUN/Cr

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12
Q

Hydrochlorothiazide

Other SE

A 
HyperGlycemia
HyperLipidemia
HyperUricemia
HyperCalcemia
HypOnatremia/magnesia
Gout
Photosensitivity
Impotence
Drug Interactions
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13
Q

Hydrochlorothiazide

Miscellaneous

A

Avoid NSAIDs and Bile sequestrants;

Ineffective if GFR < 30

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14
Q

Chlorthalidone

Class

A

Thiazide-Like Diuretic

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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

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16
Q

Chlorthalidone

Uses

A 
Reduce Stroke Risk &
CHF Events
HTN (intravasc contraction)
Chronic Edema (cardiac)
Idiopathic Hypercalciuria (stones)
Nephrogenic Diabetes Insipidous
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17
Q

Chlorthalidone

HENN + 2 - Uses

A 
HTN
Edema
Nephrolithiasis
Nephrogenic Diabetes Insipidous 
\+ Reduce Stroke risk and CHF events
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18
Q

Chlorthalidone

Impt SE

A

Hypokalemia
Hypomagnesemia
Contraction Alkalosis
Inc BUN/Cr

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19
Q

Chlorthalidone

Other SE

A 
HyperGlycemia
HyperLipidemia
HyperUricemia
HyperCalcemia
HypOnatremia/magnesia
Gout
Photosensivity
Impotence
Drug interactions
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20
Q

Chlorthalidone

Misc

A

Avoid NSAIDs and Bile sequestrants;

Ineffective if GFR <30

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21
Q

Metolazone

Class

A

Thiazide-Like Diuretic

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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

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23
Q

Metolazone

Uses (HENN)

A 
HTN (intravasc. cont.)
Chronic Edema
Idiopathic Hypercalciuria (stones)
Nephrogenic Diabetes Insipidous
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24
Q

Metolazone

Impt SE

A

Hypokalemia
Hypomagnesemia
Contraction Alkalosis
Inc BUN/Cr

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25
Q

Metolazone

Other SE

A 
HyperGlycemia
HyperLipidemia
HyperUricemia
HyperCalcemia
HypInatremia/magnesia
Gout
Photosensitivity
Impotence
Drug Interactions
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26
Q

Metolazone

Misc

A

Avoid NSAIDs and Bile Sequestrants,

Ineffective if GFR < 30

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27
Q

Amiloride

Class

A

Renal ENaC Inhibitor

K-sparing

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28
Q

Amiloride

MOA

A

Blocks Na channel and Na/H antiporter in late DCT and CD –> Dec K and DCT acid secretion, Inc Ca absorption

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29
Q

Amiloride

Uses

A 
Combined with other diuretics to prevent hypokalemia;
Edema;
Idiopathic Hypercalciuria (stones);
Lithium-induced Polyuria/Toxicity;
Liddle Syndrome;
Mucocilliary Clearance
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30
Q

Amiloride

Impt SE

A

Hyperkalemia in pts with renal failure or on an ACEI

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31
Q

Amiloride

Misc

A

Contraindicated in pts with renal failure (hyperkalemia) and ACEI/ARB use;
FeNa = 2%

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32
Q

Spironolactone

Class

A

Aldosterone Receptor Blocker

K sparing

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33
Q

Spironolactone

MOA

A

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

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34
Q

Spironolactone

Uses

A

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

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35
Q

Spironolactone

HELP - Uses

A

cHf
Edema
Low K
Primary/Secondary aldosteronism

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36
Q

Spironolactone

Impt SE

A

Hyperkalemia in pts with renal failure or on ACEI;
Gynecomastia;
Erectile Dysfunction/Loss of libido;
Amenorrhea/Oligomenorrhea/breast soreness in women

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37
Q

Spironolactone

Misc

A

Contraindicated in pts with renal failure (hyperkalemia);
Requires a salt restricted diet;
FeNa = 2%;
Only drug not requiring tubular lumen access

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38
Q

Eplerenone

Class

A

K-sparing Diuretic

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39
Q

Eplerenone

MOA

A

Block aldosterone;

