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HTN Drugs Flashcards

1
Q

Most common HTN patients

A

older women, blacks

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2
Q

Organs effected by HTN

A

Heart - heart failure Brain - aneurysm, hemorrhage, stroke Kidney - failure Eye - retinopathy

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3
Q

JNC8 guidelines for HTN therapy; goals

A

>60 = <150, <90

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4
Q

Drug classes used in HTN

A

Vasodilators CCBs SNS-altering RAAS inhibitors Diuretics

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5
Q

Vasodilator drugs

A

Minoxidil, diazoxide, hydralazine, nitroprusside, fenoldopam

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6
Q

Mechanism of minoxidil and diazoxide

A

Increase K+ ATPase = hyperpolarization

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7
Q

Fenoldopam; unique feature

A

Only IV arterial dilator to also increase renal perfusion

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8
Q

Hydralazine; unique SE

A

Lupus-like

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9
Q

Common vasodilator side effects

A

Reflex tachycardia - stimulation of baroreceptors by dropping BP Increased renin/RAAS - stimulation of kidney due to decreased perfusion

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10
Q

CCB drugs

A

Dihydropyridines - nifedipine, amlodipine Non-dihydropyridines - verapamil, diltiazem

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11
Q

Dihydropyridines vs non-dihydropyridines

A

Dihydropyridines = reflex tachycardia; do not effect heart Non-dihydropyridines = decrease AV node conduction = no tachycardia = decreased HR

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12
Q

CCB common SE

A

flushing, headache

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13
Q

CCB unique SE

A

Verapamil - constipation V>D>N - negative inotropic N - edema and refractoriness

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14
Q

Vasodilators; a specific use

A

Hypertensive crisis - BP >180/120 IV arterial dilators - fenoldopam, nitroprusside

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15
Q

How to treat hypertensive crisis

A

IV arterial dilators - fenoldopam and nitroprusside Gradual, titrated treatment - a big BP drop = ischemia and further organ damage

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16
Q

Organs and associated SNS receptors

A

Heart - B1 Lung - B2 Kidney - A1/B1 Arteriole - A1/B2 Venule - A2

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17
Q

non-specific alpha antagonists

A

phenoxybenzamine phentolamine

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18
Q

non-specific alpha antagonist side effects

A

Inhibit A2 = no NE reuptake = rebound HTN when stopping drug

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19
Q

A1 specific antagonists

A

Prazosin, terazosin, doxazosin

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20
Q

A1 selective antagonist side effects

A

First-pass effect -orthostatic hypotension/dizziness/syncope

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21
Q

How to avoid A1 selective antagonist side effects

A

Give first dose at night before bed

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22
Q

non-specific beta antagonists

A

Propranolol - B1 and B2

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23
Q

Effects of B1 block

A

Heart - decreased HR Kidney = decreased RAAS

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24
Q

Effects of B2 block

A

Lung = bronchospasm Liver/pancreas = hypoglycemia, inc TAG/dec HDL Arterioles = constriction

