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Pharmacology (Dale Turley) > Exam 5 - HTN part II > Flashcards

Exam 5 - HTN part II Flashcards

1
Q

Beta Blockers are competitive ___________ that block the receptor sites for the endogenous ______________ epinephrine (adrenaline) and norepinephrine ( noradrenaline)

A

antagonist

catecholamines

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2
Q

Beta Blockers block adrenergic beta receptors, of the ___________ nervous system , which mediates the flight-or-fight response.

A

sympathetic

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3
Q

Common uses for BB’s?

A 
HTN
Angina
Cardiac Arrhythmias
Migraine prophylaxis
Mitral Valve Prolapse
Acute Aortic Dissection - 
Hypertrophic Obstructive Cardiomyopathy
Anxiety - BB
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4
Q

Use of beta blockers around the time of cardiac surgery decreases the risk of heart _____________.

A

dysrhythmias

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5
Q

Non-selective beta blocker agents ?

A 
Propranolol
Carvedilol 
Labetalol 
Nadolol
Sotalol
Timolol
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6
Q

Some beta blockers exhibit _________ ______________ activity .

A

intrinsic sympathomimetic activity (ISA).

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7
Q

ISA agents are capable of exerting low-level agonist activity at the __________________ while simultaneously acting as a receptor site antagonist.

A

β-adrenergic receptor

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8
Q

BB Agents with ISA are not used after what?

A

MI

Also be less effective than other beta blockers in the management of angina and tachyarrhythmia

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9
Q

Beta-1 selective agent examples?

A

EMAA

Atenolol
Metoprolol
Acebutolol
Esmolol

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10
Q

What are the two types of CCB’s?

A

Dihydropyridine

Non-dihydropyridine

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11
Q

Dihydropyridine is _____ acting.

A

short

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12
Q

Non-dihydropyridine is ____ acting.

A

long

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13
Q

CCB’s MOA?

A

Inhibit calcium ions from entering slow or voltage-gated channels seen in

Vascular smooth muscle - Relaxation of blood vessels - vasodilation

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14
Q

CCB’s effects on myocardium?

A

Depress SA node activity

Slow AV node conduction

Reduce cardiac contractility

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15
Q

CCB’s examples Verapamil (Calan, Isoptin),

Diltiazem (Cardizem) act on _____ and _____ _______.

A

heart

blood vessels

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16
Q

Amlodipine (Norvasc), nifedipine (Procardia), and all other calcium channel blockers act primarily on what?

A

blood vessels

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17
Q

Nicardipine (Cardene)?

A

AHA stroke protocol standard

Easily titrated IV

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18
Q

CCB’s clinical uses?

A

Cardiac arrhythmias (verapamil and diltiazem)

Angina

Vasospastic angina (Prinzmetal’s)

Diastolic heart failure

HTN

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19
Q

Many side effects with CCB’s but remember what?

A

peripheral edema

gingival hyperplasia!

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20
Q

Alpha-2 adrenergic receptor agonists AKA Central alpha agonists _____ blood pressure by stimulating alpha-receptors in the _____ which open peripheral arteries easing blood flow

A

lower

brain

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21
Q

When is Centrally Acting 
Alpha-Agonists prescribed?

A

when other medications have failed

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22
Q

What are Centrally Acting 
Alpha-Agonists typically combined with?

A

diuretic

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23
Q

Example of Centrally Acting 
Alpha-Agonists?

A

Clonidine (Catapres)

Methyldopa (Aldomet)

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24
Q

Clonidine (Catapres) MOA?

A

Activates inhibitory neurons

Reduces CNS sympathetic output

Decreases peripheral resistance via peripheral artery dilation

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25
Q

Methyldopa (Aldomet) decreases __________ outflow at the Heart, peripheral vasculature, and kidneys

A

sympathetic

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26
Q

Why do you have to be careful with Methyldopa ( Aldomet)?

A

Drug-induced lupus - autoimmune disorder (similar to systemic lupus erythematosus caused use of certain drugs

Hemolytic anemia

Positive Coombs test - Coombs test is used to test for autoimmune hemolytic anemia

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27
Q

Hydralazine (Apresoline) produces direct __________ of vascular smooth muscle

A

relaxation

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28
Q

Hydralazine (Apresoline)

is used in ________ to ______ HTN.

A

moderate

severe

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29
Q

Hydralazine (Apresoline) may cause drug-induced _____, and can be administer both __ & __.

