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PCM 1 > Antihypertensives > Flashcards

Antihypertensives Flashcards

1
Q

Captopril

A

CLASS: Ace Inhibitor( 1st line)
particularly for diabetics

MOA: No reflex tachycardia, etc.
[indirect, 2° mechanisms]
Inhibit ACE! ↓Na+ and H2O
retention
↑renin & ↑Angiotensin I
↑bradykinin [potent vasodilator

USES:HTN– most effective in young white pts. DOC for Post-MI

AE:Hyperkalemia, dry hacking cough, rash, fever, altered taste, and hypotension

Acute renal failure in pts w/ bilateral renal aa. stenosis

Contraindicated in pts w/ bilateral renal aa. stenosis and
Pregnancy

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2
Q

Enalapril

A

CLASS: Ace Inhibitor( 1st line)
particularly for diabetics

MOA: No reflex tachycardia, etc.
[indirect, 2° mechanisms]
Inhibit ACE! ↓Na+ and H2O
retention
↑renin & ↑Angiotensin I
↑bradykinin [potent vasodilator

USES:HTN– most effective in young white pts. DOC for Post-MI

AE:Hyperkalemia, dry hacking cough, rash, fever, altered taste, and hypotension

Acute renal failure in pts w/ bilateral renal aa. stenosis

Contraindicated in pts w/ bilateral renal aa. stenosis and
Pregnancy

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3
Q

Lisinopril

A

CLASS: Ace Inhibitor( 1st line)
particularly for diabetics

MOA: No reflex tachycardia, etc.
[indirect, 2° mechanisms]
Inhibit ACE! ↓Na+ and H2O
retention
↑renin & ↑Angiotensin I
↑bradykinin [potent vasodilator

USES:HTN– most effective in young white pts. DOC for Post-MI

AE:Hyperkalemia, dry hacking cough, rash, fever, altered taste, and hypotension

Acute renal failure in pts w/ bilateral renal aa. stenosis

Contraindicated in pts w/ bilateral renal aa. stenosis and
Pregnancy

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4
Q

Losartan

A

CLASS: ARB,

MOA: Very similar to ACE-I’s
↓ PVR → ↓ BP
↓aldosterone! ↓Na+ and H2O
retention
↓ diabetic nephrotoxicity
No effect on bradykinin

USES: HTN, Lostarn helps pts with Gout, alternative to ACE-I

AE:Similar to ACE-Is excepts that angioedema risk is much lower
[related to bradykinin] and NO dry cough

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5
Q

Valsartan

A

CLASS: ARB,

MOA: Very similar to ACE-I’s
↓ PVR → ↓ BP
↓aldosterone! ↓Na+ and H2O
retention
↓ diabetic nephrotoxicity
No effect on bradykinin

USES: HTN, alternative to ACE-I

AE:Similar to ACE-Is excepts that angioedema risk is much lower
[related to bradykinin] and NO dry cough

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6
Q

Aliskiren

A

CLASS: Renin Inhibitor

MOA:Inhibits renin!prevent
conversion of angiotensinogen to
ATI!↓production of both ATII & aldosterone

USES: HTN

AE:Similar to ACE-Is excepts that angioedema risk is much lower [related to bradykinin] and NO dry cough

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7
Q

Verapamil

A

CLASS: Ca channel blocker (1st line) , Non Dihydropyridine

MOA: Bind to L-type Ca2+ channels in the
Heart and Muscle of the
peripheral vasculature→
↓calcium entry → relaxation of muscle → -ve inotropism and/or vasodilation
Intrinsic natriuretic effect!no
need for diuretic

USES:Angina
SVT tachyarrhythmia
HTN (black and/or elderly pts)
Migraine
Cerebral vasospasm
Useful in pts with asthma,
diabetes, and peripheral
vascular resistance

AE:Constipation
Contraindicated in pts on β-blockers, 2n/3rd° AV block or severe LV systolic
dysfx

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8
Q

Diltiazem

A

CLASS: Ca channel blocker (1st line) , Non Dihydropyridine

MOA: Bind to L-type Ca2+ channels in the
Heart and Muscle of the
peripheral vasculature→
↓calcium entry → relaxation of muscle → -ve inotropism and/or vasodilation
Intrinsic natriuretic effect!no
need for diuretic

USES:Angina
SVT tachyarrhythmia
HTN (black and/or elderly pts)
Migraine
Cerebral vasospasm
Useful in pts with asthma,
diabetes, and peripheral
vascular resistance

