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Cardio > Drugs used in HTN > Flashcards

Drugs used in HTN Flashcards

1
Q

How do diuretics work in treating HTN?

A

Lower BP by reduction of blood volume (and possibly a direct vascular effect).

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2
Q

How do you use a diuretic?

A

monotherapy or adjunctive with other antihypertensives (like beta blockers)

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3
Q

What type of diuretic is used in mild HTN?

What type of diuretic is used to treat severe HTN and used in hypertensive emergencies?

A

thiazides (ex. hydrochlorothiazide)

furosemide (loop diuretic)

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4
Q

People with what type of hypertension require diuretics?

A

patients with edematous conditions like heart failure and renal insufficiency and that have “volume dependent hypertension” with low renin have better responses

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5
Q

Why might a patient have a poor response to a diuretic?

A

overwhelmind load of dietary sodium or high renin (so impaired capacity to excrete sodium)

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6
Q

What is another name for CNS-Active Agents ?

A

alpha 2 agonists (ex. clonodine and methyldopa)

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7
Q

How do alpha 2 agonists work?

A

Agonists of postsynaptic alpha2 adrenoceptors in the RVLM that decrease sympathetic impulses from the RVLM to heart and blood vessels. These lower BP by reducing vascular resistance and decreasing CO. Use with “triple combinations”

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8
Q

What are other uses for clonodine? Why?

A

analgesic in neuropathic pain approved for ADHD–> because it releases endogenous opiates

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9
Q

What are some adverse effects of alpha 2 agonists?

A

sedation, drowsiness, fatigue (can cross BBB), rebound HTN (with clonodine)

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10
Q

What is the major compensatory response seen with alpha 2 agonists?

A

salt retention

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11
Q

What vasodilators release NO?

A

nitroprusside

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12
Q

Adverse effects of hydralazine.

A

very toxic (tachycardia, palpitations, salt retention) and can induce lupus (hemolytic anemia)

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13
Q

ROA and MOA of nitroprusside.

A

short-acting pro-drug agent that must be infused; releases NO and stimulates guanylyl cyclase to increase cGMP concentration in smooth muscle to RELAX arteries and veins. This increases TPR and induces venous pooling (decrease CO)

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14
Q

What vasodilators work by Opening potassium channels→hyperpolarizaiton.

A

Minoxidil

Diazoxide

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15
Q

MOA of minoxidil.

A

Prodrug that opens K+ channels to relax arteriolar smooth muscle. Only used in severe hypertension.

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16
Q

Compensatory responses of minoxidil and hydralazine.

A

Compensatory response is tachycardia and salt retention(increase in renin release) so must take with beta-blocker and diuretic

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17
Q

What is another use of minoxidil?

A

Can be used as topical agent for baldness (leads to hirsutism)

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18
Q

Which vasodilators work by blocking L-type calcium channels?

A

NifeDIPINE (prototype dihydropyridine calcium channel blocker) Verapamil, diltiazem

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19
Q

How do dihydopyridines work?

A

decrease BP by relaxing arteriolar SM and decreasing PVR (VERY FEW baroreceptor-mediated compensatory responses)

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20
Q

What vasodilator works to activate D1 dopamine receptors?

A

Fenoldopam

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21
Q

What are the 2 main types of angiotensin antagonists?

A

ACE inhibitors

ARBs

22
Q

List the ACE inhibitors?

A

captopril, Lisinopril, Enalapril, Ramipril

23
Q

What is the MOA of ACE inhibitors?

A

1) stop the conversion of angiotensin to angiotensin II, reduce blood levels of angiotensin II and aldosterone, and increase “kinin” vasodilators
2) Increase renal blood flow without increase in GFR

24
Q

What do you use ACE inhibitors for mainly?

A

best drug to treat CHF because dilated arteries and veins!

25
Q

What are the contraindications of ACE inhibitors?

A

pregnancy (2nd and 3rd trimesters)a
renal disease (renal artery stenosis)
high potassium diets

26
Q

What is the main adverse effects of ACE inhibitors? Why?

