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Pharm Part II > E1: anti-HyperTensioN > Flashcards

E1: anti-HyperTensioN Flashcards

1
Q

HTN: Most common cardiovascular disease…Prevalence increases with age…Higher among the sex of _____ than _____…Higher among _______ populations….Individuals at age 55 with normal BP have a ____% lifetime risk for developing hypertension..WOAH

A

Higher among women than men..Higher among MINORITY populations: non-Hispanic blacks, non- Hispanics and Mexican Americans…90%

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2
Q

Did you know? Only ___% of patients with KNOWN

hypertension are treated!!!

A

50%. yes HALF that freaking know they have it!!!

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3
Q

What is the official name for idiopathic or primary HTN and it represents 85-90% of cases..?

A

Essential HTN

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4
Q

What type of HTN is associated with disease process of endocrine or renal system? Drugs: NSAIDS, birth control pills, decongestants, tricyclic antidepressants

A

Secondary HTN

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5
Q

What type of HTN develops in 5% of patients with primary or secondary HTN? BP very high or RAPIDLY rises; evidence of RETINAL and renal damage.

A

Malignant HTN

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6
Q

If a patient is showing signs of RETINAL Damage c/o HTN, what type of HTN are they most likely experiencing?

A

Malignant HTN

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7
Q

What is the first line of Tx for a Pt with HTN?

A

Life Style Changes!

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8
Q

What are the BP values used to determine need for intervention? ___/___ ˂ 60 years…____/____ ˃ 60 years

A

140/90 if younger than 60yrs…150/90 if older than 60

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9
Q

What are the 3 basic methods we can lower BP?

A
  1. Reduce Peripheral Resisitance (block the SympNS) 2.Reduce CO 3.Decrease blood Volume
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10
Q

What are the 3 classes of Diuretics?

A

1.Thiazides 2.Loop 3.Potassium Sparing

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11
Q

How do most diuretics work?

A

They block the REABSORPTION of Na+ (so its filtered and secreted, but not reabsorbed)

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12
Q

What is the typical FIRST line defense for treating HTN in America?

A

DIURETICS!

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13
Q

What 3 places in the nephron do MOST of the diuretics work?

A

Ascending Loop, D conv tubule, collecting duct…(there are some that work on the proximal, so really everywhere!

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14
Q

Mech of action for Mercury Diuretics: Block Na+ reabsorption by releasing mercury ions to interact with the _______ group of the Na+ transport receptors in tubules

A

sulfhydryl group

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15
Q

What was the first class of diuretics that are no longer on the market? (for good reason!)

A

mercurials

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16
Q

What is the helpful tool for naming mercurial diuretics?

A

they begin with “mer”..mercaptomerin (Thiomerin); meralluride (Mercuhydrun)

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17
Q

First choice agents for hypertension and congestive heart failure**

A

Thiszides (BenzoThiaZides)…(most commonly Rx’d diuretics)

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18
Q

Thiazides (benzothiazides) Inhibition of active Na+ reabsorption in which two areas of the nephron??

A

proximal and distal tubules

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19
Q

Mech of action-Thiazides: inhibition of _________ = decreased availability for H+ exchange with Na+

A

carbonic anhydrase (breaks up bicarb in lumen, puts bicarb back together in tubule)

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20
Q

Desired Effects of Thiazide Diuretics: Lower blood pressure: Decreased _______ volume…Decreased _______ fluid

A

plasma… extracellular

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21
Q

Desired Effects of Thiazide Diuretics: Decreased _______- thanks to STARLINGS law (if decrease amount of blood returning to the heart (preload), heart doesn’t have to work as hard to eject blood back into the systemic circulation)

A

cardiac output

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22
Q

Desired Effects of Thiazide Diuretics: Normalization of cardiac output after how long???

A

several days

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23
Q

What are the two main oral complications from HCTZ?

A

Xerostomia & lichenOID reaction

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24
Q

What is the main adverse affect of thiazide diuretics?

A

HYPOKALEMIA (K+ follows Na+ out in the urine) (more Na+ eaten, more K+ loss!)

