HTN 2 Drugs 2

Question 1

CCBs and Direct Vasodilators are

Answer 1

approaching the vasculature Directly

Question 2

Calcium Channel Blockers (CCBs) have two categories ____ , but where their effect is different

Answer 2

Dihydropyridine

Non-dihydropyridine

Question 3

Calcium Channel Blockers (CCBs) MOA

Answer 3

MOA: vasodilator activity by inhibiting Ca2+ influx across slow channels of vascular smooth muscle and myocardium during depolarization, relaxing the coronary vascular smooth muscle and coronary vasodilation.

Question 4

Non-Dihydropyridine CCB MOA

Answer 4

Decrease contractility → decrease SV → decreases CO

cardiac smooth muscle calcium channels

Question 5

Dihydropyridine-CCB → MOA

Answer 5

dilate peripheral arterioles → decrease PVR

periphery smooth muscle channels

Question 6

Dihydropyridine CCBs MOA ( )

Answer 6

MOA: Act on vascular smooth muscle → Dilate peripheral arterioles (↓PVR)

Question 7

Dihydropyridine CCBs ARE

Answer 7

Amlodipine (Norvasc) 5 – 10 Daily
Nifedipine, long acting (Adalat CC,
Nifedical XL, Procardia XL)
60 - 120 Daily

Question 8

Non-Dihydropyridine CCBs MOA ()

Answer 8

• Decrease HR and conduction across the AV node
• Negative inotropic and negative chronotropic effects
• ↓ contractility → ↓ SV → ↓ CO

Question 9

Non-Dihydropyridine CCBs are

Answer 9

Diltiazem 120 – 540 Daily
Verapamil 120 – 480 Daily (sometimes BID)

Question 10

Clinical Considerations: DHP CCBs are

Answer 10

First-line therapy ACC/AHA guidelines (without compelling indications)
Preferred therapy in black patients
Effective in older patients with isolated systolic hypertension
Also indicated in stable CAD

Question 11

Clinical Considerations: Non DHP (Diltaizam and Verapamil) CCBs are

Answer 11

• Indicated for cardiac focused benefit
• Angina (stable)
• Atrial fibrillation / flutter
• PSVT (paroxysmal supraventricular tachycardia)

When in hospital in an acute situation these agents along with BB help lowering blood pressure

Question 12

• Verapamil is very helpful in

Answer 12

migraine prophylaxis

Question 13

The adverse effect of Non-DHP (Verapamil, Diltiazem)are

Answer 13

Bradycardia (Verapamil, Diltiazem)

Constipation (verapamil)

Question 14

The adverse effect of DHP CCBs (amlodipine, Nifedipine)

Answer 14

Reflex tachycardia (DHPs)
Pedal Edema is ADEs can come from vasodilation of periphery(more frequently DHP)

Question 15

MIX ADVERSE effect of CCB are

Answer 15

Gingival hyperplasia
Headache
Orthostatic hypotension
Dizziness

Question 16

(Diltiazam and verapamil )Non-DHP contraindications are

Answer 16

Heart block
HF
Avoid use with beta-blockers

Pt with HF (ok to use amlodipine or felodipine as they are safe to use)

Question 17

Drug interactions: of p450 are

Answer 17

Verapamil, diltiazem are P450 substrates

Question 18

Simvastatin dosing limitations are

Answer 18

With Amlodipine - no more than 20mg of simvastatin

Verapamil & diltiazem - no more than 10mg

Question 19

Direct Vasodilators MOA

Answer 19

Act directly on vascular smooth muscle to dilate arterioles (not veins)
BP = CO x PVR
Lower BP via ↓ PVR

Question 20

When PVR go down by having Direct Vasodialtor we have

Answer 20

Tachycardia

Question 21

Direct Vasodilators are

Answer 21

Minoxidil (Loniten) 10 – 40 1-2
Hydralazine (Apresoline) 20 – 200 2-4

Question 22

Hydralazine is used for people as an add on

Answer 22

Resistant HTN

Question 23

Clinical considerations OF Direct vasodilator are:

Answer 23

Not considered first-line agents
Considered 4th-line or later
Likely add-on in resistant HTN
Topical minoxidil indicated in alopecia

