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CDM 1 > HTN 2 Drugs 2 > Flashcards

HTN 2 Drugs 2 Flashcards

1
Q

CCBs and Direct Vasodilators are

A

approaching the vasculature Directly

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2
Q

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

A

Dihydropyridine

Non-dihydropyridine

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3
Q

Calcium Channel Blockers (CCBs) MOA

A

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.

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4
Q

Non-Dihydropyridine CCB MOA

A

Decrease contractility → decrease SV → decreases CO

cardiac smooth muscle calcium channels

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5
Q

Dihydropyridine-CCB → MOA

A

dilate peripheral arterioles → decrease PVR

periphery smooth muscle channels

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6
Q

Dihydropyridine CCBs MOA ( )

A

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

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7
Q

Dihydropyridine CCBs ARE

A

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

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8
Q

Non-Dihydropyridine CCBs MOA ()

A
  • Decrease HR and conduction across the AV node
  • Negative inotropic and negative chronotropic effects
  • ↓ contractility → ↓ SV → ↓ CO
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9
Q

Non-Dihydropyridine CCBs are

A

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

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10
Q

Clinical Considerations: DHP CCBs are

A

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

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11
Q

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

A
  • 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

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12
Q

• Verapamil is very helpful in

A

migraine prophylaxis

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13
Q

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

A

Bradycardia (Verapamil, Diltiazem)

Constipation (verapamil)

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14
Q

The adverse effect of DHP CCBs (amlodipine, Nifedipine)

A 
Reflex tachycardia (DHPs)
Pedal Edema is ADEs can come from vasodilation of periphery(more frequently DHP)
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15
Q

MIX ADVERSE effect of CCB are

A

Gingival hyperplasia
Headache
Orthostatic hypotension
Dizziness

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16
Q

(Diltiazam and verapamil )Non-DHP contraindications are

A

Heart block
HF
Avoid use with beta-blockers

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

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17
Q

Drug interactions: of p450 are

A

Verapamil, diltiazem are P450 substrates

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18
Q

Simvastatin dosing limitations are

A

With Amlodipine - no more than 20mg of simvastatin

Verapamil & diltiazem - no more than 10mg

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19
Q

Direct Vasodilators MOA

A

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

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20
Q

When PVR go down by having Direct Vasodialtor we have

A

Tachycardia

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21
Q

Direct Vasodilators are

A

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

22
Q

Hydralazine is used for people as an add on

A

Resistant HTN

23
Q

Clinical considerations OF Direct vasodilator are:

A

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

24
Q

Topical minoxidil indicated in

A

alopecia

25
Q

Every hair growth OTC have ___ in it

A

Minoxidil

26
Q

ADEs of direct vasodilator are

A
  • Reflex tachycardia, palpitations
  • Headache, dizziness
  • Na+/H2O retention
  • Hirsutism (minoxidil)
  • Lupus-like syndrome (higher doses of hydralazine)
27
Q

Diuretics are

A

Thiazide
Loop
Potassium sparing

28
Q

Thiazide Diuretics MOA

A

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

29
Q

Thiazide Diuretics: are

A

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

Chlorthalidone 12.5 – 50 Daily

30
Q

A thiazide that should be switched from ______ to ______

A

HCTZ, Chlorthalidone

31
Q

Clinical Considerations of Thiazide diuretics

A

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

32
Q

Loop Diuretics MOA

A

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

33
Q

_______ are better than loop dieuretics

A

THiazide dieuretics

34
Q

Loop Diuretic are

A

Furosemide (Lasix) 20 – 80 1-2

35
Q

Clinical Considerations: LOOP diuretics are

A

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)

36
Q

Bumetanide 1mg is equal to

A

= torsemide 20mg = furosemide 40mg

37
Q

K-Sparing Diuretics MOA

A

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

38
Q

K-Sparing Diuretics are

A

Triamterene

39
Q

Clinical Considerations: of K-Sparing Diuretics are

A

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

40
Q

_____ and ______ can cause Hyper uricemia so people with

A

Thiazide and Loop, Gout need to be cautious

41
Q

K+ sparing dieuretics can

A

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

42
Q

Drug Interactions: All Diuretics are contraindicated with

A

NSAIDs
ACEI/ARBs (K+-sparing diuretics only)

High salt foods – less efficacy

43
Q

Monitor labs and effects in all diuretics for

A

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

44
Q

All Diuretics can cause Dehydration which can cause

A

Hypotension sx (esp with position change)

45
Q

All dieuretics caution

A 
Gout history
• Renal insufficiency
• Volume depletion
• Elderly
• History of urinary issues (incontinence, BPH sx in men)
• Adherence (? Skipping doses)
• Blood sugar
• Tinnitus (loops
46
Q

Preferred therapy in black patients are

A

Amlodipine , nifedapine

47
Q

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

A

Verapamil and Diltiazam

48
Q

what medication is Effective in older patients with isolated systolic hypertension

A

Amplodipine and Nifedapine

49
Q

Non dihydropyridine work on what part of the heart

A

(cardiac smooth muscle calcium channels)

50
Q

Dihydropyridine work on what part of the heart

A

(periphery smooth muscle channels)

51
Q

(higher doses of hydralazine) can cause

A

Lupus-like syndrome

52
Q

Avoid use of beta-blockers with

A

Diltiazam and verapamil

CDM 1 (15 decks)

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