Meds Flashcards
Thiazide Diuretics (3)
Chlorothiazide
Chlorthalidone
Hydrochlorothiazde
Thiazide MOA
Inhibit sodium and chloride reabsorption in the THICK LOOP OF HENLE and EARLY DISTAL TUBULE
–> this increases urine volume causing a decrease in plasma volume
Thiazide- how does it affect the heart?
Decreases cardiac output and lowers stroke volume and lowers BP
Adverse effects of Thiazides (5)
Hypokalemia hypomagnesemia Hyperglycemia Hyperuricemia Hyperlipidemia
Ace Inhibitors
captopril enalapril Lisinopril Benazepril Fosinopril Ramipril Quinapril Moexepril
MOA of ACE
block the enzyme that converts ANgiotensin I to angiotensin II.
What is angiotensin II?
principal pressor in the RAAS responsible for vasoconstriction, synthesis, and release of aldosterone cardiac stimulation and renal absorption of sodium
What happens when Angiotensin II is blocked by ACE?
Vascular resistance is decreased and the secretion of aldosterone is decreased– decreased water and sodium retention
Adverse effects of ACE?
cough hypotension Rash Angioedema HYPERKALEMIA
Contraindication fo ACE?
PTs with renal artery stenosis d/t risk of renal failure
ACE inhibitors Clinical use?
First-line drug for HTN reduce proteinuria slow progression of neuropathy good for HTN CHF or HTN and DM Post MI
ARBS
Candesartan Eprosartan Irbesartan Losartan Olmesartan Telmisartan Varsartan
MOA of ARBS
INHIBITS/BLOCKS angiotensin II RECEPTOR!
MOA difference between ARBS And ACE?
ARB- block receptor
Ace- blocks enzyme
Adverse effcts of ARBs
Hyperkalemia Fatigue Headache Dizziness Insomnia SINUS CONGESTION
ARBs are contraindicated for which patients?
PT with renal artery stenosis
Why do some patients need ARB over ACE?
PT cannot tolerate ACE cough s/e
Indication of ARBS
HTN and CHF but not approved for post MI
Calcium Channel ANTAGONISTS
Amlodipine Felodipine Isradipine Nicardipine NIfedipine Verapamil Bepridil
MOA of Calcium Channel ANTAGONISTS
Block L type calcium channels and decrease calcium entry into vascular and cardiac cells this results in reduced CONTRACTILITY in CARDIAC AND VASCULAR MUSCLE
Calcium Channel ANTAGONISTS decrease…
Arteriolar dilation and decreased BP
Why are CCB contraindicated with HF PT?
bc they also inhibit calcium in cardciac tissue and SLOW conduction of AV node this can decrease contractility and make HF worse
clinical use of CCB?
PT with Angina and HTN
Why should Nifedipine not be used for HTN Txt?
BC short-acting Nifedipine can cause increased risk of MI bc of reflex tachycardia
What are the three classes of Calcium channel ANTAGONISTS?
- Diphenyalkylamines
- Benzothiazepines
- Dihydriopyridine
Verapamil belongs to which class of CCB?
Diphenyalkylamines –> vascular and cardiac activity
Txt- HTN Angina and SVT
Diltiazem belongs to which class of CCB?
Benzothiazepines–>vascular and cardiac activity
Txt- HTN Angina and SVT
Nifedipine belongs to which class of CCB?
Dihydropyridine
Nifidipine
greater affinity for calcium channels in the VASCULAR system than in the heart and they provide vasodilation BUT ARE NOT effective in decreasing AV node conduction
TXT ANGINA AND HTN
SE of Diphenyalkylamine
Constipation
Bradycardia
Heart block
Worsen CHF
SE of Benzothiazepines?
Bradycardia
Worsen CHF
SE of Dihydropyridine ?
Headache
Flushing
Peripheral edema
Increased angina MI
Beta Blockers
Acebutolol Atenolol Betaxolol Metoprolol Nadolol Penbutolol Prpanolol Carvedilol Labetolol
MOA of BB
NEGATIVE CHRONOTROPE
decrease contractility and CO
block receptors on kidneys and reduce the release of renin
SE of BB
bronchoconstriction peripheral vasoconstriction brady exacerbation of HF fatigue depression sleep disturbance
Contraindication for BB
PVD
Asthma
COPD
BB careful with diabetics because…
BB decrease the normal sympathetic response to hypoglycemia
Alpha 1 Receptor Blockers
Doxazosin
Terazosin
Prazosin
MOA of alpha 1
reduce arterial pressure by blocking the peripheral post synaptic alpha 1 receptors and decrease total peripheral resistance
SE of Alpha 1 Recpetor Blcokers
FIRST DOSE SYNCOPE
Dizziness drowsiness headaches
CNS - think head
Which drug can be used for BPH?
TERAZOSIN
Alpha 2 AGONISTS
Clonidine
guanabenz
methyldopa
guanfacine
MOA of Alpha 2 AGONISTS
STIMULATE alpha 2 receptors in the brainstem decreasing sympathetic outflow to the heart kidneys and peripheral vasculature
NO NOREEPINEPHRINE
SE of alpha 2 AGONISTS
Think CNS sedation dry mouth drowsiness constipation and abd pain decreased lipido and impotence RASH WITH PATCH
Can you abruptly stop alpha 2 agonists?
NO rebound HTN can occur must be tapered
Which medication can be used for PT that is pregnant and has HTN?
Methyldopa
