Misc. Pharmacotherapy Flashcards
Which classes of drugs are used to treat hypertension? (hint: there are 12!)
ACEI, ARBs, Direct Renin Inhibitors, Beta-blockers, thiazides, loop diuretics, potassium sparing diuretics, CCBs, alpha 1 blockers, Aldosterone receptor blockers, central alpha2 agonists, vasodilators
List all of the ACEIs
Captopril (Capoten), Enalapril (Vasotec), Lisinopril (Zestril, Prinivil), Ramipril (Altace), Trandolapril (Mavik)
Indications to use ACEI as first line
- Non- AA, 2. DM, 3. CKD, 4. HF or LVEF <40%, 5. CAD, 6. Recurrent stroke prevention
Which ACEIs are available as $4 generics?
Captopril, Enalapril, Lisinopril
Which ACEI has the highest incidence of cough?
Captopril
T or F: Tekturna is safe for pts with renal insufficiency.
False. Tekturna has not been studied in patients with renal insufficiency.
Which class of B-blocker is preferred in HTN, and give an example.
Beta-1 selective (Atenolol, Metoprolol, bisoprolol)
With Beta blockers, an increase in lipid solubility increases which side effect?
Fatigue. (Atenolol is most lipid soluble and therefore causes the most fatigue).
Which class of beta blockers should you NEVER use in HTN? give an example
those with Intrinsic Sympathomimetic Activity (ISA) Ex: Acebutolol and Pindolol
Thiazides are ineffective for patients with a GFR less than ___________
30 mL/Minute
When using a diuretic for HTN which 3 labs should you monitor in 7-10 days after initiation or titration?
SCr, Na and K
Which Beta blockers have alpha1 blocking activity?
Carvedilol and labetalol
Which has more risk of hypokalemia, HCTZ or Chlorthalidone?
Chlorthalidone
which loop diuretics have a $4 generic available?
HCTZ and Indapamide
(T or F) Bumetanide is available as a $4 generic?
True.
You should avoid using K+ sparing diuretics in pts with a CrCl of less than ________
10 mL/Min
Which diuretic is used to treat Liddle’s Syndrome?
Amiloride (Bonus: Liddle’s syndrome is an autosomal dominant disorder characterized by HTN, hypokalemia and low levels of aldosterone.)
Should you use the immediate or sustained release versions of Nicardipine and nifedipine for treatment of HTN?
ONLY use the sustained release dosage forms.
(T or F) You should generally use the sustained release form of Nifedipine, but it is ok to use the immediate release form in hypertensive emergencies and urgencies.
FALSE. “use of immediate release nifedipine (sublingually or orally) in hypertensive emergencies and urgencies is neither safe nor effective”
(T or F) Non- DHP CCBs are often used as 1st line therapy in combination with beta blockers.
False. They are usually reserved for patients with concomitant conditions (such as afib or angina) and should be used with caution in pts on beta blockers.
Should you use the immediate release version or the sustained release version of Diltiazem and Verapamil in HTN?
Sustained release.
In what patient do we most often see Alpha 1 blockers used?
the hypertensive male patient with concomitant BPH. It is generally a 4th or 5th line agent.
(T of F) Aldosterone Receptor Blockers should NEVER be used as a single agent for HTN.
True.
What 2 labs should you moniter 7-10 days after starting or titrating an aldosterone receptor blocker?
SCr and K
What drug can be used for HTN with HF and hyperaldosteronism?
Spironolactone
Which class of drugs are beneficial in hypertensive urgencies, but should be avoided in HF?
Central alpha 2 agonists.
What is the most commonly used anti-HTN agent in pregnancy?
Methyldopa
Which hypertension drug is also used in ADHD?
Guanfacine
Which class of HTN drugs is useful for resistant HTN and for patients with HF?
Vasodilators (Hydralazine)
Vasodilators should always be used with what other class of HTN drugs?
Loop diuretics.
