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unit 4 pharm > HTN > Flashcards

HTN Flashcards

1
Q

Loop diuretics

A
  • ethacrynic acid, furosemide, bumetamide and torsemide
  • inhibit Na-K-2Cl transporter in tALH
  • high potency
  • necessary for severe HTN, in setting of CHF or cirrhosis and with renal insufficiency (GFR <30-40)
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2
Q

thiazide diuretics

A
  • hydrochlorothiazide, chlorthalidone, indapamide, metolazone (in order of increasing potency)
  • medium potency
  • most often used diuretic because they have medium potency and dont have to pee as often
  • mild-mod HTN (use for high volume HTN)
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3
Q

SE of loops and thiazides

A
  • hypokalemia, hypomagnesemia –> cardiac arrythmias)
  • impaired glucose tolerance (insulin resistance)
  • increased lipids (increased cholesterol and LDL)
  • increased uric acid
  • ED
  • volume depletion
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4
Q

SE of K+ sparing diuretics

A
  1. spironolactone is a competitive antagonism of androgen receptors:
  • gynecomastia, ED, loss of libido (men)
  • menstrual irregularities, menorrhagia an nipple tenderness (women)
  1. hyperkaelemia (cardiac probs)
  2. can’t use with ACEI or ARBs
  3. cant use with renal failure
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5
Q

effects of Angiotensin II

A
  1. increased sympathetic tone
  2. increased tubular reabsorption of NaCl and K+ secretion
  3. aldo secretion
  4. vasoconstriction
  5. ADH secretion
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6
Q

ACEI

A
  • more potent BP than ARBs
  • block endothelial ACE and inhibit breakdown of bradykinin which is a potent vasodilator and responsible for cough
  • captopril (short acting)
  • isinopril, benazepril, quinapril, ramipril (long acting)
  • Enalapril (converted to enalaprilat which is more active metabolite)
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7
Q

ARBs

A
  • competitive receptor binding of angio II to vascular endothelium
  • less SE bc they act further downstream but not as potent
  • losartan, valsartan, irbesartan
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8
Q

SE of ACEI and ARBs

A
  • cough (only ACEI)
  • hypotension
  • decreased renal function (dilation of efferent arteriole decreases GFR)
  • angioedema rarely
  • hyperkalemia
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9
Q

contraindications of ACEI and ARBs

A
  • renal artery stenosis (can cause acute renal failure)
  • hyperkalemia (angio II promotes NaCl reabsorption and K+ excretion –> block this and you block the ability to rid of K+)
  • acute renal failure (decreases GFR)
  • pregnancy
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10
Q

when to use of ACEI/ARBs

A
  • chronic renal kidney disease/proteinuria (ppl with chronic renal failure of worsening GFR –> as glomeruli burn out the remaining ones have increased GFR which causes quicker burn out –> need to block this to preserve remaining nephrons)
  • heart failure
  • Post MI (LV remodeling post MI and LV hypertrophy)
  • diabetes mellitus
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11
Q

beta blockers

A
  • not very effective in treating HTN
  • mechanism: reduce CO (contractility, HR); inhibit renin release, reduce NE release; decrease central vasomotor activity (sympa tone)
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12
Q

SE of propanolol

A

non-selective BB

  • decreased exercise capacity
  • bronchospasm
  • bradycardia (neg chronotrope)
  • CHF (neg inotrope –> decreased contractility)
  • mask sx of hypoglycemia in diabetics
  • depression (crosses BBB)
  • worsening sx of PVD
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13
Q

moderately selective BBs

A
  • metoprolol, atenolol
  • block B1 and very little B2
  • less likely to cause bronchospasm, hypoglycemia and dpression
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14
Q

carvedilol and labetalol

A
  • potent, some vasodilation (via alpha blocking)
  • carvedilol used in setting of CHF or ACS
  • labetalol used in CCU for HTN urgency
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15
Q

esmolol

A

Unique BB (IV) in it’s short half-life and used mostly for AV nodal blocking in unstable PTs

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16
Q

terazosin and doxazosin

A
  • alpha1 receptor antagonists –> reduce vascular resistance
  • SE: orthostatic hypotension, fluid retention, worsening angina (due to reflexive tachy)
  • benefits: help BPH
  • 2nd tier meds for HTN bc they are more likely to cause cardiac complications
17
Q

minoxidil and hydralazine

A
  • vasodilators –> relax smooth mms of peripheral arterioles
  • Min. used for refractory HTN (and is rogaine)
  • Hydra. used IV in ICU for acute HTN urgency or in setting of CHF with combined HTN (Lupus SE!)
18
Q

central acting sympathoplegic drugs

A
  • reduces sympa outflow from vasomotor centers in brainstem –> decreased renin release too
  • clonidine is the only one routinely used
  • alpha methyl dopa used in pregnancy
  • Guanabenz
  • SE: sedation, dry mouth, fatigue, orthostatic hypotension, depression, rebound HTN upon sudden discontinuation
19
Q

ganglion blocking agents (adrenergic neuron blocking agents)

A
  • guanethidine – blocks release of NE from post-gang sympa nerve (SE: sympathectomy –> postural hypotension, diarrhea and impaired ejaculation)
  • reserpine: deplete NE, DA and 5HT in central and peripheral nerves (SE: sedation, depression, parkinsonism_
20
Q

dihydropyridines

A
  • amlodipine and nifedipine
  • CCB
  • inhibit contraction of vascular smooth mm
  • can cause reflex tachycardia and may worsen angina by increasing O2 demand
21
Q

non-dihydropyridines

A
  • verapamil and diltiazem
  • CCB –> inhibit contraction of vascular smooth mm
  • decrease HR –> decreased O2 demand
22
Q

SE of CCBs

A
  1. constipation (prevent GI motility)
  2. led edema
  3. heart failure (non-dihydros are negative ionotropes)
  4. bradycardia (cardiac pacemaker potential)
  5. AV nodal block
  6. reflex tachy for dihydros
  7. short acting CCBs worsen all of these SE
23
Q

in PTs with comorbid diabetes use…

A
  • ACEIs or ARBs
24
Q

in PTs with comborbid BPH use..

A

alpha blockers

25
Q

contraindications 1) depression 2) pregnancy

A
  1. reserpine, BB, central acting alpha2 agonist
  2. ACEI, ARB
26
Q

Stage 1 and 2 HTN

A
  1. Stage 1 > 140/90
  2. Stage > 160/100
27
Q

most significant lifestyle modifications

A
  1. weight loss
  2. DASH diet
28
Q

most commonly used meds

A
  • ACEI/ARBS, Thiazides, CCB
29
Q

less commonly used

A
  • BBs and alpha blockers
30
Q

rarely used

A

central acting alpha agonists, adrenergic blocking agents

31
Q

hydralazine

A
  • direct vasodilator
  • used in ICU for acute HTN urgency (IV)
  • also used in CHF with nitrates
32
Q

minoxidil

A
  • rogaine
  • direct vasodilator
  • used for refractory HTN
33
Q

with comorbid..

  1. systolic HF (HFrEF)
  2. post MI
  3. proteinuric chronic kidney disease
  4. Afib or Aflutter
A
  1. ACEI/ARB, BB, diuretic
  2. ACEI, BB
  3. ACEI/ARB
  4. BB, non-dihydro CCB

unit 4 pharm (8 decks)

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