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Hypertension Pharmacology > Hypertension Pharmacology > Flashcards

Hypertension Pharmacology Flashcards

1
Q

When a patient has hypertension, what medication is our first go to?

A

Thiazide

You can add an ACE too

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2
Q

What are some examples of ACE inhibitors?

A

Lisinopril, Captopril, and Fosinopril

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3
Q

Why do we go to an ACE inhibitor first to treat hypertension?

A

Lowers BP by decreasing peripheral resistance and inhibiting sodium and water retention. They also help increase venous capacity, cardiac output, and vascular volume.

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4
Q

What is the main mechanism of ACE inhibitors that allows them to do so much?

A

Inhibit the conversion of angiotensin I to angiotensin II – thereby vasodilating.

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5
Q

Besides hypertension, what are the other indications for ACE inhibitors?

A

Heart Failure, left ventricular dysfunction after an MI, and diabetic neuropathy.

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6
Q

When thinking about heart failure, what do ACE inhibitors do?

A

Slow heart/muscle remodeling

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7
Q

What are the main side effects of ACE inhibitors?

A

They can cause a cough, hyperkalemia, and angioedema.

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8
Q

What if a patient can’t handle the cough the ACE inhibitor has caused?

A

You can switch them to losartan

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9
Q

What type of medication is losartan?

A

Angiotensin receptor blocker (ARB)

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10
Q

How does Losartan work?

A

It competitively blocks angiotensin 1 (1000x greater than ACE) and II. Therefore relaxing and dilating blood vessels = decreased BP

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11
Q

When we give a patient an ACE inhibitor what must we tell them about the first dose?

A

The first dose can cause hypotension

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12
Q

If a patient has renal insufficiency, can you give them an ACE inhibitor?

A

you can, but you must monitor creatinine closely

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13
Q

What are the absolute contraindications for ACE’s?

A

Bilateral renal artery stenosis, angioedema, and pregnancy

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14
Q

What lab work is especially important to watch with ACE inhibitors?

A

Potassium levels & liver function

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15
Q

In patients over the age of 50, what BP is our target goal?

A

140/90

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16
Q

What blood pressure reading is an emergency?

A

A diastolic pressure that is greater than 120

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17
Q

What can you NOT do while on an ACE inhibitor?

A

get pregnant

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18
Q

If a patient is a diabetic and has hypertension, what do we need to treat them with?

A

ACE inhibitor + Diuretic

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19
Q

In a patient with hypertension, what are the most common diuretics we would use?

A

Hydrochlorothiazide or Chlorothalidone

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20
Q

Between Hydrochlorothiazide and Chlorothalidone, which is more potent?

A

Chlorothalidone – 2x the potency

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21
Q

In general, how to the diuretics work in the body? What is the goal?

A

They increase urinary sodium and water excretion, which decreases extracellular fluid and plasma volume which helps us reach the goal of decreasing total peripheral resistance.

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22
Q

: How do the thiazide diuretics work?

A

They inhibit the sodium-chloride symporter, increasing sodium and chloride excretion.

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23
Q

Are there any side effects to be concerned about with Thiazides?

A

QT prolongation, photosensitivity, nausea, and hypokalemia

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24
Q

If a patient has an allergy to sulfa, can they take a thiazide? If not, what is the alternative?

A

Nope, Ethacrinic acid

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25
Q

If a patient has an eGFR that is less than 30 what happens to the thiazides?

A

the effectiveness decreases

26
Q

If a patient has renal failure, can you use a thiazide?

A

Nope, change to a loop

27
Q

What happens if a patient is on a beta blocker and a thiazide?

A

It increases the risk of hyperglycemia

28
Q

Can you ever take an NSAID with a diuretic?

A

No

29
Q

When you prescribe a thiazide, what should you educate patient’s about?

A

Low sodium diets, add more potassium rich foods, and the warning signs for potassium depletion are hypovalemia.

