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Pharmacology > Cardio: Drugs for HTN and HTN Emergency/Urgency > Flashcards

Cardio: Drugs for HTN and HTN Emergency/Urgency Flashcards

1
Q

What are the first line drugs used to treat HTN?

A

Thiazides
ACEi
ARBs
CCBs (both dihydropyridines/Non-dihyropyridines)

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2
Q

What are the secondary drugs for HTN?

A

Loop and K+ sparing Diuretics
B-Blockers (Cardio and Non-cardio)
a-1 blockers (-osins)
Aliskiren (direct renin inhibitors)
Central a-2 blockers (a-methyl-dopa and clonidine)
Direct Vasodilators (hydralazine, minoxidil)

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3
Q

MOA of Thiazides

A

Block NaCl in the DCT
-lowers Na, which lowers water and BP

Ca is reabsorbed in Proximal Tubule due to volume contraction

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4
Q

Clinical application of HCTZ?

A

HTN alone or with other hypertensives

Edema

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5
Q

Off label use of HCTZ

A

Calcium Nephrolithiasis prevention

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6
Q

Adverse effects of Hydrochlorothiazide?

A

Hypotension,
Electrolyte and Water depletion
Hypercalcemia, Hyperglycemia, Hyperuricemia

Sulfa allergy*

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7
Q

Preferred thiazide for HTN specialists?

A

Chlorthalidone

-longer halflife

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8
Q

Preffered thiazide for cardiologists?

A

Metolazone

-longer acting, great for HF

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9
Q

MOA of Amiloride

A

Blocks EnaC channels in collecting duct

-less H2O means lower BP

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10
Q

Clinical applications of amiloride

A

Blocks K+ loss in Loop/other diuretics

Also for ascites, Pediatric HTN

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11
Q

Adverse effects of amiloride?

A

Hyperkalemia

Hyponatremia, hypovolemia, metabolic acidosis

Dizziness, N/V

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12
Q

What should you monitor with ACEi or ARBs?

A

Serum creatine
-will increase shortly after giving it to pts

Also watch for Hyperkalemia

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13
Q

MOA of Aliskiren

A

Direct Renin inhibitor

-decreases ATII without increase in Bradykinin activity

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14
Q

Why would you stop ACEis? (main reason)

A

Angioedema

-can be deadly!

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15
Q

What are the a-receptor blockers and what is their MOA?

A

Phentolamine
-competitive a-receptor blocker

Phenoxybenzamine
-non-competitive a-receptor blocker

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16
Q

Adverse effects of phentolamine/phenoxybenzamine?

A

Hypotension, orthostatics, tachycardia (reflex), cardiac arrythmias

Miosis is for phenoxybenzamine

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17
Q

MOA of Prazosin? (and other osins)

A

competitively blocks a-1 receptors

-leads to vasodilation of veins, decreasing PVR and BP

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18
Q

Clinical applications of Prazosin

A

Late choice for HTN and PTSD

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19
Q

Toxicities associated with prazosin

A

Orthostatics, edema, palpitations, increase in urinary frequency, nasal congestion

and more

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20
Q

When would you use tamsulosin, terazosin?

A

Marketed specifically for BPH and to help pass kidney stones

-“potential drug for old man in wheelchair”

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21
Q

MOA of Clonidine?

A

Alpha-2 receptor agonsit

-results in transient increase in BP, followed by decreased sympathetic outflow so decrease in BP

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22
Q

Clinical applications for clonidine?

A

Oral tablets/patch for HTN
ADHD
Given for Severe cancer pain

23
Q

Adverse effects of clonidine?

A

Drosiness, headache, fatigue
Xerostomia
Rebound HTN if dose missed**

24
Q

MOA of a-methyldopa

A

a-2 agonist

-great for HTN due to reducing sympathetic flow

25
Q

Clinical applications of a-methyldopa

A

Moderate to severe HTN

Drug of choice for gestational HTN**

26
Q

Adverse effects of a-methyldopa

A 
Bells Palsy
Angina aggrevation
Orthosatitcs
Positive direct Coombs teset**
SLE like syndrome**
27
Q

MOA of propranolol

A

Nonselective B blocker

-decreases HR and contractility=decrease BP

28
Q

Clinical applications of propranolol

A 
HTN
Angina Pectoris
Essential tremor
V-tach
Prevention of MI
Migraine
29
Q

Adverse effects of Propranolol?

A

Bronchospasm, dyspnea, cold extremities

bradycardia, AV block, heart failure

30
Q

Is propranolol indicated for PVD?

A

No, can worsen the cold extremities

31
Q

MOA for atenolol

A

Cardioselective B-1 antagonist

-slows HR and contractility to decrease O2 demand

32
Q

Clinical applications ofr Atenolol

A

HTN
Angina Pectoris
Secondary MI prevention
A-fib

33
Q

Toxicities with atenolol

A

bradycardia, AV block, heart failure, chest pain, cold extremities

34
Q

What makes metoprolol and bisprolol different in the category of B-1 antagonists?

A

Metoprolol is more lipid soluable, so has more CNS adverse effects

Bisoprolol is the most selective for B-1

35
Q

What happens if an a-2 agonist or B-blockers is stopped abruptly?

A

Rebound sympathetic activity and death

36
Q

Why has B-blocker use declined in recent years?

A

Does not prevent MI, HF or death as well as other therapies

Highest risk of stroke**

37
Q

MOA of hydralazine

A

Vasodilator of Arterioles!

-reduced afterload, lower BP

38
Q

When would you use hydralazine?

A

HTN emergency in pregnancy

HF that doesnt respond to ACEi/ARBs

39
Q

Adverse effects of Hydralazine? (big 2)

A

Drug induced lupus*
Worsens angina pectoris or CAD

Many others

40
Q

MOA of Nitroprusside?

A

Vasodilator of Veins and Arterioles

-decrease Afterload, increase CO

41
Q

Clinical use of nitroprusside

A

HTN emergency
ADHF
HTN during surgery

42
Q

Adverse effects of nitroprusside?

A

Flushing, HTN, orthostatics, tachycardia (reflex)

Cyanide toxicity**
-tinnitis, seizures, lactic acidosis

43
Q

MOA of Minoxidil

A

Relaxes arterioles

-lowers vascular resistance=lower BP

44
Q

Clinical applications of minoxidil

A

HTN emergency

45
Q

Adverse effects of minoxidil

A

ECG changes (t-wave), pericardial effusion

Hypertrichosis (hair growth)

46
Q

What do you use to treat HTN in stable ischemic heart disease?

A

B-blockers
-slide 83

Can add CCBs and diuretics if goal not met

47
Q

How do you treat HTN in CKD?

A

ACEi or ARBs

48
Q

Are non-dihydropyridine CCBs recommended for HTN in those w HFrEF?

A

No, contraindicated

49
Q

How do you treat HTN in those with HFpEF

A

Diuretics for symptoms, and if HTN persists then add ACEi or ARBs+B-blocker

50
Q

How do you treat HTN after renal transplantation?

A

Calcium antagonist

-CCB?

51
Q

How do you treat HTN in those with a-fib?

A

ARBs are first line choice

52
Q

How do you manage HTN in those with aortic disease?

A

B-blockers

53
Q

What drugs are used in HTN emergencies?

A 
CCBs (nicardipine, cleviidipine)
Nitrates
Hydralazine (pregnancy)
Esmolol
Labetalol
Phentolamine
Fendolapam (great for kidney damage)
Enalaprilat (ACEi)

Pharmacology (50 decks)

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