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Cardiology > Antihypertensives > Flashcards

Antihypertensives Flashcards

1
Q

Nitroprusside*

A

*IV PRODRUG

MOA: Forms NO -> Guanylate Cyclase => increased cGMP => smooth muscle relaxation
(Vasodilates Arterioles AND Veins)

*decreases CO normally (can increase w/ left ventricular failure)

SE: accumulation of cyanide in PTs w/ renal failure

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2
Q

Best tolerated drugs for monotherapy of HTN?

A

Diuretics and ACEIs

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3
Q

Pharm Effects of ACE Is

A
  1. inhibit all effects of Angiotensin II
  2. Dilate arteries AND Veins
  3. Decrease BP (sometimes increases HR)

*NO orthostatic hypotension

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4
Q

What type of PTs frequently require a diuretic for optimal control of BP?

A

PTs w/ edematous conditions

- CHF and Renal Insufficiency

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5
Q

Initial anti-HTN for patients prone to CHF?

A

ACEIs or ARB

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6
Q

ACE Inhibiting agents:

A

“PRILS”

  1. Captopril
  2. Lisinopril
  3. Enalapril*
  4. Ramipril*

*pro-drugs

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7
Q

Substitute drug for ACEI-induced dry cough?

A

ARB (no bradykinin action)

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8
Q

Hydralazine

A

Direct Vasodilator
- arteriolar smooth muscle relaxer

*Used in combo w/ 1. Diuretic and 2. B-blocker
SE: Tachycardia + Autoimmune rxn like lupus

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9
Q

When to avoid prescribing ACEI and ARBs?

A

Pregnancy!

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10
Q

T or F: “Volume dependent” HTN (low renin) patients show better responses to diuretics

A

T

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11
Q

3rd gen B-blockers preferred over older gen (1 and 2) because of less side effects

A

3rd gen B-blockers preferred over older gen (1 and 2) because of less side effects

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12
Q

MOA for ACE Inhibitors

A
  1. Inhibit the conversion of Angiotensin-I to angiotensin-II
  2. Inhibit the degradation of Bradykinin
    (a potent vasodilator)
  3. Increase renal BF w/o increase GFR
  4. Renoprotective (increase renal prostaglandins, delaying progression of renal disease in diabetics)
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13
Q

Initial anti-HTN drug for diabetics w/ HTN?

A

ACE Inibitors or ARBs

-addition of CCB is appropriate if 2nd drug needed

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14
Q

Aliskerin

A

Inhibits renin

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15
Q

Minoxidil

A

Direct Vasodilator
- Opens K+ channels and relaxes smooth muscles
=> Dilation of Arterioles only, NOT veins

SE: Hirsutism

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16
Q

T or F: CCBs and ACEI are more effective tx for HTN than Thiazide-type diuretics

A

FALSE

Thiazide-type diuretics >

17
Q

Unique features of Losartan?

A
  • Prodrug
  • Competitive antagonist of thromboxane A2 receptor (=> decreased platelet aggregation)
  • Increased uric acid urinary excretion (uricosuric)
18
Q

T or F: CCBs are safe to use in diabetics?

A

T

19
Q

Side Effects of ACE Is (5)

A
  1. Hyperkalemia
  2. Renal Failure
  3. Dry Cough (bradykinin action)
  4. Angioedema (sometimes fatal)
  5. Fetotoxicity (Contraind: 2nd and 3rd trimesters of pregnancy)
20
Q

Substitute drug for ACEI-induced angioedema

A

ARB (no bradykinin action)

21
Q

MOA of Angiotensin receptor blockers

ARBs

A

Selectively block Angiotensin II type I receptors (which are responsible for all the effects)

Vasodilation and Increased Na+/water excretion (Decreases: TPR, BV, BP, CO)

*NO effect on bradykinin

22
Q

Initial tx for HTN in general black population (including those with diabetes)?

A

Dihydropyridine CCBs

23
Q

ACEI/ARB or CCB in black patients?

A

CCBs

24
Q

Diltiazem

A

Calcium Channel Blocker w/ a selectivity between myocardium and vasculature Ca-channels

25
Q

Which Dihydropyridine CCBs should be used for HTN?

A

Only the long acting CCBs:

  1. Amoldipine
  2. Nicardipine
  3. Nimodipine
26
Q

Pharm Effect of Dihyrdopyridines

A
  1. HTN: lowers BP (via vasodilation)
  • Do NOT cause large Baroreceptor-mediated sympathetic discharge
  • Mild to no change in HR

JNC-8 favors effectiveness for HTN

27
Q

B-Blockers NOT recomended as initial tx for HTN

A

B-Blockers NOT recomended as initial tx for HTN

28
Q

Main side effect for all ARBs?

A

Fetotoxicity

- contraindicated in pregnancies

29
Q

ARB Agents:

A

“SARTANs”

  1. Losartan*
  2. Irbesartan
  3. Valsartan
  4. Telmisartan
  5. Candesartan

*=prodrug

30
Q

Dihyrdopyridines

A

“DIPINEs”

  1. Amoldipine
  2. Nifedipine (short acting!)
  3. Nicardipine
  4. Nimodipine
31
Q

ARBs w/o affect on uric acid or cyp?

A
  1. Telmisartan
  2. Irbesartan
  3. Valsartan

“TIV”

32
Q

In which type of patient(s) is a combo of thiazide and ACEIs particularly necessary?

A

PTs w/ low renin levels, African-Americans and elderly

*ACEI

33
Q

Verapamil

A

Calcium channel blocker selective for myocardium

34
Q

Fenoldopam

A

Direct Vasodilator
- selective D1 receptor partial agonist

*EMERGENCY hypertensive use

Cardiology (15 decks)

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