HTN 6 Flashcards
Mechanism of which group of meds?
–Inhibit influx of calcium across the cell membrane leading to coronary and peripheral vasodilation
Calcium Channel blockers
T/F: all CCBs have the same pharmacodynamics
False
•Think of them on a spectrum from action on the heart to action on peripheral arterioles. (dihydropyridines to nondihydropyridines)
What are CCB effects on SA node?
*decrease heart rate
*decrease O2 demand
CCB effect on ventricular myocardium
*decrease contractility
*decrease O2 demand
CCB effect on coronary arteries
*Increase vasodilation
*increase O2 supply
CCB effects on ther arterioles?
*Decrease BP (afterload)
*Decrease myocardial O2 demand
Calcium channel antagonists block the inward movement of calcium by binding to the ___- type calcium channels in the heart and in smooth muscle of the peripheral vasculature
L-type
CCB’s dilate coronary arteries and peripheral arterioles, but not _____
veins
CCB’s also decrease _______, automaticity at the SA node and conduction at the AV node
Cardiac contractility (negative inotropic effect)
Dihydropyridines have minimal effect on________or ______, while they have potent actions as arteriolar _______.
Minimal effect on cardiac condution or heart rate
potent effect as arteriolar vasodilators
Dihydropyridines (CCBs) can cause _______ when peripheral vasodilation is marked
reflex tachycardia
Nondihydropyridines, verapamil and diltiazem do what 3 things
- slow AV conduction
- decrease SA node automaticity
- decrease heart rate.
Which nondihydropyridine (CCB) is often used in the management of angina?
Diltiazem
Which CCBs?
•Effective in elderly with isolated systolic HTN and may be considered as an add on to diuretic
•Decrease HR and slow AV nodal conduction
•Able to treat supraventricular tachyarrhythmias
•Both able to produce negative inotropic and chronotropic effects
Nondihydropyridines- Verapamil, diltiazem
•Both able to produce negative inotropic and chronotropic effects with verapamil>diltiazem
Which CCBs?
–Baroreceptor reflex tachycardia through peripheral vasodilation properties
–Do not alter conduction through AV node
–***Used in treatment of Raynauds
Dihydropyridine
_____ is the only CCB with established safety in patients with severe heart failure
**Amlodipine
Efficacy of which group of meds?
–Not first-line agents in JNC 7 but option in JNC 8
–Considered first-line in 2017 AHA/ACA
–Equivalent to ACE I and thiazide diuretics in prevention of CHD and total mortality
–Protective effect against stroke
CCBs
Effective antihypertensives particularly in African-Americans
CCBs
What 4 things should be monitored with CCBs?
- LFTs
- BP
- ECG
- HR
Side effects of which group of meds
–All: dizziness, flushing, HA, gingival hyperplasia, peripheral edema, mood changes, bradycardia
–Negative inotropic effects—caution in patients w/ cardiac dysfunction
CCBs
Which CCB has the specific side effect of constipation?
Verapamil
WHich group of meds?
Drug interactions CP40 systems
- Inhibit metabolism of
- Cyclosporine, digoxin, lovastatin, simvastain, tracrolimus and theophylline
- **Caution with beta blocker—increased chance of heart block
CCBs
Which med?
Drug interactions CP40 systems:
- ***metabolism inhibited by large quantities of grapefruit juice (> 1quart)
Nifedipine
Which 2 meds are direct arterial vasodilators?
Hydralizine
Minoxidil
Which meds?
- **Direct arteriolar smooth muscle relaxation
- Little or no venous vasodilation
- **Can precipitate angina in patients with CAD
- *Adjust in renal impairment
Direct Arterial vasodilators (hydralazine minoxidil)
Which meds?
Activates baroreceptors w/ compensatory increase in sympathetic outflow—increase in HR, CO, and renin release—tachyphylaxis and loss of efficacy—use with beta blocker or clonidine to prevent; diuretic for the sodium and water retention
Direct arterial vasodilators (hydralazine, minoxidil)
Which med?
dose dependent lupus-like syndrome and slow acetylators (hepatic N-acetyltransferase) are prone; more common in women
Hydralazine (direct arterial vasodilators)
Which meds are used with isosorbide-dinitrate in patients with heart failure , specifically African Americans
Direct Arterial vasodilators (Hydralazine, minoxidil)
Which med is used for hypertrichosis (improves hair growth)
Minoxidil (Direct arterial vasodilator)
What is an alternative use of minoxidil?
Male pattern baldness (both men and women)
What is considered a HTN urgency vs emergency?
Both have >180/>120 but emergency also has target organ damage
Meds used for HTN emergencies
Compelling indication for which meds?
HF with reduced EF
Standard therapy
- Diuretic w/ ACE/ARB
- then add BB
Add on if needed for BP control:
- Aldosterone antagonist
Compelling indication for which meds?
post- MI
BB then add ACE/ARB
Compelling indication for which meds?
Coronary Artery Disease
Standard therapy:
- BB
- then add ACE/ARB
Add on if needed for BP control
- CCB
- Thiazide
Compelling indication for which meds?
Diabetes
Standard therapy: ACE or ARB
Add on if needed for BP control: CCB–>Thiazide, BB
Compelling indication for which meds?
CKD
ACE/ARB
Compelling indication for which meds?
Recurrent stroke prevention
Thiazide
or
Thiazide w/ ACE
What is an osmotic diuretic
Mannitol
How does Mannitol work
Mannitol is an osmotic diuretic
•remains in the lumen and “hold” water by virtue of its osmotic effect.
What is the major location of action of Mannitol (osmotic diuretic)
PCT
_______can also reduce brain volume and intracranial pressure by osmotically extracting water from the tissue into the blood. A similar effect occurs in the eye.
Mannitol (osmotic diuretic)
What are the 3 clinical applications of osmotic diuretics (Mannitol)
- Solute overload in rhabdomyolisis, hemolysis
- Brain edema w/ coma
- Acute glaucoma
ADEs of which meds?
Hyponatremia followed by hypernatremia, HA, N/V
Osmotic diuretics (Mannitol)
________ facilitates water reabsorption from the collecting tubule by activation of V2 receptors, which stimulate adenylyl cyclase via Gs
•The increased cAMP causes the insertion of additional aquaporin AQP2 water channels into the luminal membrane in this part of the tubule
ADH
