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Pharm 2 Exam SHEA > HTN 6 > Flashcards

HTN 6 Flashcards

1
Q

Mechanism of which group of meds?

–Inhibit influx of calcium across the cell membrane leading to coronary and peripheral vasodilation​

A

Calcium Channel blockers

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2
Q

T/F: all CCBs have the same pharmacodynamics

A

False

•Think of them on a spectrum from action on the heart to action on peripheral arterioles. (dihydropyridines to nondihydropyridines)

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3
Q

What are CCB effects on SA node?

A

*decrease heart rate

*decrease O2 demand

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4
Q

CCB effect on ventricular myocardium

A

*decrease contractility

*decrease O2 demand

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5
Q

CCB effect on coronary arteries

A

*Increase vasodilation

*increase O2 supply

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6
Q

CCB effects on ther arterioles?

A

*Decrease BP (afterload)

*Decrease myocardial O2 demand

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7
Q

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

A

L-type

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8
Q

CCB’s dilate coronary arteries and peripheral arterioles, but not _____

A

veins

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9
Q

CCB’s also decrease _______, automaticity at the SA node and conduction at the AV node

A

Cardiac contractility (negative inotropic effect)

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10
Q

Dihydropyridines have minimal effect on________or ______, while they have potent actions as arteriolar _______.

A

Minimal effect on cardiac condution or heart rate

potent effect as arteriolar vasodilators

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11
Q

Dihydropyridines (CCBs) can cause _______ when peripheral vasodilation is marked

A

reflex tachycardia

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12
Q

Nondihydropyridines, verapamil and diltiazem do what 3 things

A
  1. slow AV conduction
  2. decrease SA node automaticity
  3. decrease heart rate.
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13
Q

Which nondihydropyridine (CCB) is often used in the management of angina?

A

Diltiazem

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14
Q

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

A

Nondihydropyridines- Verapamil, diltiazem

•Both able to produce negative inotropic and chronotropic effects with verapamil>diltiazem

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15
Q

Which CCBs?

–Baroreceptor reflex tachycardia through peripheral vasodilation properties

–Do not alter conduction through AV node

–***Used in treatment of Raynauds

A

Dihydropyridine

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16
Q

_____ is the only CCB with established safety in patients with severe heart failure

A

**Amlodipine

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17
Q

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

A

CCBs

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18
Q

Effective antihypertensives particularly in African-Americans

A

CCBs

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19
Q

What 4 things should be monitored with CCBs?

A
  1. LFTs
  2. BP
  3. ECG
  4. HR
20
Q

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

A

CCBs

21
Q

Which CCB has the specific side effect of constipation?

A

Verapamil

22
Q

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
A

CCBs

23
Q

Which med?

Drug interactions CP40 systems:

  • ***metabolism inhibited by large quantities of grapefruit juice (> 1quart)
A

Nifedipine

24
Q

Which 2 meds are direct arterial vasodilators?

A

Hydralizine

Minoxidil

25
Q

Which meds?

  1. **Direct arteriolar smooth muscle relaxation
  2. Little or no venous vasodilation
  3. **Can precipitate angina in patients with CAD
  4. *Adjust in renal impairment
A

Direct Arterial vasodilators (hydralazine minoxidil)

26
Q

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

A

Direct arterial vasodilators (hydralazine, minoxidil)

27
Q

Which med?

dose dependent lupus-like syndrome and slow acetylators (hepatic N-acetyltransferase) are prone; more common in women

A

Hydralazine (direct arterial vasodilators)

28
Q

Which meds are used with isosorbide-dinitrate in patients with heart failure , specifically African Americans

A

Direct Arterial vasodilators (Hydralazine, minoxidil)

29
Q

Which med is used for hypertrichosis (improves hair growth)

A

Minoxidil (Direct arterial vasodilator)

30
Q

What is an alternative use of minoxidil?

A

Male pattern baldness (both men and women)

31
Q

What is considered a HTN urgency vs emergency?

A

Both have >180/>120 but emergency also has target organ damage

32
Q

Meds used for HTN emergencies

A
33
Q

Compelling indication for which meds?

HF with reduced EF

A

Standard therapy

  1. Diuretic w/ ACE/ARB
  2. then add BB

Add on if needed for BP control:

  1. Aldosterone antagonist
34
Q

Compelling indication for which meds?

post- MI

A

BB then add ACE/ARB

35
Q

Compelling indication for which meds?

Coronary Artery Disease

A

Standard therapy:

  1. BB
  2. then add ACE/ARB

Add on if needed for BP control

  1. CCB
  2. Thiazide
36
Q

Compelling indication for which meds?

Diabetes

A

Standard therapy: ACE or ARB

Add on if needed for BP control: CCB–>Thiazide, BB

37
Q

Compelling indication for which meds?

CKD

A

ACE/ARB

38
Q

Compelling indication for which meds?

Recurrent stroke prevention

A

Thiazide

or

Thiazide w/ ACE

39
Q

What is an osmotic diuretic

A

Mannitol

40
Q

How does Mannitol work

A

Mannitol is an osmotic diuretic

•remains in the lumen and “hold” water by virtue of its osmotic effect.

41
Q

What is the major location of action of Mannitol (osmotic diuretic)

A

PCT

42
Q

_______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.

A

Mannitol (osmotic diuretic)

43
Q

What are the 3 clinical applications of osmotic diuretics (Mannitol)

A
  1. Solute overload in rhabdomyolisis, hemolysis
  2. Brain edema w/ coma
  3. Acute glaucoma
44
Q

ADEs of which meds?

Hyponatremia followed by hypernatremia, HA, N/V

A

Osmotic diuretics (Mannitol)

45
Q

________ 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

A

ADH

46
Q
A

Pharm 2 Exam SHEA (15 decks)

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