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C/R > Hypertension > Flashcards

Hypertension Flashcards

1
Q

Chlorthalidone

brand name:
Class:
Dose:

A

brand name: (hydroton)

class: Thiazide diuretic
dose: 12.5-25 mg/ day daily

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2
Q

Hydrochlorothiazide

brand name:
class:
Dose:

A

brand name: Hydrodiuril
class: thiazide like diuretic
Dose: 25-50 mg/ day daily

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3
Q

Indapamide

brand name:
class:
Dose:

A

brand name: (Lozol)
class: thiazide like diuretic
Dose: 1.25-2.5 mg/ day daily

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4
Q

Metalazone

brand name:
class:
dose:

A

brand name: Zaraxolyn

class: thiazide like diuretic
dose: 2.5-5 mg/day daily

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5
Q

Thiazide Diuretics

Class:

Indication:

Mechanism of Action:

Effects of mechanism of Action:

Adverse Effects:

Absolute Contraindications:

Pregnancy: –

Warning/ Precautions:

Drug-Drug Interactions (DDIs):

Monitoring Parameters:

A

Thiazide Diuretics

examples: Chlorthalidone( hydroton) , indapamide (Lozol), hydrochlorothiazide (hydrodiuril), Metolazone (Zaroxolyn)

Class: Thiazide Diuretics

Indication: Management of hypertension. Effective in treating hypertension in elderly and African American populations

Mechanism of Action: Inhibits sodium and chloride reabsorption in the distal convoluted tubule, causing increased excretion of sodium, chloride, water, and potassium

Effects of mechanism of Action: decrease blood volume, cardiac output, and peripheral vascular resistance

Adverse Effects: Hyponatremia, hypokalemia, HYPERcalcemia, hyperuricemia, hypovolemia, hyperglycemia, elevated lipids (LDL, triglycerides).

Absolute Contraindications: hypersensitivity, patients with hypersensitivity to sulfonamide-derive drugs (sulfa allergy)

Pregnancy: –

Warning/ Precautions: Use with caution in patients with history of acute gout unless the patient is on uric acid lowering therapy
Not effective in patients with low GFR, high salt intake.
Not effective in CrCl <30 mL/min

Drug-Drug Interactions (DDIs): NSAIDS, Lithium (decrease lithium clearance which increases toxicity)

Monitoring Parameters: Assess electrolytes and renal function 2-4 weeks after initiating therapy or changing doses.

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6
Q

NON Dihydropyridines (DHP)

examples:

Class:

Indication:

Mechanism of Action:

Effects of mechanism of Action:

Adverse Effects:

Absolute Contraindications:

Pregnancy: –

Warning/ Precautions: –

Drug-Drug Interactions (DDIs):

Monitoring Parameters: –

A

NON Dihydropyridines (DHP)

examples: Diltiazem ER, Verapamil (Canalan)

Class: Calcium Channel Blockers

Indication: Management of hypertension.

Mechanism of Action: inhibits calcium ions form entering vascular smooth muscle and myocardial

Effects of mechanism of Action: peripheral arterial and coronary artery vasodilation, ALSO has negative Inotropy (decreased contractility) and negative chronotropy (decreased heart rate).

Adverse Effects: Diltiazem: edema, headache, constipation, conduction disturbances, bradycardia, heart failure.
Verapamil : edema, constipation, gingival hyperplasia, headache, conduction disturbances, bradycardia, dizziness, heart failure exacerbations.

Absolute Contraindications:
avoid use in patients with HFrEF.

Pregnancy: –

Warning/ Precautions: –

Drug-Drug Interactions (DDIs): avoid routine use with beta blockers, CP3A4 major substrate and moderate inhibitor->dose aadjustments required for simvastatin an lovastatin, as well as be careful with interactions with other drugs involved with CYP3A4

Monitoring Parameters: –

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7
Q

Dihydropyridines (DHP).

examples:

Class:
Indication:

Mechanism of Action:

Effects of mechanism of Action:

Adverse Effects:

Absolute Contraindications:–

Pregnancy: –

Warning/ Precautions: –

Drug-Drug Interactions (DDIs): –

Monitoring Parameters: –

Pearls:

A

Dihydropyridines (DHP).

examples:end in -DIPINE: Amlodipine (Norvasc), Nifedipine (Procardia) etc.

