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Pharmacology Test 3 > HTN > Flashcards

HTN Flashcards

1
Q

HTN

A
  • 2 elevated BPs in 2 or more visits
  • less than 60, 140/90
  • more than 60, 150/90
  • over 18 w/ kidney or diabetes 140/90
  • pt seated, back and feet supported, arm supported and at level of heart
  • if untreated can damage organs
  • dont blame white coat
  • no symptoms
  • silent killer
  • start w/ 1 med, then add
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2
Q

HTN

EXAM

A
  • heart and lung sounds
  • orthoststics (old, meds)
  • fundoscopic (eyes, cataracts)
  • peripheral pulse, bruits, edema
  • manual best, pump up 20-30mmhg over
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3
Q

HTN

Diag

A
  • ECG
  • Labs: CBC, BMP, LFTs, Lipids, TSH, UA (protein, occcult bacteremia) (looking for compromised renal and liver function)
  • chest x-ray
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4
Q

HTN

JNC 8

A
  • pre-HTN=lifestyle 1st (monthly, after 3 months start meds)
  • 1st choice: Ace Inhibitors
  • 2nd choice: Calcium Channel Blockers
  • 3rd choice: Diuretics
  • Black: CCB 1st
  • Diabetics: Ace Inhibitor or ARB
  • less strict over 60
  • ED
  • occasional tachy: BB or CCB
  • anxiety: BB
  • age and risk affect choices
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5
Q

HTN

Types

A
  • Primary=most common, geri, family?,
  • Secondary=uncommen, drugs, OCPs, obesity, diabetes, renal, meth, coke, stimulants, thyroid disease, adrenal cancer, sleep apnea, premie baby w/ line, caffeine, smoking
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6
Q

HTN

SE

A
  • headache
  • dizziness
  • syncope
  • hypotension
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7
Q

HTN

MONITOR

A
  • BP

- BMP

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8
Q

Diuretics

A
  • HTN
  • electrolytes
  • 3rd choice
  • Thiazide
  • Loop
  • K-sparing
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9
Q

Thiazide

A
  • Diuretic
  • Hydrochlorothiazide, Chlorthalidone
  • Excreted in breast milk (BUT MAY DECREASE MILK PRODUCTION
  • good for blacks
  • Preg B
  • CHECK BMP prior to starting and after initiating therapy
  • Eat Mg and K rich foods, decrease sugar
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10
Q

Thiazide
-Hydrochlorothiazide, Chlorthalidone
MOA

A
  • Inhibits Na Reabsorption in distal renal tubule causing increased H2O as well as Na, K, and H
  • decreased circulating volume=lower BP
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11
Q

Thiazide
-Hydrochlorothiazide, Chlorthalidone
PHARM

A
  • Good PO absorption
  • Diuresis in 2 hrs, Antihypertensive effects in 3-4 days
  • 68% protein bound
  • Not metabolized
  • Excreted in urine as unchanged drug
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12
Q

Thiazide
-Hydrochlorothiazide, Chlorthalidone
CONTRA

A
  • Anuria

- Sulfa Allergy

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13
Q

Thiazide
-Hydrochlorothiazide, Chlorthalidone
SE

A
  • Hypokalemia
  • Hypomagnesmia
  • Pancreatitis
  • Hyperglycemia
  • Photoxicity (sunlight)
  • CHECK BMP prior to starting and after initiating therapy
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14
Q

Thiazide
-Hydrochlorothiazide, Chlorthalidone
PTS

A
  • Category B safe in pregnancy
  • Excreted in breast milk (BUT MAY DECREASE MILK PRODUCTION)
  • Safe in Pediatrics
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15
Q

Loop

A
  • Furosemide (Lasix), Torsemide (Demedex)
  • NOT great antihypertensive, NOT first line
  • HIGHLY PROTEIN BOUND 99%
  • main job is diuretic, not BP
  • monitor BMP (especially K)
  • mainly HF to reduce volume
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16
Q