Question 24

Topical minoxidil indicated in

Answer 24

alopecia

Question 25

Every hair growth OTC have ___ in it

Answer 25

Minoxidil

Question 26

ADEs of direct vasodilator are

Answer 26

* Reflex tachycardia, palpitations * Headache, dizziness * Na+/H2O retention * Hirsutism (minoxidil) * Lupus-like syndrome (higher doses of hydralazine)

Question 27

Diuretics are

Answer 27

Thiazide Loop Potassium sparing

Question 28

Thiazide Diuretics MOA

Answer 28

Inhibit NaCl reabsorption in the distal convoluted tubule (DCT) increase Na+ and H2O excretion • BP = CO X PVR Decrease in Vol, decrease in preload, Decrease in SV and decrease in CO

Question 29

Thiazide Diuretics: are

Answer 29

Hydrochlorothiazide (HCTZ) 12.5 – 25 (no use in going to 50mg) Daily Chlorthalidone 12.5 – 50 Daily

Question 30

A thiazide that should be switched from ______ to ______

Answer 30

HCTZ, Chlorthalidone

Question 31

Clinical Considerations of Thiazide diuretics

Answer 31

They cause HYPOkalemia Do not use if significant allergy hx with sulfonamides (e.g., Bactrim) When switching: 12.5 mg dose of chlorthalidone is equivalent to 25 mg of HCTZ means chlorthalidone is more potent Little efficacy in CrCl < 30ml/min

Question 32

Loop Diuretics MOA

Answer 32

selectively inhibit NaCl reabsorption in the thick ascending limb of the Loop of Henle

Question 33

_______ are better than loop dieuretics

Answer 33

THiazide dieuretics

Question 34

Loop Diuretic are

Answer 34

Furosemide (Lasix) 20 – 80 1-2

Question 35

Clinical Considerations: LOOP diuretics are

Answer 35

Can result in hypokalemia: Give with K+supplement if needed Someone with a Sulfur allergy should avoid Loop diuretic Loops most potent (work at CrCl <30 ml/min) Preferred in symptomatic HF and mod-to-severe CKD (eGFR<30)

Question 36

Bumetanide 1mg is equal to

Answer 36

= torsemide 20mg = furosemide 40mg

Question 37

K-Sparing Diuretics MOA

Answer 37

MOA: reduce Na+reabsorption into the collecting ducts/tubules

Question 38

K-Sparing Diuretics are

Answer 38

Triamterene

Question 39

Clinical Considerations: of K-Sparing Diuretics are

Answer 39

Not recommended for initial tx of HTN per ACC/AHA and JNC8 Avoid in pts with significant CKD Contraindicated if K > 5.5, receiving K-supplements, or on meds that can increase K

Question 40

_____ and ______ can cause Hyper uricemia so people with

Answer 40

Thiazide and Loop, Gout need to be cautious

Question 41

K+ sparing dieuretics can

Answer 41

primarily used to prevent hypokalemia caused by other agents (i.e., thiazide or loop diuretics) so avoid with ACE/ARB and

Question 42

Drug Interactions: All Diuretics are contraindicated with

Answer 42

NSAIDs ACEI/ARBs (K+-sparing diuretics only) High salt foods – less efficacy

Question 43

Monitor labs and effects in all diuretics for

Answer 43

Basic metabolic panel 2-4 weeks after initiation or dose increase: renal function (Cr, BUN), electrolytes (Na, K, etc..) • Uric acid, BG

Question 44

All Diuretics can cause Dehydration which can cause

Answer 44

Hypotension sx (esp with position change)

Question 45

All dieuretics caution

Answer 45

``` Gout history • Renal insufficiency • Volume depletion • Elderly • History of urinary issues (incontinence, BPH sx in men) • Adherence (? Skipping doses) • Blood sugar • Tinnitus (loops ```

Question 46

Preferred therapy in black patients are

Answer 46

Amlodipine , nifedapine

Question 47

When in hospital in an acute situation _______ agents along with BB help lowering blood pressure

Answer 47

Verapamil and Diltiazam

Question 48

what medication is Effective in older patients with isolated systolic hypertension

Answer 48

Amplodipine and Nifedapine

Question 49

Non dihydropyridine work on what part of the heart

Answer 49

(cardiac smooth muscle calcium channels)

Question 50

Dihydropyridine work on what part of the heart

Answer 50

(periphery smooth muscle channels)

Question 51

(higher doses of hydralazine) can cause

Answer 51

Lupus-like syndrome

Question 52

Avoid use of beta-blockers with

Answer 52

Diltiazam and verapamil