Class: Calcium Channel Blockers

Indication: Management of hypertension.

Mechanism of Action: inhibits calcium ions form entering vascular smooth muscle and myocardial

Effects of mechanism of Action: peripheral arterial and coronary artery vasodilation

Adverse Effects: pedal edema (D/C if this happens), headache, dizziness, flushing, potential for reflex tachycardia (short acting agents only).

Absolute Contraindications:–

Pregnancy: –

Warning/ Precautions: –

Drug-Drug Interactions (DDIs): –

Monitoring Parameters: –

Pearls: can take up to one week to see full blood pressure lowering effects

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8
Q

Amlodipine

brand name:
class:
dose:

A

brand name: norvasc

class: dihyrdopyridine calcium channel blocker
dose: 2.5-10 mg / day daily

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9
Q

Nifedipine ER

brand name:
class:
dosage:

A

brand name: Procardia

class: dihydropyridine calcium channel blocker
dosage: 30-120mg/ day daily

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10
Q

Felodipine

brand name:
class:
dose:

A

brand name: Plendil

class: dihydropyridine calcium channel blockers
dosage: 2.5-10 mg / day daily

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11
Q

Diltiazem ER

brand name:
class:
dose:

A

brand name: Cardizem

class: NONdihydropyridine calcium channel blocker
dose: 120-360 mg/ day daily

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12
Q

Verapamil

Brand name:
class:
dosage:

A

brand name: Canalan

class: NON dihydropyridine calcium channel blocker
dosage: 120-360 mg/ day daily

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13
Q

Angiotensin converting enzyme inhibitors (ACEi)

examples:

Class:

Indication:

Mechanism of Action:

Effects of mechanism of Action:

Adverse Effects:

Absolute Contraindications:

Pregnancy:

Warning/ Precautions:

Drug-Drug Interactions (DDIs):

Monitoring Parameters:

Pearls:

A

Angiotensin converting enzyme inhibitors (ACEi)

examples: end in -PRIL. Lisinopril (Privinil/Zestril), Enalapril (Vasotec)

Class: Ace inhibitors

Indication: Management of hypertension.

Mechanism of Action:Prevents conversion of angiotensin ! to angiotensin II by way of the angiotensin converting enzyme. this prevents actions such as vasoconstriction, sympathetic activation, and aldosterone release.

Effects of mechanism of Action: decreased vasoconstriction and decreased aldosterone( corticosteroid that stimulates absorption of sodium by the kidneys) release.

Adverse Effects: HYPERkalemia, acute renal failure (in its with severe bilateral renal stenosis), dry cough( because of bradykinin), angioedma, hypotension.

Absolute Contraindications:pregnancy, history of angioedema, 36 hours of an angiotensin receptor/ neprilysin inhibitor[ARNI-sacubritil/valsartan], bilateral renal stenosis

Pregnancy: DO NOT USE

Warning/ Precautions: –Do not initiate if potassium > 5 mmol/L.Discontinue if potassium >5.6 mol/L

Drug-Drug Interactions (DDIs):

Monitoring Parameters: Assess electrolytes and renal function 2-4 weeks after initiating therapy or changing doses.

Pearls: 1.drug of choice in its with diabetes, heart failure, post MI, stroke, and/ or CKD due to target organ protection

  1. do not use in combo with RAAS drugs
  2. protect the myocardium from remodeling/ hypertrophy in patients with heart failure
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14
Q

Lisinopril

brand name:
class:
dose

A

(privinil/ Zestril)

class: ACEI
dose: 10-40 mg / day daily

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15
Q

Enalapril

brand name:
class:
dose:

A

brand name: Vasotec

class: ACEi
dose: 5-40 mg/ day in 1-2 divided doses

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16
Q

Quinapril
brand name:
class:
dose:

A

brand name: accupril

class: ACEi
dose: 10-80 mg / day in 1-2 divided doses

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17
Q

captopril
brand name:
class:
dose:

