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cardiology > AntiHypertensives and Diuretics > Flashcards

AntiHypertensives and Diuretics Flashcards

1
Q

regular exercises causes what

A

decreased heart rate and concentration of circulating catechoalmines, increases HDL and increases ANP release

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2
Q

what are the four classes of anti-hypertensive medications

A

diuretics
sympatholytics
vasodilators
renin-angiotensin system antagonists

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3
Q

why are patients noncompliant with medications

A

largely asymptomatic and benefit is not immediate

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4
Q

what are the two beta blockers that are cardioselective

A

atenolol

metoprolol

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5
Q

what are the 3 beta blockers that are vasodilating agents

A

carvedilol
labetalol
nebivolol

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6
Q

what are the agents with instrinsic sympathomimmetic activites (ISA)

A

pindolol

acebutolol

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7
Q

what is the primary mechanisms for using beta blockers for treatment of hypertension

A

beta 1 decreases myocardial contratility which therefore decreases Cardiac ouput by decreaseing HR and contractility, leading to decreased renin secretion, decreased AngII and decreased TPR

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8
Q

what are the clinical effects of beta blockers

A

decreased heart rate (negative chronologic effect)
decreased contractility
decreased renal renin secretion

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9
Q

beta blockers are effective when the following comorbidities are present

A

ischemic heart disease
heart failure
dissecting aneurism of the thoracic aorta

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10
Q

_______are inferior to diuretics when used in elderly or african american hypertensive patients

A

beta blockers

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11
Q

beta blockers are contraindicated in

A

acute decompensated heart failure and asthma patients

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12
Q

adverse effects of beta blockers

A

elevated TG and decreased HDL
bronchospasm
fatigue, cold extremities, vivid dreams
impotence, hyperglycemia and raynauds phenomenon may be worsened

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13
Q

beta blocker metabolism is ________indirectly by decreasing hepatic blood flow secondary to decreased CO

A

decreased

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14
Q

what drugs have additive effects with beta blockers and may cause excessive negative inotropic and AV nodal efffects

A

verapamil, lidocaine, and other negative inotropes

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15
Q

in general how do Vasodialtors work

A

decrease vascular resistance by eliciting a compensatory response and work best with other HT meds that oppose compensatory responses

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16
Q

example of strict venodialtors

A

nitrates

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17
Q

examples of arteriolar dilators

A

hydralazine, minoxidil and calcium channel blockers

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18
Q

what is the MOA of ACE inhibitors

A

inhibits the synthesis of angiotensin II and increased bradykinin and decreases circulating levels of aldosteron