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25
B1-selective antagonists
Metoprolol, atenolol -effect B2 at high doses
26
Preferred beta-blocker and why
Metoprolol and atenolol -Safe in = asthmatics, diabetics, peripheral arterial disease
27
beta-blocker SE
impotence, hypoglycemia, bradycardia, depression, excersise intolerance, inc TAGs and dec HDL
28
Mixed beta-blockers
Labetalol and cravedilol - B1 + B2 + A1
29
How to avoid vasodilator SE
Combination therapy w/ beta-blocker and diuretic
30
Central A2 agonists
Clonidine, Guanadine, methyldopa
31
Mechanism of central A2 agonists
Decrease SNS outflow and Increase PNS outflow
32
SE of central A2 agonists
Depression, Na/water retention, orthostatic hypotension, rebound hypertension
33
Methyldopa - unique SE
hepatitis and hemolytic anemia
34
Clonidine - unique SE
anticholinergic (Blind as a bat, dry as a bone, hot as a hare, etc.)
35
Neuronal/ganglionic A2 agonists
Reserpine, guanethidine, guanadril, Trimethaphan
36
Only ganglionic A2 agonist?
Trimethaphan
37
SE of neuronal/ganglionic A2 agonists
increased gastric secretions, diarrhea, Na/water retention, depression, orthostatic hypotension, bradycardia
38
Drug combined w/ A2 agonists?
Diuretics - to prevent fluid retention
39
K+ sparring diuretic
Amiloride
40
Diuretic SE
orthostatic hypotension, hypomagnesium/hypokalemia/hypocalcemia/hyposodium, hyperglycemia/hyperuricemia Photosensitivity and ototoxicity
41
How to treat african americans initially?
Start w/ diuretics - more effects in blacks than ACE inhibitors
42
Aldosterone antagonists
Spironolactone, eplerenone
43
SE of aldosterone antagonists
Hyperkalemia
44
Renin inhibitor
Aliskiren
45
AT2 receptor
Binds angiotensin II/III - opposite effects of AT1 antiinflammatory, vasodilatory, apopototic
46
Special effect of ACE inhibitors and aldosterone antagonists
Regress and prevent heart hypertrophy
47
ACE inhibitors
Captopril, lisinopril, enalapril
48
ARBs
Losartan
49
ACE inhibitors; unique SE
Angioedema (discontinue immediately), cough
50
ACE inhibitors; general SE
Hyperkalemia, neutropenia
51
What to monitor w/ ACE inhibitors?
K+ levels and serum creatinine
52
When are ACE inhibitors contraindicated
In patients w/ renal artery stenosis - bilateral or unilateral; will cause failure Pregnancy
53
ARB side effects
orthostatic hypotension, renal insufficiency, hyperkalemia
54
How fast do ARBs/ACE inhibitors work?
Take 6 weeks to reach max effect
55
SE of renin inhibitor
orthostatic hypotension, hyperkalemia
56
ARBs/ACE inhibitors and drug interactions; what to watch out for
NSAIDs - due to prostaglandins Hyperkalemia inducing drugs
57
An example of synergistic combo therapy involving ACE inhibitors/ARBs
Diuretics - decreased fluid retention = increased renin release by kidney for increased perfusion Diuretics + ACE/ARB combo = no renin release = more effective drop in BP
58
ACE inhibitors and race
not as effective in blacks; diuretics more effective
59
JNC7 vs JNC8
Removed lifestyle modification Added grading system based on importance of guideline Systemic literature review Added racial, CKD, and diabetic subgroups Altered goals of therapy for \>60
60
JNC8 first line therapy recommendations
General population * First line - ACEi, ARB, thiazide diuretics, CCB Black * First line - thiazide diuretics, CCB Diabetic * First line - thiazide diuretics, CCB, ACEi, ARB CKD * First line - ACEi, ARBs
61
JNC8 therapy strategy
First visit = 1 anti-HTN drug If goal not met w/in a month = add a second drug or increase dose of first drug If goal not met w/ 2 medications = add a third drug (titrate); do not use ACEi and ARB together (similar action) If goal not met w/ 3 medications = refractory HTN
62
What to monitory w/ diuretic therapy
BP BUN/creatinine Electrolytes - K+, Mg, Ca uric acid - mainly for thiazide
63
What to consider with ACEi therapy in blacks?
Angioedema - 2 to 4x higher Diuretics show stronger effect
64
Which drugs are contraindicated w/ LVH
Hydralazine and minoxidil
65
Which anti-HTN can be used w/ pregnancy?
Avoid ACEi/ARBs Use - methyldopa, beta-blockers, vasodilators
66
anti-HTN drugs in sexually active teens?
Avoid ACEi/ARBs
67
General Tx strategy
2 or more drugs are usually needed Thiazide diuretic should be one of those drugs

Cardiovascular (12 decks)

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