Loop
-Furosemide (Lasix), Torsemide (Demedex)
MOA

A

-Inhibits Na and Cl Reabsorption in proximal and distal tubules and loop of henle

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17
Q

Loop
-Furosemide (Lasix), Torsemide (Demedex)
PHARM

A
  • Good PO absorption
  • HIGHLY PROTEIN BOUND
  • Metabolized in liver
  • Excreted in urine
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18
Q

Loop
-Furosemide (Lasix), Torsemide (Demedex)
SE

A
  • Muscle Cramps (Mg)
  • Glucose Intolerance
  • Rash
  • Gout
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19
Q

Loop
-Furosemide (Lasix), Torsemide (Demedex)
PTS

A
  • Lasix: Category C in pregnancy
  • Torsemide: Category B in pregnancy, not approved in pediatrics
  • NEITHER to be used in lactation
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20
Q

K Sparing

A
  • Diuretic
  • Sprinolactone (Aldactone), Triamterene (Dyrenium)
  • Directly BLOCKS Na reabsorption in distal renal tubule
  • VERY PROTEIN BOUND
  • CHECK BMP!! ESSENTIAL TO PERFORM
  • Addisons Disease and renal insuff
  • NO Ace Inhibitors!
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21
Q

K Sparing
-Sprinolactone (Aldactone), Triamterene (Dyrenium)
MOA

A
  • Directly BLOCKS Na reabsorption in distal renal tubule
  • Competitively binds to aldosterone-dependent Na/K exchange site in distal convoluted tubule causing an increase H2O excretion
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22
Q

K Sparing
-Sprinolactone (Aldactone), Triamterene (Dyrenium)
PHARM

A
  • Well absorbed PO
  • VERY PROTEIN BOUND
  • Metabolized in liver and kidneys
  • Excreted in both urine and stool
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23
Q

K Sparing
-Sprinolactone (Aldactone), Triamterene (Dyrenium)
SE

A
  • Rash
  • Photosensitivity
  • Thrombocytopenia
  • Stevens Johnson Syndrome
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24
Q

K Sparing
-Sprinolactone (Aldactone), Triamterene (Dyrenium)
CONTRA

A
  • Anything that can cause hyperkalemia (Addison’s disease)
  • Anuria
  • Liver disease
  • adrenal insuff
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25
Q

K Sparing
-Sprinolactone (Aldactone), Triamterene (Dyrenium)
PTS

A
  • CHECK BMP!! ESSENTIAL TO PERFORM
  • Category C in pregnancy
  • NOT for breastfeeding
  • OFF LABEL in pediatrics
  • not peeing, don’t give
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26
Q

SYMPATHOLYTICS

A
  • HTN
  • Centrally Acting Alpha 1 Agonist
  • Centrally Acting Alpha 2 Agonist=Clonidine (Catapres)
  • Centrally Acting Alpha 2 Agonist=Methyldopa (Aldomet)
  • Beta 1 Antagonist=Propranolol (Inderal), Nadolol (Corgard)
  • Beta 1 Antagonist= Atenolol (Tenormin), Metoprolol (Toprol XL, Lopressor)
  • Mixed alpha/Beta Antagonist=Labetolol
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27
Q

-Centrally Acting Alpha 1 Agonist
-Doxazosin (Cardura), Terazosin (Hytrin)
MOA

A

-Blocks postsynaptic alpha 1 receptors causing arterial, arteriolar, and venous dilation, DECREASING peripheral resistance

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28
Q

-Centrally Acting Alpha 1 Agonist
-Doxazosin (Cardura), Terazosin (Hytrin)
PHARM

A
  • Good PO absorption
  • HIGHLY protein bound
  • Metabolized extensively in liver
  • Excreted in urine
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29
Q

-Centrally Acting Alpha 1 Agonist
-Doxazosin (Cardura), Terazosin (Hytrin)
SE

A
  • Dizziness
  • Fatigue
  • Dose Related Orthostasis (FIRST DOSE EFFECT)
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30
Q

-Centrally Acting Alpha 1 Agonist
-Doxazosin (Cardura), Terazosin (Hytrin)
CONTRA

