Antihypertensives Flashcards
Before an antihypertensive medication can be approved by the FDA it typically needs to:
a. show that it significantly reduces blood pressure vs placebo
b. show it reduces morbidity & mortality
c. both
a. show that it significantly reduces blood pressure vs placebo
What are the 2 adverse effects seen in BOTH types of CCBs?
- gastroesophageal reflux
- gingival hyperplasia
This drug has CYP450-related drug interactions with DOACs.
a. Amlodipine (Norvasc)
b. Triamterene (Dyrenium)
c. Nitroprusside (Nitropress)
d. Verapamil (Verelan)
d. Verapamil (Verelan)
The main side effect of this drug is peripheral edema, primarily in the ankles.
a. Amlodipine (Norvasc)
b. Triamterene (Dyrenium)
c. Nitroprusside (Nitropress)
d. Spironolactone (Aldactone)
a. Amlodipine (Norvasc)
Why is there a decreased risk of reflex tachycardia with Amlodipine (Norvasc)?
- Amlodipine has some cross over with non-dyhydropyridines so it can lower HR
This Calcium channel blocker works by blocking the Ca++ influx in the arteries.
a. Amlodipine (Norvasc)
b. Diltiazem
c. Verapamil
a. Amlodipine (Norvasc)
What is the adverse effect of Hydralazine or Minoxidil?
- reflex tachycardia
* direct acting vasodilators
This is the drug of choice for hypertension emergency.
a. Lisinopril
b. Triamterene (Dyrenium)
c. Nitroprusside (Nitropress)
d. Spironolactone (Aldactone)
c. Nitroprusside (Nitropress)
* direct-acting vasodilators
This drug inhibits the sodium/potassium exchange in the distal tubule and collecting duct leading to potassium being sparred.
a. Lisinopril
b. Triamterene (Dyrenium)
c. HCTZ
d. Spironolactone (Aldactone)
b. Triamterene (Dyrenium)
Taking this diuretic also may result in an increase bone density and decrease the risk of osteoporosis.
a. loop
b. thiazide
c. osmotic
d. potassium-sparing
b. thiazide
What are all the side effects of thiazide diuretics? (6)
- hypotension
- hypokalemia
- hyperuricemia
- hyperglycemia
- hypercalcemia
- sulfonamide allergy
If you have an underlying history of gout using this type of diuretic may increase your risk of a gout flare up.
a. loop
b. thiazide
c. osmotic
d. potassium-sparing
b. thiazide
The mechanism of action of this drug is to inhibit sodium and chloride reabsorption, mostly in the distal tubule.
a. Lisinopril
b. Losartan
c. HCTZ
d. Spironolactone (Aldactone)
c. HCTZ
What is the difference between HCTZ and chlorthalidone?
- chlorthalidone a higher potency thiazide
* evidence based
What are the 2 K+ sparring diuretics?
- Amiloride
- Triamterene
What effect from diuretics leads to the long term benefits of using this drug?
- relaxation of venous tone
This drug works by antagonizing aldosterone.
a. Lisinopril
b. Losartan
c. Aliskiren (Tekturna)
d. Spironolactone (Aldactone)
d. Spironolactone (Aldactone)
* mineralocorticoid receptor antagonists
A patient with HTN is taking this drug in high amounts and develops gynecomastia. What drug did he take?
a. Lisinopril
b. Losartan
c. Aliskiren (Tekturna)
d. Spironolactone (Aldactone)
d. Spironolactone (Aldactone)
What are all the side effects of ACE/ARBs? (7)
- Headache, dizziness, hypotension
- hyperkalemia
- rash, angioedema (ACE>ARB)
- teratogenic
- acute renal failure
- cough (ACE only)
What drugs may lead to acute renal failure in a patient who has renal artery stenosis (low perfusion)?