AE:Constipation
Contraindicated in pts on β-blockers, 2n/3rd° AV block or severe LV systolic
dysfx

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9
Q

Nifedipine [1st gen]

A

CLASS: Ca channel blocker (1st line) , Dihydropyridine

MOA: Greater affinity for vasculature Ca
channels! No ↓CO
Intrinsic natriuretic effect!no
need for diuretic

USES:HTN (black and/or elderly pts)
Angina Useful in pts with asthma,
diabetes, and peripheral
vascular resistance

AE:Hypotension
Peripheral edema
Dizzy, HA, fatigue, flushing
Gingival hyperplasia
Reflex tachycardia
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10
Q

Amlodipine [2nd gen]

A

CLASS: Ca channel blocker (1st line) , Dihydropyridine

MOA: Greater affinity for vasculature Ca
channels! No ↓CO
Intrinsic natriuretic effect!no
need for diuretic

USES:HTN (black and/or elderly pts)
Angina Useful in pts with asthma,
diabetes, and peripheral
vascular resistance

AE:Hypotension
Peripheral edema
Dizzy, HA, fatigue, flushing
Gingival hyperplasia
Reflex tachycardia
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11
Q

Chlorthalidone

A

CLASS:Thiazide Diuretic(1st line)

MOA:↑Na+ & H2O excretion →↓ECF → ↓CO & renal blood flow [in the long term, thereis normal plasma volume, but
↓ PVR]

USES:Counteract Na+ & H2O
retention caused by other
anti HTN drugs [useful in
combination therapy]

DOC for Blacks and elderly
[with normal renal and
cardiac fxn]

AE:Hypokalemia
Hyperuricemia
Hyperglycemia
Hypomagnesemia
Hyperlipidemia

Contraindicated in diabetics

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12
Q

Hydrochlorothiazide

A

CLASS:Thiazide Diuretic(1st line)

MOA:↑Na+ & H2O excretion →↓ECF → ↓CO & renal blood flow [in the long term, thereis normal plasma volume, but
↓ PVR]

USES:Counteract Na+ & H2O
retention caused by other
anti HTN drugs [useful in
combination therapy]

DOC for Blacks and elderly
[with normal renal and
cardiac fxn]

AE:Hypokalemia
Hyperuricemia
Hyperglycemia
Hypomagnesemia
Hyperlipidemia

Contraindicated in diabetics

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13
Q

Metolazone

A

CLASS:Thiazide Diuretic(1st line)

MOA:↑Na+ & H2O excretion →↓ECF → ↓CO & renal blood flow [in the long term, thereis normal plasma volume, but
↓ PVR]

USES:Counteract Na+ & H2O
retention caused by other
anti HTN drugs [useful in
combination therapy]

DOC for Blacks and elderly
[with normal renal and
cardiac fxn]

AE:Hypokalemia
Hyperuricemia
Hyperglycemia
Hypomagnesemia
Hyperlipidemia

Contraindicated in diabetics

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14
Q

Furosemide

A

CLASS:Loop diuretic

MOA:↓ renal vascular resistance ↑ renal blood flow

USES:DOC for pts with poor
renal function or
unresponsive to other
diuretics i.e. thiazides

AE:More potent and can cause more side effects

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15
Q

Torsemide

A

CLASS:Loop diuretic

MOA:↓ renal vascular resistance ↑ renal blood flow

USES:DOC for pts with poor
renal function or
unresponsive to other
diuretics i.e. thiazides

AE:More potent and can cause more side effects

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16
Q

Amiloride

A

CLASS:K sparing diuretics, 2nd line agents

MOA:Decrease the K+ lost in urine caused by thiazide or loop diuretics

USES:Used in combo with other diuretics

AE:

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17
Q

Triamterene

A

CLASS:K sparing diuretics, 2nd line agents

MOA:Decrease the K+ lost in urine caused by thiazide or loop diuretics

USES:Used in combo with other diuretics

AE:

18
Q

Spironolactone

A

CLASS:K sparing diuretics, 2nd line agents

MOA:Aldosterone antagonists → inhibition of Na+ and H2O retention
→ inhibition of vasoconstriction

USES:1st line in patients with
HTN and severe LV dysfunction

AE:Reduced K+ excretion → risk of hyperkalemia

19
Q

Eplerenone

A

CLASS:K sparing diuretics, 2nd line agents

MOA:Aldosterone antagonists → inhibition of Na+ and H2O retention
→ inhibition of vasoconstriction