A

Severe liver disease

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31
Q

-Centrally Acting Alpha 1 Agonist
-Doxazosin (Cardura), Terazosin (Hytrin)
PTS

A
  • Category C in pregnancy
  • Unknown if excreted in breast milk (AVOID)
  • OFF LABEL in pediatrics
  • GOOD OPTION IN MEN WITH BPH
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32
Q
  • Centrally Acting Alpha 1 Agonist

- Doxazosin (Cardura), Terazosin (Hytrin)

A
  • Symphatholytic
  • Doxazosin (Cardura), Terazosin (Hytrin)
  • Blocks postsynaptic alpha 1 receptors causing arterial, arteriolar, and venous dilation, DECREASING peripheral resistance
  • HIGHLY protein bound
  • Dose Related Orthostasis (FIRST DOSE EFFECT)
  • GOOD OPTION IN MEN WITH BPH
  • START LOW AND GO SLOW
  • MONITOR LIVER AND BPH
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33
Q
  • Centrally Acting Alpha 2 Agonist

- Clonidine (Catapres)

A
  • Symphatolytic
  • Decreases sympathetic outflow decreases HR, vascular tone = decrease in BP
  • Dry mouth (Teach to give ice chips and hard candy)
  • MONITORING LFTS IMPORTANT!!
  • Safe in PREG
  • ADHD
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34
Q

-Centrally Acting Alpha 2 Agonist
-Clonidine (Catapres)
MOA

A

Decreases sympathetic outflow decreases HR, vascular tone = decrease in BP

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35
Q

-Centrally Acting Alpha 2 Agonist
-Clonidine (Catapres)
PHARM

A
  • Well absorbed PO
  • Metabolized in liver
  • Excreted in urine
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36
Q

-Centrally Acting Alpha 2 Agonist
-Clonidine (Catapres)
CONTRA

A

Rash

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37
Q

-Centrally Acting Alpha 2 Agonist
-Clonidine (Catapres)
SE

A
  • Dry mouth (Teach to give ice chips and hard candy)
  • Anxiety
  • Constipation
  • Rash
  • Abnormal LFTS
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38
Q

-Centrally Acting Alpha 2 Agonist
-Clonidine (Catapres)
PTS

A
  • MONITORING LFTS IMPORTANT!!
  • Safe in pregnancy
  • NOT recommended in breastfeeding
  • Approved for use in pediatrics >12 y/o
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39
Q
  • Centrally Acting Alpha 2 Agonist

- Methyldopa (Aldomet)

A

-Sympatolytic
-Drug of choice in pregnancy
-Decreases Sympathetic outflow decreases HR, vascular tone = decrease in BP
-Competitive inhibitor inhibitor of DOPA
(LESS NE/E)
-Parkinsonism (BC of antidopaminergic effects)
-VERY safe in pregnancy and breastfeeding
-Approved for use in pediatrics

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40
Q

-Centrally Acting Alpha 2 Agonist
-Methyldopa (Aldomet)
MOA

A

-Decreases Sympathetic outflow decreases HR, vascular tone = decrease in BP
-Competitive inhibitor inhibitor of DOPA
(LESS NE/E)

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41
Q

-Centrally Acting Alpha 2 Agonist
-Methyldopa (Aldomet)
PHARM

A
  • Well absorbed PO
  • MINIMAL protein binding
  • Metabolized in liver
  • Excreted in urine
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42
Q

-Centrally Acting Alpha 2 Agonist
-Methyldopa (Aldomet)
CONTRA

A
  • Liver disease
  • Concomitant use of MAOIs
  • Pheochromocytoma
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43
Q

-Centrally Acting Alpha 2 Agonist
-Methyldopa (Aldomet)
SE

A
  • Depression
  • Anxiety
  • Parkinsonism (BC of antidopaminergic effects)
  • Hyperprolactinemia
  • Gynecomastia
  • Rash
  • Hemolytic Anemia
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44
Q

