Antihypertensives Flashcards
Patients that suffer from heart failure or have had MIs in the past do better with with what 2 medications?
ACE–i
beta-blockers
What Diabetic anti-hypertensives ward off further renal damage (2)?
ACEi
ARBs
Hydralazine, labetalol, methyldopa, nifedipine can all be used for what kind of HTN?
HTN in pregnancy
“Hide La baby from Meth and Knifes”
ARBs, CCBs, thiazide diuretics, cardio-selective β-blockers can all be used for what type of HTN?
Asthma HTN
What 2 anti-hypertensive drugs should be avoided in asthmatics?
Avoid non-selective β-blockers to prevent β2-receptor–induced broncho-constriction.
Avoid ACE inhibitors to prevent confusion between drug or asthma related cough
What is 1 consideration when using Beta Blockers for treating HTN in Diabetics
.
β-blockers can mask hypoglycemia symptoms
ACEinhibitors/ARBs,
Ca2+ channel blockers,
thiazide diuretics,
β-blockers
can all be used to treat what kind of HTN
HTN w/ DM
β blockers must beused cautiously in pts with ______ and contraindicated in ________.
decompensated HF
cardiogenic shock
In HF, ARBs may be combined with what neprilysin inhibitor?
sacubitril
Diuretics, ACEinhibitors/ARBs, β-blockers, aldosterone antagonists can be used for what kind of HTN?
HTN w/ HF
β-blockers (in compensated HF only)
What is the MOA for:
Amlodipine, clevidipine, nicardipine, nifedipine, nimodipine
Calcium channel blockers
(dihydropyridines, act on vascular smooth muscle)
What is the MOA for:
diltiazem, verapamil
Calcium channel blockers
(non-dihydro pyridines ,act on heart)
This class of antihypertensive blocks calcium channels in cardiac and smooth muscle to
decrease contractility.
ARBs
Dihydropyridines (except _____) treat: hypertension, angina (including vasospastic type), Raynaudphenomenon.
nimodipine
Adverse effects of
Non dihydropyridine: Gingival Hyperplasia, cardiac depression, AV-block, hyperprolactinemia ( mostly by ____), constipation
verapamil
Increases cGMP smooth muscle relaxation.
Vasodilates arterioles >veins;
afterload reduction.
Hydralizine
Frequently co-administered with a β-blocker to prevent reflex tachycardia.
Hydralazine
Compensatory tachycardia (contraindicated in angina/CAD), fluid retention, headache, angina, drug-induced lupus
Hydralazine
Treat with labetalol, clevidipine, fenoldopam, nicardipine, nitroprusside
Hypertensive emergency
Dopamine D1 receptor agonist → vasodilator.
Lower BP, Increase natriuresis (pee Na)
Can cause hypotension and tachycardia.
Fenoldopam
Type of Drug class
Nitroglycerin,
isosorbidedinitrate,
isosorbidemononitrate
Nitrates
((use with caution; they lower R side venous return to heart; some patients are pre-load dependent))
Dilate veins >> arteries.
↓ preload (R heart venous return)
Nitrates
Vasodilate by ↑ NO in vascular smooth muscle in ↑ cGMP and smooth muscle relaxation.
Nitrates
Contraindicated in right ventricular infarction, hypertrophic cardiomyopathy, and with concurrent PDE-5 inhibitor use.
Nitrates
What are the 4 myocardial O2 consumption (MVO2) determinants :
end-diastolic volume,
BP,
HR,
contractility.
This medication
Inhibits the late phase of inward sodium current thereby reducing diastolic wall tension and oxygen consumption.
Does not affect heart rate or blood pressure
Ranolazine
This medication is a
Short acting vasodilator (arteries = veins)
↑cGMP via direct release of NO
Nitroprusside
This medication
Can cause cyanide toxicity
(by releasing cyanide)
Nitroprusside
This medication
prevents degradation of natriuretic peptides:
angiotensin II & substanceP
→ ↑vasodilation, ↓ECF volume
Sacubitril
This medication is
Used in combination with
valsartan (an ARB)
to treat
HFrEF.
Sacubitril
This medication is
contraindicated with ACE inhibitors due to angioedema.
Sacubitril
This medication is a
Direct inhibition of Na+/K+ ATPase
Presents with blurry yellow vision, hyperkalemia, and fatigue
DIgoxin
This medication is an
indirect inhibition of Na+/Ca2+ exchanger.
Digoxin
This medication
↑ [Ca2+]intracellular → positive inotropy.
Stimulates vagus nerve
↓HR
Digoxin
This medication is indicated for
HF ( to ↑ contractility)
Atrial fibrillation ( to ↓ conduction at AV node and depression of SA node)
Digoxin
The following is the management for what medication toxicity?
- Give anti-[Medication] Fab fragments
- Start Mg2+ infusion
- Slowly normalize K+ (via Insulin + D5W)
Digoxin toxicity
What medication can cause these Adverse effects:
- Cholinergic effects (nausea, vomiting, diarrhea),
- blurry yellow vision (think van Glow),
- arrhythmias,
- AV block.
Digoxin
Hyperkalemia indicates a poor prognosis when taking what medication?
DIgoxin
Digoxin functions via binding to open ____ binding sites of which transporter?
(permissive for drug binding at ),
drugs that displace drug from tissue-binding sites,
(eg: verapamil, amiodarone, quinidine).
K+ binding sites on the
Na+/K+ ATPase
(hence hypokalemia while on Digoxin increases risk for toxicity which results in hyperkalemia – Note digoxin is sometimes used with anti-hypertensive medication that causes hypokalemia)
Medication is contraindicated if taking:
verapamil, amiodarone, quinidine
Digoxin
(s/t lowering digoxin clearance)
What medication can cause these Adverse effects:
Luminous phenomena/visual brightness,
hypertension,
bradycardia
Ivabradine
Used for Chronic stable angina in patients who cannot take β-blockers.
ChronicHFrEF
Ivabradine
What class of medication are:
Quinidine, Procainamide, Disopyramide
Class 1A
Anti-arr
Na+ Channel Blockers
What class of medication are:
Lidocaine,
MexileTine.
Class 1B
anti- arr
Na+ channel blockers
Flecainide,
Propafenone
class 1C
anti-arry
(tight) Na+ channel blockers
Metoprolol, propranolol, esmolol, atenolol, timolol, carvedilol.
(MEP, CAT)
Class 2
anti arryth
beta blockers
Amiodarone, Ibutilide, Dofetilide, Sotalol
Class 3
anti-arryth
K+ channel blockers
Diltiazem, Verapamil
class 4
anti-arry
Calcium channel blockers
Adenosine’s effects blunted by what 2 meds/substances?
adenosine receptor antagonists
theophylline
caffeine
Drug of choice in diagnosing/ terminating certain forms of SVT.
Adenosine
↑ K+ out of cells hyperpolarizing the cell and ↓ICa, decreasing AV node conduction.
Adenosine
Adverse effects: include flushing, hypotension, chestpain, sense of impending doom, bronchospasm
Adenosine
(A-doom-osine)
Effective in torsades de pointes and digoxin toxicity.
Magnesium
for subarachnoid hemorrhage (prevents cerebral vasospasm).
Nimodipine
For hypertension, angina, atrial fibrillation/flutter
Non-dihydropyridines: Diltiazem, Verapamil
Nicardipine, clevidipine can specifically be used for
hypertensive urgency or emergency
___ cause peripheral edema, flushing, dizziness.
____ cause cardiac depression, AVblock, constipation
Dihydropyridine
Non-dihydropyridine
hyperprolactinemia (verapamilk)