USES:1st line in patients with
HTN and severe LV dysfunction

AE:Reduced K+ excretion → risk of hyperkalemia

20
Q

Propranolol

A

CLASS:B-Blockers(2nd line), Non Selective B

MOA:↓CO, contractility &
HR!↓BP
↓CNS sympathetic output
[especially with exercise]
↓NE & renin (β1)→ ↓ ATII &
Aldosterone secretion

USES:More effective in
young/white pts
DOC only for patients with
CAD, HF or post-MI

AE:Bradycardia, CNS effects, hypotension,
↓libido, impotence, lipid disturbance
[↓HDL, ↑TAG]
Abrupt withdrawal→ angina and MI in pts
with heart disease

Contraindicated in asthma and COPD

Mask symptoms of hypoglycemia

21
Q

Pindolol

A

CLASS:B-Blockers(2nd line), Partial B agonist

MOA:↓CO, contractility &
HR!↓BP
↓CNS sympathetic output
[especially with exercise]
↓NE & renin (β1)→ ↓ ATII &
Aldosterone secretion

USES:More effective in
young/white pts
DOC only for patients with
CAD, HF or post-MI

Preferred B-blocker in pregnancy

AE:Bradycardia, CNS effects, hypotension,
↓libido, impotence, lipid disturbance
[↓HDL, ↑TAG]
Abrupt withdrawal→ angina and MI in pts
with heart disease

Mask symptoms of hypoglycemia

22
Q

Doxazosin

A

CLASS:a-blockers

MOA:Competitive inhibition of a1 receptors

↓PVR and MAP by relaxation of arterial and venous smooth muscle

Minimal change in CO, renal
blood flow & GFR → no long
term tachycardia

USES:Mild to moderate HTN in combination with
propranolol or a diuretic
[less common now due to
adverse effects]

BPH

AE:Reflex tachycardia and orthostatic hypotension may be seen with first dose, but not long term (α2 blocks
response by inhibiting NE) → add β-blocker

Dizziness, drowsiness, HA, fatigue, nausea, palpitations

Doxazosin has been shown to ↑rate of CHF

23
Q

Prazosin

A

CLASS:a-blockers

MOA:Competitive inhibition of a1 receptors

↓PVR and MAP by relaxation of arterial and venous smooth muscle

Minimal change in CO, renal
blood flow & GFR → no long
term tachycardia

USES:Mild to moderate HTN in combination with
propranolol or a diuretic
[less common now due to
adverse effects]

BPH

AE:Reflex tachycardia and orthostatic hypotension may be seen with first dose, but not long term (α2 blocks
response by inhibiting NE) → add β-blocker

Dizziness, drowsiness, HA, fatigue, nausea, palpitations

24
Q

Labetalol

A

CLASS: Mixed a/b blocker

MOA:NO reflex tachycardia or ↑CO [β1 effect is greater]
Safe in pregnancy

USES:Long term treatment of
HTN

HTN emergencies: IV
admin→ rapid drop in BP

AE:Orthostatic hypotension

Contraindicated in pheochromocytoma

25
Q

Clonidine

A

CLASS:Central acting α2 -agonist

MOA:↓sympathetic outflow[NE] by acting on presynaptic autoreceptors→ ↓PVR and CO→ ↓BP

USES: 2nd line when HTN does not respond to TXT with 2+
drugs

AE:Sedation, dry mouth, dizziness, HA,
sexual dysfunction! common

Abrupt withdrawal! Rebound HTN (avoid use w/ β-blocker)

26
Q

Methyldopamine

A

CLASS:Central acting α2 -agonist

MOA:↓ sympathetic outflow → ↓ PVR and BP [CO not affected]

USES: DOC for pregnancy
induced HTN

Renal Insufficiency

AE:Same as Clonidine + nightmares, mental
depression, vertigo

+ve coombs test can develop!hemolytic anemia, hepatitis & drug fever

27
Q

Hydralazine

A

CLASS:Direct Vasodilators [3rd line], NEVER FIRST LINE

MOA:Opening of K+ channels in smooth muscle → Arteriolar dilation
[NOT venous)

Direct acting smooth muscle relaxant.

