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NAPLEX: CVD > HTN: Medications > Flashcards

HTN: Medications Flashcards

1
Q

Thiazide Diuretics: MOA

A

Blocks Na+/Cl- symporter (DCT)

Prevents Na+ reabsorption –> shifts osmotic balance in renal filtrate

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2
Q

Thiazide Diuretics (5)

[CCHIM]

A 
Chlorothiazide (Diuril)
Chlorthalidone (Thalitone)
Hydrocholorthiazide (Microzide)
Indapamide (--)
Metolazone (Zaroxolyn)
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3
Q

Thiazide: Primary Side Effects (7)

A
  1. ) Hypokalemia (muscle cramps)
  2. ) Hypomagnesmia
  3. ) Hyponatremia
  4. ) Hypercalcemia**
  5. ) Hyperuricemia
  6. ) Hyperglycemia
  7. ) Photosensitivity

**Take in morning (nocturia)

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4
Q

Thiazide: Monitoring Parameters (5)

A
  1. ) BP
  2. ) Electrolytes
  3. ) BUN/SrCr Levels
  4. ) Blood Glucose
  5. ) Uric Acid levels
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5
Q

Chlorothiazide

A

Brand: Diuril
Generic: Chlorothiazide
Class: Thiazide Diuretic (TZD)
Dose: 500-2000mg/day

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6
Q

Chlorthalidone

A

Brand: Thalitone
Generic: Chlorthalidone
Class: Thiazide Diuretic (TZD)
Dose: 12.5-100mg/day

Top 200

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7
Q

Hydrochlorothiazide (HCTZ)

A

Brand: Microzide
Generic: HCTZ
Class: Thiazide Diuretic (TZD)
Dose: 12.5-50mg/day

Top 200

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8
Q

Indapamide

A

Brand: —
Generic: Indapamide
Class: Thiazide Diuretic (TZD)
Dose: 1.25-5mg/day

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9
Q

Metolazone

A 
Brand: Zaroxolyn
Generic: Metolazone
Class: Thiazide Diuretic (TZD)
Dose: 2.5-5mg/day
Other: Can be used in 30mL/min patients

Top 200

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10
Q

Loop Diuretics: MOA (2)

A
  1. ) Inhibit Na+ reabsorption in ASCENDING Loop of Henle
    * *blocks Na+/K+/2Cl- symporter**
  2. ) Decreases PRELOAD
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11
Q

Loop Diuretics (3)

[BFT]

A

Bumetanide (—)
Furosemide (Lasix)
Torsemide (Demadex)

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12
Q

Loop Diuretics: Contraindiation (1) + Key Drug Interactions (4)

A

1.) Sulfa Allergy

  1. ) Increase Li toxicity risk
  2. ) Increase OTOTOXICITY risk with aminoglycosides
  3. ) Decrease DIABETES medication efficacy (SLGTs?)
  4. ) NSAIDs decrease effects
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13
Q

Loop Diuretics: Primary Side Effects (8)

A
  1. ) Hypocalcemia***
  2. ) Hypokalemia
  3. ) Hypomagnesmia
  4. ) Hyponatremia
  5. ) Hyperglycemia
  6. ) Hyperuricemia
  7. ) Metabolic alkalosis **
  8. ) Azotemia (high nitrogen wastes in blood) **

(** vs TZDs)

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14
Q

Loop Diuretics: Monitoring (8)

A
  1. ) BP
  2. ) Electrolyte levels
  3. ) SrCl/BUN
  4. ) Blood Glucose
  5. ) Uric acids
  6. ) Jugular venous pressure (JVP)
  7. ) Urine output
  8. ) Weight (~0.5-1kg drop in first day)
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15
Q

Bumetanide

A

Brand: –
Generic: Bumetanide
Class: Loop
Dose: 0.5-10mg/day

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16
Q

Furosemide

A 
Brand: Lasix
Generic: Furosemide
Class: Loop
Dose: 20-600mg/day 
PO = 2x IV dose