30
Q

What medication can you add to a thiazide if your patient is experiencing hypokalemia?

A

Potassium sparing adjunct = Triamterene

31
Q

What over the counter medication can cause hypertension?

A

Ibuprofen

32
Q

How does ibuprofen cause hypertension?

A

Inhibits prostaglandins therefore causing vasoconstriction

33
Q

Say your patient is African American and hypertension, what medication would you start with and if it still didn’t control hypertension, what medication would you add?

A 
Start with Hydrochlorothiazide (diuretic)
	Then add (NOT AN ACE) a Calcium Channel Blocker
34
Q

What are calcium channel blockers? What are the major categories?

A

They are vasodilators. Either nondihydropyradines or dihydropyradines.

35
Q

What medications are our dihydropyradines?

A

Amlodipine & Nifedipine

36
Q

What medications are our nondihydropyradines?

A

Diltiazem & Verapamil

37
Q

What medications block calcium channels and dilate smooth muscle of the myocardium?

A

Dihydropyradines

38
Q

What medications dilate the coronary arteries and decrease myocardial oxygen demands?

A

Nondihydropyradines

39
Q

What are the nondihydropyradine medications used for?

A

angina, hypertension, afib, aflutter, and PSVT

40
Q

When can you never use nondihydropyradines?

A

can’t use them with beta blockers or heart failure

41
Q

What are the dihydropyradine medications used for?

A

angina & hypertension. It can also be used for heart failure (mainly Amlodipine)

42
Q

What medications are contraindicated with grapefruit juice?

A

Calcium channel blockers

43
Q

What medication would you use for urgent to emergent elevated BP?

A

Hydralazine

44
Q

What medications are our selective Beta-1 adrenergic receptors?

A

Metoprolol & Atenolol

45
Q

What medications are non-selective beta blockers? Which one blocks alpha receptors?

A

Propranolol, Prazosin, & Carvedilol

Carvedilol & Prazosin blocks alpha receptors

46
Q

What is different about propranolol than any other beta blocker?

A

It can cause sedation & fatigue more than any of the others

47
Q

What is propranolol mainly used for?

A

Migraine prophylaxis

48
Q

What is the function of non-selective beta/alpha blockers?

A

vascular smooth muscle vasodilation and decrease total peripheral resistance

49
Q

What can Prazosin cause, more-so than the other non-selective beta/alpha blockers?

A

Can decrease peripheral resistance so much that it causes postural hypotension

50
Q

In general what are beta blockers used to treat?

A

angina, hypertension, and post-MI

51
Q

: Is there a beta blocker that can also be used for heart failure?

A

carvedilol

52
Q

What is key about prescribing beta blockers?

A

You must start low, titrate up, and down titrate

53
Q

Which form of metoprolol is longer acting?

A

Metoprolol Succinate

54
Q

What is special about Atenolol?

A

You cannot use it in hypertension. It can also cause peripheral edema

55
Q

What medications do we need to avoid if our patient has hypertension and asthma?

A

Propranolol & Carvediolol

56
Q

In treating hypertension, what are the 1st, 2nd, 3rd, 4th, order medications?

A

Start with an ACE (can combo with a diuretic), then try a beta blocker (skip if African American), then try a calcium channel blocker.

57
Q

What is the one medication we can use for hypertension in a pregnant woman? What is its class?

A
  • Methyldopa

- Centrally acting alpha2 adrenergic agonist.

58
Q

In general, how do the centrally acting alpha2 agonists work?

A

Decrease the release of norepinephrine, which increases vasodilation, decreasing total peripheral resistance.

59
Q

What other centrally acting alpha2 agonist can be used to treat hypertension, narcotic addiction, and ADHD?

A

Clonidine

60
Q

we go to take a patient off of clonidine, what must we be careful of?

A

You cannot stop it abruptly, it will cause rebound hypertension

61
Q

What medication is out direct renin inhibitor?

A

Aliskerin

Hypertension Pharmacology (1 decks)

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