-Centrally Acting Alpha 2 Agonist
-Methyldopa (Aldomet)
PTS

A
  • VERY safe in pregnancy and breastfeeding
  • BEST BP PREG
  • Approved for use in pediatrics
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45
Q

Beta 1 Antagonist

NONSELECTIVE

A

-BP
-Sympatholytic
-Propranolol (Inderal), Nadolol (Corgard)
-Atenolol (Tenormin), Metoprolol (Toprol XL, Lopressor)
-LIPID SOLUBLE CROSSES BBB
-Asthma
-COPD
-DO NOT stop abruptly; MUST taper dose; cause cause cardiac ischemia
-Not metabolized (Nadolol)
-propanalol high protein bound in adults
-monitor bp and hr
-

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46
Q

Beta 1 Antagonist-non
-Propranolol (Inderal), Nadolol (Corgard)
MOA

A
  • Block stimulation of beta-1 and beta-2 adrenergic receptors
  • LIPID SOLUBLE CROSSES BBB
  • nonselective
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47
Q

Beta 1 Antagonist-non
-Propranolol (Inderal), Nadolol (Corgard)
PHARM

A
  • Fair PO absorption
  • Minimally protein bound
  • Not metabolized (Nadolol)
  • Metabolized in liver via CYP2d6 (Propranolol)
  • Excreted in urine
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48
Q

Beta 1 Antagonist-non
-Propranolol (Inderal), Nadolol (Corgard)
SE

A
  • Fatigue
  • Depression
  • Constipation
  • Raynaud phenomenon
  • Erectile Dysfunction
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49
Q

Beta 1 Antagonist-non
-Propranolol (Inderal), Nadolol (Corgard)
CONTRA

A
  • Asthma
  • COPD
  • Bradyarrthymias
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50
Q

Beta 1 Antagonist-non
-Propranolol (Inderal), Nadolol (Corgard)
PTS

A
  • DO NOT stop abruptly; MUST taper dose; cause cause cardiac ischemia (tachy)
  • Category C Pregnancy
  • Excreted in milk but safe per AAP
  • Propranolol off label in pediatrics
  • Nadolol NOT approved in peds
  • propanalol anxiety
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51
Q

-Beta 1 Antagonist
-Atenolol (Tenormin), Metoprolol (Toprol XL, Lopressor)
SELECTIVE

A
  • SELECTIVE
  • not as effective as other beta blockers
  • no peds=fetal bradycardia and resp depress
  • PREG C
  • Lopressor less money, bid; Toprol XL more money
  • fights anxiety lowers HR
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52
Q

-Beta 1 Antagonist
-Atenolol (Tenormin), Metoprolol (Toprol XL, Lopressor)
MOA

A
  • Block stimulation of beta 1 adrenergic receptors with little to no effect on beta 1 receptors
  • selective
  • LIPID SOLUBLE CROSSES BBB
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53
Q

-Beta 1 Antagonist
-Atenolol (Tenormin), Metoprolol (Toprol XL, Lopressor)
PHARM

A
  • Good PO absorption
  • Minimally protein bound
  • Metabolized in liver, Metoprolol via CYP2d6
  • Excreted in urine
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54
Q

-Beta 1 Antagonist
-Atenolol (Tenormin), Metoprolol (Toprol XL, Lopressor)
CONTRA

A
  • Asthma
  • COPD
  • Bradyarrthymias
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55
Q

-Beta 1 Antagonist
-Atenolol (Tenormin), Metoprolol (Toprol XL, Lopressor)
SE

A
  • Fatigue
  • Depression
  • Constipation
  • Raynaud phenomenon
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56
Q

-Beta 1 Antagonist
-Atenolol (Tenormin), Metoprolol (Toprol XL, Lopressor)
PTS

A
  • DO NOT stop abruptly; MUST taper dose; cause cause cardiac ischemia
  • Category C in pregnancy
  • Drug excreted in breast milk but safe per AAP
  • DO NOT breastfeed with atenolol
  • Metoprolol safe in peds
  • Atenolol OFF LABEL
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57
Q

