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DIT Cardiology > Car 16 - Antihypertensives > Flashcards

Car 16 - Antihypertensives Flashcards

1
Q

What are the clinical uses of ACE inhibitors?

A

HTN. CHF. Post MI. Diabetic renal disease (reduce the progression of proteinuria and diabetic nephropathy).

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2
Q

What are the side effects of ACE inhibitors?

A

Cough (elevated levels of bradykinin). Angioedema (swelling of lips to the larynx). ^ serum K+. \/ GFR slightly, ^ creatinine (up to 20%). Teratogenic.

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3
Q

What are the side effects of ARBs?

A

Teratogenic. Hyperkalemia. Renal insuff. DONT CAUSE COUGH. But can cause Angioedema.

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4
Q

What does Aliskiren do?

A

A renin inhibitor. Only indicated for HTN. Can cause hyperkalemia and renal insuff. Still teratogenic.

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5
Q

What does Hyrdalazine do?

A

It increases cGMP, activating myosin phosphatase, removing the phosphate from myosin-PO4, causing smooth muscle relaxation. Dilates arterials more than veins.

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6
Q

What are the clinical uses of hydralazine?

A

HTN in pregnancy. Urgent and emergency HTN.

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7
Q

What four drugs can be safely used during pregnancy for HTN?

A

[Hypertensive Moms Love Nifedipine] Hydralazine. Methyldopa. Labetalol. Nifedipine.

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8
Q

What are the side effects of hydralazine?

A

Reflex tachycardia (give beta blocker at same time). Fluid retention. Nausea. Headache. Drug-induced lupus (with antihistone Ab).

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9
Q

What is the MOA of Minoxidil?

A

Opens K+ channels and hyperpolarizes smooth muscle, resulting in relaxation of vascular smooth muscle (Ca2+ cannot get in).

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10
Q

What are the toxicities associated w/ Minoxidil?

A

Hypetrichosis. Hypotension. Reflex tachycardia. Fluid retention/edema.

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11
Q

What is the difference in MOA b/w Dihydropyridine CCB vs non-dihydropyridine CCB?

A

Non-dihydropyridine CCB: Block Ca-channels at pacemaker cells. Dihydropyridine CCB: act on vascular smooth muscle to cause vasodilation.

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12
Q

What are the clinical uses of dihydropyridine CCB?

A

Hypertension, angina, vasospasm (Prinzmetal’s angina, Raynaud phenomenon), Esophageal spasm, migraine prophylaxis.

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13
Q

What are the clinical uses of non-dihydropyridine CCB?

A

Hypertension, angina, arrhythmias.

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14
Q

What are five dihydropyridine CCB?

A

Nifedipine. Amlodipine. Felodipine. Nicardipine. Nisoldipine.

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15
Q

What are two Non-dihydropyridine CCB?

A

Verapamil. Diltiazem.

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16
Q

What are the side effects associated w/ Dihydropyridine CCB?

A

Peripheral edema, flushing, dizziness, constipation, reflex tachycardia.

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17
Q

What are the side effects associated w/ non-Dihydropyridine CCB?

A

Cardiac depression, AV-block, flushing, dizziness, constipation.

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18
Q

What does Hydralazine reduce?

A

They dilate capillaries more than veins, therefore reduce Afterload.

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19
Q

What doe Nitroglycerin and Isosorbide dinitrate reduce?

A

They dilate veins more than arteries, therefore reduce Preload.

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20
Q

What do ARBs and ACE inhibitors decrease?

A

Both preload and afterload.

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21
Q

What are the two clinical uses of nitroglycerin and Isosorbide dinitrate?

A

Angina. Acute pulmonary edema.

22
Q

What drug is recommend for patients w/ essential HTN and nothing else?

A

Thiazide-type diuretics.

23
Q

What drugs are recommended for patients w/ HTN plus CHF? What do we need to avoid?

A

Give: Thiazide but if they have edema, use a loop diuretic. Combine w/ ACE inhibitors/ARB, Beta-blockers, or aldo antagonists. Avoid Beta-blocker in acute decompensated CHF or cardiogenic shock and CCB (because of fluid retention and Edema And may have negative inotrophic effects).

24
Q

What drugs are recommended for patients w/ HTN plus diabetes? What do we need to avoid?

A

Give: ACE inhibitor/ARB first line (b/c they slow down the progression of proteinuria and diabetic nephropathy). Can combine w/ thiazide. Avoid beta-blockers or use w/ caution (b/c they can raise glycemia a bit, masking adrenergic symptoms of hypoglycemia).

