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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
Angiotensin converting enzyme inhibitors (cautions)
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
Angiotensin receptor blockers (general)
block angiotensin II from binding to receptor, allows for vascular vasodilation, decreased retention of Na/water usually dosed 1x daily
27
Angiotensin receptor blockers
``` azilsartan candesartan eprosartan irbesartan losartan olmesartan telmisartan valsartan ```
28
Angiotensin receptor blockers (AE)
hyperkalemia renal function deterioration angioedema hypotension/syncope
29
Angiotensin receptor blockers (cautions)
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
Direct renin inhibitors (general)
directly inhibits renin, allows for vascular vasodilation, decreased retention of Na/water
31
direct renin inhibitors
aliskren
32
direct renin inhibitors (AE)
hyperkalemia | hypotension
33
direct renin inhibitors (cautions)
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
Alpha 1 blockers (general)
block alpha 1 receptors to decrease vasoconstriction, peripheral resistance, blood pressure
35
Alpha 1 blockers
doxazosin prazosin terazosin
36
Alpha 1 blockers (AE)
``` syncope dizziness palpitations orthostatic hypotension falls ```
37
Alpha 1 blockers (cautions)
not for HTN monotherapy (increase CV events), 4th/5th line add on contraindicated: hypersensitivity
38
Central alpha 2 agonist (general)
Inhibit NE release, causing reduced sympathetic outflow, enhanced parasympathetic activity, reduced HR, CO, total PR may use occasionally for resistant HTN
39
Central alpha 2 agonist
clonidine methyldopa guanfacine guanabenz
40
Central alpha 2 agonist (AE)
transient sedation, visual disturbances, sedation Methyldopa: hepatotoxicity, hemolytic anemia, peripheral edema orthorstatic hypotension Clonidine: orthostatic hypotension, dry mouth, muscle weakness
41
Central alpha 2 agonist (cautions)
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
Peripheral sympathetic inhibitors (general)
Reduces sympathetic tone and PR, depletes NE for sympathetic nerve endings slow acting
43
Peripheral sympathetic inhibitors
reserpine
44
Peripheral sympathetic inhibitors (AE)
Gastric ulceration, depression, sexual side effects, orthostatic HTN, nasal congestion, fluid retention, peripheral edema, diarrhea, increased gastric secretion
45
Peripheral sympathetic inhibitors (cautions)
Poorly tolerated, interacts with OTC cold/cough meds (acute hypertensive) Contrindications: hypersensitivity, peptic ulcer disease, ulcerative colitis, hx depression or ECT
46
Direct Vasodilators (general)
Relax smooth muscles in arterioles, activate baroreceptors Used for resistant hypertension Consult with specialist before prescribe
47
Direct Vasodilators
isorbide dinatrate/hydralazide hydralazine minoxidil
48
Direct vasodilators (AE)
edema, hyper trichosis (minoxidil) tachycardia lupus-like syndrome (hydralazine)
49
Direct vasodilators (caution)
May cause reflex tachycardia, fluid retention so use with BB and diuretics Contraindicated: hypersensitivity, pheochromocytoma (minoxidil), increased ICP (isosorbide)
50
Pregancy
Methyldopa is first line Labetalol also ok Consult before others (fetal concerns)

Cardiovascular Pharmacology (4 decks)

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