A

brand name: capoten

class: ACEI
dose: 12.5-150 mg in 2-3 divided doses

18
Q

Angiotensin Receptor blockers (ARBs)

examples:

Class:

Indication:

Mechanism of Action:

Effects of mechanism of Action:

Adverse Effects:

Absolute contraindications:

Pregnancy:

Warning/ Precautions:

Drug-Drug Interactions (DDIs):

Monitoring Parameters:

Pearls:

A

Angiotensin Receptor blockers (ARBs)

examples: end in -SARTAN. i.e Irbesartan (Avapro), Losartan (Cozaar)

Class: ARBS

Indication: Management of hypertension.

Mechanism of Action: blocks angiotensin II activity at the angiotensin receptor on vascular smooth muscle

Effects of mechanism of Action: decreased vasoconstriction and decreased aldosterone( mineralocorticoid that stimulates sodium reabsorption by way of the kidneys) release.

Adverse Effects: HYPERkalemia, acute renal failure (in its with severe bilateral renal stenosis), , hypotension. Olmesartan: can cause spur-like enteropathy (severe diarrhea with profound weightloss)

Absolute Contraindications:pregnancy, bilateral renal stenosis

Pregnancy: DO NOT USE

Warning/ Precautions: –Do not initiate if potassium > 5 mmol/L.Discontinue if potassium >5.6 mol/L
history of angioedema (angioedema may be less likely to occur in ARBS over ACEI, but risk cannot be ruled out)

Drug-Drug Interactions (DDIs):

Monitoring Parameters: Assess electrolytes and renal function 2-4 weeks after initiating therapy or changing doses.

Pearls: 1.drug of choice in its with diabetes, heart failure, post MI, stroke, and/ or CKD due to target organ protection

  1. do not use in combo with RAAS drugs
  2. protect the myocardium from remodeling/ hypertrophy in patients with heart failure
  3. no washout period required when transitioning to a neprilysin inhibitor
  4. Less dry cough/ angioedema due to lack of peripheral effects of angioedema
  5. Olmesartan can cause spur-like enteropathy (severe diarrhea with profound weight loss.
  6. comes available (with HCTZ, CCBs)
19
Q

Direct Renin Inhibitors

examples:
Indication:

Mechanism of Action:
Effects of mechanism of Action:

Adverse Effects:

Absolute Contraindications:
Pregnancy:

Warning/ Precautions: –

Drug-Drug Interactions (DDIs): –

Monitoring Parameters:

Pearls:

A

Direct Renin Inhibitors

examples: Aliskiren ( Tekturna)

Class: Direct Renin Inhibitor

Indication: Management of hypertension. not recommended as initial treatment for HTN

Mechanism of Action: decreases renin-> overall decrease in angiotensin II

Effects of mechanism of Action: decreased vasoconstriction and decreased aldosterone( mineralocorticoid that stimulates sodium reabsorption by way of the kidneys) release.

Adverse Effects: HYPERkalemia, acute renal failure (in its with severe bilateral renal stenosis), , hypotension, diarrhea

Absolute Contraindications: pregnancy, avoid use with ACEi or ARBS in patients with diabetes

Pregnancy: DO NOT USE

Warning/ Precautions: –Do not initiate if potassium > 5 mmol/L.Discontinue if potassium >5.6 mol/L

Drug-Drug Interactions (DDIs): –

Monitoring Parameters: Assess electrolytes and renal function 2-4 weeks after initiating therapy or changing doses.

Pearls:

  1. do not use in combo with RAAS drugs
  2. Long half life
  3. lack of long term studies on CV outcomes
  4. high drug cost
20
Q

Beta Blockers

examples:

Class:

Indication:

Mechanism of Action:

Effects of mechanism of Action:

Adverse Effects:

Absolute Contraindications:

Pregnancy: —

Warning/ Precautions:

Drug-Drug Interactions (DDIs):

Monitoring Parameters: –

Pearls:

A

Beta Blockers

examples: in general, end in -OLOL.