25
Q

What drugs are recommended for patients w/ HTN plus post-MI/CAD? What do we need to avoid?

A

Give: Thiazide and combine w/ beta-blocker or ACE inhib/ARB. Use CCB or Nitrates as needed for angina. Nothing to avoid.

26
Q

What drugs are recommended for patients w/ HTN plus atrial fibrillation? What do we need to avoid?

A

Use beta-blocker or Diltiazem/verapamil for rate control.

27
Q

What drugs are recommended for patients w/ HTN plus bradycardia? What do we need to avoid?

A

Avoid beta-blockers and diltiazem/verapamil.s

28
Q

What drugs are recommended for patients w/ HTN plus Renal insuff? What do we need to avoid?

A

Give: ACE inhib/ARB (for proteinuria). Avoid: ACE inhib/ARB (when creatinine is elevated) and K+sparing diuretics (they are already prone to hyperkalemia).

29
Q

What drugs are recommended for patients w/ HTN plus renal stenosis? What do we need to avoid?

A

Avoid: ACE inhib/ARB b/c it can cause significant renal insuff.

30
Q

What drugs are recommended for patients w/ HTN plus BPH? What do we need to avoid?

A

Alpha-blocker.

31
Q

What drugs are recommended for patients w/ HTN plus hyperthyroidism? What do we need to avoid?

A

Propranolol.

32
Q

What drugs are recommended for patients w/ HTN plus Hyperparathyroidism? What do we need to avoid?

A

Give loop diuretics (loops lose calcium). Avoid thiazide (b/c it can raise the Ca2+).

33
Q

What drugs are recommended for patients w/ HTN plus Osteoporosis? What do we need to avoid?

A

Give Thiazide.

34
Q

What drugs are recommended for patients w/ HTN plus Gout? What do we need to avoid?

A

Avoid thiazide b/c they can raise uric acid.

35
Q

What drugs are recommended for patients w/ HTN plus Pregnancy? What do we need to avoid?

A

Give: Hydralazine, methyldopa, labetalol, or Dihydropyridine CCB. Avoid ACE inhib/ARB (b/c they are teratogenic).

36
Q

What drugs are recommended for patients w/ HTN plus Migraines? What do we need to avoid?

A

Give: CCB or beta-blockers.

37
Q

What drugs are recommended for patients w/ HTN plus Essential tremor? What do we need to avoid?

A

Propranolol.

38
Q

What is the best drug for hypertensive emergency and why?

A

Nitroprusside: It releases NO and increases cGMP. Dilates both arteries and veins, reducing both preload and afterload. Very short acting so it can be given in continuous IV infusion to get the BP just right. However, it can cause cyanide toxicity.

39
Q

Which antihypertensive class or drug is associated with the following side effects: First dose orthostatic hypotension.

A

Alpha1 -blockers (-zosins).

40
Q

Which antihypertensive class or drug is associated with the following side effects: ototoxic (esp. W/ aminoglycosides).

A

Loop diuretics.

41
Q

Which antihypertensive class or drug is associated with the following side effects: hypertrichosis.

A

Minoxidil.

42
Q

Which antihypertensive class or drug is associated with the following side effects: Cyanide toxicity.

A

Sodium Nitroprusside.

43
Q

Which antihypertensive class or drug is associated with the following side effects: dry mouth, sedation, severe rebound HTN.

A

Clonidine.

44
Q

Which antihypertensive class or drug is associated with the following side effects: Bradycardia, impotence, asthma exacerbation.

A

Beta-blockers.

45
Q

Which antihypertensive class or drug is associated with the following side effects: reflex tachycardia.

A

Nitrates, hydralazine, dihydropyridines.

46
Q

Which antihypertensive class or drug is associated with the following side effects: cough.

A

ACE inhibitors.

47
Q

Which antihypertensive class or drug is associated with the following side effects: avoid in patients w/ sulfa allergy.

A

Loop and thiazide diuretics.

48
Q

Which antihypertensive class or drug is associated with the following side effects: possible angioedema.

A

ACE inhib.

49
Q

Which antihypertensive class or drug is associated with the following side effects: possible development of drug-induced lupus.

A

Hydralazine.

50
Q

Which antihypertensive class or drug is associated with the following side effects: hypercalcemia, hypokalemia.

A

Loops and thiazide diuretics.

51
Q

Which antihypertensives are particularly beneficial to heart failure patients?

A

Proven to increase survival: ACE inhib, ARBs, Aldosterone antagonists, specific beta-blockers (Carvedilol, metoprolol, bisoprolol).

DIT Cardiology (22 decks)

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