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Cardiovascular Pharmacology > HTN > Flashcards

HTN Flashcards

1
Q

Diuretics (general)

A

decrease blood pressure by decreasing blood volume (increase sodium excretion by kidneys, water follows)
MUST MONITOR ELECTROLYTES

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2
Q

Thiazide diuretics

A

hydrochlorothiazie
chlorthalidone
metalozone
indapamide

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3
Q

Thiazide dirueretic (Pros/Cons)

A

Pros: 12.5mg effective w/o side effects, often first line (especially older/black), also some dilation of peripheral resistance, good in combos

Cons: Not effective if GFR<30
Hypokalemia, hyperuricemia, hyperglycemia, diuresis

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4
Q

Loop diuretics

A

Furosemide
Toresemide
Bumetanide
Ethacrynic acid

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5
Q

Loop diuretics (Pros/Cons)

A

Pros: Also treat HF/edema, block Na/Cl re-absorption even if poor renal function, work quickly, decrease renal vascular resistance

Cons: rarely used alone for HTN, not first line

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6
Q

Potassium sparking diuretics

A 
Amiloride
Triamterene
Spironolactone*
Eplerenone*
(*aldosterone receptor antagonist, diminish cardiac remodeling in HR)
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7
Q

Potassium sparking diuretics (Pros/cons)

A

Pros: Inhibit Na+ transport at late distal+collecting ducts (stays in urine), can be used with other diuretics to reduce loss of K+
Cons: not first line

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8
Q

Beta Blockers (general)

A

Block beta adrenergic receptors (1,2), decrease HR/CO, some inhibition of renin release
+ISA
Cardioselective OK for asthma, COPD, PV disease
Dose 1-2x daily

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9
Q

Non-selective beta blockers

A 
-ISA: Nadolol
         Propanolol
         Timolol
\+ISA: Pindolol
          Carteolol
          Penbutolol
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10
Q

Selective beta blockers (B1)

A 
-ISA: Atenolol
         Metroprolol
         Esmolol
         Betaxolol
         Bisorolol
\+ISA: Acebutolol
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11
Q

Beta blockers with vasodilatory properties

A

Labetolol (alpha-1 blocking)_
Carvedilol (alpha-1 blocking)
Nebivolol (NO activity)

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12
Q

Beta blockers (adverse affects)

A 
Bradycardia, heart block, HF
dyspnea, bronchospasm
fatigue, dizziness, lethargy, depression
decreased libido, erectile dysfunction
Hyper/hypoglycemia
Hyperkalemia
hyperlibidemia
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13
Q

Beta blockers (cautions)

A

HR <60, respiratory disease, abrupt discontinuation (1-2 week taper), hypoglycemia (masked symptoms), hypokalemia (with diuretic)

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14
Q

Beta blockers (contraindicated)

A

Hypersensitivity, sinus node dysfunction/bradycardia, heart block, cardiogenic shock, decompensated HR
asthma (nonsenselective)

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15
Q

Calcium channel blockers (general)

A

blocks calcium movement into smooth muscles to prevent contraction of arterioles, results in dilation
usually short half life (except amlodipine), so prefer extended release

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16
Q

Calcium channel blockers (dihydropyridines)

A

greater affinity for vascular channels, not with atrial dysrhythmia, some coronary vasodilation

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17
Q

Calcium channel blockers (non-dihydropyridines)

A

vascular and cardiac channels, also decreases CO, coronary vasodilation, negative inotropic effects (not with HRrEF), blocks cardiac conduction via AV node (helps Afib),

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18
Q

Calcium channel blockers

A 
Dihydropyridines:
      nifedipine
      amlodipine (ok for HF)
Non-dihydropyridines:
       verapamil
       diltiazem
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19
Q

Calcium channel blockers (adverse effects)

A

(esp nondih) bradycardia, heart block, constipation, perpheral edema
headache, flushing, edema
(esp dihyd) gingival hyperplasia, reflex tachycardia

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20
Q

Calcium channel blockers (cautions)

A

heart rate <60 (nondi)

concomitant use with BB (heart block poss)

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21
Q

Calcium channel blockers (contraindications)

A

hypersensitivity, HFrEF (except amlodipine)

non-dihy: sinus node dysfunction/bradycardia, heart block, afib/flutter with accessory bypass tract

22
Q

Angiotensin converting enzyme inhibitors (general)

A

inhibit conversion of angiotensin I to angiotensin II, allows for vascular vasodilation, decreased retention of Na/water
usually does 1x daily

23
Q

Angiotensin converting enzyme inhibitors

A 
benazepril
captopril
enalapril
lisinopril
moexipril
perindopril
quinapril
trandolipril
24
Q

Angiotensin converting enzyme inhibitors (adverse effects)

A

common: hyperkalemia, dry cough, reduced GRF/serum CR increase
serious: acute renal failure, blood dycrasias, angioedema