Class: Beta blockers

Indication: Management of hypertension. not recommended as first line treatment for HTN, unless a compelling indication exists such as coronary artery disease and left ventricular dysfunction

Mechanism of Action: inhibiting Beta 1 +/- Beta 2 receptors.
contains subclasses:
Cardio-selective Beta blockers:More selective for beta 1 receptors then beta 2
Cardio-selective and vasodilatory: block beta 1 only
intrinsic sympathomimetic activity (ISA): exhibit low level agonist activity at the beta adrenergic receptor site while simultaneously acting as a receptor antagonist.

Effects of mechanism of Action: decreased heart rate and myocardial contractility. (variable based on beta blocker subclass

Adverse Effects: Bradycardia, heart block, worsening heart failure, bronchospasm fatigue, depression, reduced exercise tolerance, decreased libido, insomnia, impotence.

Absolute Contraindications: severe bradycardia

Pregnancy: —

Warning/ Precautions: Use with cautioning patients with bronchospastic diseases (COPD, asthma). use with caution in patients with diabetes

Drug-Drug Interactions (DDIs): Use with caution with other drugs that cause bradycardia

Monitoring Parameters: —

Pearls:

  1. MUST BE TAPERED upon D/C. can cause rebound hypertension
  2. can mask symptoms of hypoglycemia in patients with diabetes.( i.e palpitations, shakiness, anxiety)
  3. enhance hypoglycemic effects of insulin and sulfonylureas
21
Q

cardio selective beta blocker

MOA:
benefit:
example

A

More selective for b1 blockade than b2.

benefit: can be used in patients with bronchospastic diseases such as asthma and COPD.

examples:Atenolol (Tenormin)
Metoprolol succinate (Toprol XL)
Betaxolol (Kerlone)

22
Q

cardioselective and vasodilatory beta blocker

MOA:
example

A

MOA: selective for blockade of b1 receptor only.

example: Nebivolol (Bystolic)

23
Q

beta blocker with intrinsic sympathomimetic activity

MOA:
examples:
pearl:

A

has low-level agonist activity at beta receptors while simultaneously having antagonist activity

examples: Acebutolol (Sectral)
Penbutolol
Pindolol (visken)

pearl: do not use in patients with MI because they do not decrease heart rate because of sympathomimetic activity

24
Q

Combined alpha and beta receptor blockade

MOA:
examples:
benefit

A

MOA: blockade of both beta adrenergic receptors and has some alpha blinking activity.

examples: don't directly end in -OLOL 
carvedilol (coreg)
carvedilol CR(Coreg CR)
Labetalol (normodyne)
Propanolol (Inderal)

benefit: alpha blockade good because it causes vasodilation.

25
Q

Alpha 1 Blockers

examples:

Class: alpha 1 blockers

Indication:

Mechanism of Action:

Effects of mechanism of Action:

Adverse Effects:

Absolute Contraindications:–

Pregnancy: —

Warning/ Precautions:

Drug-Drug Interactions (DDIs):

Monitoring Parameters: –

Pearls:

A

Alpha 1 Blockers

examples: in general, end in -ZOSIN (i.e prazosin (cardura) Terazosin (Hytrin)

Class: alpha 1 blockers

Indication: Management of hypertension. *not recommended as first line treatment for HTN

Mechanism of Action: Bind and block alpha adrenergic receptors

Effects of mechanism of Action: peripheral dilation of arterioles and veins

Adverse Effects: syncope, orthostatic hypotension, first dose phenomenon ( transient dizziness and syncope), headache, dizziness.

Absolute Contraindications:

Pregnancy: —

Warning/ Precautions: Use with cautioning when administered with PDE5 inhibitors- enhance hypotensive effects.

Drug-Drug Interactions (DDIs): Use with caution with other drugs that cause bradycardia

Monitoring Parameters: —

Pearls:

  1. may be used in men who have hypertension and benign prostatic hypertrophy (BPH).
  2. increased risk for heart failure
  3. first dose orthostatic hypotension- administer the first dose at bedtime
26
Q

Central Alpha 2 agonists

examples:

Class:

Mechanism of Action:

Effects of mechanism of Action:

Adverse Effects:

Absolute Contraindications:

Pregnancy:

Warning/ Precautions: –

Drug-Drug Interactions (DDIs): –

Monitoring Parameters:–

Pearls:

A

Central Alpha 2 agonists

examples:Clonidine PO (Catapres), Clonidine patch (Catapres-TTS), Methyldopa (Aldomet)

Class: Central alpha 2 agonist

Indication: Management of hypertension. *not recommended as first line treatment for HTN. LAST LINE therapy.