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19
Q

what are some examples of long acting ACEI

A

trandolapril and ramipril

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20
Q

long acting ACE-I are preferred in

A

young, white asian

patient with high plasma renin

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21
Q

trandolaprim and ramipril are contraindicated in

A

pregnancy

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22
Q

ACE-I are effective in patients with the following comorbidities

A

acute MI
congestive HF
risk of Cardiovascular diseases

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23
Q

______are useful against chronic kidney diseases and in hypertensive patients with diabetic neuropathy

A

ACE-I

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24
Q

are potassium sparing or potassium wasting diuretics bad with ACE-I

A

potassium sparing

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25
examples of dentrimental drug interactions with ACE-I's
potassium supplements all potassium sparing diureetics NSAIDS cause salt and water retention increase K+ in plasma ARB's
26
contraindications with ACE-I
angioedema pregnancy bilateral renal artery stenosis, renal failure
27
what are the adverse effects of ACE-I
``` first dose hypertension dry cough angioedema increased serum K developmental defects hypoglycemia functional renal failure in pts with renal stenosis ```
28
the ACE-I's are the
Apirls
29
what are the ARB's
the "sartans"--losartan, candesartan, olmesartan, valsartan
30
what is the mechanism of action for ARB's
inhibits angiotensin 2 receptors which decreases aldosterone levels, decreasing plasma volume and total peripheral resistance
31
what are the side effects of ARBS
less increase K- than Ace | less potential for angioedema or cough, everything else is the same
32
________is a direct renin inhibitor
aliskiren
33
What are the three available calcium channel blockers for hypertension
dihydropyridines verapamil diltaizem
34
slows AV nodal conduction
verapamil
35
clinical effects of calcium channel blockers
vasodilation and decreased totoal TPR, decreased cardiac contractility and slows AV nodal conduction
36
clinical uses for calcium channel blockers
generally effective in elderly patients, african americans and patients from the caribbean, angina, and decreased rrisk of myocardial infract and stroke in HT pts and used in atrial arrhthmias
37
Iv ________can cause circulatory collapse in paitnets treated concurrently with beta blockers
verapamil
38
adverse effects of calcium channel blockers
well tolerated, short acting preparations, ankle swelling is common, can exacerbate heart failure and constipation
39
what is the main physiologic mechanisms of action for nitrates
venous vasodilation
40
_____is given IV for severe hypertensive emergencies in the ICU
sodium nitroprusside
41
sodium nitroprusside requires
co administration with a beta blocker
42
prolonged use of sodium nitroprusside can result in
cyanide toxicity
43
it dilates the arterioles ONLY resulting in rapid fall in BP leading to profound reflex tachycardia and increased CO
diazoxide
44
what are the adverse effects of diazodie
hypotension, hyperglycemia, salt and water retenion
45
diazoxide is contraindicated in
ischemic heart disease, reflex sympathetic response can promoke angina and cardiac failure
46
what is the mechanism for fenoldopam
D1 agonist which dialates arterioles
47
what are the adverse effects of fenoldopam
reflex tachycardia, headache and flushing
48
what are the indications for fenoldopam
reflex tachycardia, headache, and flushing
49
is used with a beta blocker in CAD pts to prevent ischemia
hydralazine
50
used for treatment of severe refractory hypertension
hydralazine
51
combine with a nitrate in african americans CHF patients for added benefit
hydralazine
52
what drug has retianed a place in severe hypertension during pregnancy
hydralazine
53
long term therapy of what drug can produce systemic lupus like symptoms in susceptible pts especially low acetylators
hydralazine
54
is a prodrug that works via sulfate metabolite which activates K+ channels and relaxes vascular smooth muscles-predominately arteriolar dilator
minoxidil
55
linked to causing hirsuitism and coarseness of facial features (used with caution in female patients)
minoxidil
56
minixidil should be combined with what for better results in severe refractory hypertensive pts esp renal failure pts
beta blocker and loop diruetic
57
example of alpha adrenergic blocker
doxazosin
58
what is the MOA of alpha adrenergic blockers
relaxes vascular smooth muscles by preventing NE from interacting with alpha 1 receptors
59
what are the adverse effects of alpha adrenergic blockers
first dose hypotension postural hypotension urinary incontinence
60
what are the systemic alpha 1 selectives
prazosin, doxasin and terazosin
61
what are the alpha 1 and alpha 2 blockers
phenoxybenzamine, phentolamine
62
_________is combined with propranol to treat clonidine withdrawal syndrome
phentolamine