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25
Q

What are 5 of the main adverse effects of thiazide diuretics? (10 total)

A

1.HypoKalemia 2.HYPERglycemia 3.Elevated cholesterol 4.Weakness/Fatigue 5.Sexual Dysfxn…(others: loss of bicarb, low Mg+,low Na+, HyperUricemia, elevated TAGs)

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26
Q

Since were talkin bout adverse effects of thiazides, they are not good for _____ patients and patients with high ______.

A

diabetes (hyperglycemia a side effect) and high lipid/cholesterol(another side effect)

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27
Q

What are the drugs that cause a MAJOR loss of plasma volume and are the go to for serious edema?

A

Loop Diuretics

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28
Q

Loop diuretics result in a major loss of ____ and ____ = serious electrolyte imbalances may result

A

Na+ and K+

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29
Q

How do Loop Diuretics work?? Potent inhibition of active Na+ reabsorption in the _________ by blocking reabsorption of ___….Inhibits the _____ “symporter”

A

ascending Loop of Henle..Cl-..Na+K+Cl-

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30
Q

Which class of drugs are notorious for OTOTOXIC effects( hearing loss/deafness)????

A

LOOP DIURETICS

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31
Q

What are the two most common preparations for thiazide diuretics?

A

1.HydroChloroThiaZide (HCTZ) 2.chlorothiazide (Diuril)

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32
Q

What is the most common Loop Diuretic preparation? What is the second loop diuretic she emphasized?

A

furo-sem-ide (Lasix)…eth-ac-ryn-ic acid (Edecrin)

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33
Q

A lot of the adverse effects of Loop diuretics are similar to thiazide diuretics, but these 2 are a bit different…

A

1.Nephrotoxicity (when used with cephalexin (keflex)) 2.OTOTOXICITY

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34
Q

What is a good way to see that a thiazide or loop diuretic has caused a lichenOID reaction and NOT lichen planus???

A

lichenOID will be on the lips! REAL lichen planus is not.

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35
Q

Potassium-SPARING diuretics: Competes with _______ for receptor sites in the ____ renal tubules, increasing Na+, Cl- and water excretion while CONSERVING K+ and ____.

A

adosterone…distal…conserving K+ AND H+

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36
Q

Potassium-SPARING diuretics: Blocks the effect of _________

A

aldosterone

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37
Q

Interesting! 5 Adverse effects of Potassium-SPARING diuretics:

A

1.HyperKalemia 2.Gynecomastia 3.Tenderness of breasts in young women 4.Menstrual irregularities 5.decreased libido in males

38
Q

Mechanism: Carbonic Anhydrase Inhibitors. Also what is the strength of this diuretic? Where does it act on the nephron?

A

CA usually allows for Na+ reabsorption, when we inhibit it we excrete more Na+ and hold onto H+. It is a MILD diuretic. Proximal & distal convoluted tubules.

39
Q

What is the main indication for a Carbonic Anhydrase Inhibitor?

A

Glaucoma!

40
Q

When do we use OSMOTIC diuretics? Where do they work? What is the preparation name?

A

EMERGENCY renal failure….bowman’s capsule/proximal tubule (drug is filtered and NOT reabsorbed..water follows)…prep: urea(Ureaphil)

41
Q

What is the situation for Acidifying Diurectics? How does it work? What is the preparation?

A

EMERGENCY tx of metabolic alkalosis…increases Cl- and Na+ into urine (keeps H+ in blood)…Ammonium Chloride

42
Q

THE 3 WAYS Xanthines Work!!! 1. stimulate cardiac function to increase renal blood flow and ______. 2. They also inhibit tubular reabsorption of ___. 3.THEY ALSO inhibit the hormone ___.

A

1.GFR…interesting! coffee is AWESOME…2. Na+…3. ADH

43
Q

Rank the potency of the 4 most regularly used diuretics.

A

Most potent: 1.Loop 2.Thiazide 3.Carbonic Anhydrase 4.Potassium-SPARING

44
Q

DENTAL considerations for Diuretics: MAJOR ONE due to water loss.

A

Xerostomia

45
Q

DENTAL considerations for Diuretics: another term for mouth ulcers

A

Aphthous stomatitis

46
Q

DENTAL considerations for Diuretics: delayed drug hypersensitivity that looks like something else. Caused by WHICH two diuretics???

A

LichenOID….loop and thiazide

47
Q

DENTAL considerations for Diuretics: the use of _____ for more than 3 weeks can decrease the effectiveness of diuretics!!