Inhibits Na reabsorption in DCT

40
Q

Eplerenone

Uses

A

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
Q

Eplerenone

Impt SE

A

Hyperkalemia in pts with renal failure or on an ACEI;
Gynecomastia;
Erectile Dysfunction/loss of libido;
Amenorrhea/Oligomenorrhea/Breast soreness in women

42
Q

Eplerenone

Misc

A

Contraindicated in pts with renal failure (hyperkalemia);
Requires a salt restricted diet;
FeNa = 2%;
Only drug not requiring tubular lumen access

43
Q

What are the names of the ACE Inhibitors (vasodilators)?
(6 of them)
(CLBQRE)

A 
Captopril (SA)
Lisinopril (LA)
Benazepril (LA)
Quinapril (LA)
Ramipril (LA)
Enalapril
44
Q

Which ACEI is short acting?

A

Captopril

45
Q

What is the MOA for the ACEIs?

A

Block endothelial ACE from converting Angio I to Angio II (potent vasoconstrictor);
As a SE, it also prevents breakdown of bradykinin (potent vasodilator)

46
Q

What are the long acting ACEIs?

A

Lisinopril
Benazepril
Quinapril
Ramipril

47
Q

ACEI Uses

A

CHF
LV Hypertrophy
Post-MI (prevents LV remodeling)

48
Q

What are the SEs of ACEIs?

A 
Dry cough
Angioedema
Hypotension
Dec Renal function in most
(Except Captopril inhibits renal autoregulation)
49
Q

ACEIs

Contraindications

A

Pregnancy
Renal artery stenosis
Prior angioedema
Use caution in renal failure

50
Q

ACEIs

Misc

A

Reduces incidence of future CAD events and may reduce risk of diabetes

51
Q

Enalapril

Specific Misc

A

Metabolized to enalaprilat (a more active metabolite)

52
Q

Name the three Angiotensin II Receptor Blockers (ARBs)

LVI

A

Losartan
Valsartan
Irbesartan

53
Q

ARBs MOA

Losartan, Valsartan, Irbesartan

A

Competitive inhibition of Angio II in vascular endothelium

54
Q

ARBs Uses

Losartan, Valsartan, Irbesartan

A

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
Q

ARBs

SEs

A

Angioedema
Decrease renal function
Hypotension
Dry cough less frequent

56
Q

ARB

Contraindications

A 
-Same as ACEI
Pregnancy
Renal Artery Stenosis
Hyperkalemia
Prior Angioedema
Caution in Renal Failure
57
Q

Aliskiren

Class & MOA

A

Renin Inhibitor

Not very effective

58
Q

Name the 4 Ca channel blockers used to treat HTN:

DVAN

A

Diltiazem
Verapamil
Amlodipine
Nifedipine

59
Q

The Ca Channel blockers are divided into 2 groups, and they are…

A

Non-dihydropyridine

Dihydropyridine

60
Q

Name the two Non-Dihydropyridine CCBs

A

Diltiazem

Verapamil

61
Q

Name the two Dihydropyridine CCBs

A

Amlodipine

Nifedipine

62
Q

Non-Dihydropyridine CCBs
MOA
(Diltiazem, Verapamil)

A

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
Q

Dihydropyridine CCBs
MOA
(Amlodipine, Nifedipine)

A

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
Q

Non-Dihydropyridine CCBs
Uses
(Diltiazem, Verapamil)

A

HTN
Angina (chronotropic effects causing dec myocardial O2 demand)
SVT (Class IV anti-arrhythmic)

65
Q

Dihydropyridine CCBs
Uses
(Amlodipine, Nifedipine)

A

HTN
Raynauds
Angina (3rd choice drug)

66
Q

Non-Dihyrdopyridine CCBs

Impt SE

A 
Leg Edema
Bradycardia
AV Nodal blockade
Hypotension
Worsening HF
67
Q

Dihydropyridine CCBs

Impt SE

A

Leg Edema ( More reflex sympathetic activation; long-acting agents are less lipophilic thus less symp activation)