25
Q

Angiotensin converting enzyme inhibitors (cautions)

A

Monitor electrolytes and renal function, adjust doses as needed
Caution: baseline hyperkalemia
Contraindication: pregnancy, hypersensitivity, bilateral renal artery stenosis (unilateral if only one working kidney), concurrent ARB use

26
Q

Angiotensin receptor blockers (general)

A

block angiotensin II from binding to receptor, allows for vascular vasodilation, decreased retention of Na/water
usually dosed 1x daily

27
Q

Angiotensin receptor blockers

A 
azilsartan
candesartan
eprosartan
irbesartan
losartan
olmesartan
telmisartan
valsartan
28
Q

Angiotensin receptor blockers (AE)

A

hyperkalemia
renal function deterioration
angioedema
hypotension/syncope

29
Q

Angiotensin receptor blockers (cautions)

A

Monitor electrolytes and renal function, adjust doses as needed
Caution: baseline hyperkalemia
Contraindication: pregnancy, hypersensitivity, bilateral renal artery stenosis (unilateral if only one working kidney), concurrant ACE-I use

30
Q

Direct renin inhibitors (general)

A

directly inhibits renin, allows for vascular vasodilation, decreased retention of Na/water

31
Q

direct renin inhibitors

A

aliskren

32
Q

direct renin inhibitors (AE)

A

hyperkalemia

hypotension

33
Q

direct renin inhibitors (cautions)

A

Monitor electrolytes (K+)and renal function (serum Cr, GFR)
Caution: severe renal impairment, deteriorating renal function, renal artery stenosis
Contraindication: pregnancy, combo with ACE-I or ARBs (especially in patients with diabetes)
Interactions: ACE-I, ARBs, cyclosporine, K+ sparing diuretics, K+ supplements or salt substitutes, furosemide, ketoconazole

34
Q

Alpha 1 blockers (general)

A

block alpha 1 receptors to decrease vasoconstriction, peripheral resistance, blood pressure

35
Q

Alpha 1 blockers

A

doxazosin
prazosin
terazosin

36
Q

Alpha 1 blockers (AE)

A 
syncope
dizziness
palpitations
orthostatic hypotension
falls
37
Q

Alpha 1 blockers (cautions)

A

not for HTN monotherapy (increase CV events), 4th/5th line add on
contraindicated: hypersensitivity

38
Q

Central alpha 2 agonist (general)

A

Inhibit NE release, causing reduced sympathetic outflow, enhanced parasympathetic activity, reduced HR, CO, total PR
may use occasionally for resistant HTN

39
Q

Central alpha 2 agonist

A

clonidine
methyldopa
guanfacine
guanabenz

40
Q

Central alpha 2 agonist (AE)

A

transient sedation, visual disturbances, sedation
Methyldopa: hepatotoxicity, hemolytic anemia, peripheral edema orthorstatic hypotension
Clonidine: orthostatic hypotension, dry mouth, muscle weakness

41
Q

Central alpha 2 agonist (cautions)

A

Must taper clonidine when stop (severe rebound hypertension), taper BB first if on both, may have withdrawal (increased SNS activity)
Contraindications: hypersensitivity, MAO-I and/or hepatic disease and/or pheochromocytoma (methyldopa)

42
Q

Peripheral sympathetic inhibitors (general)

A

Reduces sympathetic tone and PR, depletes NE for sympathetic nerve endings
slow acting

43
Q

Peripheral sympathetic inhibitors

A

reserpine

44
Q

Peripheral sympathetic inhibitors (AE)

A

Gastric ulceration, depression, sexual side effects, orthostatic HTN, nasal congestion, fluid retention, peripheral edema, diarrhea, increased gastric secretion

45
Q

Peripheral sympathetic inhibitors (cautions)

A

Poorly tolerated, interacts with OTC cold/cough meds (acute hypertensive)
Contrindications: hypersensitivity, peptic ulcer disease, ulcerative colitis, hx depression or ECT

46
Q

Direct Vasodilators (general)

A

Relax smooth muscles in arterioles, activate baroreceptors
Used for resistant hypertension
Consult with specialist before prescribe

47
Q

Direct Vasodilators

A

isorbide dinatrate/hydralazide
hydralazine
minoxidil

48
Q

Direct vasodilators (AE)

A

edema, hyper trichosis (minoxidil)
tachycardia
lupus-like syndrome (hydralazine)

49
Q

Direct vasodilators (caution)

A

May cause reflex tachycardia, fluid retention so use with BB and diuretics
Contraindicated: hypersensitivity, pheochromocytoma (minoxidil), increased ICP (isosorbide)

50
Q

Pregancy

A

Methyldopa is first line
Labetalol also ok
Consult before others (fetal concerns)

Cardiovascular Pharmacology (4 decks)

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