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Pharmacology BAS208 > Hypertension Drugs > Flashcards

Hypertension Drugs Flashcards

1
Q

Which drug is used to treat HTN and BPH?

A

Prazosin with BB or diuretic

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2
Q

What is the drug of choice for athletes?

A

Pindolol

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3
Q

Drug of choice for 55 y.o. african american?

A

Calcium Channel Inhibitors

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4
Q

What drugs are ACE inhibitors?

A

-pril

captopril, lisinopril, enalapril, ramipril, fasinopril, benazepril

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5
Q

ACE Inhibitor MOA

A

Reversibly inhibits ACE, prevents conversion of Angiotensin I to II
Highest activity is in endothelium of pulmonary vasculature
Diminish rate of bradykinin inactivation
Decreases aldosterone production

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6
Q

Which drug is used to treat HTN post-MI, diabetes, KI dz or stroke?

A

ACE Inhibitors

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7
Q

What are the Cardiorenal effects of ACE inhibitors?

A

vasodilation
decrease blood volume
depress sympathetic activity
inhibit cardiac and vascular hypertrophy

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8
Q

ACE Inhibitor PK

A

Given orally, rapid onset
LV/KI metabolism
Several require biotransformation (except lisinopril, captopril)

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9
Q

What are the adverse effects of ACE Inhibitors?

A 
dry cough
angioedema
hyperkalemia
reversible acute renal failure
hypotension
rashes, loss of taste
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10
Q

What are the Contraindications of ACE inhibitors?

A

pregnancy and breastfeeding

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11
Q

What drugs are contraindicated with ACE inhibitors?

A

lithium
NSAIDs
K+ sparing diuretics/supplements

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12
Q

What are ACE Inhibitor herbal interactions?

A

cayenne
ephedra
rhubarb

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13
Q

What are ACE Inhibitor nutrient interactions

A

Potassium

Zinc

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14
Q

What are the Angiotensin Receptor Blockers?

A

-sartans

losartan, valsartan, candesartan, telmisartan

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15
Q

Angiotensin Receptor Blockers MOA

A

block the Ang II (AT1) receptor blocking the effect of Ang II thus decreasing peripheral vascular resistance and decreasing the effective circulating volume of fluid in the body
(no effect on metabolism of bradykinin)

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16
Q

Angiotensin Receptor Blockers Side effects

A

Dizzy, drowsy, headache
dry mouth, nausea ab pain
no increase in glucose, cholesterol or uric acid
increased side effects with ACE(-)
increased risk of MI, hypotension, KI impairment

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17
Q

Adrenergic agonist drug MOA

A

reduce firing rate of sympathetic nerves

activation of alpha2-adrenergic receptors in CNS to inhibit sympathetic vasomotor centers

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18
Q

What drugs are centrally acting α2- adrenergic agonists?

A

Clonidine

α-methyldopa

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19
Q

When do you use Clonidine?

A

Mild/moderate HTN not responding to diuretics

causes Na+ and H2O retention

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20
Q

Adverse effects of clonidine

A

Sedation, drying of nasal mucosa

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21
Q

When to use α-methyldopa

A

Patients with renal insufficiency and in pregnancy

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22
Q

Adverse effects of α-methyldopa

A

sedation, impotence, rare hepatic necrosis

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23
Q

What drugs are α-adremergic blocking agents?

A

Prazosin

Doxazosin (cardura)

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24
Q

α1- adrenergic blocking agents MOA

A

blocks α1-adrenoceptors of smooth muscle causing relaxation of arterial and venous smooth muscle, decreases peripheral vascular resistance

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25
Q

What can happen on first dose of α1-adrenergic blocking agent (prozosin, doxazosin)?

