BP Lowering Medication Flashcards
Adverse effects for DHP CCBs:
Flushing, headache, excessive hypotension, peripheral edema, and reflex tachycardia
MOA of direct renin inhibitor:
Inhibiting the activity of renin (vasodilation) which is responsible for stimulating angiotensin II formation
MOA of loop diuretics:
Inhibit Na-K-Chloride cotransporter in thick ascending limb leading to diuresis and natriuresis
Contraindications for NON-DHP CCBs:
Preexistent bradycardia, heart conduction defects, heart failure caused by systolic dysfunction
Common clinical uses of ACE inhibitors:
Heart failure
CAD
HTN
Chronic renal disease with proteinuria
Common clinical uses for BB:
Heart failure
CAD
Tachyarrhythmias
HTN
Common clinical uses for aldosterone antagonists:
Heart failure
CAD
HTN
Hyperaldosteronism
Adverse effects of alpha-1 blockers:
Headache and dizziness Orthostatic hypotension Nasal congestion Reflex tachycardia Fluid retention
Minoxidil adverse effect:
Hypertrichosis (extensive hair growth) and pericardial effusion (boxed warning)
MOA of nitrates:
Dilate both arteries and veins through venous dilation predominates when drugs are given at normal therapeutic doses
3 subclasses of beta-blockers:
- Nonselective BB
- Beta-1 BB
- Vasodilating BB
MOA of direct vasodilators:
Directly relaxing arteriolar SM (reduce SVR)
Which alpha-1 blockers are used in HTN emergencies caused by pheochromocytoma:
Phentolamine and phenoxybenzamine
MOA of ARBs:
Blocky type 1 angiotensin II (AT1) receptors on blood vessels and other tissues (heart) preventing angiotensin II induced vasoconstriction
Vasodilating BB have what vasodilating properties?
Alpha-1 with beta inhibition
4 classes of vasodilators:
- Non-dihydropyridine calcium channel blockers
- Dihydropyridine calcium channel blockers
- Direct vasodilators
- Nitrates
MOA of thiazide diuretics:
Inhibit Na-Chloride transporter in distal tubule of nephron increasing excretion of Na and water
Common clinical uses for thiazide diuretics:
HTN
Edema
Calcium nephrolithiasis (kidney stones)
Common clinical uses of central alpha-2 agonists:
HTN (NOT 1st line)
Hydralazine adverse effect:
Lupus-like syndrome
Adverse effects from BB:
1 Exaggeration of cardiac therapeutic actions 2 Smooth muscle spasm 3 CNS penetration 4 Worsened quality of life 5 Adverse metabolic side effects 6 Withdrawal phenomenon
IV vasodilator stimulates DI-like dopamine receptors:
Fenoldapam
MOA of central alpha-2 agonists:
Binding to and activating alpha-2 adrenoceptors:
- reduces sympathetic outflow to heart (decrease CO, HR and contractility)
- reduces sympathetic output to vasculature (decrease SVR)
2 classes of diuretics:
- Loop diuretics
2. Thiazide diuretics
Adverse effects of neprilysin inhibitor plus ARB:
Hyperkalemia
Angioedema
Renal function deterioration
Hypotension
Adverse effects of NON-DHP CCBs:
Flushing, headache, peripheral edema, excessive hypotension, excessive bradycardia, impaired electrical conduction, and depressed contractility
Common clinical uses of nitrates:
HTN
Heart failure
Angina
MI
MOA of aldosterone antagonists:
Block the aldosterone receptor in renal collecting tubule which increases sodium and water excretion while conserving K+ and hydrogen ions
Adverse effects of thiazide diuretics:
Hypovolemia
Electrolyte disturbance (hypokalemia, hyponatremia, hypochloremia, hypomagnesemia)
Hypercalcemia, hyperuricemia
Alkalosis
MOA beta-1:
Inhibit receptors and cause decrease HR, CO, renin release, and BP
Aldosterone antagonists adverse effect risk of hyperkalemia:
Increased with declining renal function and with the concurrent use of ARBs and ACE inhibitors
Adverse effects for direct renin inhibitor:
Diarrhea
Hyperkalemia
Angioedema
Where are beta-2 receptors found?
