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Renal 2 > HTN Drugs - Kruse > Flashcards

HTN Drugs - Kruse Flashcards

1
Q

4 categories of HTN drugs

A
  1. Vasodilators
  2. Sympathetic antagonists
  3. Diuretics
  4. ACE Inhibitors/ARBs
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2
Q

How to use vasodilator drugs?

A

W/ diuretic or beta blocker – for compensatory tachycardia, salt/water retention, etc.

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3
Q

Classes of vasodilator drugs

A
  • Calcium channel blockers (DHP, non-DHP)
  • Potassium channel openers
  • D1 agonists
  • N.O. release agents
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4
Q

Function of calcium channel blockers

Channel types?

A

Block L-type (voltage-gated) Ca++ channels to reduce frequency of opening w/ depol.

  • Vascular channels = vasodilate
  • Cardiac channels = decreased ht function
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5
Q

When not to use CCBs

A

Heart slowing failure of any kind (CHF, bradycardia, heart block)

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6
Q

Types of CCBs

A
  • DHPs = vascular selective

- Non-DHPs = both L-type channels

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7
Q

DHP CCB drug names

A
  • Nifedipine

- Amlodipine

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8
Q

Non-DHP CCB drug names

A
  • Verapamil

- Diltiazem

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9
Q

Nifedipine vs. Amlodipine

A

Both DHP CCBs

N = short acting, no AV problems
A = long acting, some AV problems
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10
Q

Nifedipine vs. Amlodipine:

Use when?
Don’t use when?

A

N - use for AV conduction abnormality, short term. DON’T USE for chronic HTN

A - use for angina or HTN. DON’T USE for heart failure

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11
Q

Verapamil and Diltiazem (Non-use)

A

Both non-DHP CCBs

 - Decrease vascular AND cardiac mm. fxn
 - NOT w/ BETA BLOCKER
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12
Q

Verapamil side effect

A

Constipation

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13
Q

Diltiazem side effect

A

Facial rash

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14
Q

A patient is on Nifedipine or Amlodipine. What else should they be on?

A

Other vasodilator (CCB, K+ channel opener, D1 agonist, N.O. modulator)

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15
Q

K+ channel opener drug names

Function?

A
  • Diazoxide
  • Minoxidil

Relax smooth muscle (hyperpolarize)

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16
Q

Diazoxide

A

Long-acting K+ channel opener
Injections

USE - hypertensive emergency
DON’T - renal failure, beta blockers, ischemic ht disease

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17
Q

Minoxidil

A

K+ channel opener
Pro-drug
Use with BETA-BLOCKER and LOOP DIURETIC

USE - long term outpatient severe HTN

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18
Q

Side effects of Minoxidil

A
  • HA, sweating, hair growth (Rogaine)

- REFLEX SNS stimulation –> tachycardia, palpitations, angina, edema

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19
Q

Fenoldopam

A 
D1 agonist
Peripheral vasodilation
Needs continuous IV for short 1/2 life
USE - HTN emergency, operative HTN
DON'T - glaucoma (increased IOP)
S.E.'s = reflex SNS, HA, sweating
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20
Q

N.O. release drugs

Function?

A
  • Hydralazine
  • Nitroprusside

Arteriolar dilation via cGMP

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21
Q

Hydralazine:

Function?
Use? (alone)
Don’t?
Side effects?

A

Fxn = N.O. release (cGMP)
Use - long term HTN
Don’t - Ischemic ht disease
Sides = reflex tach (could lead to arrhythmias in ischemic heart disease)

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22
Q

When might hydralazine be used in combo with something else? (2)

A

HTN + heart failure = Hydralazine + nitrates

HTN + pregnancy = Hydralazine + methyldopa

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23
Q

Nitroprusside:

Function?
Use?
Side effects?

A

Fxn = Metabolized into N.O. –> dilates ALL
- Rapid on, rapid off (continuous IV needed)

Use - HTN emergencies, acute decompensated heart failure, aortic dissection

Sides = Cyanide poisoning (chronic use)

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24
Q

Nitroglycerin:

Function?
Use?
Don’t?
Side effects?