Mixed alpha/Beta Antagonist

A
  • Sympatholytic
  • Labetalol
  • nonselective
  • asthma
  • copd
  • bradyrythmias
58
Q

Mixed alpha/Beta Antagonist
-Labetalol
MOA

A

NON selective beta antagonist with additional alpha antagonism

59
Q

Mixed alpha/Beta Antagonist
-Labetalol
PHARM

A
  • Poor PO absorption
  • Protein bound
  • Metabolized via conjugation to glucuronide metabolites
  • Excreted in urine
60
Q

Mixed alpha/Beta Antagonist
-Labetalol
CONTRA

A
  • Asthma
  • COPD
  • Bradyarrthymias
61
Q

Mixed alpha/Beta Antagonist
-Labetalol
SE

A
  • Tingling sensation on scalp (decreases w use)
  • Fatigue
  • Depression
  • Elevated LFTs
62
Q

Mixed alpha/Beta Antagonist

  • Labetalol
  • PTS
A
  • Category C in pregnancy
  • Safe in breastfeeding
  • OFF label in Peds
63
Q

VASODILATORS:

A
  • HTN
  • Hydralazine
  • Nitroprusside Sodium (Nipride)
64
Q
  • Vasodilator

- Hydralazine

A
  • Vasodilator
  • VERY PROTEIN bound
  • Thrombocytopenia
  • Leukopenia
  • Dissecting aortic aneurysm
  • Mitral valve rheumatic heart disease
  • MONITOR CBC and LFT
  • NOT for use in breastfeeding
  • Safe in peds
65
Q

-Vasodilator
-Hydralazine
MOA

A

Directly vasodilates arterioles with little effect on veins, decreasing systemic vascular resistance

66
Q

-Vasodilator
-Hydralazine
PHARM

A
  • Good PO absorption
  • VERY PROTEIN bound
  • Metabolized in liver
  • Excreted in urine
67
Q

-Vasodilator
-Hydralazine
SE

A
  • Palpitations
  • Headache
  • Psychotic reactions
  • N/V/D
  • Thrombocytopenia
  • Leukopenia
  • Hepatotixicity
68
Q

-Vasodilator
-Hydralazine
CONTRA

A
  • Dissecting aortic aneurysm

- Mitral valve rheumatic heart disease

69
Q

-Vasodilator-Hydralazine

PTS

A
  • MONITOR CBC and LFT
  • Category C pregnancy
  • NOT for use in breastfeeding
  • Safe in peds
70
Q

Nitroprusside Sodium (Nipride)

A
  • vasodilator
  • HTN
  • FOR SEVERE HYPERTENSIVE CRISIS ONLY NOT USED FOR OUTPATIENT!!!
71
Q

-Vasodilator
Nitroprusside Sodium (Nipride)
MOA

A

-Relaxes vascular smooth muscle to reduce preload and afterload by producing NO, also dilates coronary arteries

72
Q

-Vasodilator
Nitroprusside Sodium (Nipride)
PHARM

A
  • IV ONLY!
  • Rapid onset
  • Metabolized in blood
  • Ferrous ion in nitroprusside reacts with sulfhydryl compounds in RBCs causing cyanide release
  • Metabolized in liver and kidney into thiocyanate
73
Q

-Vasodilator
Nitroprusside Sodium (Nipride)
SE

A
  • Blood pressure
  • SpO2 (for cyanide toxicity monitoring)
  • Thiocyanate levels
74
Q

-Vasodilator
Nitroprusside Sodium (Nipride)
PTS

A
  • Category C in pregnancy
  • NOT for use in breastfeeding
  • Safe in pediatrics
  • FOR SEVERE HYPERTENSIVE CRISIS ONLY NOT USED FOR OUTPATIENT!!!
75
Q

Calcium Channel Blockers

A
  • HTN
  • Dihydropyridines
  • NON dihydropyridines
76
Q

Dihydropyridines

-Amlodipine (Norvasc), Nifedipine (Procardia)

A 
VERY protein bound
Concomitant use with strong CYP3a4 Inducers (REDUCES drug effects)
Important: CHECK LFTS!!!
-grapefruit juice increases effects
-Primary MOA is vasodilation.
-NO PEDS
77
Q

Dihydropyridines
-Amlodipine (Norvasc), Nifedipine (Procardia)
MOA

A
  • grapefruit juice increases effects

- Primary MOA is vasodilation.