USES:DOC pregnancy induced hypertensive emergencies related to eclampsia

AE:HA, tachycardia, nausea, sweating, flushing

Lupus like syndrome [NAT]

Reflex tachycardia and fluid retention [coadminister with a diuretic & β-blocker]

Volume overload → edema and CHF

28
Q

Hydralazine

A

CLASS:Direct Vasodilators [3rd line], NEVER FIRST LINE

MOA:Opening of K+ channels in smooth muscle → Arteriolar dilation
[NOT venous)

Direct acting smooth muscle relaxant.

USES:DOC pregnancy induced hypertensive emergencies related to eclampsia

AE:HA, tachycardia, nausea, sweating, flushing

Lupus like syndrome [NAT]

Reflex tachycardia and fluid retention [coadminister with a diuretic & β-blocker]

Volume overload → edema and CHF

29
Q

Minoxidil

[Rogaine]

A

CLASS:Direct Vasodilators [3rd line], NEVER FIRST LINE

MOA:Opening of K+ channels in smooth muscle → Arteriolar dilation
[NOT venous)

Direct acting smooth muscle relaxant.

USES:Severe malignant HTN
Male pattern baldness

AE:HA, tachycardia, nausea, sweating, flushing

Lupus like syndrome [NAT]

Reflex tachycardia and fluid retention [coadminister with a diuretic & β-blocker]

Volume overload → edema and CHF

30
Q

Epoprostenol

A

CLASS:Prostaglandin, synthetic PGI2

MOA:Lowers peripheral, pulmonary and coronary resistance

USES:Pulmonary HTN, continuous IV

AE:Flushing, HA, jaw pain, diarrhea, arthralgia

31
Q

Bosentan

A

CLASS: Non selective endothelin receptor blocker, PDE5 inhibitor

MOA:Blocks endothelin mediated vasoconstriction by blocking initial transient depressor (ETA) and the prolonged pressor (ETB)

USES:Pulmonary HTN, continuous IV

AE:Pregnancy category X

32
Q

Sildenafil

A

CLASS:Phosphodiesterase
Inhibitor,PDE5 inhibitor

MOA:↑cGMP causing vasodilation

USES:Pulmonary HTN

AE:HA, flushing, dyspepsia, cyanopsia (seeing everything blue)

Contraindicated: Nitrates

33
Q

Sodium

Nitroprusside

A

CLASS:DOC for hypertensive emergencies

MOA:Prompt vasodilation and venodilation
Reflex tachycardia [also given β-blocker]

USES: hypertensive emergencies

AE:Hypotension [overdose]
Abdominal cramping, nausea, vomiting, goose bumps

Cyanide toxicity: can be treated with sodium thiosulfate infusion→ thiocyanate→ elimination

34
Q

Labetalol

A

CLASS:Combined α/β blocker

MOA:NO reflex tachycardia

USES: hypertensive emergencies

AE:Contraindicated in pts with asthma, COPD 2nd or 3rd degree AV block Bradycardia

35
Q

Fenoldopam

A

CLASS:Peripheral D1 agonist

Safe in pts with renal insufficiency

MOA:Arteriolar dilation
Maintains renal perfusion as it lowers BP [protects
the kidney]

Promotes natiuresis

USES: hypertensive emergencies

AE:Contraindicated in patients with glaucoma

36
Q

Nicardipine

A

CLASS:Ca2+ Channel blocker (Dihydropyridine

MOA:Vascular smooth muscle relaxation

USES: hypertensive emergencies

AE:Reflex tachycardia

37
Q

Nitroglycerin

A

CLASS:DOC for HTN emergencies in pts with
cardiac ischemia, angina, or past cardiac bypass

MOA:Vasodilation (veins>arteries)

USES: hypertensive emergencies

AE:

38
Q

Diazoxide

A

CLASS:DOC for HTN emergencies in pts with
cardiac ischemia, angina, or past cardiac bypass

MOA:Vasodilation (veins>arteries)

USES: hypertensive emergencies

AE:

39
Q

Diazoxide

A

CLASS:

MOA:muscle contraction by opening K+ channels and
stabilizing the membrane potential

USES: hypertensive emergencies

Can also be used to treat hypoglycemia secondary
to an Insulinoma by inhibiting insulin release

AE:Hypotension
Reflex tachycardia
Na+ and H2O retention

40
Q

Phentolamine

A

DOC for pts with catecholamine release emergencies [pheochromocytoma

41
Q

Esmolol

A

Used for aortic dissection or post-op HTN

42
Q

Hydralazine

A

DOC for pregnancy induced hypertensive emergencies related to eclampsia

PCM 1 (157 decks)

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