Cardiovascular 2 Anti-hypertensives Flashcards
Drug class for Propranolol
sympatholytics: peripheral adrenergic ‘r’ blockers-beta blockers
MoA for Propranolol
adrenergic B1 & B2 receptor inhibitor: reduction in myocardial oxygen demand
Indications for Propranolol
angina, HTN, tachyarrhythmias, essential tremor, migraine Px, anxiety
SE/ADRs for Propranolol
fatigue, sleep disturbance, depression
Contra-indications for Propranolol
hypersensitivity, bradycardia, heart block, uncompensated HF, severe depression, bronchospasm
Dx-Dx interactions for Propranolol
ethanol (may increase or decrease conc)
Monitoring for Propranolol
BP, chest pain, HR, LFTs
What might Propranolol mask?
hypoglycemia
Drug class for Metoprolol
sympatholytics: peripheral adrenergic ‘r’ blocker-beta blocker
MoA for Metoprolol
selective B1 adrenergic receptor inhibitor
Indications for Metoprolol
angina, HTN, hemodynamically stable post MI
SE/ADRs for Metoprolol
fatigue, sleep disturbance, depression, bradycardia, rebound angina/HTN, hypotension
Contra-indications for Metoprolol
hypersensitivity, bradycardia, heart block, uncompensated heart failure, severe depression
Dx-Dx interactions for Metoprolol
multiple
Monitoring for Metoprolol
BP, HR, LFTs
Drug class for Atenolol
sympatholytics: peripheral adrenergic ‘r’ blockers-beta blockers
MoA for Atenolol
selective B1 adrenergic receptor inhibitor
Indications for Atenolol
angina, HTN, hemodynamically stable post MI
SE/ADRs for Atenolol
fatigue, sleep disturbance, depression, bradycardia, rebound angina, HTN, hypotension
Contra-indications for Atenolol
hypersensitivity bradycardia, heart block, uncompensated heart failure, severe depression
Dx-Dx interactions for Atenolol
multiple
Monitoring for Atenolol
BP, HR, eGFR
Drug class for Prazosin
alpha-blocker
MoA for Prazosin
selective alpha1 blocker which relaxes smooth muscle in arteries, veins, & prostate
Indications for Prazosin
HTN, off-label: PTSD, Raynaud’s phenomenon
SE/ADRs for Prazosin
postural hypotension, nausea, drowsiness, syncope, palpitations, dizziness, ‘floppy iris’ syndrome
Contra-indications for Prazosin
orthostatic hypotension
Dx-Dx interactions for Prazosin
PDE-5 blockers (Tadalafil), anti-hypertensive meds
Monitoring for Prazosin
BP, BUN, eGFR, syncopal episodes
PG category for Prazosin
C but avoid
Drug class for Carvedilol
B1, B2, A1 blockers
MoA for Carvedilol
mixed alpha, beta receptor inhibitor
Indications for Carvedilol
angina (off label), HTN, stable HF, stable post MI
SE/ADRs for Carvedilol
fatigue, sleep disturbance, depression, bradycardia, rebound angina/HTN, hypotension
Contra-indications for Carvedilol
hypersensitivity, bradycardia, heart block, uncompensated HF, severe depression, bronchospasm, severe liver failure
Dx-Dx interactions for Carvedilol
multiple
Monitoring for Carvedilol
BP, HR, eGFR, LFTs
Drug class for Clonidine
centrally acting A2 agonist
MoA for Clonidine
stimulates A2 receptors in brain stem which stimulates inhibitory neuron resulting in reduced sympathetic outflow from CNS which results in reduction in TPR
Indications for Clonidine
HTN (immediate release form), ADHD (extended release form), Narcotic addiction
SE/ADRs for Clonidine
bradycardia, drowsiness, HA, rash, xerostomia, weakness
Contra-indications for Clonidine
pre-existing CNS depression, severe CAD, caution in CKD, recent AMI, stroke
