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Cardiovascular > HTN Drugs > Flashcards

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
Q

B1-selective antagonists

A

Metoprolol, atenolol -effect B2 at high doses

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26
Q

Preferred beta-blocker and why

A

Metoprolol and atenolol -Safe in = asthmatics, diabetics, peripheral arterial disease

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27
Q

beta-blocker SE

A

impotence, hypoglycemia, bradycardia, depression, excersise intolerance, inc TAGs and dec HDL

28
Q

Mixed beta-blockers

A

Labetalol and cravedilol - B1 + B2 + A1

29
Q

How to avoid vasodilator SE

A

Combination therapy w/ beta-blocker and diuretic

30
Q

Central A2 agonists

A

Clonidine, Guanadine, methyldopa

31
Q

Mechanism of central A2 agonists

A

Decrease SNS outflow and Increase PNS outflow

32
Q

SE of central A2 agonists

A

Depression, Na/water retention, orthostatic hypotension, rebound hypertension

33
Q

Methyldopa - unique SE

A

hepatitis and hemolytic anemia

34
Q

Clonidine - unique SE

A

anticholinergic (Blind as a bat, dry as a bone, hot as a hare, etc.)

35
Q

Neuronal/ganglionic A2 agonists

A

Reserpine, guanethidine, guanadril, Trimethaphan

36
Q

Only ganglionic A2 agonist?

A

Trimethaphan

37
Q

SE of neuronal/ganglionic A2 agonists

A

increased gastric secretions, diarrhea, Na/water retention, depression, orthostatic hypotension, bradycardia

38
Q

Drug combined w/ A2 agonists?

A

Diuretics - to prevent fluid retention

39
Q

K+ sparring diuretic

A

Amiloride

40
Q

Diuretic SE

A

orthostatic hypotension, hypomagnesium/hypokalemia/hypocalcemia/hyposodium, hyperglycemia/hyperuricemia Photosensitivity and ototoxicity

41
Q

How to treat african americans initially?

A

Start w/ diuretics - more effects in blacks than ACE inhibitors

42
Q

Aldosterone antagonists

A

Spironolactone, eplerenone

43
Q

SE of aldosterone antagonists

A

Hyperkalemia

44
Q

Renin inhibitor

A

Aliskiren

45
Q

AT2 receptor

A

Binds angiotensin II/III - opposite effects of AT1 antiinflammatory, vasodilatory, apopototic

46
Q

Special effect of ACE inhibitors and aldosterone antagonists

A

Regress and prevent heart hypertrophy

47
Q

ACE inhibitors

A

Captopril, lisinopril, enalapril

48
Q

ARBs

A

Losartan

49
Q

ACE inhibitors; unique SE

A

Angioedema (discontinue immediately), cough

50
Q

ACE inhibitors; general SE

A

Hyperkalemia, neutropenia

51
Q

What to monitor w/ ACE inhibitors?

A

K+ levels and serum creatinine

52
Q

When are ACE inhibitors contraindicated

A

In patients w/ renal artery stenosis - bilateral or unilateral; will cause failure Pregnancy

53
Q

ARB side effects

A

orthostatic hypotension, renal insufficiency, hyperkalemia

54
Q

How fast do ARBs/ACE inhibitors work?

A

Take 6 weeks to reach max effect

55
Q

SE of renin inhibitor

A

orthostatic hypotension, hyperkalemia

56
Q

ARBs/ACE inhibitors and drug interactions; what to watch out for

A

NSAIDs - due to prostaglandins Hyperkalemia inducing drugs

57
Q

An example of synergistic combo therapy involving ACE inhibitors/ARBs

A

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
Q

ACE inhibitors and race

A

not as effective in blacks; diuretics more effective

59
Q

JNC7 vs JNC8

A

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
Q

JNC8 first line therapy recommendations

A

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
Q

JNC8 therapy strategy

A

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
Q

What to monitory w/ diuretic therapy

A

BP

BUN/creatinine

Electrolytes - K+, Mg, Ca

uric acid - mainly for thiazide

63
Q

What to consider with ACEi therapy in blacks?

A

Angioedema - 2 to 4x higher

Diuretics show stronger effect

64
Q

Which drugs are contraindicated w/ LVH

A

Hydralazine and minoxidil

65
Q

Which anti-HTN can be used w/ pregnancy?

A

Avoid ACEi/ARBs

Use - methyldopa, beta-blockers, vasodilators

66
Q

anti-HTN drugs in sexually active teens?

A

Avoid ACEi/ARBs

67
Q

General Tx strategy

A

2 or more drugs are usually needed

Thiazide diuretic should be one of those drugs

Cardiovascular (12 decks)

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