Hypertension Flashcards by Quinn Banks

MOA of Loop diuretics

block sodium and chloride reabsorption in the ascending loop of Henley

20% of NA and Cl typically reabsorbed here, inhibition leads to profound diuresis

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What are the four loop diuretics

"ide"
Furosemide
Torsemide
Bumetanide
Etharcrynic acid

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Which loop diuretic can be used in a patient with a self allergy?

Etharcrynic Acid

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For what indications (diseases) are loop diuretics used?

Congestive heart failure
Pulmonary edema
Peripheral edema
Hypertension

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What adverse effects must be monitored in loop diuretics?

Dehydration
Electrolyte abnormalities
Hypotension
Ototoxicity
Hyperuricemia

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Why should IV for loop diuretics be given slowly?

to avoid ototoxicity

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What is the mechanism of action for Thiazide diuretics?

Block reabsorption of Na+ and Cl- at the early segment of the distal convoluted tubule (DCT)

10% of NA and Cl reabsorbed from DCT; inhibition leads to diuresis

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What are the four thiazide diuretics?

Hydrochlorothiazide (HCTZ)
Chlorthiazide
Chlorhalidone
Metolazone

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Which thiazide diuretic is IV?

Chlorothiazide

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For what indications (diseases) are thiazide diuretics used?

Hypertension (first-line)
Edema
Diabetes insipidus

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What are adverse effects of thiazide diuretics that must be monitored?

Dehydration
Electrolyte abnormalities
hyperglycemia
hyperuricemia

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What are common drug interactions with thiazide diuretics?

Digoxin
Potassium-sparing diuretics
Lithium
Anti-hypertensive drugs
NSAIDs

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Can thiazide diuretics be used in patients with self allergies?

Yes, use caution

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Potassium-sparing diuretics types

Aldosterone Antagonists (spironolactone)
Non-aldosteron Antagonists (amiloride and Triamterene)

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What are the MOA for Spironolactone

Aldosterone Antagonist

Blocks aldosterone (typically causes sodium retention and potassium excretion) in the distal convolute tubule

Increased excretion of sodium and retention of potassium

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What are the MOA for Amiloride and Triamterene

Non-aldosteron Antagonists

Direct inhibitor of the NA/K ion exchange transporter

Increased excretion of sodium and retention of potassium

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What indications call for Spironolactone?

Hypertension and edema
Heart failure
Acne
Polycystic ovarian syndrome

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What indications call for Amiloride and Triamterene?

Hypertension

Edema

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What are adverse effects of Spironolactone?

Hyperkalemia (elevated potassium)

Endocrine effects

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What are adverse effects of Amiloride and Triamterene?

Hyperkalemia

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Which is associated with endocrine effects like gynecomastia?

Spironolactone

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What are common drug interactions for all three potassium-sparing diuretics

Thiazide and loop diuretics

Agents that raise potassium

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What is the MOA for Mannitol

filtered by the glomerulus
Does not undergo reabsorption and remains in the lumen
Increased osmotic pressure keeps water from being reabsorbed

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For what indications is Mannitol used?

Reduce elevated intracranial pressure

Reduce elevated intraocular pressure

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Why does mannitol require a filter for administration

To remove micro crystals (0.22 micron filter)

What time of day should loop diuretics be administered?

avoid taking before bed

What is the MOA for ACE inhibitors ?

inhibit angiotensin converting enzyme (ACE) from converting angiotensin I to angiotensin II

What are the physiologic effects of ACE inhibitors?

``` Vasodilation Low blood volume Low cardiac and vascular remodeling Potassium retention Fetal injury ```

What four-letter syllable do all ACE Inhibitors share?

"pril"

Which ACE inhibitor is IV?

Enalaprilat

For what indications (diseases) are ACE inhibitors used for?

``` hypertension heart failure Myocardial Infarction diabetic nephropathy prevention of MI, stroke and death in patients at high risk for CV disease ```

What adverse effects must be monitored when using ACE inhibitors?

``` first-dose hypotension dry cough hyperkalemia renal failure in patients with bilateral renal artery stenosis Fetal injury Angiodema ```

What is a rare but life threatening adverse reaction that can be seen with ACE inhibitors?

Angiodema

What are common drug interactions with ACE inhibitors?

``` Diuretics Antihypertensive Agents Drugs that raise potassium Lithium NSAIDs ```

Can ACE inhibitors be used in pregnant patients?