Dx-Dx interactions for Clonidine
meds altering AV/SA nodal function, ethanol
Monitoring for Clonidine
BP, mental status, HR
PG category for Clonidine
C but avoid
Drug class for Methyldopa
centrally acting A2 agonist
MoA for Methyldopa
central alpha-adrenergic inhibition decrease sympathetic outflow to heart, kidneys, peripheral vasculature
Indications for Methyldopa
HTN in PG
SE/ADRs for Methyldopa
depression, anxiety, dry mouth, hemolytic anemia, liver disease, edema
Contra-indications for Methyldopa
hepatic disease
Dx-Dx interactions for Methyldopa
MAO inhibitors
Monitoring for Methyldopa
LFT, CrCl, BP, eGFR
Drug class for Captopril, Lisinopril, Fosinopril
renin-angiotensin inhibitors: ACEI
MoA for Captopril, Lisinopril, Fosinopril
competitive inhibitor of ACE preventing conversion of A1 to A2, decreasing vasoconstriction by A2 & decreases aldosterone secretion
Indications for Captopril, Lisinopril, Fosinopril
HTN, HF, LV dysfunction after MI, diabetic nephropathy
SE/ADRs for Captopril, Lisinopril, Fosinopril
cough, hyperkalemia, angioedema
Contra-indications for Captopril, Lisinopril, Fosinopril
hx angioedema, concurrent use of Aliskerin in diabetic patients, bilateral renal artery stenosis, PG; not w/ ARBs
Dx-Dx interactions for Captopril, Lisinopril, Fosinopril
don’t use w/ ARBs, Aliskerin
Monitoring for Captopril, Lisinopril, Fosinopril
BP, serum, K+, eGFR, BUN, weight, CBC, liver function
PG category for Captopril, Lisinopril, Fosinopril
D
Drug class for Losartan
angiotensin receptor blockers: ARBs
MoA for Losartan
selectively & competitively blocks AT1 & AT2
Indications for Losartan
HTN, diabetic nephropathy in T2DM, stroke risk reduction in HTN, LVH
SE/ADRs for Losartan
esp in people w/ T2DM: chest pain, fatigue, hypoglycemia, diarrhea, UTI; hyperkalemia
Contra-indications for Losartan
not w/ Aliskerin or ACE inhibitors
Dx-Dx for Losartan
multiple (see contra-indications)
Monitoring for Losartan
BP, K+, eGFR, BUN, CBC, HR, wt
PG category for Losartan
do not use
What does Losartan increase the excretion of?
uric acid
Drug class for Aliskirin
direct renin inhibitor
MoA for Aliskirin
direct rening inhibitor that prevents conversion of angiotensinogen to AT1 which reduces conversion to AT2 producing arteriolar vasodilation
Indications for Aliskirin
HTN
SE/ADRs for Aliskirin
hyperkalemia, hypotension
Contra-indications for Aliskirin
don’t use w/ ACEI’s or ARB’s, hereditary or prior angioedema, concomitant use w/ Itraconazole
Dx-Dx interactions for Aliskirin
decrease effect of Furosemide, NSAIDs decrease effect of Aliskirin, not w/ grapefruit juice
Monitoring for Aliskirin
BP, serum K+, BUN, serum creatinine
PG category for Aliskirin
PG D
Drug class for Amlodipine
vasodilator: CCB DHP
MoA for Amlodipine
vasodilation due to blocking Ca channels in vascular smooth muscle & myocardium
Indications for Amlodipine
angina (chronic stable & vasospastic), HTN
SE/ADRs for Amlodipine
nausea, palpitations, peripheral edema, elderly-hypotension
Contra-indications for Amlodipine
hypersensitivity
Dx-Dx interactions for Amlodipine
grapefruit juice
Monitoring for Amlodipine
BP, chest pain
Drug class for Nifedipine
vasodilator: CCB DHP
MoA for Nifedipine
vasodilation due to blocking Ca channels in vascular smooth muscle & myocardium
Indications for Nifedipine