Top 200

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17
Q

Torsemide

A

Brand: Demadex
Generic: Torsemide
Class: Loop
Dose: 10-200mg/day

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18
Q

Potassium-Sparing Diuretics (2) + Doses

[AT]

A

Amloride (–) [5-10mg/day]

Triamterene (Dyrenium) [50-100mg/day]

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19
Q

Potassium-Sparing Diuretics: Contraindications (2) + Drug Interactions (5)

A
  1. ) HyperKALEMIA
  2. ) CKD

Hyperkalemia Risking Meds

  1. ) K-supplements
  2. ) ACEis
  3. ) ARBs
  4. ) ARAs
  5. ) NSAIDs
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20
Q

Potassium-Sparing Diuretics: Primary Side Effects (1)

A

Hyperkalemia

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21
Q

Potassium-Sparing Diuretics: Key Monitoring (3)

A
  1. ) BP
  2. ) Potassium Levels
  3. ) BUN/Sr
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22
Q

Aldosterone Receptor Antagonists (ARAs) (2)

A
  1. ) Spironolactone (Aldactone)

2. ) Eplerenone (Inspra)

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23
Q

ARAs: Monitoring (5)

A
  1. ) Hyperkalemia
  2. ) Metabolic Acidosis (in cirrhotic patients)
  3. ) Altered clearance of salicylates and glycosides
  4. ) Diarrhea
  5. ) CYP3A4 inhibitors (eplerenone)
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24
Q

ARA: Mechanism

A

Block mineralcorticoid receptors –> prevent expression of aldosterone-induced proteins (AIPs)

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25
Q

Aldosterone Receptor Activation Induced Effects (8)

A
  1. ) Activation of Na+-channels
  2. ) Removal of Na+ channels from membrane (ENaC) inhibition
  3. ) De novo Na+-channel synthesis
  4. ) Activation of membrane-bound Na/K-ATPase
  5. ) Redistribution of Na/K-ATPase channels to membrane
  6. ) De novo Na/K-ATPase-channel synthesis
  7. ) Tight junction permeability changes
  8. ) Increased mitochondrial production
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26
Q

SGK1 Mechanism + Related HTN Disease

A

Activated by aldosterone
Inhibits Nedd4-2 phosphorylation (UBQ ligase)
**Nedd4-2 phosphorylates and internalizes ENaC

Liddle Syndrome (mutated Nedd4-2 binding domain on ENaC)

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27
Q

Beta Blocker: MOA ()

A
  • Reduced cardiac output (CO)

- Negative ionotrope + chronotrope

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28
Q

Cardioselective BBs (6)

[BAMBAN]

A 
Betaxolol
Acebutolol
Metoprolol
Bisprolol
Atenolol
Nebivolol
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29
Q

Cardioselective BBs: MOA

A

Blocks beta adrenergic receptors (b1 > b2)

-Loss of cardioselectivity @ high doses

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30
Q

Intrinsic sympathomimetic activity (ISA) BBs

[CAPP]

A

Carvedilol
Acebutolol
Pindolol
Propranolol

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31
Q

BB: Lipophillic (6) + Primary Side Effect

CLPPMN

A 
Carvedilol
Labetalol
Propranolol
Pindolol
Metoprolol
Nebivolol

More likely to cause CNS side effects (i.e. fatigue)

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32
Q

BB: Hydrophillic

A

A

Atenolol

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33
Q

Acebutolol

A

Brand: Sectral
Generic: Acebutolol
Class: Cardioselective BB
Dose: 200-1,200mg/day

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34
Q

Atenolol

A

Brand: Tenormin
Generic: Atenolol
Class: Cardioselective BB
Dose: 25-100mg/day

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35
Q

Betaxolol

A

Brand: Kerlone
Generic: Betaxolol
Class: Cardioselective BB
Dose: 5-20mg/day

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36
Q

Bisoprolol

A

Brand: Zebeta
Generic: Bisprolol
Class: Cardioselective BB
Dose: 2.5-20mg/day

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37
Q

Metoprolol Tartrate

A

Brand: Lopressor
Generic: Metoprolol Tartrate
Class: Cardioselective BB
Dose: 25-400mg/day (BID dosing)