63
use is limited by severe postural hypotension and is useful only as an add on to treat resistant hypertension
prazosin
64
alpha methyldopa
Taken up by adrenergic nerve terminals and converted to α-methyl norepinephrine in the CNS where α2 receptors are stimulated to decrease sympathetic out flow to the periphery-
65
DOC for hypertension in pregnancy
alpha methyldopa
66
adverse effects of alpha methyldopa
drowsiness, depression, hepatitis, immune hemolytic anemia and fever
67
toxicity of clonidien results in
xerostomia and sedation
68
MOA and class for clonidine
centrally acting sympatholytic reducing sympathetic outlfow to the heart, blood vessels and the kidneys
69
what are the three main causes of peripheral edema
cardiac failure hepatic disease renal disease
70
the majority of sodium gets reabsorbed in the
proximal tubule
71
what percentage of sodium gets reabsosrbed in DCT
7%
72
what percentage of sodium the proximal tubule gets reabsorbed
65%
73
what % of sodium gets reabsorbed in the collecting duct
2-3%
74
what percentage of sodium gets reabsorbed in the ascending loop of henle
25%
75
what part of the nepron does carbon anhydrase inhibitors work on
proximal convoluted tubule
76
what part of the kidney do loop diruetics wokr on
loop of henle (ascneding)
77
where do thiazides work
distal convoluted tubule
78
where do potassium sparring diruetics work
collecting duct
79
where do osmotic diruetics work
proximal tubule and descending loop of henle
80
what are the four thiazides
chlrothalidone, hydrochlrothiazide, indapamide, and metolazone
81
Act at the luminal surface of the cortical (proximal) diluting segment of the distal convoluted tubule and early collecting duct to inhibit the Na+/Cl+ cotransporter.
thiazides
82
what are the loop diruetics
bumentadine, fuorsemide, torsemide
83
Bind to the Na+/K+/2Cl- cotransporter complex at the luminal border of the thick ascending limb of the loop of Henle, and inhibit Cl- re-absorption.
loop diuretics
84
what are the three aldosterone antagonists
eplernone, spironolactone and spironolactone/hctz
85
what are the potassium sparing diuretics
amiloride, tramterene or both drugs and hctz
86
what class is acetazolamide
carbonic anhydrase inhibitor
87
_____________interferes with the small proportion of sodium that is reabsorbed in the proximal tubule in exchange for Hydrogen
acetazolamide
88
________exerts osmotic activity within the proximal renal tubule and particuarly the descending limb of the loop of Henle and limits passive tubular water reabsorption
mannitol
89
what remains the basis of treatment in patients with congestive heart failure
diuretics and ACE inhibitors
90
why can loop diruetics also be used to treat hypercalcemia
because they also cause increased urinary calcium excretion
91
patients on loop diruetics should also receive
potassium supplements or a potassium sparring agent
92
what is a common adverse side effect of treatment with high dose IV diuretics
acute gout
93
act on the cortical diluting segment of the nephron
thiazide diuretics
94
thiazides are often ineffective in what patient population
elderly patients
95
what are the side effects of thiazide diuretics
hyponatremia and hypokalemia are commonly assoc with higher doses of thiazide diuretics
96
metolazone is contraindicated in
liver failure patients
97
if patient has chronic or severe CHF in the presence of renal impairment what should you do
give thiazide like diuretic and combine it with a loop diuretic but only under close supervision!!!
98
what are the potassium sparing diuretics
amiloride and triamterine and spironolactone (competitive aldosterone inhibitor)
99
potassium sparing diruetics must be used in caution in patients receiving _____because of the risk for hyperkalemia
ACE I
100
what are the risk factors for hyperkalemia
spironolactone greater than 50 high dose ACE-I evidence of renal failure
101
pt has MI should give
beta antagonist and ACE-I
102
pt has isolated systolic hypertension in elderly then give
diruetics, ACE-I, ARBS, dihydropyridines, and calcium antagonists
103
drugs used to treat CHF
ACE-I diruetics beta blockers
104
drugs use to treat uncomplicated hypetension
diuretics, ACE-I, ARB, and CCA
105
thiazides are contraindicated in
renal insufficiency and diabetics
106
what drug to you give for sulfa allergy
ethacrynic acid
107
__________are reserved for patients whose creatinine levels are above 2mg %
loop dirutics
108
large doses of ethacrynic acid can cause
otoxicity
109
increased cholesterol has been reported with the use of thiazide diuretics but one of them is better than the others
imdapamide
110
``` ACE inhibitors Antipsychotics Beta-blockers Ethanol Ca-channel blockers Antiadrenergic agents are known to ```
increase antihypertensive effects
111
``` ASA/NSAIDs Anticonvulsants Bile acid resins Sympathomimetics (e.g., albuterol, dobutamine, etc). ```
know to decrease antihypertensive effects

cardiology (11 decks)

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