A

lupus

IV & PO

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30
Q

Minoxidil (Loniten) can cause drug induced _________.

A

Hirsutism

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31
Q

Minoxidil (Loniten) decreased __________ vascular resistance

A

peripheral

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32
Q

Minoxidil (Loniten)

is used in HTN with end-organ damage not controlled with a _______ plus 2 other __________________.

A

diuretic

antihypertensives

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33
Q

Minoxidil (Loniten) is also known as ?

A

Rogaine

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34
Q

What is the drug of choice for HTN emergencies ?

A

Nitroprusside (Nitropress)

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35
Q

Nitroprusside (Nitropress) generally relaxes _____ more than ________ and is _____ acting.

A

veins more than arteries

short acting

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36
Q

How long does therapy last with Nitroprusside (Nitropress)

?

A

Therapy to last no longer than 1 to 3 days

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37
Q

Nitroprusside (Nitropress)

side effects?

A

Toxic metabolite, thiocyanate, may cause cyanide poisoning

38
Q

If on Nitroprusside (Nitropress) what levels must be monitored for toxicity?

A

Thiocyanate

39
Q

Nitroprusside (Nitropress) can cause what?

A

Methemoglobinemia

40
Q

What is Methemoglobinemia

?

A

presence of a higher than normal level of methemoglobin (Fe3) decreased ability to bind oxygen

41
Q

Nesiritide (Natrecor) increases ____, which results in what?

A

cGMP resulting in smooth must relaxation

42
Q

When is Nesiritide (Natrecor)

used?

A

Used in acute decompensated heart failure

43
Q

Nesiritide (Natrecor) reduces _________ _________ resistance and systemic ________ pressure.

A

pulmonary capillary resistance and systemic arterial pressure

44
Q

What do diuretics cause?

A

Increase sodium and water excretion by the kidney

Decreases intravascular volume

Decreases preload, stroke volume, and cardiac output

45
Q

What are the Six classes of diuretics classified by site of action in the nephron?

A 
Thiazide
Thiazide-like
Loop
Potassium sparing
Osmotic
Carbonic anhydrase inhibitors
46
Q

Thiazide diuretics MOA?

A

Inhibit NA/Cl transporter in the distal convoluted tubule

47
Q

Clinical uses of thiazide diuretics?

A

Mild to moderate HTN, CHF, cirrhosis, renal insufficiency, nephrotic syndrome

48
Q

Pharmacokinetics of thiazide diuretics ?

A

Rapid absorption after oral administration

Well distributed into extracellular space

Excreted unchanged by the kidneys

49
Q

Examples of Thiazide diuretics?

A

Hydrochlorothiazide (HCTZ, HCT, HZT)

50
Q

What is a drug that is common combo with ARB’s, BB’s, CCB’s?

A

Hydrochlorothiazide (HCTZ, HCT, HZT)

51
Q

Indications for Hydrochlorothiazide (HCTZ, HCT, HZT)

?

A

CHF
High Ca Gout
Edema

52
Q

Thiazide Diuretics cautions?

A

Caution renal impaired

Caution gout

Caution elderly

Causes electrolyte imbalance
hypokalemia / hyponatremia

53
Q

Thiazide Diuretics special populations / category?

54
Q

Thiazide Diuretics: Adverse 
Reactions?

A

CV: hypotension

Endo: hyperglycemia

GI: anorexia, nausea, cramping, vomiting

GU: erectile dysfunction

META: metabolic alkalosis

MS: muscle cramps

Neuro: dizziness, drowsiness, lethargy, weakness

55
Q

Thiazide Diuretics: Interactions?

A

Potentiates digoxin toxicity

NSAIDS reduce diuretic effect

Corticosteroids enhance hypokalemia

Get synergistic effect if used concurrent with loop diuretics

56
Q

Thiazide Diuretics may reduce effectiveness of?

A

lithium, warfarin, vitamin D

57
Q

Why may diuretics be limited?

A

dehydration

58
Q

What do you want to do before you prescribe thiazide diuretics?

A

Perform initial determination of serum electrolytes, BUN uric acid, and glucose to monitor for electrolyte imbalances

Watch for drugs that alkalinize urine
Always review for possible drug interactions
Use with care if using insulin

59
Q

Thiazide diuretic family/patient education?