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38
Q

Metoprolol Succinate

A

Brand: Toprol XL
Generic: Metoprolol Succinate
Class: Cardioselective BB
Dose: 25-400mg/day (QD Dosing)

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39
Q

Nebivolol

A

Brand: Bystolic
Generic: Nebivolol
Class: Cardioselective BB
Dose: 5-40mg/day

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40
Q

Carvedilol IR

A

Brand: Coreg
Generic: Carvedilol IR
Class: Nonselective BB
Dose: 12.5-50mg/day (BID)

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41
Q

Carvedilol CR

A

Brand: Coreg CR
Generic: Carvedilol CR
Class: Nonselective BB
Dose: 20-80mg (QD)

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42
Q

Labetalol

A

Brand: Trandate
Generic: Labetalol
Class: Nonselective BB
Dose: 200-2,400mg/day

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43
Q

Nadolol

A

Brand: Corgard
Generic: Nadolol
Class: Nonselective BB
Dose: 20-320mg/day

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44
Q

Pindolol

A

Brand: –
Generic: Pindolol
Class: Nonselective BB
Dose: 5-60mg/day

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45
Q

Propranolol

A

Brand: Inderal
Generic: Propranolol
Class: Nonselective BB
Dose: 80-640mg/day

IR (BID-TID) + ER (QD)

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46
Q

Timolol

A

Brand: –
Generic: Timolol
Class: Nonselective BB
Dose: 20-60mg/day

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47
Q

Cardioselective BB: Primary Side Effects (9)

A
  1. ) Bradycardia/Heart block
  2. ) HF exacerbation
  3. ) Bronchospasm
  4. ) Cold extremities
  5. ) Fatigue
  6. ) Decreased exercise tolerance
  7. ) Depression (lipophilllc)
  8. ) Glucose intolerance
  9. ) Marked hypoglycemia (DM patients)

[same as nonselective]

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48
Q

Cardioselective BB: Contraindications + Drug Interactions

A

≥ 2nd Degree Heart Block
HF (EXCEPT bisoprolol and metoprolol succinate)

*avoid abrupt discontinuation (titration required)

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49
Q

Cardioselective BB: Monitoring Parameters (4)

A
  1. ) BP
  2. ) HR
  3. ) S/S HF
  4. ) Blood Glucose (DM patients)
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50
Q

Nonselective BB: Primary Side Effects

A
  1. ) Bradycardia/Heart block
  2. ) HF exacerbation
  3. ) Bronchospasm
  4. ) Cold extremities
  5. ) Fatigue
  6. ) Decreased exercise tolerance
  7. ) Depression (lipophilllc)
  8. ) Glucose intolerance
  9. ) Marked hypoglycemia (DM patients)

[same as selective]

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51
Q

Nonselective BB: Contraindications + Drug Interactions

A
  • ≥ 2nd degree heart block (w/o pacemaker)

- HF (except carvedilol)

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52
Q

Nonselective BB: Monitoring Parameters

A
  1. ) BP
  2. ) HR
  3. ) S/S HF
  4. ) Blood Glucose (DM patients)
53
Q

Combination Products: Tenoretic

A

Atenolol/chlorthalidone

54
Q

Combination Products: Ziac

A

Bisoprolol/HCTZ

55
Q

Combination Products: Corzide

A

Nadolol/Bendroflumethiazide

56
Q

Combination Products: Inderide

A

Propranolol/HCTZ

57
Q

Combination Products: Lopressor HCT

A

Metoprolol Tartrate/HCTZ

58
Q

Combination Products: Dutoprol

A

Metoprolol Succinate/HCTZ

59
Q

ACEi (10) Meds

BCEFLMPQRT

A
  1. ) Benazepril (Lotensin)
  2. ) Captopril (Capoten)
  3. ) Enalapril (Vasotec)
  4. ) Fosinopril (–)
  5. ) Lisinopril (Prinivil, Zestril)
  6. ) Moexipril (Univasc)
  7. ) Perindopril (Aceon)
  8. ) Quinapril (Accupril)
  9. ) Ramipril (Atlace)
  10. ) Trandolapril (Mavik)
60
Q

