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Pharm-HTN/CHF > HTN Day 2 > Flashcards

HTN Day 2 Flashcards

1
Q

Name the Non-dihydropyridines (CCB)

A

Verapamil

Diltiazem

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2
Q

Name the Dihydropyridines (CCB)

A

Amlodipine
Felodipine
Isradipine
Nifedipine

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3
Q

What is the role of calcium in relation to contraction?

A

When channels are opened: causes calcium influx into smooth muscle: specifically cardiac & vascular. Results in activation of intracellular calcium with ultimately leads to muscle contraction (activates myosin & actin).

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4
Q

What is the general MOA of CCBs

A

Inhibits Ca++ influx into cells to prevent muscle contraction.

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5
Q

What is the MOA of Dihydropyridines?

A

Inhibits Ca++ influx into vascular smooth muscle specifically, resulting peripheral vasodilation (decrease in BP)

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6
Q

What is the MOA of Non-dihydropyridines?

A

Inhibits Ca++ influx into cardiac smooth muscle specifically, resulting in a decrease of rate and force of contraction (chronotropy & inotropy).

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7
Q

What is the place in therapy of the CCBs?

A

First Line for HTN

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8
Q

What are the other uses of the Non-dihydropyridines?

A

Supraventricular tachycardia

a fib

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9
Q

What is another use of Verapamil specifically?

A

Migraine prophylaxis

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10
Q

What is the general adverse effect of all CCBs?

A

Hypotension

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11
Q

Name the ARDs of the Non-dihydropyridines?

A 
Constipation (Verapamil)
Bradycardia
worsening of CHF
Heart block
Gingival hyperplasia
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12
Q

Name the ARDs of the Dihydropyridines?

A

Peripheral edema (worst with Nifedipine)
Reflex tachycardia
Flushing
HA

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13
Q

What are the issues with sublingual Nifedipine?

A

Risk for severe hypotension and there is a reported increased risk for MI and death.

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14
Q

What population are dihydropyridines especially good for?

A

Elderly bc they tend to have isolated systolic HTN

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15
Q

What is special about Clevidipine?

A

It is IV only and is contraindicated in soy and/or egg allergic patients

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16
Q

What are the drug interactions associated with Verapamil?

A

It is metabolized by CYP3A4 and also an inhibitor of this enzyme.

17
Q

Name the Alpha 1 Blockers FDA approved for HTN?

A

Prazosin
Terazosin
Doxazosin

18
Q

Name the Alpha 1 Blockers FDA approved for BPH?

A

Tamsulosin

Alfuzosin

19
Q

What is the MOA of Alpha 1 Blockers?

A

Competitively inhibits alpha-1 receptors in the periphery which causes vasodilation.

20
Q

What is the Place in Therapy of Alpha 1 Blockers?

A

Only as an add on especially in males. Not to be used often, not as monotherapy.

21
Q

What are the uses of Alpha 1 Blockers?

A

HTN

BPH

22
Q

What are the ARDs of Alpha 1 Blockers?

A 
"First dose effect" - significant orthostatic hypotension w first dose & any subsequent dose titrations. SLOWLY titrate.
Orthostatic hypotension
Dizziness
Vertigo
Reflex tachycardia (esp. early in therapy - not seen if on BB too)
Fatigue
vivid dreams
depression
dry mouth
23
Q

What are the doses of Alpha 1 Blockers?

A

Take at night!!
Doxazosin 1x/day
Terazosin 1 to2x/day
Prazosin 2-3x/day

24
Q

Name the Centrally acting agents - Alpha 2 agonists.

A

Methyldopa

Clonidine

25
Q

What is the MOA of Centrally acting agents - Alpha 2 agonists?

A

Stimulates alpha 2 receptors in brain, reduces sympathetic outflow from brain, which produces a decrease in BP and peripheral vascular resistance.

26
Q

What is the place in therapy of Methyldopa?

A

Good for use during pregnancy (Category B)

27
Q

What is the place in therapy of Clonidine?

A

Often used for resistant HTN. Other uses are substance abuse tx (opiate withdrawal & avoidance) and adjunct in pain mgmt.

28
Q

What are the general ARDs of Centrally acting agents - Alpha 2 agonists?

A 
Orthostatic hypotension
dizziness
fatigue
depression
sedation
Na+ & H2O retention
Rebound tachycardia & HTN if stopped abruptly
29
Q

What are the ARDs of methyldopa specifically?

A

Liver toxicity

Hemolytic anemia

30
Q

What are the ARDs of clonidine?

A

Rash w patch

“anticholinergic-like side effects” dry mouth, sedation, constipation, urinary retention

31
Q

What is another route of admin for clonidine?

A

Available as a patch applied every 7days, effects begin within 12-24 hours & last up to 3 days after patch removal

32
Q

What are the vasodilators of HTN?

A

Hydralazine

Minoxidil

33
Q

What is the MOA of the vasodilators?

A

Direct vasodilator, especially in arteries & arterioles, leading to decreased systemic vascular resistance. Causes peripheral vasodilation

34
Q

What is the are the common ARDs of vasodilators?

A

Reflex tachycardia (consider co-admin of BB)
Increase in renin as response to vasodilation, (consider co-admin w diuretic).
HA

35
Q

What the ARDs of hydrazine specifically?

A 
Lupus-like syndrome (butterfly like rash)
Dermatitis
Drug fever
Peripheral neuropathy
Hepatitis
36
Q

What the ARDs of minoxidil?

A

Hirsutism

37
Q

What are the preferred combos?

A

ACE/ARB and Thiazide

ACE/ARB and Dihydropyridine CCB

38
Q

What are the acceptable combos?

A

CCB and thiazide
Thiazide and K sparing diuretic
BB and diuretic or dihydropyridine CCB

39
Q

Name some drugs that can induce HTN?

A
  • Corticosteroids
  • Excessive alcohol
  • NSAIDs
  • ACTH
  • Amphetamines
  • Appetite suppressants
  • Caffeine
  • Cyclosporine
  • Estrogen
  • Pseudoephedrine
  • Thyroid hormone (in excess)
  • Duloxetine
  • Venlafaxine
  • Bevacizumab
  • Sorafenib
  • Erythropoietin

Pharm-HTN/CHF (4 decks)

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