Hypertension Drugs Flashcards by Frances Samantha Ledesma

Target BP according to JNC 7 for:
no comorbidities?
DM?
CKD?

no comorbidities: <140/90
DM: <130/80
CKD: <130/80

How well did you know this?

Not at all

Perfectly

Target BP according to JNC 8 for:
no comorbidities: >/= 60 years old? < 60 years old?
DM?
CKD?

> /= 60 years old: < 150/90, < 60 years old: < 140/90
DM: <140/90
CKD: <140/90

How well did you know this?

Not at all

Perfectly

inhibits Na/Cl transporter in DCT
causes moderate diuresis and and reduced excretion of Ca (increased reabsorption)
first line for hypertension
heart failure, hypercalciuria, nephrogenic diabetes insipidus, renal calcium stones

thiazide diuretic

How well did you know this?

Not at all

Perfectly

types of thiazide diuretic

Hydrochlorothiazide
Chlorthalidone
Indapamide
Metolazone
Chlorothiazide

How well did you know this?

Not at all

Perfectly

side effects of thiazide diuretics

hypokalemic metabolic alkalosis
hyperlipidemia
hyperuricemia
sulfa allergy

How well did you know this?

Not at all

Perfectly

inhibits Na/K/2Cl transporter in thick ascending limb of loop of henle
causes powerful diuresis and increased Ca excretion
used for pulmonary edema, hypercalcemia, acute renal failure, anion overdose

loop diuretic

How well did you know this?

Not at all

Perfectly

types of loop diuretic

Furosemide
Bumetanide
Torsemide
Ethacrynic acid (phenoxyacetic acid derivative)

How well did you know this?

Not at all

Perfectly

side effect of loop diuretics

dehydration
ototoxicity
sulfa allergy (EXCEPT ethacrynic acid)
hyperuricemia
nephritis

How well did you know this?

Not at all

Perfectly

CNS sympathetic outflow blocker
activates alpha 2 adrenergic receptors –> decreases central sympathetic outflow
used for hypertension
side effect: rebound hypertension

clonidine

How well did you know this?

Not at all

Perfectly

dose limit for clonidine

900 mcg

How well did you know this?

Not at all

Perfectly

antidote for rebound hypertension

phentolamine

How well did you know this?

Not at all

Perfectly

CNS sympathetic outflow blocker
activates alpha 2 adrenergic receptors –> decreases central sympathetic outflow
used for pre-eclampsia
side effect: hemolytic anemia (POSITIVE COOMBS TEST)

Methyldopa

How well did you know this?

Not at all

Perfectly

ganglion blocker
competitively blocks Nn nicotinic Ach receptors
used for hypertension (obsolete), hypertensive emergencies
side effect: POSTURAL HYPERTENSION, dry mouth, blurred vision, constipation, sexual dysfunction

Hexamethonium

How well did you know this?

Not at all

Perfectly

nerve terminal blocker
irreversibly blocks vesicular monoamine transporter (VMAT)
used for hypertension (obsolete)
side effects: sedation, severe psychaitric depression, suicidal ideation

reserpine

How well did you know this?

Not at all

Perfectly

nerve terminal blocker
inhibits vesicular release of NE from presynaptic neuron
used for hypertension (obsolete)
side effects: sedation, severe psychiatric depression, suicidal ideation

guanethidine

guanadrel

How well did you know this?

Not at all

Perfectly

which part of the nephron is acted on:
carbonic anhydrase inhibitors?
loop diuretics?
thiazide diuretics?
potassium-sparing diuretics?
osmotic diuretics?

carbonic anhydrase inhibitors: PCT
loop diuretics: Na/K/2Cl transporter in thick ascending limb of LoH
thiazide diuretics: Na/Cl transporter in DCT
potassium-sparing diuretics: collecting duct
osmotic diuretics: all parts, ESPECIALLY PCT

How well did you know this?

Not at all

Perfectly

primary site for calcium absorption due to Na-Ca changer

loop of henle

potassium escape mechanism located in which part of nephron?

thick ascending limb of loop of henle

adrenergic blocker
alpha 1 selective antagonist
used for benign prostatic hyperplasia, hypertension
side effects: FIRST DOSE –> ORTHOSTATIC HYPOTENSION, less chance of reflex tachycardia

Prazosin

Doxazosin, Terazosin, Tamsulosin, Silodosin, Alfuzosin

most selective for prostatic smooth muscle

Tamsulosin

adrenergic blocker
non-selective beta blocker
blocks sympathetic effects on heart and BP
reduces renin release
used for prophylaxis and hypertension
side effects: bronchospasm, AV block, heart failure, CNS sedation, erectile dysfunction
masks symptoms of hypoglycemia in diabetics

Propranolol, Pindolol, Timolol, Labetalol, Carvedilol, Nadolol, Levobunolol, Metapranolol

has combined alpha and beta blockade (may be used in pheochromocytoma)

Carvedilol and Labetalol

what drugs are used to control BP in pheochromocytoma?