ACEi: Contraindications (4)

A
  1. ) Pregnancy
  2. ) Hx: Angioedema or previous failure
  3. ) Hyperkalemia
  4. ) Bilateral artery stenosis
61
Q

ACEi: Primary Side Effects (4)

A
  1. ) Hyperkalemia
  2. ) Renal insufficiency
  3. ) Cough (DRY)
  4. ) Angioedema
62
Q

ACEi: Monitoring (3)

A
  1. ) BP
  2. ) BUN/SCr
  3. ) Potassium
63
Q

Benazepril

A

Brand: Lotensin
Generic: Benazepril
Class: ACEi
Dosing: 4-50mg/day

64
Q

Captopril

A

Brand: Capoten
Generic: Captopril
Class: ACEi
Dosing: 12.5-450mg/day

-Shortest duration of action

65
Q

Enalapril

A

Brand: Vasotec
Generic: Enalapril
Class: ACEI
Dosing: 2.5-40mg/day

-Oral (Epaned) and Injectable (Enalaprilat) preparations available

66
Q

Fosinopril

A

Brand: –
Generic: Fosinopril
Class: ACEi
Dosing: 5-80mg/day

67
Q

Lisinopril

A

Brand: Zestril, Prinivil
Generic: Lisinopril
Class: ACEi
Dosing: 2.5-40mg/day

68
Q

Moexipril

A

Brand: Univasc
Generic: Moexipril
Class: ACEi
Dosing: 3.75-30mg/day

69
Q

Perindopril

A

Brand: Aceon
Generic: Perindopril
Class: ACEi
Dosing: 4-16mg/day

70
Q

Quinapril

A

Brand: Accupril
Generic: Quinapril
Class: ACEI
Dosing: 10-80mg/day

71
Q

Ramipril

A

Brand: Atlace
Generic: Ramipril
Class: ACEi
Dosing: 1.25-20mg/day

72
Q

Trandolapril

A

Brand: Mavik
Generic: Trandolapril
Class: ACEi
Dosing: 0.5-4mg/day

73
Q

ACEi: MOA

A 
Inhibit ACE (angiotensin I --> II conversion)
Decrease in aldosterone production
Inhibit Bradykinin breakdown (cough source)
74
Q

ARBs (8)

A 
Azilsartan (Edarbi)
Candesartan (Atacand)
Eprosartan (Teveten)
Irbesartan (Avapro)
Losartan (Cozaar)
Olmesartan (Benicar)
Telmisartan (Micardis)
Valsartan (Diovan)
75
Q

ARB: MOA

A

Inhibit angiotensin II binding with AT1 receptors
Reduction in aldosterone production
NO EFFECTS ON BRADYKININ

76
Q

ARB: Contraindications (4)

A
  1. ) Pregnancy
  2. ) Hx: Angioedema or previous failure
  3. ) Hyperkalemia
  4. ) Bilateral artery stenosis
77
Q

ARB: Drug Interactions

A

Hyperkalemia risk with combinations (ACEi, supplements, etc.)
Increases lithium toxicity risk

78
Q

Azilsartan

A

Brand: Edarbi
Generic: Azilsartan
Class: ARB
Dosing: 40-80 mg/day

79
Q

Candesartan

A

Brand: Atacand
Generic: Candesartan
Class: ARB
Dosing: 4-32mg/day

80
Q

Eprosartan

A

Brand: Teveten
Generic: Eprosartan
Class: ARB
Dosing: 400-800mg/day

81
Q

Irbesartan

A

Brand: Avapro
Generic: Irbesartan
Class: ARB
Dosing: 75-300mg/day

82
Q

Losartan

A

Brand: Cozaar
Generic: Losartan
Class: ARB
Dosing: 25-100mg/day

83
Q

Olmesartan

A

Brand: Benicar
Generic: Olmesartan
Class: ARB
Dosing: 20-40mg/day

84
Q

Telminsartan

A

Brand: Micardis
Generic: Telminsartan
Class: ARB
Dosing: 20-80mg/day

85
Q

Valsartan

A

Brand: Diovan
Generic: Valsartan
Class: ARB
Dosing: 80-320mg/day

86
Q

DRI (1) + MOA

A

Direct Renin Inhibitor
Aliskiren (Tekturna)