Mechanism of Action: stimulation of central alpha 2 agonists adrenergic receptors in the brain

Effects of mechanism of Action: decreased sympathomimetic outflow of norepinephrine. decreases systemic vascular resistance and heart rate

Adverse Effects:dry mouth, somnolence, bradycardia, sedation
Methyldopa-edema, weight gain, drug induced lupus (DILE)
Clonidine patch: skin rash, pruritis, erythema

Absolute Contraindications: Methyldopa: active liver disease, concurrent use of MAOis.

Pregnancy: Methyldopa is the Drug of choice in pregnancy

Warning/ Precautions: –

Drug-Drug Interactions (DDIs): –

Monitoring Parameters:–

Pearls:

  1. MUST BE TAPERED upon D/C. can cause rebound hypertension. not good for people with adherence problems
  2. LAST LINE therapy due to significant CNS effects
  3. methyldopa is the drug of choice in pregnancy
27
Q

MEthyldopa

brand name

class:

indication:

notable side effects:

pearl:

A

brand name: (aldomet)

class: central alpha 2 agonist
indication: HTN
pearl: drug of choice for HTN in pregnancy

notable side effects: edema, weight gain, drug induced lupus

28
Q

Clonidine PO

brand name:

class:

indication:

A

brand name(Catapress)

class: central alpha 2 agonist
indication: HTN

29
Q

Clonidine patch

brand name:
indication:
class:
dosing:

A

brand name: Catapress TTS

indication: HTN
class: central alpha 2 agonist
dosing: weekly

30
Q

Loop Diuretics

examples:
Class:

Indication:

Mechanism of Action:

Effects of mechanism of Action:

Adverse Effects:

Absolute Contraindications:

Pregnancy: –

Warning/ Precautions:

Drug-Drug Interactions (DDIs):

Monitoring Parameters:

Pearls:

A

Loop Diuretics

examples:Furosemide (Lasix), Butanemide (Bumex), Torsemide (Demadex)

Class: Loop diuretic

Indication: Management of hypertension. *not recommended as first line therapy unless compelling indication exists, such as left ventricular dysfunction. *

Mechanism of Action:inhibits sodium, chloride, and potassium reabsorption in the thick ascending limb of the nephron

Effects of mechanism of Action: decreased blood volume, cardiac output, and peripheral vascular resistance.

Adverse Effects: hypokalemia, hyponatremia, HYPOcalcemia, hyperuricemia, hypochloremia, metabolic acidosis, ototoxicity, hyperglycemia, hypertryglyceridemia, orthostatic hypotension

Absolute Contraindications:hypersensitivity, sulfa allergy

Pregnancy:–

Warning/ Precautions: use precaution in patients with gout

Drug-Drug Interactions (DDIs): NSAIDS( causes sodium and water retention

Monitoring Parameters: Assess renal function and electrolytes 2-4 weeks after intiating therapy or changing doses.

Pearls:

  1. preferred over thiazides if CrCl <30 ml/min
  2. preferred in patients with HF for volume control/ diuresis
  3. consider ethacrynic acid if a patient ha s a true sulfa allergy
31
Q

Ethacrynic Acid

class:
pearl indication:

A

class: loop diuretic
indication: use as diuretic if patient has true sulfa allergy

32
Q

Potassium sparing Diuretic

examples:

Class:

Indication:

Mechanism of Action:

Effects of mechanism of Action:

Adverse Effects:

Absolute Contraindications:–

Pregnancy: –

Warning/ Precautions:—-

Monitoring Parameters:

Pearls:

A

Potassium sparing Diuretic

examples:Amiloride (Mimador), Triamterene (Dyrenium)
Class: potassium sparing diuretic

Indication: counteract potassium loss induced by other diuretics in the treatment of HT. usually used in conjunction with more potent diuretics such as loop or thiazides.