78
Q

Dihydropyridines
-Amlodipine (Norvasc), Nifedipine (Procardia)
PHARM

A
  • grapefruit juice increases effects
  • Primary MOA is vasodilation.
  • Good PO availability
  • VERY protein bound
  • Metabolized in liver
  • Excreted in urine and stool
79
Q

Dihydropyridines
-Amlodipine (Norvasc), Nifedipine (Procardia)
SE

A
  • Peripheral edema
  • Flushing
  • Stevens Johnsons syndrome
  • Photosensitivity
80
Q

Dihydropyridines
-Amlodipine (Norvasc), Nifedipine (Procardia)
CONTRA

A

Concomitant use with strong CYP3a4 Inducers (REDUCES drug effects)

81
Q

Dihydropyridines
-Amlodipine (Norvasc), Nifedipine (Procardia)
PTS

A
  • grapefruit juice increases effects
  • Important: CHECK LFTS!!!
  • Category C in pregnancy
  • Nifedipine safe in breastfeeding
  • NOT FDA approved in children
82
Q
  • Calcium Channel Blocker
  • NON dihydropyridines
  • Verapamil (Calan), Diltiazem (Cardizem)
A
  • Affects rate (DOES NOT cause vasodilation)
  • VERY protein bound
  • AVOID IV diltiazem in newborns (has benzyl alcohol)
  • Verapamil ONLY APPROVED for SVT (slows signal to AV Node)
83
Q

-Calcium Channel Blocker
-NON dihydropyridines
-Verapamil (Calan), Diltiazem (Cardizem)
MOA

A

Affects rate (DOES NOT cause vasodilation)

84
Q

-Calcium Channel Blocker
-NON dihydropyridines
-Verapamil (Calan), Diltiazem (Cardizem)
PHARM

A
  • Fair PO availability
  • VERY protein bound
  • Metabolized in liver
  • Excreted in urine
85
Q

-Calcium Channel Blocker
-NON dihydropyridines
-Verapamil (Calan), Diltiazem (Cardizem)
CONTRA

A
  • History of bradyarrhythmias
  • CHF
  • AVOID IV diltiazem in newborns (has benzyl alcohol=gasping syndrome)
86
Q

-Calcium Channel Blocker
-NON dihydropyridines
-Verapamil (Calan), Diltiazem (Cardizem)
SE

A
  • Peripheral edema
  • Gingical hyperplasia (need good po care)
  • Headaches
  • Flushing
  • Constipation
87
Q

-Calcium Channel Blocker
-NON dihydropyridines
-Verapamil (Calan), Diltiazem (Cardizem)
PTS

A
  • Category C
  • Excreted in breast milk
  • Diltiazem OFF label in peds
  • Verapamil ONLY APPROVED for SVT
88
Q

Angiotensin Converting Enzyme Inhibitors

A
  • HTN
  • 1st choice HTN
  • Ace Inhibitor
  • doesnt affect HR just BP
89
Q

Angiotensin Converting Enzyme Inhibitors
ACE
“PRIL”
-Lisinopril, Trandolopril

A
  • HTN
  • Angiotensin II will INCREASE systemic vascular resistance thereby increasing preload/afterload
  • POOR PO
  • COUGH
  • NOT SAFE IN PRENANCY OR BREASTFEEDING
  • 1st choice for HTN
  • Monitor Potassium
90
Q 
Angiotensin Converting Enzyme Inhibitors
ACE
“PRIL”
-Lisinopril, Trandolopril
MOA
A
  • Prevents conversion of angiotensin I to angiotensin II;

- Angiotensin II will INCREASE systemic vascular resistance thereby increasing preload/afterload