MOA of Angiotensin II receptor blockers (ARBs)

block angiotensin II from binding to its receptor

Physiologic effects of ARBs

vasodilation decrease production of aldosterone reduce cardiac remodeling dilation of renal blood vessels

What ending do all ARBs share?

"sartan"

For what indications (diseases) are ARBs used?

*identical to ACE inhibitors ``` hypertension heart failure Myocardial Infarction diabetic nephropathy prevention of MI, stroke and death in patients at high risk for CV disease ```

What adverse effects must be monitored when taking ARBs

*identical to ACE inhibitors angiodema fetal harm renal failure

What is a rare but life threatening adverse reaction that can be seen with ACE inhibitors

Angioedem

What are common drug interactions for ARBs

*identical to ACE inhibitors Diuretics Antihypertensives Drugs that raise potassium levels

Can ACE inhibitors be used in pregnant patients?

MOA for Direct Renin Inhibitors (DRI)

binds to renin and prevents it from cleaving Angiotensinogen to angiotensin I Cannot create angio II without angio I Angio II is the problematic element that increases blood pressure

Physiologic Actions for DRI

Vasodilation Decrease production of aldosterone Reduce cardiac remodeling Dilation of renal blood vessels

What is the only direct renin inhibitor

Aliskiren

For what indications (diseases) are DRIs used for

Hypertension

What adverse effects must be monitored when administering DRIs?

``` Angiodema Dry Cough Diarrhea * only thing dif from ACE or ARB Hyperkalemia Fetal Injury ```

What is the difference between dihyropyridine and non-dihydropyridine calcium channel blockers?

Dihydropyridines: several drugs, work only on the vascular smooth muscle Non-Dihydropyridines: two drugs, work on heart and vascular smooth muscle

MOA of Dihydropyridine CCB

block calcium channels in the vascular smooth muscle, decrease blood pressure, prevent ism from contracting

Physiologic Effects of Dihydropyridine CCB

Vasodilitation of the arteries and arterioles which decrease blood pressure Vasodilation cardiac vasculature which increases myocardial perfusion (improved oxygen and blood supply) Reflex tachycardia

What ending do all Dihyropyridine CCB drugs share?

"dipine

For what indications (diseases) are Dihydropyridine Calcium Channel Blockers used for?

Angina Pectoris and hypertension

Which Dihydropyridine CCB would be preferred in an emergency when bp must be reduced right away?

Nicardipine and Clevidipine

Which dihydropyridine CCBs are administered IV

Nicardipine and Clevidipine

What adverse effects must be monitored for dihydropyridine CCBs

``` flushing dizziness headache peripheral edema reflex tachycardia ```

Which dihydropyridine CCB is only indicated for SAH (bleeding in brain)

Nimodipine - not used for BP

MOA for Non-dihydropyridine CCB

block of calcium channels in the vascular smooth muscle and heart

Physiologic Effects for Non-dihydropyridine CCB

decrease BP Increase Myocardial Perfusion Decreases Heart Rate Decreased force of myocardial contraction

What are the Non-dihydropyridine CCBs?

Verapamil | Diltiazem

For what indications (diseases) are Non-dihydropyridine CCBs used?

angina pectoris hypertension cardiac dysrhthmias

What adverse effects must be monitored for Non-dihydropyridine CCBs and how?

``` constipation (verapamil) dizziness flushing headache bradycardia AV nodal block Peripheral edema ``` Monitor BP, ECG, and heart rate

What are common drug interactions for Non-dihydropyridine CCBs?

digoxin and beta-blockers | possible interaction with grapefruit juice

What is an important counseling point regarding ER products?

Do not crush or chew

What lifestyle modifications can be implemented to help treat high blood pressure?

``` Sodium restriction - max 2grams/day Dash Diet - high in fruits, veg, low-fat dairy, low in sat fats and chol Alcohol Restriction Weight loss Smoking Cessation Exercise ```

What strategies can be used to improve patient adherence to therapy?

``` simplify regimen establish a collaborative relationship minimize side effects teach self-monitoring teach importance of med for pt to take ```

Which blood pressure medications are preferred in pregnant patients?

magnesium, labatelol, methyldopa

What drugs cause hypokalemia?

Loop diuretics | Thiazide Diuretics

What drugs cause Hyperkalemia?

K-sparing diuretics, ACE-inhibitors, Direct Renin Inhibitors, ARBs, Aldosterone antagonists