A

NSAIDS!!! REMEMBER THIS!!!!

48
Q

What do a lot of patients take to counteract the loss of K+ with diuretics? What do they all start with? What is a major adverse affect?

A

Potassium supplements…K in the name (K-Tab, Klor-Con)…adverse-GI distress

49
Q

Think REAL hard…which HTN family is K+ supplements contraindicated with?

A

ACE Inhibitors

50
Q

What affect does Blocking Beta1’s have on vessels?

A

reduce peripheral resistance (a normal symp NS response)

51
Q

What are the two classes of Beta Blockers and what is the MAGICAL way to distinguish them by name? WHAT IS THE ONLY EXEPTION (damn new drug!)

A

CardioSelective (A-M) and Non-CardioSelective (N-Z)…ALPHABETICALLY!…exception: NEB-iv-o-LOL

52
Q

What are the main reasons for side effects when using beta blockers? What is Dr. S’ nickname for these people with sideffects?

A

over-activity of the ParasymNS (we are blocking the Sym!)..FAINTERS & FALLERS

53
Q

What is the counterintuitive side effect of beta blockers?

A

xerostomia! although we are getting MORE parasym stimulation, Pt’s get a ‘sticky’ mucus.

54
Q

What are the 4 contraindications for Rxing Beta Blockers?

A

1.Congestive Heart Failure 2.Asthma (can use selective blocker) 3.Heart Block 4.Diabetes

55
Q

Which blockers produce peripheral vasodilation in arterioles and venules, decreasing peripheral vascular resistance? Who are they usually Rx’d to? What are they usually paired with to make them more effective?(2)

A

Alpha 1!!…OLD MEN (they help BPH!!!)..usually paired with diuretics and/or beta blockers

56
Q

Whats the numero uno adverse effect of alpha blockers?

A

othrostatic hypOtension

57
Q

What are the 3 Alpha1 blockers that “everyone should know”?

A

1.dox-az-OSIN 2.pr-az-OSIN 3.tam-sul-OSIN (flowmax)

58
Q

What do ACE inhibitors all end in?

A

“-pril”

59
Q

ACE inhibitors prevent conversion of angiotensin I to angiotensin II, “______ing” vasoconstriction

A

angiotensin I to angiotensin II…inhibiting vasoconstriction

60
Q

ACE inhibitor results in lower levels of angiotensin II, which causes an increase in plasma _____ activity and a reduction in ________ secretion.(among MANY other effects! A-II is POWERful!)

A

RENIN…aldosterone

61
Q

What is the drug of choice for HTN in diabetes patients? (you think this IMPORTANT?!?!?!? :)

A

ACE inhibitor- LISIN-O-PRIL

62
Q

What is a very common side effect of ACE inhibitors? What is causing it? Why should we watch it as oral physicians?

A

Chronic Dry Chough…so annoying!….bradykinin in lungs….CARIES c/o lozenges/cough syrups

63
Q

What is a secondary side effect with ACE inhibitors?

A

AngioNeurotic Edema (with the FIRST dose!) (eye and lip swelling)

64
Q

Which ACE inhibitor is the ORIGINAL GANGSTER in its class? Which ACE Inhibitor is the biggest market seller in the US?

A

O.g: EN-AL-a-pril….biggest market seller: LI-SIN-o-pril

65
Q

What are the 3 mechanisms of Action for Angiotensin Receptor Blockers? (if you get the first one wrong I will kill you)

A

1.Blocks Vasoconstrictor and 2. Aldosterone-secreting effects of Angiotensin II….3.increases RENIN (which causes vasodilation, decreased sodium and water retention.

66
Q

Which is more preferred: ACE inhibitor OR Angiotensin Receptor Blockers?? WHYYYY? (2)

A

ARBs!!! 1.specific site of action 2.less side effects!

67
Q

What are the two most common Angiotensin Receptor Blockers? What do these drugs usually end in?

A

end in “-artan”……1. Lo-sar-tan 2.val-sar-tan

68
Q

NEW DRUGS!!! What name and mech of action for the NEW RENIN inhibitors??

A

ALI-SKI-REN……binds to Renin and therefore decreases levels of angiotensin I, II, and aldosterone

69
Q

Ca2+ Channel Blockers…Drop some knowledge! Inhibits calcium ion from entering the “slow channels” or select voltage-sensitive areas of ________ and ________ during depolarization.