68
Q

CCB (all 4)
Other SE
(Diltiazem, Verapamil, Amlodipine, Nefidipine)

A

Constipation (most com)
Headache
Flushing

69
Q

CCB (all 4)
Contraindications
(Diltiazem, Verapamil, Amlodipine, Nefidipine)

A

Decompensated HF
Bradycardia
Sinus Node Dysfunction
High-degree AV block

70
Q

What Beta blockers are used to treat HTN? (8)

PMAEBNLC

A 
Propranolol
Metoprolol
Atenolol
Esmolol
Bisoprolol
Nadolol
Labetolol
Carvedilol
71
Q

Which of the 8 Beta blockers is non-selective?

A

Propranolol

primarily reduces CO

72
Q

Propranolol

Impt SE

A

Bronchospasm
Bradycardia (neg chronotrope)
CHF (neg ionotrope)
Masking of Hypoglycemia Sxs

73
Q

Propranolol

Other SE

A

Decreased exercise capacity
Depresses (crosses BBB)
Worsening Sxs of Peripheral Vasc Dz

74
Q

Which Beta blockers are B1 selective?

A 
Metoprolol 
Atenolol
Esmolol (short half-life)
Bisoprolol
Nadolol
75
Q

B1 selective blockers
Impt SE
(Minus Esmolol)

A

(Metoprolol, Atenolol, Bisoprolol, Nadolol)
-Less likely to have bronchospasm
Hypoglycemic awareness
Depression

76
Q

Which B1-selective blockers are longer-acting than the other beta blockers?

A

Bisoprolol & Nadolol

77
Q

Esmolol

Uses

A

AV Nodal blockade in unstable pts (short half-life)

78
Q

Which antihypertensive drugs are Combined Alpha/Beta blockers

A

Labetolol

Carvedilol

79
Q

Labetolol & Carvedilol

MOA

A

B1 blockade with vasodilatory effects

80
Q

Labetolol

Uses

A

Hypertensive urgency

81
Q

Carvedilol

Uses

A

Acute coronary syndrome

CHF

82
Q

Terazosin & Doxazosin

Class

A

Alpha-1 adrenergic receptor antagonist

83
Q

Terazosin & Doxazosin

MOA

A

Block post-synaptic Alpha-1 receptor on vascular smooth muscle

84
Q

Terazosin & Doxazosin

Uses

A

BPH (not so much anymore)

Second tier meds (use when there is a combo of things going on, not for isolated HTN)

85
Q

Terazosin & Doxazosin

Impt SE

A 
Orthostatic Hypotension
Fluid Retention
Worsening Angina (secondary to reflex tachycardia)
86
Q

Clonidine & Methyldopa

Class

A

Central Alpha-2 Agonists

87
Q

Clonidine & Methyldopa

MOA

A

Stimulation of Alpha-2 receptors causing dec sympathetic outflow from vasomotor systems in brainstem;
Inhibition of Renin release (secondary to dec symp tone)

88
Q

What is the only use of Methyldopa in HTN?

A

HTN of Pregnancy

89
Q

Clonidine & Methyldopa

Impt SE

A

Rebound HTN if abruptly stopped;

Moderate Orthostatic Hypotension

90
Q

Clonidine & Methyldopa

Other SE

A

Sedation
Dry mouth
Fatigue
Depression

91
Q

Methyldopa

Misc

A

Takes place of dopamine (so less NE);

Methyl-NE also activates Alpha-2

92
Q

Hydralazine

Class

A

Direct vasodilator

93
Q

Hydralazine

MOA

A

Relaxes smooth muscle of peripheral arterioles

94
Q

Hydralazine

Uses

A

Hypertensive urgency;

Pts with BOTH Advanced CHF and HTN

95
Q

Hyrdralazine

Impt SE

A

Drug-induced Lupus

96
Q

Hydralazine

Other SE

A

Reflex Tachycardia

97
Q

Hydralazine

Misc

A

Serves as an antioxidant, preventing the oxidation of NO

Pharm (7 decks)

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