91
Q 
Angiotensin Converting Enzyme Inhibitors
ACE
“PRIL”
-Lisinopril, Trandolopril
PHARM
A
  • POOR PO
  • Minimal protein bound
  • Lisinopril: NOT metabolized, excreted in urine
  • Trandolapril: Metabolized by liver, excreted in urine and stool
92
Q 
Angiotensin Converting Enzyme Inhibitors
ACE
“PRIL”
-Lisinopril, Trandolopril
CONTRA
A

Bilateral renal artery stenosis

93
Q 
Angiotensin Converting Enzyme Inhibitors
ACE
“PRIL”
-Lisinopril, Trandolopril
SE
A
  • COUGH
  • Hyperkalemia
  • Angioedema
94
Q 
Angiotensin Converting Enzyme Inhibitors
ACE
“PRIL”
-Lisinopril, Trandolopril
PTS
A
  • NOT SAFE IN PRENANCY OR BREASTFEEDING

- Lisinopril – not enough data for peds

95
Q
  • Angiotensin Converting Enzyme Inhibitors
  • Angiotensin Receptor Blockers
  • Renin Inhibitors
A
  • HTN
  • ACE; “PRIL” (Lisinopril, Trandolopril)
  • ARB; “SARTAN” (Losartan (Cozaar), Olmesartan (Benicar))
  • RENIN (Aliskiren (Tekturna))
96
Q
  • ARB
  • “SARTAN”
  • Losartan (Cozaar); Olmesartan (Benicar)
A
  • Angiotensin Receptor Blockers
  • Drug of choice for diabetics and chronic kidney disease
  • Causes vasoconstriction and increases aldosterone secretion
  • Angiotensin I conversion to Angiotensin II
  • Hypoglycemia
  • DO NOT use in pregnancy, breastfeeding women
  • AVOID in peds
97
Q

-ARB
-“SARTAN”
-Losartan (Cozaar); Olmesartan (Benicar)
MOA

A
  • Blocks binding of angiotensin II to receptors, which blocks the vasoconstriction and aldeosterone-secreting effects of angiotensin II
  • Causes vasoconstriction and increases aldosterone secretion
  • Angiotensin I conversion to Angiotensin II
98
Q

-ARB
-“SARTAN”
-Losartan (Cozaar); Olmesartan (Benicar)
PHARM

A
  • Poor PO absorption
  • HIGHLY protein bound
  • Metabolized in liver via CYP2C9
  • Losartan: Excreted in urine
  • Olmesartan: Excreted in urine and stool
99
Q

-ARB
-“SARTAN”
-Losartan (Cozaar); Olmesartan (Benicar)
SE

A
  • Hypoglycemia
  • Anemia
  • Cough
  • Angioedema
100
Q

-ARB
-“SARTAN”
-Losartan (Cozaar); Olmesartan (Benicar)
CONTRA

A

Allergy

101
Q

-ARB
-“SARTAN”
-Losartan (Cozaar); Olmesartan (Benicar)
PTS

A
  • DO NOT use in pregnancy, breastfeeding women

- AVOID in peds

102
Q

RENIN

Aliskiren (Tekturna)

A
  • HTN
  • NEED to check history, kidney disease and diabetes
  • new
103
Q

RENIN
Aliskiren (Tekturna)
MOA

A

Reduces plasma renin, thereby reduces angiotensin I and angiotensin II and aldosterone

104
Q

RENIN
Aliskiren (Tekturna)
PHARM

A
  • Poor PO absorption, reduced when taken with high fat meal
  • Metabolized in liver
  • Excreted in urine
  • Needs 2 weeks for anti-hypertensive effect
105
Q

RENIN
Aliskiren (Tekturna)
SE

A
  • Diarrhea
  • Cough
  • Rash
  • Hyperkalemia
  • Increase creatinine
  • Angioedema
106
Q

RENIN
Aliskiren (Tekturna)
CONTRA

A

Do NOT use in diabetics already taking an ACEI or an ARB (increased risk of stroke, renal complications, hyperkalemia, HYPOtension)