A

Fainting

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26
Q

Use of α1- adrenergic blocking agents (prazosin, doxazosin)

A

In combination with Beta-blockers or diuretics

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27
Q

Adverse effects of α1-adrenergic blocking agents

A

nasal congestion, GI hypermotility, edema, orthostatic hypotention

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28
Q

Contraindication of α1- adrenergic blocking agent

A

> 55 yrs

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29
Q

What drugs are Beta-blockers?

A

-olol

Propranolol

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30
Q

Which BB is antagonist of both B1 and B2 adrenergic receptors?

A

Propranolol

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31
Q

Which BB is selective for B1 adrenergic receptors

A

Atenolol

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32
Q

Which BB penetrates the CNS?

A

Propranolol

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33
Q

Which BB is a partial agonist of B1 and B2 receptors?

A

Pindolol

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34
Q

Which BB are also antagonists of α1-adrenergic receptors?

A

Labetalol, carvedilol

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35
Q

BB MOA

A

Competitively antagonize the effects of norepinephrine and epinephrin on B1 adrenergic receptors in the heart and inhibit renin-sercreting cells of the KI

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36
Q

What are the Cardiac effects of BB?

A

decrease contractility
decrease relaxation rate
decrease heart rate
decrease conduction velocity

37
Q

What are the vascular effects of BB?

A

Smooth muscle contractions (mild vasoconstriction)

38
Q

When to use BB?

A

caucasian, young

HTN with comorbidities

39
Q

Contraindications of BB

A

severe chronic obstructive lung disease, chronic CHF, sever symptomatic occlusive peripheral vascular disease, asthmatics

40
Q

What is Propranolol used to treat?

A 
HTN
glaucoma
migraine
hyperthyroidism
angina pectoris
MI
41
Q

Which drug is used for asthmatics or smokers?

A

Athenolol/Metoprolol

42
Q

Which BB is used for chronic and ER HTN?

A

Labetalol

43
Q

Which BB is used with CHF?

A

Carvedilol

44
Q

BB PK

A

Abs in gut (50% bioavail)
extensively metabolized by the LV
excreted in KI and feces
dose often limited by resulting bradycardia

45
Q

BB adverse effects

A

may take several weeks to take full effect
depression, fatigue, lethargy, insomnia, hallucinations, cold extremities
bradycardia, hypotension, CHF
hypoglycemia
bronchoconstriction
disturb lipid metabolism

46
Q

Contraindications of BB

A

asthma, angina, peripheral vascular dz

47
Q

BB herbal interactions

A 
ginkgo
yohimbe
valeriam, wild lettuce, hops
caffein, cola, guarana
ephedra
48
Q

What are BB nutrient interactions?

A

Potassium (possible hyperkalemia)

No depletions

49
Q

What are the non-DHP Ca+ Channel Blockers?

A

verapamil

diltiazem

50
Q

What are the DHP Ca+ Channel Blockers?

A

nifedipine

amlodipine

51
Q

CCB MoA

A

block V-dependent L-type Ca channels of cardiac and smooth muscle –> reduce muscle contractility

Effect on vascular smooth muscle: amolidpine/nifedipine > diltiazem > verapamil

Effect on Heart:
verapamil > diltiazem > amlodipine/nifedipine
“verapamil,ventricle”

52
Q

What is treated with CCB?

A

hypertension
angina
arrhythmias

53
Q

Therapeutic use of CCB

A

no concurrent diuretic

taken 3x/day

54
Q

What is the treatment of choice for african american >55?

A

CCB

55
Q

Verapamil

A 
CCB
Myocardial cells
extensive first-pass effect
t1/2= 5 hrs
slows heart rate
CI- CHF
56
Q

Nifedipine

A 
CCB
vascular smooth muscle
60-70% bioavailability
t1/2= 2hrs
causes reflex tachycardia
57
Q

Diltiazem

A 
CCB
Myocardial cells
extensive first pass effect
t1/2= 3.5 hrs
causes litte or no change to heart rate
58
Q

CCB adverse effects

A

infrequent
constipation (10%)
dizziness, headache, flushing, fatigue, gingival swelling, edema

59
Q

CCB contraindications

A

Verapamil with CHP

60
Q

CCB drug interactions

A

verapamil and diltiazem have negative isotropic activity, are inhibitors of P450 3A4

61
Q

What are the CCB Interactions

A 
Intravenous Ca+ and Mg+
grapefruit juice
cardiac glycosides (blue cohosh, pleurisy root)
ginger
CYT P450 sensitivev
62
Q

Which drugs cause latrogenic HPT?

