Pharm: Antihypertensive drugs Flashcards by Ryan Hutten

What are the first line drugs of choice for treating hypertension?

Diuretics
Calcium channel blockers
ACE inhibitors
Angiotensin receptor blockers

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Which anti-hypertensive drugs are not used as first line drugs of choice?

Centrally acting agonists
Alpha adrenergic blockers
Beta blockers
Vasodilators

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What are the anatomic sites of blood pressure control?

1) Arterioles
2) Veinous capacitance
3) Heart
4) Kidneys: RAA system

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What class of anti-hypertensive is the best choice for uncomplicated hypertension therapy?

Diuretics

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What are the major thiazide diuretics?

Hydrochlorothiazide

Chlorthalidone

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What are the side effects of the thiazide diuretics?

Hyponatremia
Hyperglycemia
Increased LDL/HDL
Hypokalemia

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What is the mechanism for diuretics causing hypokalemia and metabolic alkalosis?

The Na+ concentration in the lumen of the collecting duct is increased.
A net negative lumenal charge drives K+ and H+ out of cells into lumen to be excreted.

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What are the drug interactions for thiazides?

NSAIDs and beta blockers

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What are the contraindications for thiazides?

Hypokalemia

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What are the side effects of the loop diuretics?

Dehydration/hyponatremia
Hypokalemia
Impaired diabetes control
Increased LDL/HDL
Ototoxicity

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What drug interactions are associated with loop diuretics?

NSAIDs

Aminoglycosides

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What are the potassium sparing diuretics?

Aldosterone receptor blocker: Spironolactone, Eplerenone

ENaC blocker: Triamterene, Amiloride

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What are the side effects of potassium sparing diuretics?

Hyperkalemia

Gynecomastia

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What are the drug interactions for potassium sparing diuretics?

NSAIDs

ACE inhibitors with ARBs

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What are contraindications for potassium sparing diuretic treatment?

RAS inhibitors

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What are the two types of calcium channel blockers and how do they differ?

Dihydropyridines: selective for smooth muscle

Non-dihydropyridines: smooth muscle and cardiac pacemakers

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What are the major calcium channel blockers and which class do they fall in?

Nifedipine: dihydropyridine
Diltiazem: nondihydropyridine
Verapamil: nondihydropyridine

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Side effects of nifedipine

Acute tachycardia

Peripheral edema

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Major side effect of diltiazem

Bradycardia

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Side effects of verapamil

Constipation

Bradycardia

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CCBs should not be given to patients with what condition?

Contraindicated for patients with conduction disturbances, heart failure

What class of drugs may interact with CCBs?

Beta blockers

Use together with caution

What CCBs shouldnt be used to treat chronic hypertension?

Short acting CCBs put chronic HTN patients at high risk for MI

What are the sympatholytic drugs used to treat hypertension?

Clonidine and Guanfacine
Methyldopa
*Both are alpha 2 agonists

What are the side effects of clonidine?

Sedation Dry mouth Dermatitis Rebound hypertension

What is the difference between clonidine and guanfacine?

Guanfacine has a longer half life, less chance for rebound hypertension

When is methyldopa most often prescribed?

Pregnancy with hypertension

What is the mechanism of action for reserpine?

Blocks VMAT, preventing NE concentration in vesicles

What side effects are associated with reserpine?

Depression/suicidal ideations | Nasal congestion

What is phenoxybenzamine used for?

Treating HTN in patients with Pheochromocytoma

What is the mechanism of action of Prazosin?

Selective alpha 1 antagonist

What is the difference between prazosin, terazosin, and doxazosin?

Terazosin and doxazosin have longer half lives than prazosin

What is the mechanism of action of the beta blockers?

Decreased 1) cardiac contractility 2) Cardiac Output 3) renin secretion

What are the most commonly used beta blockers?

Metoprolol | Atenolol

What is the major difference between metoprolol and atenolol?

Metoprolol crosses the BBB, atenolol does not

What are the side effects of all beta blockers?

``` Bradycardia Impotence Increased TGs Decreased HDLs Hyperglycemia Impaired exercise tolerance ```

What are the side effects of the non-selective beta blockers?

Increased airway resistance

What are the side effects of the lipophilic beta blockers?

Insomnia | Chronic fatigue

What additional risk must be considered for diabetic patients taking beta blockers

Masked hypoglycemia Epinephrine is released when glucose is low, but its effect is blocked so the typical hypoglycemic symptoms may not present

What drugs are vasodilators used for treating HTN?

Hydralazine Minoxidil Nitroprusside

When are vasodilators used for?

Used in combo for patients not responding to first line treatment for HTN

Side effects of hyralazine

Tachycardia Angina aggrevation Fluid retention NSAIDs can reduce effectiveness

What is a unique side effect of nitroprusside?

Cyanide poisoning

What are the ACE inhibitor drugs?

Captopril Enalapril Lisinopril

What advantages does lisinopril have over enalopril?

Easily absorbed | Not metabolized, excreted unchanged by kidney

Side effects of ACE inhibitors

Hyperkalemia Dry cough Angioedema

Contraindications of ACE inhibitors

Pregnancy | Bilateral renal stenosis

How do ACE inhibitors affect renal function in diabetics?

Preserve renal function

Mechanism of action for Losartan

Angiotensin II receptor blocker | Mediates vasoconstriction and sodium retention

What is the major contraindication for losartan treatment?

Pregnancy | Causes fetal renal failure

What are the "good combinations" of drugs used to treat hypertension?

Thiazide/Loop diuretic + K+ sparing diuretic Thiazide with beta blockers CCBs with ACEi's

What are the "bad combinations" of drugs used to treat hypertension?

ACEi's with K+ sparing diuretics | ACEi's with ARBs have no advantage in diabetics