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Pharm 5 > antihypertensives II > Flashcards

antihypertensives II Flashcards

1
Q

MOA of hydrazine

A

direct vasodilation of arterioles (with little effect on veins)

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2
Q

S/E of hydrazine?

A
  • HA (increased blood flow to head),
  • nausea,
  • edema (unless on diuretic)

anorexia, palpitations, sweating and flushing (increased blood flow to skin)
Drug induced systemic lupus erythematous (SLE or lupus causes arthralgia, myalgia, rash, fever), peripheral neuropathy, drug fever

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3
Q

Special populations for hydralazine?

A

CHF & African americans on nitrates for CHF

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4
Q

MOA of minoxidil

A

dilates arteries

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5
Q

which lowers BP more minoxidil or hydralazine?

A

minoxidil

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6
Q

what drugs should pt on minoxidil also be on?

A

beta blockers and loop diuretics prevent tachycardia and edema

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7
Q

when is minoxidil used?

A

renal failure pt with severe HTN

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8
Q

MOA of sodium nitroprusside?

A

dilates arteries and increases capacity of veins: hold more blood… decreases PVR and BP

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9
Q

benefits of sodium nitroprussides?

A

1 choice for monitoring BP in hospital; rapid acting, can pull it off and stops working immediately

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10
Q

pt who benefit from sodium nitroprusside?

A

severe HTN and CHF

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11
Q

MOA of diazoxide? IV

A

dilates arterioles and lowers BP

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12
Q

SE of diazoxide? IV

A

tachycardia, increased CO

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13
Q

Downside of diazoxide?

A

takes 5 minutes to work; lasts about 4-12 hours (if we go to low takes longer to fix)

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14
Q

S/E of diazoxide?

A

Lowering BP too much (can cause stroke & MI)
Hyperglycemia
Fluid retention (edema)

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15
Q

Fenoldopam MOA? IV

A

target DA1 makes BP go down (all dopamine receptors increases BP… DA1 only decreases it)

vasodilation of renal, mesenteric, coronary, & cerebral vascular beds, without vasoconstriction in other beds

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16
Q

SE of Fenoldopam?

A

tachycardia, HA, flushing and increased IOP

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17
Q

when do you use IV nitroglycerin?

A

myocardial ischemia & high BP

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18
Q

MOA of calcium channel blockers?

A

inhibit influx of CA into smooth muscle walls.. vasodilator… decreased PVR… decreased BP

in heart: decreased conduction, decreased contraction (unwanted)

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19
Q

Nondihydropyridine?

A

Verapemil & diltiazem

20
Q

MOA of Nondihydropyridine?

A

vasodilate, lower BP, slows conduction of AV node (V>D), decreased contractility (V>)

verapamil will cause the most damage

21
Q

SE of Nondihydropyridine?

A

decreased HR can make heart block worse (heart block= conduction problem); decreased contractility can decrease CO making heart failure worse

don’t use for pt at risk for heart block or heart failure

pt can get CHF, AV block, bradycardia

constipation (V>D), anorexia, nausea, hypotension (V>D)

22
Q

drug interactions with Verapamil and diltiazem?

A

Blockers cause additive conduction effect (increased risk of heart block)

Inhibits P450 system (interferes with metabolism of digoxin, HMGCoA, reeducate inhibitors (for hypercholesterolemia), and theophylline (for asthma/COPD)

23
Q

Dihydropyridine MOA?

A

vasodilate, cause less cardiac depression, reflex SNS (increased HR)

24
Q

SE of dihydropyridine?

A

dizziness, flushing, HA, palpitations, edema

25
Q

Inhibitors of RAS pathway?

A

ACE inhibitors & ARBs

26
Q

MOA of ACE inhibitors?

A
  • inhibit ACE from converting ATI to ATII (less ATII and ALD)
  • prevent degradation of bradykinin (more vasodilation and increased BP)
  • all decrease PVR
27
Q

what happens when you don’t let bradykinin break down?

A

cough associated with ACE inhibitors

28
Q

What eliminates ACE inhibitors? Pros and Cons?

A

Kidneys; ACE inhibitors slow destruction of kidney failure; also if kidney’s fail will lead to ACE inhibitors accumulation (need to decrease dose)

29
Q

SE of ACE inhibitors?

A
  • 10% get cough (try different ACE or ARB)
  • rash
  • hyperkalemia (greater with renal insufficiency or DM… check lab values… check it a month after you change dose.. looking at creating and K levels)
  • if pt is on a diuretic you can balance K loss (diuretics cause K loss)
30
Q

contrindications for ACE inhibitors?

A
  • teratogen (risk in 1st semester, greatest risk in 2nd and 3rd semesters… causes fetal hypotension, anuria, renal failure, death)
  • angioedema Hx or cause
31
Q

Drug interactions of ACEI?

A
  • NSAIDs block bradykinin vasodilation so don’t get lowering BP effect
  • potassium supplements or K sparing diuretics can increase hyperkalemia
32
Q

Who benefits from ACEI?

A
  • HTN with chronic kidney disease (often associate with DM): decreases protein in urine, stabilizes kidney fxn (even in absence of lower BP)
  • HTN and heart failure or after myocardial infarction
    Increased survival if taken in this setting
  • High renin states: renal artery stenosis or malignant HTN
33
Q

ACEIs examples?

A 
Benazepril (Lotensin)
Captopril (Capoten)
Fosinopril (Monopril)
Enalapril (Vasotec): use declining
Lisinopril (Zestril)**
Moexipril (Univasc)
Quinapril (Accupril)
Ramipril (Altace)
Trandolapril (Mavik)
34
Q

When to use ARB?

A

when pt can’t tolerate ACEI

35
Q

SE of ARB?

A
  • less cough, rash, angioedema than ACEI
  • same rate of hypotension, renal failure, and hyperkalemia as ACEI
  • teratogen
36
Q

When shouldn’t you use an ARB?

A

if they are on an ACEI

37
Q

contraindication of ARBs?

A

pregnancy

38
Q

who benefits from ARBs?

A
  • CHF
  • chronic kidney disease
  • high renin states
39
Q

Examples of ARBs?

A 
Candesartan (Atacand)
Eprosartan (Teveten)**
Irbesartan (Avapro)
Losartan (Cozaar)***
Olmesartan (Benicar).. brand only
Telmisartan (Micardis)
Valsartan (Diovan)**
40
Q

common suffix of ARBs?

A
  • sartan
41
Q

Who to go to for guidelines?

A

JNC8 – Joint National Committee number 8 from US Department of Health from 2014
AHA- American Heart Association

42
Q

How to approach HTN?

A
  1. lifestyle changes
  2. set BP goal and initiate BP lowering medications based on age, DM, CKD (chronic kidney disease)
  3. no DM or CKD go one direction
    - divide 60yo
    - >60: BP goal
43
Q

medication not working?

A
  • maximize dose
  • add 2nd agent (titrate up to max dose)
  • add 3rd agent and titrate up to max dose
44
Q

why is two low doses of different drugs better than one high dose of a drug and addition of another drug?

A

lower SE

45
Q

First line anti-HTN?

A
  • HCTZ (especially for elderly) add drug if needed

Pharm 5 (8 decks)

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