107
Q

RENIN
Aliskiren (Tekturna)
PTS

A
  • NEED to check history, kidney disease and diabetes
  • NOT safe in pregnancy
  • NOT safe in breastfeeding
  • NOT approved in pediatrics
108
Q

HTN

HXof MI

A

-beta blocker and aceI

109
Q

HTN

Diabetes

A

-ACE

110
Q

HTN

PREG

A
  • Methlodopa 1st
  • labetalol
  • maybe beta blockersand diuretics
111
Q

HTN

BF

A
  • diuretics and beta blockers

- fine to contine methladopa or labetalol from preg

112
Q

HTN

PEDS

A
  • ACEI, Metroprolol, Amlodopine
  • ARB >6
  • otherwise propanalol or hydralazine
113
Q

Choosing HTN MEDS

-No diab or ckd over 60 white:

A
  • thiazide
  • ACEI
  • ARB
  • CCB
114
Q

Choosing HTN MEDS

-No diab or ckd over 60 black:

A
  • thiazide

- CCB

115
Q

Choosing HTN MEDS

No diab or ckd below 60 white:

A
  • thiazide
  • ACEI
  • ARB
  • CCB
116
Q

Choosing HTN MEDS

No diab or ckd below 60 black:

A
  • thiazide

- CCB

117
Q

Choosing HTN MEDS

all ages diabetes no ckd white:

A
  • thiazide
  • ACEI
  • ARB
  • CCB
118
Q

Choosing HTN MEDS

all ages diabetes no ckd black:

A
  • thiazide

- CCB

119
Q

Choosing HTN MEDS

all ages ckd:

A
  • ACE

- ARB

120
Q

Main cause of hypertension

A

Hypovolemia – Main cause of hypertension; Remember the renin and angiotensin conversion

121
Q

ACE inhibitors SE

A

ACE inhibitors – Cough is the biggest side effect

122
Q

ARB

A
  • prescribe for diabetes and chronic kidney disease

- ANGIOTENSIN I conversion ANGIOTENSIN II

123
Q

Betablocker

A

are highly lipid soluble – WILL CROSS BBB

Atenolol noted to be LESS effective than any other beta blockers because it has the shortest half life

124
Q

Calcium Channel blockers

A

Verapamil is the best med for history of SVT

125
Q

Diuretics

A

Lasix depletes potassium effectively and quickly CHECK BMP!

126
Q

Aldosterone

A

K+ SPARING. Good for hypokalemia; NOT a good choice for Addisons disease

127
Q

Clonidine

A

ALPHA 2 AGONIST!!! Know that it is EFFECTIVE be DECREASING HR and DECREASING VASCULAR TONE

128
Q

Methyldopa

A

best for PREG

129
Q

drug to use if HTN, diabetic, and ckd

A

losartan

  • angiotensin II Receptor
  • treats htn and slow kidney damage
130
Q

diuretics and kids

A

diuretics not great, kid will miss class

131
Q

lipid soluable drug

A

will cross BBB easy

132
Q

atenalol AND metropolol

A
  • atenool short half life

- metropalol also short but can give more expensive ER with meals

133
Q

BLACK

A

THIAZIDE OR CCB

134
Q

NONDIHYDROPYRIDINES

VERAPAMIL; CALAN, DILTIAZEM, CARDIZEM

A

HR

135
Q

ACEI

A

COUGH

136
Q

PROPANALOL

A

BBB

HIGHLY LIPOPHILIC

137
Q

TEENAGERS

A

METROPOL, CLONADINE, HYDRALAZINE

138
Q

CLONADINE

A

OVER 12 OK

139
Q

SYMPATHOLYTICS
CENTRALLY ACTING ALPHA 2 AGONIST
CLONADINE/ CATAPRES

A

DECREASES HR AND VASULAR TONE = DECREASED BP

140
Q

DIABETIC

A

ACE OR ARB

141
Q

ADDDISONS DISEASE

A

NO K-SPARING OR ALDOSTERONE

Pharmacology Test 3 (5 decks)

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