A

vascular smooth muscle…myocardium

70
Q

Ca2+ Channel Blockers…Drop some knowledge! Produces _______ of coronary vascular smooth muscle and coronary ________.

A

relaxation…vasodilation

71
Q

Ca2+ Channel Blockers…Drop some knowledge! Increases myocardial _______ delivery (good for angina too)

A

oxygen

72
Q

What are the 3 indications for the use of Ca2+ blockers?

A

1.HTN 2.Angina 3.Arrhythmias

73
Q

What are the 3 main Ca2+ channel blockers? YOU BETTER NOT GET at least one of these!!! ALSO…which one is the NEWEST? Oldest?

A

1.Ni-fed-ipine!! (gingival hyperplasia) 2.verapamil (original gangster 8% chance of gong overgrowth) 3.Aml-od-ipine (newest #1 in sales)

74
Q

Speaking of Ca2+ channel blockers and gingival hyperplasia…how long until we know the extent of this side effect? DOES oral hygiene have an effect?

A

3 months will tell you a lot..YEP, Dr. Spolarich did the research!

75
Q

What are the 2 names of the Alpha2 agonists acting on the CNS?

A

clon-id-ine(catapres)…guan-fac-ine

76
Q

Clonidine activates alpha2 receptors on the brainstem which activates an inhibitory neuron…sooooo WHAT is the overall effect on the Sympathetic NS??

A

Decreases sympathetic outflow from CNS

77
Q

What are the three main side effects of clonidine?

A

1.Xerostomia 2.Parotid Gland Swelling 3. Dysgeusia

78
Q

What are the ‘not really used any more’ drugs that block granular uptake and storage (depletion) of norepinephrine = decrease sympathetic activity due to lack of neurotransmitter supply

A

Catecholamine Release Blockers

79
Q

What are the two catecholamine release blockers? Which one crosses the BBB for schizophrenia? Which one blocks APs?

A

Res-er-pine (BBB) & Guanethidine (blocks AP)

80
Q

Catecholamine Release Blockers are CONTRAINDICATED in patients with _________.

A

PEPTIC ULCERS

81
Q

You think this is important???Dental Drug Interactions with Antihypertensive Medications!!! Enhanced hypotension with general anesthetics and ________.

A

CNS depressants (clonidine, reserpine)

82
Q

You think this is important???Dental Drug Interactions with Antihypertensive Medications!!! Prolonged action of _________, sedatives and tranquilizers (think central acting drugs)

A

analgesics

83
Q

You think this is important???Dental Drug Interactions with Antihypertensive Medications!!! Use EPINEPHRINE with caution– Remember safe cardiac dose of epinephrine = _____ mg – Always take ____ prior to injection of local anesthetics

A

0.04 mg…BP

84
Q

You think this is important???Dental Drug Interactions with Antihypertensive Medications!!! OTC sympathomimetics (_____ capsules and _____ tablets) may counteract antihypertensive therapy.

A

cold…asthma

85
Q

You think this is important???Dental Drug Interactions with Antihypertensive Medications!!! Use of NSAIDS for longer than ________ may decrease effectiveness of some diuretics, beta blockers and ACE inhibitors
– Worst offender: indomethacin

A

3 weeks…in-do-meth-acin (an NSAID)

86
Q

You think this is important???Dental Drug Interactions with Antihypertensive Medications!!! What are the 2 actions of Nicotine in cigars and cigarettes?

A

constricts blood vessels and increases blood pressure

87
Q

Dental Considerations with Antihypertensive Medications: Prevent sudden changes in _______

A

posture

88
Q

Dental Considerations with Antihypertensive Medications: Tissue retraction with vasopressors (e.g. impregnanted gingival retraction cord) is ____________!!!!!

A

CONTRAINDICATED!!!!

89
Q

Dental Considerations with Antihypertensive Medications: ________ hypertension may develop if antihypertensive agents are abruptly withdrawn

A

Rebound

90
Q

REMEMBER!!! Diuretics make you ______ potassium

A

LOSE

91
Q

REMEMBER!!! ACEI and ARBs _________ potassium

A

INCREASE

Pharm Part II (28 decks)

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