Mechanism of Action: competitive inhibition of epithelial sodium channel ENaC in the collecting duct of the nephron.

Effects of mechanism of Action: decreased sodium reabsorption and increase potassium reabsorption.

Adverse Effects: hyperkalemia, dehydration, hypnoatremia, dizziness

Absolute Contraindications:–

Pregnancy: –

Warning/ Precautions:—-

Monitoring Parameters: Assess renal function and electrolytes 2-4 weeks after intiating therapy or changing doses.

Pearls:
1. minimally fficacious blood pressure control when used as monotherapy
2. can use in combo with thiazide, thiazide like, or loops to combat hypokalemia.
avoid if CrCl< 45 mL/min

33
Q

Amiloride

brand name:
class:

A

brand name: Midamor

potassium sparing diuretic

34
Q

Triamterene

brand name:

class:

A

brand name: (dyrenium)

class: potassium sparing diuretic

35
Q

Direct vasodilators

examples:

Class:

Indication:

Mechanism of Action:

Effects of mechanism of Action:

Adverse Effects:

Absolute Contraindications:–

Pregnancy: –

Warning/ Precautions:—-

Monitoring Parameters: –

Pearls:

A

Direct vasodilators

examples: HYdralazine, Minoxidil

Class: direct vasodilators

Indication: management of HTN. not recommended as first line treatment

Mechanism of Action:direct vasodilation

Effects of mechanism of Action: decreased systemic vascular resistance

Adverse Effects: Minoxidil: reflex tachycardia, peripheral edema, hirsutism
Hydralazine: reflex tachycardia, peripheral edema, palpitations, DILE

Absolute Contraindications:–

Pregnancy: –

Warning/ Precautions:—-

Monitoring Parameters: –

Pearls:
1.minoxidil is associated wit sodium/ water retention and reflex tachycardia (use with diuretic and beta blocker)

36
Q

Hydralazine

brand name:
class:

A

brand name: apresoline (IV)

class: vasodilator

37
Q

Minoxidil

brand name:
class:

A

brand name: Loniten

class: vasodilator

38
Q

Mineralcorticoid receptor antagonists

examples:

Class:

Indication:

Mechanism of Action:

Effects of mechanism of Action:

Adverse Effects:

Absolute Contraindications:

Pregnancy: –

Warning/ Precautions:—-

Monitoring Parameters:

Pearls:

A

Mineralcorticoid receptor antagonists

examples:Sprinolactone (non selective) , Eplerenone (selective)

Class: Mineralcorticoid receptor antagonists

Indication: management of HTN unresponsive to other therapies. spirinolactone is first line get for resistant HTN

Mechanism of Action: competitive antagonists of the mineralocorticoid receptor

Effects of mechanism of Action: decreased sodium reabsorption and increasing potassium reabsorption

Adverse Effects: hyperkalemia, dehydration, hyponatremia.

spironolactone: gynecomastia, breast tenderness, impotence
eplerenone: increased triglycerides

Absolute Contraindications: hyperkalemia, anuria
Eplerenone: contraindicated when Crcl<50 mL/min or SCr >2 mg/dL in males or >1.8 mg/dL (females)

Pregnancy: –

Warning/ Precautions:—-

Monitoring Parameters: assess electrolytes and renal function 2-4 weeks after initiating therapy or changing doses

Pearls:

  1. preferred in primary aldosteronism and resistant hypertension
  2. minimally efficacious BP control when used as mono therapy.
  3. used in combo with loops and thiazides to combat potassium loss
39
Q

Spironolactone

class:

pearl: when is it used?

dose:

A

class: mineralocorticoid receptor antagonist

potassium sparing diuretic

pearl: first line therapy for resistant hypertension
dose: 25-100 mg daily

40
Q

Eplerenone:

class:

A

class: mineralcorticoid receptor antagonist

potassium sparing diuretic

41
Q

Isosorbide dinitrate

Class:

A

class: direct vasodilator

C/R (12 decks)

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