angina (chronic stable & vasospastic), HTN
SE/ADRs for Nifedipine
nausea, HA, palpitations, peripheral edema, elderly-hypotension
Contra-indications for Nifedipine
hypersensitivity
Dx-Dx interactions for Nifedipine
grapefruit juice
Monitoring for Nifedipine
BP, chest pain
Drug class for Diltiazem
vasodilators: CCB NDHP
MoA for Diltiazem
dilate coronary arteries & decrease myocardial oxygen demands
Indications for Diltiazem
angina, HTN, A fib, A flutter, PSVT
SE/ADRs for Diltiazem
edema, HA, dyspepsia
Contra-indications for Diltiazem
bradycardia, SSS if no pacer
Dx-Dx interactions for Diltiazem
grapefruit juice
Monitoring for Diltiazem
BP, chest pain, LFTs
Drug class for Verapamil
vasodilators: CCB NDHP
MoA for Verapamil
dilate coronary arteries & decrease myocardial oxygen demands
Indications for Verapamil
angina, HTN, A fib, A flutter, PSVT
SE/ADRs for Verapamil
HA, gingival hyperplasia, constipation, fatigue
Contra-indications for Verapamil
bradycardia, SSS if no pacer
Dx-Dx interactions for Verapamil
grapefruit juice
Monitoring for Verapamil
BP, chest pain, LFTs
NDHP CCBs (Diltiazem & Verapamil) should not be used in combo with?
beta blockers
Drug class for Hydralazine
vasodilator: direct acting
MoA for Hydralazine
direct acting arteriolar vasodilator
Indications for Hydralazine
urgent to emergent BP reduction; preclampsia & eclampsia
SE/ADRs for Hydralazine
angina, orthostatic hypotension, depression, peripheral neuritis, SLE-like syndrome
Contra-indications for Hydralazine
mitral valve rheumatic heart disease, CAD
Dx-Dx interactions for Hydralazine
anti-hypertensive meds
Monitoring for Hydralazine
BP, HR, CBC, ANA
PG category for Hydralazine
PG C but avoid if possible
Drug class for HCTZ
diuretics: thiazides
MoA for HCTZ
Na-Cl symporter inhibition in DCT increasing Na & Cl excretion max 5% of filtered NaCl
Indications for HCTZ
HTN, edema in nephrotic syndrome, lithium induced diabetes insipidus (off label)
SE/ADRs for HCTZ
rare vertigo, anorexia, nausea, photosensitivity, QT prolongation, hypokalemia
Contra-indications for HCTZ
sulfa sensitivity, hypersensitivity
Dx-Dx interactions for HCTZ
beta blockers increase risk of hyperglycemia, may decrease renal excretion Li; NSAIDs
Monitoring for HCTZ
serum K+, glucose, BP
Drug class for Chlorthalidone
diuretics: ‘thiazide-like’
MoA for Chlorthalidone
Na-Cl symporter inhibition in DCT increasing Na & Cl excretion max 5% of filtered NaCl
Indications for Chlorthalidone
HTN, edema in nephrotic syndrome, lithium induced diabetes insipidus (off label)
SE/ADRs for Chlorthalidone
rare vertigo, anorexia, nausea, photosensitivity; QT prolongation, hypokalemia
Contra-indications for Chlorthalidone
sulfa sensitivity, hypersensitivity
Dx-Dx interactions for Chlorthalidone
beta blockers increase risk of hyperglycemia, may decrease renal excretion Li; NSAIDs
Monitoring for Chlorthalidone
serum K+, glucose, BP
Drug class for Triamterene
diuretic adjunct: K+ sparing
MoA for Triamterene
direct inhibitor of Na influx in DCT & CCT
Indications for Triamterene
hypokalemia
SE/ADRs for Triamterene
hypotension, edema, constipation, dyspnea, hyperkalemia
Contra-indications for Triamterene
hypersensitivity, hyperkalemia
Dx-Dx interactions for Triamterene
other K+ retaining drugs
Monitoring for Triamterene
serum electrolytes, CrCl, BUN