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Pharm II Unit II > Antihypertensives > Flashcards

Antihypertensives Flashcards

1
Q

10-15% of hypertension is caused by…

A

A specific cause

Examples:
Renal artery constriction
Coarctation of the aorta
Pheochromocytoma 
Cushings
Primary aldosteronism
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2
Q

What’s the difference between Stage 1 and Stage 2 HTN?

A

Stage 1 (130-139/80-89) only needs 1 med

Stage 2 (≥140/90) requires two meds

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3
Q

Blood pressure is directly proportional to …

A

CO and vascular resistance

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4
Q

What is the key to treatment of HTN?

A

Lifestyle modifications before or combined with drug therapy

Examples:
Increased physical activity/exercise
Weight reduction
Moderation of dietary salt, fats, EtOH
Avoid/reduce smoking
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5
Q

What is the most common cause of HTN treatment failure?

A

Non-compliance

The drugs have a lot of side effects so people don’t like to take them

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6
Q

HTN drug treatment OR lifestyle mods can reduce BP by…

A

~15 mmHg

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7
Q

Why do we use drug combos for HTN rather than maxing out the dose of a single drug?

A

Can reduce side effects produced by single drugs

Reduce doses by using different mechanisms to reduce BP

Cause synergism between drugs

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8
Q

Main goals of HTN treatment are…

A

Reduce BP and keep it normal
Reduce CV risk
Produce minimal side effects without reducing quality of life

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9
Q

What are the four groups of HTN agents?

A

Diuretics
Sympathoplegic agents
Direct vasodilators
Angiotensin inhibitors

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10
Q

________ diuretics are used to treat mild to moderate hypertension, reducing BP in 40-60% of patients

A

Thiazide diuretics

Lower BP by 10-15 mmHg

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11
Q

How do thiazides lower BP?

A

Short term by reducing CO

Long term by reducing peripheral vascular resistance

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12
Q

Thiazide diuretic that is also a direct vasodilator

A

Indapamide (has the most pronounced effect)

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13
Q

Common side effects of diuretics

A 
Impotence
Gout
Increased renin (baroreflex)
Hypokalemia
***Reduced glucose tolerance
***Increased plasma lipid concentration

Most can be avoided by lowering doses

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14
Q

HTN doses of diuretics are _______ than those used for diuresis

A

Much lower

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15
Q

Thiazide diuretics are most effective at lowering BP in …

A

African Americans

Elderly

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16
Q

When are Loop Diuretics used for HTN management?

A

In severe cases (renal insufficiency, HF)

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17
Q

Sympatholytics reduce BP by…

A

Reducing sympathetic vasomotor tone —> reducing peripheral resistance

Activate baroreflexes and generally cause Na and H2O retention but DO NOT cause reflex tachycardia

Best when combined with a diuretic

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18
Q

Examples of central acting sympatholytics

A

Clonidine

Methyldopa

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19
Q

MOA for central acting sympatholytics

A

Stimulate medullary a2 adrenergic receptors —> reduced peripheral sympathetic nerve activity —> reduced renin and reduced BP

Clonidine will reduce HR and CO more than methyldopa

Both given orally, but clonidine can also be used as a patch

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20
Q

Which central acting sympatholytics can safely be used to treat HTN in pregnancy?

A

Methyldopa

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21
Q

Adverse effects of Central Acting Sympatholytics?

A

SEDATION and other CNS effects

XEROSTOMIA

ED

Methyldopa —> hemolytic anemia with a (+) Coombs test, hepatotoxicity, GYNECOMASTIA/lactation

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22
Q

Why don’t you want to suddenly withdraw clonidine?

A

Can induce hypertensive crisis

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23
Q

What drugs can inhibit clonidine’s therapeutic action?

A

Tricyclic antidepressants

Yohimbine (b/c it’s an a2 antagonist)

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24
Q

What drugs are a1 adrenergic antagonists?

A

The “-zosins”

PRAZOSIN, Terazosin, Doxazosin

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25
Q

MOA for the zosins

A

Specifically block a1-adrenergic receptors —> reducing NE vasoconstriction —> vasodilation

Reduces peripheral resistance —> lower BP

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26
Q

What are the main benefits of using a1 adrenergic antagonists to lower BP?

