HTN Day 2 Flashcards
Name the Non-dihydropyridines (CCB)
Verapamil
Diltiazem
Name the Dihydropyridines (CCB)
Amlodipine
Felodipine
Isradipine
Nifedipine
What is the role of calcium in relation to contraction?
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).
What is the general MOA of CCBs
Inhibits Ca++ influx into cells to prevent muscle contraction.
What is the MOA of Dihydropyridines?
Inhibits Ca++ influx into vascular smooth muscle specifically, resulting peripheral vasodilation (decrease in BP)
What is the MOA of Non-dihydropyridines?
Inhibits Ca++ influx into cardiac smooth muscle specifically, resulting in a decrease of rate and force of contraction (chronotropy & inotropy).
What is the place in therapy of the CCBs?
First Line for HTN
What are the other uses of the Non-dihydropyridines?
Supraventricular tachycardia
a fib
What is another use of Verapamil specifically?
Migraine prophylaxis
What is the general adverse effect of all CCBs?
Hypotension
Name the ARDs of the Non-dihydropyridines?
Constipation (Verapamil) Bradycardia worsening of CHF Heart block Gingival hyperplasia
Name the ARDs of the Dihydropyridines?
Peripheral edema (worst with Nifedipine)
Reflex tachycardia
Flushing
HA
What are the issues with sublingual Nifedipine?
Risk for severe hypotension and there is a reported increased risk for MI and death.
What population are dihydropyridines especially good for?
Elderly bc they tend to have isolated systolic HTN
What is special about Clevidipine?
It is IV only and is contraindicated in soy and/or egg allergic patients
What are the drug interactions associated with Verapamil?
It is metabolized by CYP3A4 and also an inhibitor of this enzyme.
Name the Alpha 1 Blockers FDA approved for HTN?
Prazosin
Terazosin
Doxazosin
Name the Alpha 1 Blockers FDA approved for BPH?
Tamsulosin
Alfuzosin
What is the MOA of Alpha 1 Blockers?
Competitively inhibits alpha-1 receptors in the periphery which causes vasodilation.
What is the Place in Therapy of Alpha 1 Blockers?
Only as an add on especially in males. Not to be used often, not as monotherapy.
What are the uses of Alpha 1 Blockers?
HTN
BPH
What are the ARDs of Alpha 1 Blockers?
"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
What are the doses of Alpha 1 Blockers?
Take at night!!
Doxazosin 1x/day
Terazosin 1 to2x/day
Prazosin 2-3x/day
Name the Centrally acting agents - Alpha 2 agonists.
Methyldopa
Clonidine
What is the MOA of Centrally acting agents - Alpha 2 agonists?
Stimulates alpha 2 receptors in brain, reduces sympathetic outflow from brain, which produces a decrease in BP and peripheral vascular resistance.
What is the place in therapy of Methyldopa?
Good for use during pregnancy (Category B)
What is the place in therapy of Clonidine?
Often used for resistant HTN. Other uses are substance abuse tx (opiate withdrawal & avoidance) and adjunct in pain mgmt.
What are the general ARDs of Centrally acting agents - Alpha 2 agonists?
Orthostatic hypotension dizziness fatigue depression sedation Na+ & H2O retention Rebound tachycardia & HTN if stopped abruptly
What are the ARDs of methyldopa specifically?
Liver toxicity
Hemolytic anemia
What are the ARDs of clonidine?
Rash w patch
“anticholinergic-like side effects” dry mouth, sedation, constipation, urinary retention
What is another route of admin for clonidine?
Available as a patch applied every 7days, effects begin within 12-24 hours & last up to 3 days after patch removal
What are the vasodilators of HTN?
Hydralazine
Minoxidil
What is the MOA of the vasodilators?
Direct vasodilator, especially in arteries & arterioles, leading to decreased systemic vascular resistance. Causes peripheral vasodilation
What is the are the common ARDs of vasodilators?
Reflex tachycardia (consider co-admin of BB)
Increase in renin as response to vasodilation, (consider co-admin w diuretic).
HA
What the ARDs of hydrazine specifically?
Lupus-like syndrome (butterfly like rash) Dermatitis Drug fever Peripheral neuropathy Hepatitis
What the ARDs of minoxidil?
Hirsutism
What are the preferred combos?
ACE/ARB and Thiazide
ACE/ARB and Dihydropyridine CCB
What are the acceptable combos?
CCB and thiazide
Thiazide and K sparing diuretic
BB and diuretic or dihydropyridine CCB
Name some drugs that can induce HTN?
- Corticosteroids
- Excessive alcohol
- NSAIDs
- ACTH
- Amphetamines
- Appetite suppressants
- Caffeine
- Cyclosporine
- Estrogen
- Pseudoephedrine
- Thyroid hormone (in excess)
- Duloxetine
- Venlafaxine
- Bevacizumab
- Sorafenib
- Erythropoietin