A

cough- when you inhibit ACE, you get increase in chymase (kinins) that can bind to receptors in the through and cause a cough
*angioedema also occurs

27
Q

What are ACE inhibitors used for?

A

congestive heart failure, renal protection in diabetes, and high-renin hypertension

28
Q

List the ARBs?

A

losartan, valsartan, Irbesartan, Telmisartan, candesartan

29
Q

What is the MOA of ARBs?

A

competitively inhibit antiotensin II at its AT1 receptor site. Cause vasodilation and increase sodium and water excretion to decrease TPR, plasma volume, CO and BP

30
Q

What are the adverse effects of ARBs?

A

not in pregnancy

lower incidence of cough compared to ACE inhibitors (no effect on bradykinin)

31
Q

What is the MOA of aliskiren?

A

inhibit renin’s actions on angiotensinogen

32
Q

What are the adverse effects of aliskiren?

A

diarrhea and headache

NO cough, avoided in human pregnancy

33
Q

List the 5 steps used for controlling HTN.

A
  • Lifestyle measures (diet, salt restriction, reduced weight)
  • Diuretics (a thiazide)
  • Sympathoplegics (a beta-blocker)
  • ACE inhibitor
  • Vasodilator (usually calcium channel blocker first)
34
Q

When is monotherapy used?

A

useful in patients with mild and moderate HTN and is becoming more popular due to its efficacy, simplicity, and low toxicity

35
Q

Both blacks and older people have poor responses to what type of antihypertensive?

A

beta blockers

36
Q

What do you give in a hypertensive emergency?

A

a vasodilator, diuretic, and beta blocker to lower BP to range of around 140-160/90-110).

37
Q

What is labetalol? When is it given?

A

non-selective beta + alpha 1 antagonist

ONLY in hypertensive emergencies

38
Q

What is carvedilol? What is its MOA?

A

non-selective beta + alpha 1 antagonist

1) Antioxidant (scavenges ROS)
2) Protects membrane from lipid peroxidation (prevents LDL oxidation and LDL uptake into coronary blood vessels)

39
Q

Carvedilol is used in what type of patients?

A

mild to moderate CHF and HTN patients

40
Q

What is Nebivolol? What is its MOA?

A

highly beta1 selective drug

1) NO mediated vasodilation
2) Antioxidant activity
3) Increase SV while maintaining CO

41
Q

What type of patients do you use Nebivolol on?

A

best beta blocker to treat metabolic syndrome

42
Q

What does captopril do that other ACE inhibitors do not?

A

increase synthesis of renal prostaglandins and delays progression of renal disease in diabetics

43
Q

What is the most potent vasoconstrictor in the body?

A

angiotensin II

44
Q

List the 5 major actions of angiotensin II.

A
  1. vasoconstriction
  2. increase thirst (to increase blood volume)
  3. stimulate release of ADH from pituitary
  4. stimulate zona glomerulosa in AC to release aldosterone (increase K+ aborb)
  5. cardiac and vascular hypertrophy
45
Q

What is special about the ARB losartan?

A

prodrug that it metabolized, competitive antagonist of Thromboxane A2 receptor to attenuate platelet aggregation, and INCREASES uric acid excretion

46
Q

What is the main type of patient you would treat with losartan?

A

hypertensive patient with gout

47
Q

What type of HTN do CCB’s like dihydropyridines best treat? What other disease does CCB treat?

A

low-renin hypertension (such as elderly subjects with systolic hypertension and African Americans) and CAD

48
Q

What is the MOA of hydralazine?

A

selective arteriolar smooth muscle relaxer (no effect on veins) that triggers reflex sympathetic stimulation to increase catecholamine and renin secretion to cause Na+ retention.

49
Q

When and why would you use nitroprusside?

A

Good for people who just had MI or who have ventricular failure, because you want as little blood putting a load on the heart as possible (dilation of arteries and veins reduces TPR so reduced afterload)

50
Q

What type of anti-hypertensive has been shown to provide secondary protection in CAD?

A

beta-blockers

51
Q

Which beta1 blocker is considered a standard treatment option with ACE inhibitors and diuretics?

A

bisoprolol

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