A

Do not adversely effect plasma lipids

Beneficial in BPH**

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27
Q

What is the “first dose phenomenon”?

A

Postural hypotension pronounced with the first dose of an a1 antagonist (zosin)

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28
Q

Besides first dose phenomenon, what are some other adverse effects of a1 antagonists?

A

Na and H2O retention (increased renin) - so maybe combine with a diuretic)

Reflex tachycardia

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29
Q

***What is the only beta blocker that is a vasodilator?

A

Nebivolol (b/c it increases NO release)

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30
Q

What are the non-selective beta blockers?

A

Propranolol
Nadolol
Timolol

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31
Q

Which are the selective B1 blockers?

A

Metoprolol
Atenolol
Nebivolol
Acebutolol

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32
Q

MOA for beta blockers in HTN

A

Reduce BP by blocking beta adrenergic receptors:
• In heart to reduce CO
• In kidneys to reduce renin
• In CNS to reduce sympathetic vasomotor tone

***Not direct vasodilators (except Nebivolol)

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33
Q

Beta blockers work best in what population?

A

Young white males

34
Q

Beta blockers are combined with other drugs to..

A

Counteract reflex tachycardia and increase renin secretion

No longer recommended for monotherapy

35
Q

Beta blockers are the preferred drug for patients with…

A

Angina
Post MI
Migraine

Nebivolol —> those with ED

36
Q

Beta blockers are the least preferred drug for patients with…

A 
High physical activity 
African heritage 
***Asthma***
DM
Hypercholesterolemia
Peripheral vascular disease
37
Q

Contraindications for beta blockers

A 
DM
End-stage HF
Severe bradycardia
Heart block
Asthma
38
Q

Which drugs are combined a1 and beta blockers?

A

Carvedilol - good for patients with both HTN and HF, especially after MI

Labetalol - used for hypertensive emergencies and in pregnancy (stronger than methyldopa, but some hepatotoxicity so not used long term)

39
Q

Adverse effects of combined a1/B blockers (Carvedilol/Labetalol)

A

Orthostatic hypotension (worse than beta blockers)
Bronchospasm
Hepatotoxicity (that’s why Labetalol is for emergency use only)

40
Q

All vasodilators relax arterial smooth muscle but sodium nitroprusside preferentially relaxes…

A

Veins

41
Q

Why do the effects of vasodilators diminish with time?

A

Reflex tachycardia and increased renin secretion

42
Q

Hypotension from any vasodilator may be accompanied by:

A

Reflex tachycardia and increased myocardial contraction

Increased renin secretion

Fluid retention

Headaches, flushing

Palpitations, dizziness

43
Q

Which vasodilator is one of the HIP drugs —> SLE?

A

Hydralazine

44
Q

Hydralazine dilates ______ but not ______

A

Arterioles

Used in chronic therapy of severe hypertension or hypertensive emergencies in pregnancy

45
Q

What is the MOA for sodium nitroprusside (Nitropress)

A

Rapidly lowers BP in minutes by venodilation

Effect disappears in minutes after d/c

Used for emergency hypertensive situations - IV infusion only

46
Q

Adverse effects of sodium nitroprusside

A

Cyanide accumulation (b/c metabolized in liver to thiocyanate before excreted by kidneys)

Metabolic acidosis, arrhythmias, excessive hypotension, death (esp in patients with severe liver disease)

47
Q

Topical minoxidil stimulates hair growth but orally it reduces BP by…

A

Opening the potassium channels and stabilizing membrane

Used for severe hypertension that is refractory to other drugs

Can cause tachycardia, palpitations, angina, etc but also HYPERTRICHOSIS

48
Q

What is the MOA for Fenoldopam?

A

Specific D1 agonist

Postsynaptic D1 receptor stimulation relaxes arteriolar smooth muscle

Used for emergency hypertensive situations

IV administration with short half-life

49
Q

Which drugs are dihyropyridine calcium channel blockers?

A

NIFEDIPINE
Nimodipine
(Amlodipine - has a longer half life)

50
Q

Which drugs are non-dihydropyridine CCBs?

