pharm 10-14 AntiHTN Drugs Flashcards
Hydralazine
- A: MOA*
- B: Indication (3)*
- C: Adverse Effects (3)*
- D: Contraindication*
- D2: _____ can DEC* Hydralazine effectiveness
A: Arteriole Vasodilator
B:
- Resistant HTN
- Pregnancy HTN
- Acute/Chronic [Mitral Regurgitation]
C:
- Tachycardia
- Angina exacerbation
- Fluid retention
D: CAD
D2: NSAIDs can DEC effectiveness
Chlorthalidone
- A: MOA*
- B: Indication*
- C:* Why are Thiazides often used in combination with antiHTN drugs that vasoDilate
A: Thiazide diuretic
B: [1st Line - Uncomplicated HTN]
C: Thiazides are often used in combination with antiHTN drugs that vasoDilate in order to counteract Adverse side effects of BP change in presence of vasodilation and volume contraction
Furosemide Indication
HTN in Severe Renal Insufficiency
Nifedipine
- A: MOA (2)*
- B: Indication (3)*
- C: Side Effects (2)*
A:
- [mild Ca+ channel blocker]
- [Selective Vasodilator]
B:
*[1st Line - HTN]
*DM
*Hyperlipidemia
C:
(x) acute reflex tachycardia
(x) Peripheral Edema (from Arterial dilation being > than venous)
Verapamil
- A: MOA*
- B: Indication*
- C: Side Effects (2)*
A: [Ca+ channel blocker]
B: [1st Line - HTN]
C:
- Constipation (from anti-cholinergic effects)
- Bradycardia
- has greatest effect on heart out of the Non-dihydropyridines*
Clonidine
- A: MOA*
- B: Indication*
- C: Adverse Effects (4)*
A: [Medullary Alpha 2 AGONIST]
B: [2nd Line - HTN]
C:
(x) Sedation
(x) Dry Mouth
(x) Contact Dermatitis with transdermal patch
(x) MUSTH DISCONTINUE SLOWLY TO PREVENT REBOUND HTN
Guanfacine
- A: MOA*
- B: Indication*
A: [Alpha 2 AGONIST]
B: [2nd Line - HTN]
Methyldopa
- A: MOA*
- B: Indication*
- C: How does it affect Sympathetic Tone? What 3 things does Methyldopa prevent?*
- D: Side Effect*
A: [Alpha 2 AGONIST]
B: Pregnancy HTN
C:
**DEC Sympathetic Tone but also competes for [DOPA Decarboxylase] β> prevents [L-Dopas Therapeutic affects], production of dopamine and [NorEpi/Epi in peripheral nerves]
D: SEDATION
Phenoxybenzamine
- A: MOA*
- B: Indication (2)*
- C: How does this class of drugs work?*
A: [General Alpha BLOCKER]
B:
- Rx for pheochromocytoma before surgery
- HTN 2ΒΊ to pheochromocytoma
C: Blocks post-synaptic alpha receptors β> prevents VENOUS constriction
Prazosin
- A: MOA*
- B: Indication*
- C: What are the other 2 Drugs similar to this tht are QD dosing?*
- D: Side Effects (3)*
A: [Alpha 1 BLOCKER]
B: [2nd line - Chronic HTN]
C: [Terazosin / Doxazosin] which are dosed QD and
D:
- hypOtension (postural and [occurs especially in 1st dose])
- Beneficial DEC in [LDL/HDL ratio]
- Fluid Retention
Terazosin
- A: MOA*
- B: Indication*
- C: Drugs in this class have less ______ effects than ______ or __________*
A: [Alpha 1 BLOCKER]
B: [2nd line - Chronic HTN]
C: [Alpha 1 BLOCKERS] have [less tachycardia effects] than vasodilators or [general alpha blockers]
Doxazosin
- A: MOA*
- B: Indication*
A: [Alpha 1 BLOCKER]