Lung and vasculature
Common clinical uses for loop diuretics:
Edema
Hyperkalemia
HTN
Common clinical uses for neprilysin inhibitor plus ARB:
Heart failure
MOA of neprilysin inhibitor plus ARB:
Inhibition of neprilysin increases the concentration of bradykinin which leads to vasodilation and natriuresis
Contraindication for ARBs:
Pregnancy
Bilateral renal artery stenosis
Adverse effects of nitrates:
Headache
Postural hypotension and reflex tachycardia
Lose efficacy with sustained use (tolerance)
Risk of thiocyanante toxicity
Interact with phosphodiesterase inhibitors to treat erectile dysfunction
Common clinical uses for direct renin inhibitor:
HTN
Common clinical uses for DHP CCBs:
HTN
Angina
Adverse effects of only ACE inhibitors:
Dry cough
Adverse effects of central alpha-2 agonists:
- Sedation, dry mouth and nasal mucosa, bradycardia, orthostatic hypotension, impotence
- Constipation, nausea and GI upset
- Rebound HTN if stopped suddenly bc excessive sympathetic activity
MOA of NON-DHP Ca channel blockers:
CCBs bind to L-type calcium channels located on vascular SM, cardiac myocytes, and cardiac nodal tissue
Adverse effects of loop diuretics:
Na/volume depletion
Hypokalemia, hypocalcemia, hypomagnesemia, alkalosis
Ototoxicity
Hyperuricemia with chronic therapy
5 different classes of renin angiotensin aldosterone system antagonists
- ACE inhibitors (angiotensin-converting enzyme)
- ARBs (angiotensin-II receptor blockers)
- Neprilysin inhibitors Plus angiotensin-II receptor blocker
- Aldosterone antagonists
- Direct renin inhibitor
Adverse effects of direct vasodilators:
Headaches, flushing
Baroreceptor-mediated reflex tachycardia
Salt and water retention (edema)
Common clinical uses for ARBs:
Heart failure
CAD
HTN
Chronic renal disease with proteinuria
What can concomitant use or use within 36hrs of ACE inhibitors cause adverse effect?
Increase risk of angioedema and is contraindicated
Contraindication for ACE inhibitors:
Pregnancy
Bilateral renal artery stenosis
MOA of ACE inhibitors:
Reduces the synthesis of angiotensin II and prevents bradykinin breakdown
-bradykinin»angiotensin II = vasodilation (reduction in PVR and BP)
Common clinical uses for NON-DHP CCBs:
HTN
Tachyarrhythmias
Angina
Where is beta-1 receptors found?
Heart and kidney
Common clinical uses of alpha-1 blockers:
HTN
Benign prostatic hypertrophy
MOA of alpha-1 blockers:
Block binding of Epi and NE to alpha-1 adrenoceptors located on the vascular SM causing vasodilation
3 classes of sympatholytics:
- Alpha-1 blockers
- Beta-blockers
- Central alpha-2 agonists
Adverse effects of aldosterone antagonists:
Hyperkalemia
Renal function deterioration
Gynecomastia
MOA of beta-2:
Inhibition of receptors cause bronchospasm and vasoconstriction
Common clinical uses for direct vasodilators:
HTN (resistant HTN and emergency)
Heart failure
Adverse effects of ACE inhibitors:
Hyperkalemia
Acute renal failure
Angioedema
Contraindication for neprilysin inhibitor plus ARB:
Pregnancy
Bilateral renal artery stenosis
Contraindication for direct renin inhibitor:
Pregnancy
MOA of DHP CCBs:
Prevent flow of calcium through L-type calcium channels located on vascular SM (reduce SVR and BP)
Adverse effects of ARBs:
Hyperkalemia
Acute renal failure