*or in a patient who is dehydrated
- ACE/ARBs
* give IV fluid + hold the drug
This drug works by directly suppressing renin release.
a. Lisinopril
b. Losartan
c. Aliskiren (Tekturna)
d. Spironolactone (Aldactone)
c. Aliskiren (Tekturna)
This drug is on the top of the list for causing angioedema.
a. Lisinopril
b. Losartan
c. Aliskiren (Tekturna)
d. Spironolactone (Aldactone)
a. Lisinopril
What is one adverse effect of ACE inhibitors that is not seen with ARBs?
- bradykinin accumulation leads to a dry, non-productive cough
Which of the following is an ARB?
a. Lisinopril
b. Losartan
c. Aliskiren (Tekturna)
d. Spironolactone (Aldactone)
b. Losartan
Which of the following is an ACE inhibitor?
a. Lisinopril
b. Losartan
c. Aliskiren (Tekturna)
d. Spironolactone (Aldactone)
a. Lisinopril
What are the 2 primary effects of ACE/ARBs?
- vasodilation = reduce afterload
- decrease plasma volume (prevent aldosterone release)
This drug works by disrupting the membrane of vesicles that contain NE in the pre-synaptic terminal reducing the amount of NE available to bind to post-synaptic receptors.
a. Lisinopril
b. Losartan
c. Aliskiren (Tekturna)
d. Spironolactone (Aldactone)
e. Reserpine
e. Reserpine
If we need a drug to lower hypertension during pregnancy what is the drug most often used?
a. Lisinopril
b. Losartan
c. Aliskiren (Tekturna)
d. Methyldopa
e. Reserpine
d. Methyldopa
What drug therapy is used for b-blocker overdose?
- Glucagon
* provides an intra-cellular source of cAMP = cAMP main determinant of cardiac contraction*
A patient is started on this drug to treat hypertension. He now complains of fatigue and decreased sexual desire. Which of the following drugs did he most likely take?
a. Lisinopril
b. Losartan
c. Aliskiren (Tekturna)
d. metoprolol
e. Reserpine
d. metoprolol
What are the side effects of blocking B1?
- Bradyarrythmia
- Increase tri/decrease HDL
What are the side effects of blocking B2?
- Bronchospasm
- Hypoglycemia
What are the main adverse effects of alpha-2 agonists? (2)
- sedation & dry mouth (25-50%)
- rebound HTN/withdrawal syndrome*
need to taper if withdrawing
What is an anti-depressant drug that works as an alpha-2 blocker?
- mirtazapine
Why is Guanfacine (Tenex) more commonly used than Clonidine (Catapres)?
- SPRINT trial demonstrated that aggressive control of BP was better
- used Guanfacine (Tenex) as alpha-2 agonists
- d/t Clonidine being 2x a day + used in opioid withdrawal (has street value)
Which of the following Alpha-1 blockers are only used for BPH.
a. Prazosin
b. Terazosin
c. Doxazosin
d. Tamsulosin
d. Tamsulosin (Flomax)
Which of the following is NOT a cardiac selective Beta blocker?
a. propanolol
b. atenolol
c. metoprolol
a. propanolol
What is the action of B-blockers?
decreases HR and contractility
what is the mechanism of action of Clonidine (Catapres)?
- Alpha-2 agonist = decreases TPR by decreasing pre-synaptic NE release
What is the main adverse effect of Prazosin (Minipress)?
- orthostatic hypotension
* alpha 1 antagonist
What is the mechanism of action of Prazosin (Minipress)?
- Alpha-1 blocker = decreases TPR
- vasodilation
- increasing urine output
When it comes to treating HTN what is the first line options? (3)
- ACE/ARB
- thiazides (Diuretics)
- Ca++ channel blockers (Amlodipine)
How do we explain BP through physics?
- CO x TPR
Since the body will fight against blood pressure medication what is the best practice?
- use multiple drugs
Why do patients with HTN choose to not take their anti-HTN drugs?
- HTN is asymptomatic but there are side effects with anti-HTN medications
What are the 4 long term consequences that we worry about with HTN?
- CVA
- MI
- HF*
- CKD