B: [2nd line - Chronic HTN]
Nadolol
- A: MOA*
- B: Indication (2)*
A: [Beta BLOCKER]
B:
- [Long term angina]
- HTN
Pindolol
- A: MOA*
- B: Indication (2)*
A: [Beta-Blocker] with partial agonist activity at both B1 and B2 adrenergic Receptor
B:
- Chronic HTN
- [pts with symptomatic bradycardia or postural hypOtension]
Metoprolol
- A: MOA*
- B: Indication (2)*
- C: Side Effects*
A: [Lipophilic B1 Blocker] (so may have central sympatholytic effect)
B:
- HTN
- Long Term Angina
C: CNS Side Effects - Insomnia
Atenolol
- A: MOA*
- B: Indication*
A: [Hydrophilic B1 Blocker] = NO CNS SIDE EFFECTS :-)
B: Chronic HTN
Labetolol
- A: MOA*
- B: Indication (2)*
A: [Mixed alpha and beta BLOCKER thtβs Lipophilic]
B:
- Chronic HTN
- [1st choice- Pregnancy HTN]
Carvedilol
- A: MOA (2)*
- B: Indication (2)*
A:
- [Mixed alpha and beta Blocker]
- NO generator (vasodilatory)
B:
*Chronic HTN
*[Compensated CHF]
Minoxidil
- A: MOA*
- B: Indication*
- C: Adverse Effects (3)*
A: VasoDilator
B: Resistant HTN
C:
- Tachycardia
- Angina exacerbation
- Fluid retention
Nitroprusside
- A: MOA*
- B: Indication*
- C: Adverse Effect*
A: VasoDilator
B: Acute HTN Crisis
C: can cause cyanide poisoning
Captopril
- A: MOA*
- B: Indication*
- C: Con for this specific Drug*
A: [ACEk2 inhibitor]
B: [1st line- Chronic HTN]
C: Requires BID dosing
Enalapril
- A: MOA*
- B: Indication (2)*
- C: Is converted into ______ in liver and has ____ (shorter./ longer) half-life β*
A: [ACEk2 inhibitor]
B:
*[1st line- Chronic HTN]
*Heart Failure
C: Is converted into β> [Active metabolite enalaprilat] in liver and has longer half-life
Lisinopril
- A: MOA*
- B: Indication*
- C: Pros for this particular drug (2)*
- D: Adverse Effects (3)*
A: [ACEk2 inhibitor]
B:
*[1st line- Chronic HTN]
C:
- IS NOT A PRODRUG - and has more predictable onset and [duration of action] than Prodrugs.
- Longer Half-Life
D:
(x) Hyperkalemia (especially when given w/ [K+ Sparing Diuretics])
(x) Dry cough
(x) Angioedema
D:
Losartan
- A: MOA*
- B: Indication*
- C: Side Effects*
- D: Relation to [ACEk2 inhibitors] (2)*
A: [ARB - AT1](AT1 Receptor Blocker)
B: [1st line- Chronic HTN]
C: (x) Hyperkalemia
D: SAME Drug interactions and Contraindications as [ACEk2 inhibitors] but no cough or angioedema
[T or F] One of the causes of aFib is Sustained HTN
TRUE
A: Why do you use a Concomitant beta blocker, [ACEk2 inhibitor], or ARB
B: How does [Beta Blockers] interact with Thiazide Diuretics
C: Which is a better diurectic between [Loop Diuretics] and [Thiazide Diuretics] in normal renal pts? Explain why.
A: diminishes K+ loss by blunting the diuretic-induced rise in renin and aldosterone levels
B: INC Hyperlipidemia and Hyperglycemia
C: THIAZIDE DIURETICS! (Loop Diuretics cause rebound Na+ retention so instead, theyβre reserved for refractory / [renal insufficiency] /CHF pts)
[T or F] Loop Diuretics are often used alone for HTN
FALSE!
LOOP DIURETICS ARE NOT USED ALONE!
