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SGU Pharm deck -term4 > antihypertensives > Flashcards

antihypertensives Flashcards

1
Q

hypertension -elevated state

A

SBP 120-129

DBP <80

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2
Q

Hypertention-stage I

A

SBP 130-139

DBP 80-89

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3
Q

Hypertension -stage II

A

SBP >140

DBP >90

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4
Q

Antihypertensives target

A

decrease CO

decrease peripheral resistance

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5
Q

first line agents

A

ACE-inhibitors, ARBs, calcium channel blockers,

thiazide diuretic

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6
Q

second line agents

A

b-blockers, aldosterone antagonist

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7
Q

ace inhibitors

A

Captopril / Enalapril / Lisinopril

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8
Q

ACE inhibitors MOA ?

A

• BP by peripheral vascular resistance
• INHIBIT ACE (angiotensin converting enzyme) that
cleaves angiotensin I to form angiotensin II
• DECREASE Na+ & H20 retention
• INCREASE BRADYKININ levels
• DO NOT reflexively increase cardiac output, rate or
contractility

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9
Q

ACH inhibitors clinical uses

A

• Hypertension (most effective in white and/or young patients) + diuretic = effectiveness similar in non-black and blackpatients

• Preserve renal function in patients with either diabetic or non-diabetic nephropathy
• Effective in treatment of chronic HF
• Standard of care for patients following MI (started 24h
after end of infarction)

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10
Q

AE of ACE inhibitors

A 
• Dry hacking cough
• Hyperkalemia
• Hypotension
• Angioedema (rare but life-threatening)
• Acute renal failure (patients with bilateral renal artery
stenosis)
• Rash, fever, altered taste
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11
Q

ACE inhibitors contraindications

A

> Pregnancy

> Patients with bilateral artery stenosis

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12
Q

ARBs

A

Losartan

valsartan

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13
Q

ARBs MOA

A
  • Angiotension receptor blockers (ARB’s)
  • First-line agents
  • Alternatives to ACEI’s (in intolerant patients)
  • Block angiotensin-2 type 1 receptors
  • BP by causing arteriolar & venous dilation
  • Block aldosterone secretion à decrease Na+ & H20 retention
  • diabetic nephrotoxicity
  • DO NOT INCREASE BRADYKININ levels
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14
Q

ARBs AE

A

• Hyperkalemia
• Hypotension
• Angioedema (lower risk than ACE inhbit)
• Acute renal failure (patients with bilateral renal artery
stenosis)
• Rash, fever, altered taste
Losartan reduces plasma uric acid levels by inhibiting
URAT1 transporter – can be useful in patients with
gout

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15
Q

Special use of losartan

A

Losartan reduces plasma uric acid levels by inhibiting
URAT1 transporter – can be useful in patients with
gout

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16
Q

ARBs contraindications

A

Pregnancy

• Patients with bilateral renal artery stenosis

17
Q

Aliskiren

A

Renin inhibitor

18
Q

Renin inhibitor MOA

A

Alternative agent in the treatment of hypertension

MOA
• Inhibits enzyme activity of renin and prevents
conversion of angiotensinogen into angiotensin I

End result:
• Inhibits production of both angiotensin II and
aldosterone

19
Q

Aliskiren AE

A

• Similar to those of ACE inhibitors
• Dry cough does not occur (due to no effect on
bradykinin levels)
• Angioedema risk is significantly lower than with
ACEI’s

20
Q

CCA blockers

A

Verapamil / Diltiazem / Nifedipine / Amlodipine

21
Q

Non dihydropyridines CCA blockers

A
  • Verapamil

* Diltiazem

22
Q

dihydropyridines CCA blockers

A

Nifedipine, amlodipine

23
Q

verapamil overview and uses

A
  • Least selective of any Ca2+-blocker
  • Significant effects in cardiac & vascular smooth muscle

> to treat angina, supraventricular
tachyarrhythmias, hypertension, migraine & cerebral
vasospasm

24
Q

dilitiazem uses

A

Used to treat angina, hypertension, supraventricular

tachyarrhythmias & cerebral vasospasm

25
Q

CCA applications

A

• Hypertension (particularly black and/or elderly
patients)
• Have intrinsic natriuretic effect (no need for diuretic)
• Useful in patients with asthma, diabetes, peripheral
vascular disease

26
Q

CCA blocker PK

A

• High-doses of short-acting dihydropyridine Ca2+-

channel blockers can increase risk of MI

27
Q

verapamil AE

A

Constipation (~7%), negative inotropic effects, gingival

hyperplasia

28
Q

dihydropyridine AE

A

Hypotension, peripheral edema (esp. feet & ankles),
dizziness, headache, fatigue, gingival hyperplasia,
flushing, reflex tachycardia can occur (especially in
short-acting preparations)

29
Q

contraindications Non-dihydropyridines

A

Relatively contraindicated in patients taking b-blockers,
or who have 2nd or 3rd degree AV block, or severe left
ventricular systolic dysfunction

SGU Pharm deck -term4 (10 decks)

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