A

Fxn = N.O. release (VEINS smooth muscle)

Use - HTN emergencies, angina, heart failure

Don’t - Increased ICP, PDE5 inhibitors (-afil) (worsened hypotension)

Sides = Tolerance (use 8 hrs between), hypotension, syncope, THROBBING HA’s

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25
Q

How to use sympathoplegic drugs?

A

With a diuretic (avoid compensatory Na/H2O retention due to hypotension)

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26
Q

Classes of sympathoplegic drugs for HTN?

A
  • Beta blockers
  • Alpha-1 blockers
  • Alpha-2 agonists
27
Q

Function of beta-blockers for HTN

A
  • Decrease cardiac output

- Decrease renin release (volume deplete)

28
Q

When NOT to use beta blockers?

A
  • Asthma
  • COPD (unless ischemic ht disease)
  • Type 1 DM (unless after M.I.)
  • W/ non-DHP CCB’s (heart block)
29
Q

Side effects of beta blockers?

A
  • Bradycardia, fatigue

- Withdrawal –> HTN, angina, MI

30
Q

Propranolol and Carvedilol (compare)

Propranolol vs. Carvedilol (contrast)

A

Both - non-selective w/o ISA –> decrease C.O.

Prop - lipophilic –> crosses BBB

Carv - Alpha-1 partial agonist too –> decrease PVR via vasodilation

31
Q

Labetalol

A

Non-selective w/ ISA (alpha-1 block)

32
Q

Metoprolol and Atenolol (compare)

Metoprolol vs. Atenolol (contrast)

A

Both - beta-1 selective, no ISA (decrease C.O.)

33
Q

Which beta blockers to use for:

HTN?
HF?
IHD?
Arrhythmia?

A

HTN - Metoprolol, Atenolol (NOT-initial treatment)

HF - Metoprolol, Carvedilol

IHD - Metoprolol, Propranolol (prolong life after MI)

Arrh - ALL OF THEM

34
Q

Prazosin:

Function?
Use?
With anything?
Side effects?

A

Fxn = Alpha-1 reversible antagonist

Use - HTN + BPH (prostate s.m. relax)
- Less reflex tach. than non-selective alpha blockers

Use with - Diuretic (for compensatory Na/H20 retention)

Side effects - Hypotention, dizziness, palpitations, headache

35
Q

Alpha-2 agonists for HTN

Function?
Benefit of it?

A
  • Clonidine
  • Methyldopa

Decreases CNS sympathetics
Baroreceptor response IN TACT

36
Q

Clonidine:

Function?
Side effects?

A

Fxn - decreased C.O., vasodilate, derease PVR

S.E. = dry mouth, sedation, depression, sexual dysfunction

WITHDRAWAL CAUSES BAD HTN CRISIS

37
Q

Methyldopa:

Function?
Use?
Side effects?

A

Fxn = NE agonist - converted to alpha-methylNE (like L-dopa is converted to NE)

Use - PREGNANCY HTN

S.E. = dry mouth, sedation, depression, sexual dysfunction

38
Q

Types of diuretics

A
  • Carbonic anhydrase inhibitors
  • Loop diuretics
  • Thiazides
  • K+ sparing diuretics
  • Osmotic agents
  • ADH antagonists
39
Q

C.A. inhibitor (name)

Function?
HCO3-?
Body pH?
Urine pH?

A

Acetazolamide

  • prevent Na+ and HCO3- absorption in PCT
  • HCO3- excretion
  • DECREASED body pH
  • INCREASED urine pH
40
Q

When is acetazolamide used?

With anything?

When is it NOT used?

Side effects?

A

Use - glaucoma

With KCl replacement

NOT - diuresis, cirrhosis, acidosis (COPD, etc)

S.E. = metabolic acidosis, renal stones, K+ wasting

41
Q

Loop diuretic (name)

Function?
Electolyte results?
pH results?

A

Furosemide

  • NaKCl2 transporter inhibitor (TAL)
  • Na, Cl, K+, Mg, Ca, H+ excretion
  • INCREASED body pH
42
Q

When to use loop diuretics?