Name the 3 HTN Drugs that are contraindicated with [K+ Sparing Diuretics - SEAT]
β ABA HATED her SEATβ
- ACEk2 inhibitors
- ARBs
- Beta Blockers
Diltiazem is a _______ [L-type __ channel blocker] that reduces _______ AND _______
B: Side Effect
Diltiazem is a NON-Dihydropyridine [L-type Ca+ channel blocker] that reduces [Cardiac Output] AND [Peripheral Resistance]
B: Bradycardia
A: Ca+ Channel blocker Relative Contraindication (2)
B: Ca+ Channel Blocker ABSOLUTE CONTRAINDICATION
C: Whatβs [Ca+ Channel Blocker] relation to MI
A: Pts with liver failure or taking [Beta Blockers]
B: Pts with SA/AV Node conduction disturbances
C: Patients taking short-acting [Ca+ channel blockers] were 1.6 times more likely to have MI !
A: ______ is given in combination with diuretics and works by disrupting NorEpi vesicular storage.
B: Side Effects (4)
A: Reserpine is given in combination with diuretics and works by disrupting NorEpi vesicular storage.
B: Depression / Nasal Congetion / [Potentiates MAOIs] /[HTN crisis]
Propranolol
A: MOA
B: Indications (2)
C: Side Effects
A: [General Beta Blocker]
B:
- adjunct to prevent reflex tachycardia from tx with direct vasodilators,
- compensatory sodium retention with diuretics
C: CNS - dependent side effects
There is a class of BETA BLOCKERS that have the ability to VasoDilate. How do they do this? (2)
- increasing nitric oxide release
- blocking τ°[alpha adrenergic receptors]
Beta Blocker group
Adverse Effects
A: All -6
B: [General beta blocker]
C: Lipophilic beta blocker]-3
D: Contraindications (4)
A: βBeta Blockers is Adverse for BETH In Hospitals β
- Bradycardia
- Impotence sexually
- Triglyceride INC
- Heart Block
- Hyperglycemia (can mask [insulin-induced hypOglycemia] and (Hyperglycemia occurs less with cardioselective Bblockers),
- Exercise tolerance DEC (less so with 3rd generation drugs)
B: INC Airway reisstance
C: Insomnia / [Chronic Fatigue] / Depression
D: [Cardiogenic Shock] / [Sinus brady less than 55] / Asthma / [Severe Acute CHF](even though B-blockers are protective in compensated HF)
A: Why should drugs that interfere with angiotensin II production NOT be given to [2nd/3rd trimester pregnant women]?
B: What other condition is [ACEk2 inhibitors] or ARBs contraindicated with?
C:
Other uses of [ACEk2 inhibitors] includeβ¦
- prolong survival in pts with ______ or [____ dysfunction after MI]
- preserves ______ function in patients with diabetes
A: Ang II is important in fetal renal development
B: Pt with [Bilateral renal stenosis] because their renal perfusion pressure depends mostly on [Angiotensin 2]
C: [ACEk2 inhibitors] do
- prolong survival in pts with heart failure or [LV dysfunction after MI]
- preserves renal function in patients with diabetes
A: Losartan (ARBs) are less efficacious in patients of ______ descent when used as ______
A2: Which drugs are recommended as 1st line for this descent in Uncomplicated HTN? (2)
B: Why is it Good to administer [Ca+ Channel Blockers + ACEk2 inhibitors]
A: Losartan (ARBs) are less efficacious in patients of African descent when used as monotherapy
A2: Instead, Use [Ca+ Channel Blockers] or Diuretics in African Descent pts
B: CCBs can reduce fluid retention
A: Which AntiHTN drugs are best safe for DM pts
B: Which AntiHTN drug is actually used for HTN prophylaxis in DM pts
A: have few adverse effects on carbohydrate metabolism β
- [ACEk2 inhibitors]
- alpha-blockers,
- CCBs
B: [ACEk2 inhibitors]