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Pharm MSU NUR909 > HTN > Flashcards

HTN Flashcards

1
Q

First-line medications for HTN

A

-Thiazide diuretics
-ACE-inhibitors
-ARBs
-Calcium channel blockers

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2
Q

Thiazide-type diuretic medications

A

-Hydrochlorothiazide (HCTZ)
-Chlothalidone
-Indapamide
-Metolazone

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3
Q

Thiazide mechanism of action

A

Reduce sodium reabsorption in the distal convoluted tubule of the kidney; by impairing sodium transport into the tubule, natriuresis and concomitant water loss is induced

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4
Q

Thiazide adverse effects

A

-Hypokalemia
-Hyponatremia
-Hyperuricemia - caution in pts with gout

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5
Q

Thiazide monitoring

A

-ineffective with CrCl < 30
- monitor SCr, sodium and potassium 7-10 days after initiation and titration

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6
Q

ACE-inhibitor medications

A

-Lisinopril
-Enalapril
-Captopril
-Fosinopril
-Ramipril

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7
Q

ACE mechanism of action

A

Prevent conversion of antiotensin 1 to angiotensin 2

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8
Q

ACE contraindications

A

-Bilateral renal artery stenosis
-Pregnancy
-Angioedema

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9
Q

ACE adverse effects

A

-Dry cough due to bradykinin
-Increased SCr-rise up to 30% above baseline is acceptable
-Hyperkalemia
-Angioedema

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10
Q

ACE monitoring

A

SCr and potassium 7-14 days after therapy initiation and titration

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11
Q

ARBs medication

A

-Candesartan
-Eprosartan
-Irbesartan
-Losartan
-Telmisartan
-Valsartan

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12
Q

ARB mechanism of action

A

Selective, competitive angiotensin 2 receptor antagonist

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13
Q

ARB adverse effects

A

-Dry cough
-Angioedema
-Increased SCr-rise up to 30% above baseline is acceptable
-Hyperkalemia

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14
Q

ARB monitoring

A

SCr and potassium 7-14 days after initiation and titration

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15
Q

Calcium Channel Blocker (Dyhydropyridines) medications

A

-Amlodipine
-Felodipine
-Nifedipine

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16
Q

Calcium Channel Blocker (Dyhydropyridines) mechanism of action

A

Act by relaxing smooth muscle on the arterial wall, decreasing total peripheral resistance, and hence, reducing blood pressure

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17
Q

Calcium Channel Blocker (Dyhydropyridines) adverse effects

A

Peripheral edema

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18
Q

Calcium Channel Blockers (Non-Dihydropyridine) medications

A

-Diltiazem
-Verapamil

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19
Q

Calcium Channel Blockers (Non-Dihydropyridine) mechanism of action

A

Acts as a potent vasodilator of the coronary vessels, increasing blood flow and decreasing heart rate via strong depression of atrioventricular node conduction

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20
Q

Calcium Channel Blockers (Non-Dihydropyridine) adverse effects and contraindications

A

-Bradycardia, heart block
-Constipation

*these drugs are potent CYP450 inhibitors = many drug interactions

*contraindicated in pts with heart failure

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21
Q

Beta-blocker (Selective) medications

A

-Metoprolol
-Atenolol
-Bisprolol
-Nebivolol - good for pts with sexual dysfunction

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22
Q

Beta-blocker (Non-selective) medications

A

-Propranolol
-Carvedilol
-Labetalol
-Nadolol
-Sotalol

23
Q

Beta-blocker mechanism of action

A

Selective agents block the beta-1 adrenergic receptor in the heart with little or no effect on beta-2 receptors (which are more prominent in the bronchial smooth muscle)

-dose-dependent action, meaning with higher doses, you lose selectivity for the beta-1 receptor

24
Q

Beta-blocker indications

A

-Heart failure (metoprolol succinate, carvedilol, bisprolol) in combo with an ACE
-Post-MI
-High coronary artery disease risk