A

Corticosteroids
Sympatomimetics
NSAIDs
Cyclosporine

63
Q

Thiazides MOA

A

inhibits Na+/K+/2Cl- co-transporter increasing Na+ and H2O excretion
decreases extracellular volume
decreases cardiac output and renal blood flow

64
Q

What is the first choice for HTN treatment?

A

Hydrochlorothiazide

65
Q

Which drug can be used to treat osteoporosis and nephrolithiasis?

A

Thiazides

66
Q

Thiazide PK

A 
antihypertensive effect in 3-4 days
No liver metabolism
Concentrates in Kidneys
Decreases excretion of Ca++ and Uric acid
Increases excretion of MG++, K+, Na+
67
Q

Thiazide adverse effects

A

hypokalemia and hyperuricemia (70%)
hyperglycemia
increased LDL and TG
Sudden cardiac death in patients predisposed to arrhythmias

68
Q

Thiazide contraindications

A

diabetics
pt w elevated cholesterol
pregnancy/breastfeeding

69
Q

Thiazide drug interactions

A 
corticosteriods
insulin
digoxin
lithium
NSAIDs
70
Q

Thiazide herbal interactions

A

herbal diuretics
promoters of K+ loss
ginko

71
Q

Which nutrients do Thiazides decrease?

A 
folic acid
potassium
magnesium
zinc
sodium
CoQ10
Vit B2
72
Q

Which nutrients do Thiazides increase?

A

Calcium

73
Q

Which nutrients may be affected by thiazides?

A

Vit D

Phosphorus

74
Q

Which drug is a loop diuretic?

A

furosemide

75
Q

Loop Diuretic - MOA

A

Inhibition of the Na/K/2Cl transporter in the ascending limb of loop of Henle

76
Q

Loop diuretic side effects

A

pronounced diuresis
depletes K+, Ca++, Mg++
elevates blood glucose, uric acid
ototoxicity (tinnitus, vertigo, hearing loss, ear pain)

77
Q

Which drug is a K+ sparing diuretic

A

Spinolactone

78
Q

MOA of K-Sparing Diuretics?

A

Inhibit Reabsorption of Na in Distal Convoluted Tubule and Collecting Duct

79
Q

K+ sparing diuretic uses

A

hypokalemia caused by other diuretics

80
Q

K+ sparing diuretic side effects

A

less diuresis and natriuresis

watch for anti-adrenergic effects

81
Q

Direct vasodilators MOA

A

most powerful antihypertensive drugs
direct-acting smooth muscle relaxants
increases vasodilation

82
Q

Direct Vasodilator Side effects

A

reflex tachycardia
fluid retention
aggravation of angina
(side effects avoided by use of BB and diuretics concomitantly)

83
Q

Which direct vasodilator acts on arteries and arterioles?

A

Hydralazine

84
Q

Which direct vasodilator acts on arterioles and not venules?

A

Minoxidil

85
Q

Which direct vasodilator may cause reflexive tachycardia and increased cardiac output?

A

Hyralazine

86
Q

Which direct vasodilator may cause severe reflex tachycardia and Na+ and H2O retention?

A

Minoxidil

87
Q

What is an adverse effect of Hydralazine?

A

Lupus-like syndrome

88
Q

What is an adverse effect of minoxidil?

A

hypertrichosis

89
Q

Which drug is used to treat HTN and BPH?

A

Prazosin with BB or diuretic

Pharmacology BAS208 (5 decks)

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