Blocks angiotensinogen –> angiotensin I conversion via Renin

87
Q

DRI: Contraindications (4)

A
  1. ) Pregnancy
  2. ) Hx angioedema with ACEis/ARBs
  3. ) Hyperkalemia
  4. ) Bilateral renal artery stenosis
88
Q

DRI: Drug Interactions

A

Hyperkalemia risk with other drugs (ACEs, ARBs, etc.)
Avoid taking with HIGH FAT
DM/Renal Impairment

Avoid with furosemide (decrease effects), itraconazole/cyclosporine (increase effects)

89
Q

DRI: Side Effects (4)

A
  1. ) Headache
  2. ) Dizziness
  3. ) Diarrhea
  4. ) Hyperkalemia/renal insufficiency
90
Q

DRI: Key Monitoring (3)

A
  1. ) BP
  2. ) BUN/SrCr
  3. ) Potassium Levels
91
Q

Aliskiren Combo Products (3):

A
  1. ) Aliskiren/amlodipine (Tekamlo)
  2. ) Aliskiren/amlodipine/HCTZ (amturnide)
  3. ) Aliskiren/HCTZ (Tekturna HCT)
92
Q

DHP CCB: MOA

A

Block L-type channels in vascular smooth muscle
Specific/selective to vascular tissues (POTENT)
NO alterations to cardiac conductivity
NO cardiac conduction alterations

93
Q

Non-DHP CCB: MOA

A

Block L-type channels in vascular smooth muscle
Less peripheral dilation
Negative chronotropic effects

94
Q

DHP CCB (6)

A 
Amlodipine (Norvasc)
Felodipine (Plendil)
Nicardipine (--)
Nifedipine (Procardia, Nifedical, etc.)
Nisoldipine (Sular)
95
Q

Non-DHP CCB (2)

A

Diltiazem (Cardizem)

Verapamil (Calan)

96
Q

DHP CCB: Contraindications + Drug Interactions

A

None

CYP3A4 substrate (inhibitors increase, inducers decrease)

97
Q

DHP CCB: Side Effects (6)

A 
Reflex tachycardia
Headache
Flushing
Peripheral edema
Gingival hyperplasia
HF exacerbation (NOT AMLODIPINE + FELODIPINE)
98
Q

DHP CCB: Monitoring

A

BP
HR
Heart Failure S/Sx

99
Q

Non-DHP CCB: Contraindications + Drug Interactions

A

≥ 2nd Degree Heart Block
Systolic HF

CYP3A4 interactions
Use with other negative choronotropes
Increase digoxin toxicity
Increase CYP3A4 substrate toxicity

100
Q

Non-DHP CCB: Side Effects (5)

A
  1. ) Bradycardia/Heart block
  2. ) Constipation
  3. ) Peripheral edema
  4. ) Gingival hyperplasia
  5. ) HF exacerbation
101
Q

Non-DHP CCB: Monitoring

A

BP
HR
Heart Failure S/Sx

102
Q

Amlodipine

A

Brand: Norvasc
Generic: Amlodipine
Class: DHP CCB
Dosing: 2.5-10mg/day

103
Q

Felodipine

A

Brand: Plendil
Generic: Felodipine
Class: DHP CCB
Dosing: 2.5-20mg/day

104
Q

Isradipine

A

Brand: –
Generic: Isradipine
Class: DHP CCB
Dosing: 5-10mg/day

105
Q

Nicardipine

A

Brand: Cardene
Generic: Nicardipine
Class: DHP CCB
Dosing: 60-120mg/day (BID-TID)