25
Q

Beta-blockers adverse effects

A

-Bradycardia
-Heart block
-Potential to worsen bronchospastic disease
(caution in pts with asthma)
-Mask symptoms of hypoglycemia (except
sweating)
-Exercise intolerance - can improve
-fatigue - can improve
-sexual dysfunction - persists

26
Q

Renin Inhibitor medication and administration requirement

A

Aliskiren
-no data for monotherapy
-CAN NOT be combined with ACE or ARB

27
Q

Alpha-blocker medications

A

-Terazosin
-Doxazosin
-Prazosin

28
Q

Alpha-blocker mechanism of action

A

Selective alpha-1 antagonist work by blocking the action of adrenaline on the smooth muscle of the blood vessel walls

29
Q

Alpha-blocker clinical use

A

-hypertensive male with concomitant bph
-not considered 1st line therapy, usually 4th or 5th

30
Q

Alpha-blockers adverse effects

A

-Dizziness
-Orthostatic hypotension- recommend to take at night while in bed

31
Q

Loop diuretic medications

A

-Furosemide
-Torsemide
-Bumetanide
-Ethacrynic acid - no sulfa

32
Q

Loop diuretic treatment consideration

A

NOT an effective blood pressure lowering agent.
-Should be used to manage edema

33
Q

Loop diuretic adverse effects

A

-electrolyte disturbances
-photosensitivity

34
Q

Potassium-sparing diuretic medications

A

-Triamterene
-Amiloride

35
Q

Potassium-sparing diuretic mechanism of action

A

Block epithelial sodium channel on the lumen side of the kidney collecting tubule

36
Q

Potassium-sparing diuretic adverse effect

A

hyperkalemia- especially in combination with ACE or ARB

-often used in combination with thiazide-type diuretics to maintain potassium balance

37
Q

Aldosterone antagonist medications

A

-Spironolactone
-Eplerenone

38
Q

Aldosterone antagonist mechanism of action

A

inhibit the effect of aldosterone by competing for intracellular aldosterone receptors int he cortical collecting duct; decreases the reabsorption of sodium and water while decreasing the secretion of potassium

39
Q

Aldosterone antagonist clinical use

A

-evidence for low-dose spironolactone for pts with resistant hypertension
-heart failure

40
Q

Aldosterone antagonist contraindications

A

-anuria
-acute renal insufficiency
-hyperkalemia (>5)
-creatinine clearance <30 mL/min

41
Q

Aldosterone antagonist adverse effects

A

-hyperkalemia
-gynecomastia with spironolactone, but not eplerenone

42
Q

Central alpha-2 agonist medications

A

-Clonidine
-Methyldopa
-Guanfacine

43
Q

Central alpha-2 agonist mechanism of action

A

Stimulates alpha-2 receptors in the brain, which decreases sympathetic outflow cardia output and peripheral vascular resistance, lowering blood pressure and heart rate

44
Q

Central alpha-2 agonist clinical use

A

-resistant htn
-hypertensive urgency

45
Q

Central alpha-2 agonist adverse effects

A

-Dizziness and orthostatic hypotension
-drowsiness
-dry mouth

46
Q

Central alpha-2 agonist monitoring

A

-rebound htn if weaned too quickly or missed dose
-avoid in pts with heart failure
-quite sedating

47
Q

Vasodilators medications

A

-Hydralazine
-Minoxidil

48
Q

Vasodilators mechanism of action

A

Direct-acting smooth muscle relaxant that acts as a vasodilator primarily in the arteries and arterioles

49
Q

Vasodilators clinical use

A

-resistant htn

50
Q

Vasodilators adverse effects

A

-hydralazine can cause lupus-like syndrome
-minoxidil associated with hirsutism (used topically for alopecia)

51
Q

What drug can be helpful for resistant htn (pt on all 4 anti-hypertensive classes and still uncontrolled)

A

Spironolactone

52
Q

Preferred medication for htn and pregnancy

A

-Methyldopa
-Labetalol

-Hydralazine for preeclampsia

53
Q

HTN medications to avoid in pregnancy

A

-ACE
-ARB
-Renin-inhibitors
-Atenolol
-thiazide diuretics are questionable

Pharm MSU NUR909 (9 decks)

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