Perfusion Pharm Flashcards
Thiazide and Thiazide -like Diuretics
Anthihypertension and are a thiazide type drug
MOA of thiazide drugs
Chloride pump blocker
= keeps the chloride and sodium in distal tubule
Thiazide drugs act in which part of the renal system
distal TUBULE
Thiazide = tubes
Potassium sparing diuretics prototype
Spironolactone
Benefit of spironolactone
spare the potassium so they can give to those in hypokalemia
where and what does potassium sparing dietetics work on
Works on aldosterone in the distal tubule and collecting ducts
Spironolactone adverse effects
Hyperkalemia, dysrhythmias, gynecomastia, impotence, and deminished
Why isn’t potassium-sparing diuretics used as a primary diuretic
It’s a weak diuretic and usually is added as a second
mild fluid retention would most likely get which diuretic
Thiazide
Severe edema would most likely get what diuretic
LOOP
Potassium rich foods to avoid for a spironalactone
Avacado, bananas, broccoli
hypertension is the ____ common cardiovascular disease
most
HTN can cause
heart failure, MI are most common deaths related to hypertension
damage to
1. kidney
2. brain
3. your eyes (oh my!)
4. blood vessels
Dx of HTN
2 BP readings on 2 separate occasions
Categorizing BP (normal- stage 2 HTN
Normal: <120/80
Elevated: 120-129/<80
Stage 1: 130-139/80-89
Stage 2 >140/>90
Hypotension is considered
< 100/60 (unless provider specifies)
Is stage 1 HTN treated with drugs
only if there is cardiovascular risk
Is stage 2 HTN treated with drugs
oh yes.
First line drugs for non black people with HTN
Thiazides, Calcium channel blocker, Ace inhibitor, or Angiotension receptor blockers
Black people with HTN recommended to get treated with
Thiazides, Calcium CB before ACE or Angiotension receptor blockers
Medications for Kidney diseased people with HTN
ACE or ARB
Therapeutic lifestyle changes to people with HTN with no drugs
TLC
1. good weight
2. - alcohol
3. restrict sodium
4. exercise
4 first line medications for htn
thiazide
ACE inhibitors
angiotensin receptor blockers
calcium channel blockers
what can we do keep patients adherence to meds on HTN
Educations on why its important
consider generic forms (cost)
report adverse effects to dose can be adjusted or changed
Thiazide diuretics used in
mild to moderate HTN used to reduce fluid reduction
Adverse effects Thiazide
Dehydration
Increase uric acid levels
Renin-Angiotensin-Aldosterone System (RASS) is important because
Is one of the primary homeostatic mechanisms to control BP and fluid balance
Renin is secreated by and does what
kidneys and changes angio-tensin 1 that floating around in the blood to angiotensinogen
Types of angiotensin
Angiotensinogen: no change
Angiotensin 1:
See cards***
Steps to the RAAS system
BP is low so the kidney produces renin which makes agiotensin 1 from angiotensinogen
2. ace coverts 1 to 2
3. A2 causes vasoconstriction and the release of aldosterone
ACE inhibitors do what
Blocks the enzyme that creates Angiotensin 2 from being created from A1
ARB blockers do what
A2 is still being made, but A2 receptor is blocked so A2 cannot be utilized
can you be on both ACE and ARB meds
nah
ACE inhibitors meds all end in
-pril
What are ACE inhibitors often used with?
Thiazide
ACE inhibitors adverse effects
Hyper K
dry cough
angioedema (females and black)
orthostatic hypotension
Contraindications to ACE inhibitors
Pregancy cat. D due to defects
Hyperkalemia
MOA of ACE inhibitors
Block conversion of A1 to A2
ACE inhibitors Food/Drug interactions
NSAIDS - decrease antihypertensive activity and worsen preexisting renal disease.