106
Q

Nifedipine

A

Brand: Adalat, Procardia
Generic: Nifedipine
Class: DHP CCB
Dosing: 30-180mg/day

107
Q

Nisoldipine

A

Brand: Sular
Generic: Nisoldipine
Class: DHP CCB
Dosing: 10-40mg/day

108
Q

Diltiazem

A

Brand: Cardizem
Generic: Diltiazem
Class: Non-DHP CCB
Dosing: 120-540mg/day

109
Q

Verapamil

A

Brand: Calan
Generic: Verapamil
Class: Non-DHP CCB
Dosing: 120-360mg/day

110
Q

Alpha1-Receptor Antagonists: MOA

A

Block a1 receptors in peripheral blood vessels (both arterial and venous) –> dilation

111
Q

Alpha1-Receptor Antagonists: Contraindications + Drug Interactions

A

Not in combination with PDE-5 inhibitors (hypotension risk)

112
Q

Alpha1-Receptor Antagonists: Monitoring

A

BP

HR

113
Q

Alpha1-Receptor Antagonists: Side Effects (5)

A
  1. ) Orthostatic hypotension
  2. ) Reflex tachycardia
  3. ) Peripheral Edema
  4. ) Headache
  5. ) Drowsiness

Take at bedtime to avoid orthostatic hypotension

114
Q

Doxazosin

A

Brand: Cardura
Generic: Doxazosin
Class: Alpha1-Receptor Antagonists
Dosing: 1-16mg/day

115
Q

Prazosin

A

Brand: Minipress
Generic: Prazosin
Class:
Dosing: 1-20mg/day

116
Q

Terazosin

A

Brand: —-
Generic: Terazosin
Class:
Dosing: 1-20mg/day

117
Q

Central Alpha2 Receptor Agonist: MOA

A

Stimulate a2 brain receptors –> decrease sympathetic outflow [lower norepinephrine release] –> lower HR/BP

118
Q

Central Alpha2 Receptor Agonist: Monitoring

A

BP
HR
LFTs (methyldopa)
Tapering required (2w)

119
Q

Central Alpha2 Receptor Agonist: Contraindications + Drug Interactions

A

Methyldopa (liver disease)

Other negative chronotropes (i.e. digoxin, verapamil, etc.)

120
Q

Central Alpha2 Receptor Agonist: Side Effects (7)

A
  1. ) Sedation
  2. ) Orthostatic hypotension
  3. ) Depression
  4. ) Peripheral edema
  5. ) Dry mouth
  6. ) Bradycardia
  7. ) Hepatitis (methyldopa)
121
Q

Clonidine

A

Brand: Catapres
Generic: Clonidine
Class: Central Alpha2 Receptor Agonist
Dosing: 0.2-2.4mg/day

Epidural injection available (pain)
Transdermal available (0.1-0.3mg QW)
treatment needs to overlap with oral therapy

122
Q

Methyldopa

A

Brand: —
Generic: Methyldopa
Class: Central Alpha2 Receptor Agonist
Dosing: 250-1000mg/day

Safe in pregnant HIV patients

123
Q

Direct Vasodilator: MOA

A

Increase cGMP –> aterial vasodilation

124
Q

Direct Vasodilator: Side Effects

A 
Reflex tachycardia
Orthostatic hypotension
Peripheral edema
Lupus-like syndrome (hydralazine)
Hirsutism (minoxidil)
125
Q

Direct Vasodilator: Contraindications + Drug interactions

A

Acute MI
Aortic Dissection

None

126
Q

Direct Vasodilator: Monitoring

A

BP
HR
S/Sx Lupus (chest pain, joint pain, fever, rash)

127
Q

Hydralazine

A

Brand: —
Generic: Hydralazine
Class: Direct vasodilator
Dosing: 25-300mg/day

Injection available

128
Q

Minoxodil

A

Brand: —
Generic: Minoxodil
Class: Direct vasodilator
Dosing: 2.5-100mg/day

LAST LINE THERAPY DUE TO SIDE EFFECTS (Hirsutism)
Topical and solution/foam available

NAPLEX: CVD (2 decks)

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