A

Diltiazem

Verapamil

51
Q

What is the MOA for CCBs?

A

Orally active, bind to L-type channels in the myocardium to reduce cardiac contractility, automaticity, and conduction

Bind to calcium channels in vascular smooth muscles —> vasodilation
(Vascular smooth muscle most sensitive but affects ALL smooth muscles)

52
Q

Which CCB is best for relaxing vascular smooth muscle?

A

Nifedipine&raquo_space; Diltiazem&raquo_space; Verapamil

53
Q

Which CCB works most specifically on cardiac muscle?

A

Verapamil&raquo_space; Diltiazem&raquo_space; Nifedipine

54
Q

Major cardiac effects of CCBs

A

Negative inotropy (contractility)

Negative chronotropy (SA node impulse generation)

Negative dromotropy (av node conduction)

55
Q

Nifedipine will _____ HR while Verapamil with _____ HR

A

Nifedipine increases

Verapamil decreases

56
Q

Which CCB is used for reducing HTN during pregnancy?

A

Nifedipine

57
Q

Which CCB is most likely to produce reflex tachycardia?

A

Nifedipine (highest vasodilation)

Verapamil and diltiazem are weaker vasodilators so they are less likely to elicit reflex tachycardia

58
Q

Which CCBs are more likely to depress SA and AV node function?

A

Verapamil and Diltiazem

59
Q

Which antihypertensive is known to cause gingival hyperplasia?

A

The “-dipines” - Dihyropyridine CCBs

60
Q

________ is the most common side effect of verapamil

A

Constipation

61
Q

Contraindications for CCBs

A

Verapamil and diltiazem contraindicated in patients with SA or AV node abnormalities, beta blockers, and in HF

Dihydropyridines should be used cautiously in hypertensive patients with HF

62
Q

Why are ACE’s so awesome?

A

Lower BP without compromising heart, brain, or kidneys

Mild and fewer side effects, no lipid changes

Do not cause reflex sympathetic activation or tachycardia b/c of baroreceptor resetting

Effective orally and can be used for monotherapy

63
Q

ACE inhibitors are most effective in what population?

A

Young and middle-aged caucasians

64
Q

ACEIs are the definitive DOC for HTN in patients with…

A

DM (esp for preventing DM nephropathy)

CKD

HFrEF

65
Q

Adverse effects of ACEIs

A

Orthostatic hypotension and dizziness

Dry, hacking, non-productive COUGH

Angioneurotic edema

May cause hyperkalemia

Acute renal failure in patients with BL renal artery stenosis

66
Q

When are ACE/ARBs absolutely contraindicated?

A

Pregnancy (teratogenic)

67
Q

ARBs are similar to ACEs except

A

Don’t have the cough/angioedema (b/c no effect on bradykinin)

68
Q

What HTN drug should you pick:

Age over 65

A

Diuretic
ACE/ARB
CCB

NO Central acting agonists

69
Q

What HTN drug should you pick:

African heritage

A

Diuretic
CCB

NO BBs

70
Q

What HTN drug should you pick:

Pregnant

A

Methyldopa
Nifedipine
Labetalol (emergency IV only)

NO ACE/ARBs

71
Q

What HTN drug should you pick:

Angina pectorals

A

BB
CCB

No: Hydralazine, minoxidil

72
Q

What HTN drug should you pick:

Post MI/Clinical CAD

A

ACE/ARB

BB

73
Q

What HTN drug should you pick:

HF

A

ACE/ARB + BB + diuretic + aldosterone antagonist

No CCB

74
Q

What HTN drug should you pick:

Recurrent stroke prevention

A

Diuretic

ACE/ARB

75
Q

What HTN drug should you pick:

CKD

A

ACE/ARB

76
Q

What HTN drug should you pick:

DM

A

ACE/ARB
CCB

NO Diuretic or BB

77
Q

What HTN drug should you pick:

Asthma

A

CCB
ACEI

NO BB

78
Q

What HTN drug should you pick:

BPH

A

Alpha blocker

79
Q

What HTN drug should you pick:

Migraines

A

BB

CCB

80
Q

What HTN drug should you pick:

Osteoporosis

A

Diuretic

Pharm II Unit II (8 decks)

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