ARB Pharmacologic class Angiotensin 2 receptor blocker
Angiotensin 2 receptor blocker
-> antihypertension
therapeutic effect/uses of ARB
HTN, stroke prophylaxis in LVH, prevention of DMII nephropathy and off label for HF
MOA of ARB
Routes of
Adverse Effect of ARBs
HZ, Dizzy, nasal congestion (vasodilation), fatigue insomnia
Angioedema
Contraindications of ARB
Allergic and pregnancy
Food/Drug interactions to ARB
NSAID same as ACE
Calcium channel Blocker class
calcium channel blocker, dihydropyridines type
Therapeutic use of calcium channel blocker
HTN, CAD, Angina, and dysrhythmia
MOA for Calcium channel blockers
Selectively blocks calcium channels in vascular smooth muscle
Routes for Calcium channel blockers
PO
Adverse effects of Calcium channel blockers
CNS effects
GI: liver damage and nausea
CV: hypotension, flushing of the skin (big vessels)
peripheral edema
Heart block and heart failure
Non dihydro - brady, constipation
Dihydro - reflecx tachy , gingival hyperlasia
Medications that are Calcium channel blockers
end in -pine (mostly for BP due to long acting)
Verapamil and diltiazem (short acting for vascular and cardiac muscle shitt)
Contraindications for Calcium channel blockers
allergic
renal or hepatic dysfunction
brady and heartblock
Drug/food interacitons
Booze (vasodillation)
Other hypertensives
Digoxin
grape fruit juice (enhances absoption
adrenergic receptors
Alpha and beta
Alpha 1
mydriasis (pupil dilation)
Vasoconstriction
Ejaculation
Relax the bladder neck and prostate
Alpha 2 (don’t worry for test)
Location in presynaptic junction
Inhibits Norepi release
Beta 1
Heart rate increases, increases inotropic contractility, renin release from kidney
Beta 2
Bronchial dilation
relaxation of uterine muscle
vasodilation
glycogenolysis (breakdown glycogen into glucagen)
Skeletal muscle contraction
Alpha1 Adrenergic Antagonists uses
HTN and enlarged prostate
Alpha 1 antagonists end in
-sin (ahhaha sex joke)
Alpha 1 onset
4-6 weeks for optimal therapeutic effects
Alpha 1therapeutic effect/use
BPH, Raynauds disease
Adverse effects with Alpha 1
what ever is increased with parasympathetic activity
- hypotension
-orthostatic hypotension (first dose phenomenon hypotension is especially bad at the beginning or at an increase of dose
- reflex tachy (use a beta blocker to prevent)
- ED, decreased libido, inability to ejaculate
- CNS depression (crosses blood brain barrier)
Beta Blockers (antagonist) are both selective and non selective and are used in
HTN, Angina, glaucoma, HF, MI, Migraine prophylaxis,
Off label: PTSD and situational anxiety
pregnancy category for beta antagonist
C
selective and non selective prototypes
Selective (B1): metoprolol
Non selective (B1&2) propanolol
Adverse effects beta blocker agonist
prevents the signs of hypoglycemia, impotence (no feelings about it at all) and libido, abrupt withdrawal can cause rebound cardiac excitation (MI)
beta blockers are Contraindicated in
COPD and asthma (non selective like propranolol)
bradycardia and severe heart failure
During an Overdose of Beta blockers (antaganist) give
Atropine (agonist)
Nonselective A1 and Beta blocker antagonists
Carvedilol and labetalol
Direct acting vasodilators are
directly cause vasodilation by relaxing smooth muscle
Direct acting vasodilator medications
Nitroprusside (IV)
Hydralazine (PO, IV, IM)
Minoxidil aka rogaine lol (PO)
Adverse effects of DA vasodilators
sodium and water retention, reflex tachycardia, lupis symptoms, chest pain HF
Hypertensive emergency vs urgency
diastolic of pressure of >120 with organ system damage is an emergency and without organ system damage is urgent
Meds during a hypertensive emergency
Most common symptoms of medications
Chest pain, Dyspnea, headache
Treatment of HTN urgency
conservative, current med is increased or 2nd drug is added
they need to follow up in 1-3 days on the new regimen
Treatment of HTN E
BP lowered by 20-25% over 30-60 minutes. Additional reduction over 12-48 hours period until bp is within normal range
parenteral over oral because fucking duh
Nitroprusside is a
direct vasodillator
Therapeutic effect/uses of nitroprusside
1st line for aggressive, life threatening, HTN
- continuous monitoring to prevent hypotension
- limited to 72 hours because the drug is metabolized to thiocyanate and cyanide
- Switched to antihypertensive as soon as BP stabilizes
Nitroprusside contraindications
HARD FUCKING NO
- inadequate cerebral circulation
kidney impairment increased risk of thiocyanate toxicity
second line drug for hypertention
prozosin - beta adrenergic