Phenoxybenzamine
Phentolamine
or Labetalol

older oral vasodilator
alters intracellular Ca++ metabolism
relaxes arteriolar smooth muscle –> vasodilation –> decreases afterload
used for hypertension
side effects: REFLEX TACHYCARDIA, DRUG-INDUCED LUPUS

Hydralazine

older oral vasodilator opens K+ channels in vascular smooth muscle --> hyperpolarization --> muscle relaxation and vasodilation used for hypertension, alopecia side effects: REFLEX TACHYCARDIA, HYPERTRICHOSIS

Minoxidil | Diazoxide

older oral vasodilator specific for arterioles | decreases afterload

Minoxidil | Diazoxide

Medications that cause drug induced lupus?

Hydralazine Isoniazid Procainamide Penicillamine

how does minoxidil cause hypertrichosis?

minoxidil stimulates hair follicles (telogen phase) to differentiate into growth follicles (anagen phase)

calcium channel blocker non-dihydropyridine CCB block voltage-gated L-type Ca channels (cardiac > vascular --> more for arrhythmias since cardioselective) used for supraventricular tachycardia (OPD setting) side effects: CONSTIPATION, pretibial edema, GINGIVAL HYPERPLASIA, heart failure, AV block, sinus node depression

verapamil | diltiazem

dihydropyridine CCB block voltage-gated L-type Ca channels (vascular > cardiac) used for angina, hypertension side effects: PRETIBIAL EDEMA, FLUSHING, CONSTIPATION

Nifedipine | amlodipine, felodipine, nicardipine, nisoldipine, clevidipine, isradipine

``` parenteral vasodilator relaxes venous and arteriolar smooth muscle by increasing cGMP (preload unloader) decreases both preload and afterload used for hypertensive emergency side effect: CYANIDE TOXICITY light sensitive ```

Nitroprusside

``` parenteral vasodilator dopamine agonist (D1 receptor) causes arteriolar vasodilation of afferent and efferent arterioles increases renal blood flow used for hypertensive emergency side effects: HYPOKALEMIA short half life ```

Fenoldopam

angiotensin antagonist ACE inhibitor inhibits ACE and formation of angiotensin II decreases aldosterone secretion used for hypertension, heart failure, post-MI, diabetic nephropathy side effects: COUGH, TERATOGEN, HYPERKALEMIA

captopril | enalapril, benazepril, fosinopril, lisinopril, quinapril, ramipril, trandolapril, moexipril, perindopril

why use ACE inhibitors in patients with diabetic nephropathy?

ACE inhibitors decrease albumin excretion and slow progression from micro- to macro-albuminuria (renoprotective effect)

angiotensin receptor blockers blocks angiotensin (AT1 receptors) in vascular smooth muscle and adrenal cortex decreases aldosterone secretion used for hypertension, heart failure, diabetic nephropathy side effects: HYPERKALEMIA

losartan | candesartan, valsartan, irbesartan, erprosartan, telmisartan, azilsartan, olmesartan, valsartan

slows ventricular remodeling and increases survival in heart failure delays progression of diabetic nephropathy

ACE inhibitors captopril enalapril, benazepril, fosinopril, lisinopril, quinapril, ramipril, trandolapril, moexipril, perindopril ARBs losartan candesartan, valsartan, irbesartan, erprosartan, telmisartan, azilsartan, olmesartan, valsartan

combination treatment with ISDN for heart failure more effective than ACE-Is in blacks

hydralazine | older oral vasodilator

how do ARBs/ACE-Is cause hyperkalemia?

ACE-Is/ARBs reduce aldosterone levels --> potassium retention

renin antagonist inhibits renin prevents conversion of angiotensinogen to angiotensin I used for hypertension

aliskerin

management for malignant hypertension | accelerated form of severe hypertension associated with rising BP and rapidly progressing end-organ damage

powerful vasodilators (nitroprusside, fenoldopam, diazoxide) combined with diuretics (furosemide) and beta blockers to lower BP to 140-160/90-110