When NOT to use loop diuretics?

Side effects?

A

Use - acute edema, HTN + HF, hyperkalemia, hypercalcemia, ANION OD (bromide, fluoride)

Don’t - Hyponatremia, hypokalemia, metabolic alkalosis, hypomagnesemia, liver disease, sulfonamide sensitivity, renal failure, hypocalcemia, w/ lithium, aminoglycosides, or digoxin

Side effects - HypoNa, hypoK, hypoCa, hypoMg, metabolic alkalosis, hearing loss, allergic reaction, dehydration, uric acidemia

43
Q

Hydrochlorothiazide:

Function?
Electolyte changes?
pH changes?

Side effects?

A
  • Inhibit Na/Cl cotransporter in DCT –> NaCl excretion
  • K+ wasting, HCO3- wasting
  • INCREASED body pH

S.E. = Hypokalemia, WORSENED INSULIN DEPLETION, hyperlipidemia, hyponatremia, hypercalcemia, hyperuricemia

44
Q

When not to use HCTZ?

A
  • Sulfonamide hypersensitivity
  • Anticoaguable state
  • Gout
  • Diabetes mellitus
45
Q

When to use HCTZ?

A
  • Nephrolithiasis
  • Nephrogenic D.I.
  • HF
46
Q

Types of K+ sparing diuretics

A
  • MR (aldosterone) antagonists

- Na+ channel inhibitors

47
Q

MR antagonist drugs

A

Spironolactone, eplerenone

48
Q

Na+ channel inhibitors

A

Amiloride, triamterene

49
Q

MR antagonist drugs:

Function?
Use?
Don’t?

A

Fxn - Aldosterone competitive inhibitor –> decreased ENaC and decreased Na/K ATPase

Use - Ht failure, HYPERALDOSTERONISM, K+ wasting of other diuretics

Don’t - Liver disease, hyperkalemia, metabolic acidosis, renal insufficiency

50
Q

What’s special about MR antagonist drugs?

A

NOT acting on the luminal side, unlike other diuretics

51
Q

Don’t combine K+ sparing diuretics with what?

A

Beta blockers, NSAIDs, or ACE inhibitors

52
Q

Function of Na+ channel blockers

A

Same as MR antagonists

53
Q

When to use mannitol?

A

Maintain or increase urine volume, decrease IOP, decreased ICP

54
Q

When to use desmopressin?

A
  • Pituitary D.I.
  • Polyuria, polydipsia
  • Hypernatremia
  • Nocternal pissing
55
Q

Conivaptan

  • Treats?
  • Function?
A

ADH antagonist

  • Treats SIADH, HF, hyponatremia
  • V1a and V2 antagonist
56
Q

Drug combo to treat hypokalemia

A

K+ sparing + other diuretic

57
Q

Function of ACE inhibitors

A

Prevent Ang II, increase bradykinin –> decrease PVR

58
Q

When to use ACE inhibitors?

When NOT to use ACE inhibitors?

A

Use - HTN, nephropathy, HF, LV dysfunction, AMI, prophylaxis of cardiac events

Don’t - PREGNANCY, hypotension, cough, ANGIOEDEMA, acute renal failure

59
Q

Don’t combine ACE inhibitors with what drugs?

A

K+ sparing or NSAIDs

60
Q

Function of ARBs

Side effect differences compared to ACE inhibitors?

When not to use?

A

Same as ACE inhibitors EXCEPT no bradykinin increase and no AT2 receptor block

  • Less cough, less angioedema

Don’t - PREGNANCY, non-DM renal disease, w/ K+ sparing drugs

61
Q

Function of Clonidine?

Use when?

A

Alpha-2 agonist –> decreased SNS –> decreased renin

LAST RESORT

62
Q

Function of Propranolol on RAAS?

A

Decreased renin via Beta-1 antagonism on JG cells

63
Q

Aliskiren:

Use when?
Don’t use when?

A

Use - w/ increased renin via ACEI, ARB, diuretics

Don’t - PREGNANCY, renal insufficiency

Renal 2 (11 decks)

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