A

Advise urination increase at start but it subsides in a few weeks

If drug causes GI upset take with food or milk

Advise to take during day

Advise to notify clinician is any side effects occur

Avoid prolonged sunlight exposure due to potential for photosensitivity rash

If diabetic patient, watch for increase in blood sugar

Do not adjust or interrupt dosage

Avoid alcohol

60
Q

Thiazide-Like Diuretics are ___________ diuretic that has similar physiological properties to a thiazide diuretic

A

Sulfonamide

61
Q

Examples of Thiazide-Like Diuretics?

A

Metolazone

Chlortalidone

62
Q

When are Thiazide-Like Diuretics used?

A

Often used in the management of hypertension and edema

63
Q

Thiazide-Like Diuretics may be used in patients with ____ and ________ because it does not cause ____________ and _______?

A

gout and diabetes

hyperuricemia or does not increased glucose

64
Q

What diuretic is a Safer alternative to use in patients with decreased creatinine clearance?

A

Thiazide-Like Diuretics

65
Q

Examples of Loop diuretics?

A

Furosemide (Lasix)

Torsemide (Demadex)

Bumetanide (Bumex)

66
Q

Loop Diuretics MOA?

A

Inhibit the Na/K/Cl cotransporter on the thick ascending Loop of Henle

67
Q

What is there a risk of if on loop diuretics?

A

Risk of hypocalcemia, hypokalemia, hyperglycemia, and hyperuricemia

? Involve worsening of insulin resistance, inhibition of glucose uptake, and decreased insulin release

68
Q

Loop diuretics produce transient diuresis not limited by what?

A

dehydration

69
Q

Side effects of Loop Diuretics?

A

Ototoxicity may occur

70
Q

What may enhance with use of loop diuretics?

A

amino glycoside use

71
Q

Examples of potassium-sparing diuretics?

A

Spironolactone

Spironolactone/hydrochlorothiazide – (Aldactazide)

Triamterine/hydrochlorizide – (Maxzide, Dyazide)

72
Q

Potassium-Sparing Diuretics MOA?

A

Inhibit Na reabsorption; dependent on K and H+ exchange

73
Q

Potassium-Sparing Diuretics block what?

A

Block aldosterone receptor

74
Q

What is there a risk of when on Potassium-Sparing Diuretics?

A

Risk of hyperkalemia, hyponatremia, metabolic acidosis

75
Q

Potassium-Sparing Diuretics are ____ diuretics, usually use in combination with other ________ classes?

A

weak

diuretic classes

76
Q

What causes blue colored Urine? and is a Potassium-Sparing Diuretics?

A

Triamtrene

77
Q

What potentates hyperkalemia

78
Q

Examples of Osmotic Diuretics?

A

Mannitol (osmitrol)

79
Q

What is the Type of diuretic that inhibits reabsorption of water and sodium (Na)?

A

Osmotic Diuretic - Mannitol

Non-reabsorbable solute

80
Q

Where is Mannitols major effect?

A

proximal convoluted tubule and the descending limb of Henle’s Loop

81
Q

What has an opposite action of ADH in the collecting tubule?

82
Q

Osmotic diuretic are used in treatment of _____ conditions only? like?

A

acute

Acute renal failure
Glaucoma
Cerebral edema

83
Q

Examples of carbonic anhydrase Inhibitors ?

A

Acetazolamide

84
Q

Acetazolamide is used for what?

A

laucoma, epilepsy (rarely)

idiopathic intracranial hypertension

altitude sickness (respiratory alkalosis/HCO3)

85
Q

Carbonic anhydrase inhibition results in _________ excretion of __, _, and ______ ___________.

A

increased

Na, K and sodium bicarbonate

86
Q

What is the weakest diuretic ? and Not a mainstay in HTN therapy?

A

Carbonic Anhydrase Inhibitors

87
Q

What is Mainly used in the treatment of open-angle glaucoma?

A

Carbonic Anhydrase Inhibitors

88
Q

What is there a risk of when using Carbonic Anhydrase Inhibitors?

A

Risk of Stevens-Johnson syndrome
erythema multiforme
toxic epidermal necrolysis bone marrow suppression

89
Q

When can you not use Carbonic Anhydrase Inhibitors?

A

Cannot use in patients with sulfa allergy

Caution advised with high-dose aspirin

90
Q

Diuretic Resistance and Adaptation?

A

The body’s ability to adapt to repeated administration of many drugs

With diuretics, adaptation occurs as compensatory changes in body

sodium retention increases while ion transporters become enhanced (diuretic braking).

91
Q

What is diuretic braking?

A

sodium retention increases while ion transporters become enhanced

Pharmacology (Dale Turley) (31 decks)

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