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MHD/Pharm Block 4 > Pharm: Antihypertensive drugs > Flashcards

Pharm: Antihypertensive drugs Flashcards

1
Q

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

A

Diuretics
Calcium channel blockers
ACE inhibitors
Angiotensin receptor blockers

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2
Q

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

A

Centrally acting agonists
Alpha adrenergic blockers
Beta blockers
Vasodilators

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3
Q

What are the anatomic sites of blood pressure control?

A

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

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4
Q

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

A

Diuretics

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5
Q

What are the major thiazide diuretics?

A

Hydrochlorothiazide

Chlorthalidone

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6
Q

What are the side effects of the thiazide diuretics?

A

Hyponatremia
Hyperglycemia
Increased LDL/HDL
Hypokalemia

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7
Q

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

A

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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8
Q

What are the drug interactions for thiazides?

A

NSAIDs and beta blockers

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9
Q

What are the contraindications for thiazides?

A

Hypokalemia

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10
Q

What are the side effects of the loop diuretics?

A 
Dehydration/hyponatremia
Hypokalemia
Impaired diabetes control
Increased LDL/HDL
Ototoxicity
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11
Q

What drug interactions are associated with loop diuretics?

A

NSAIDs

Aminoglycosides

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12
Q

What are the potassium sparing diuretics?

A

Aldosterone receptor blocker: Spironolactone, Eplerenone

ENaC blocker: Triamterene, Amiloride

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13
Q

What are the side effects of potassium sparing diuretics?

A

Hyperkalemia

Gynecomastia

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14
Q

What are the drug interactions for potassium sparing diuretics?

A

NSAIDs

ACE inhibitors with ARBs

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15
Q

What are contraindications for potassium sparing diuretic treatment?

A

RAS inhibitors

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16
Q

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

A

Dihydropyridines: selective for smooth muscle

Non-dihydropyridines: smooth muscle and cardiac pacemakers

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17
Q

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

A

Nifedipine: dihydropyridine
Diltiazem: nondihydropyridine
Verapamil: nondihydropyridine

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18
Q

Side effects of nifedipine

A

Acute tachycardia

Peripheral edema

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19
Q

Major side effect of diltiazem

A

Bradycardia

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20
Q

Side effects of verapamil

A

Constipation

Bradycardia

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21
Q

CCBs should not be given to patients with what condition?

A

Contraindicated for patients with conduction disturbances, heart failure

22
Q

What class of drugs may interact with CCBs?

A

Beta blockers

Use together with caution

23
Q

What CCBs shouldnt be used to treat chronic hypertension?

A

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

24
Q

What are the sympatholytic drugs used to treat hypertension?

A

Clonidine and Guanfacine
Methyldopa
*Both are alpha 2 agonists

25
Q

What are the side effects of clonidine?

A

Sedation
Dry mouth
Dermatitis
Rebound hypertension

26
Q

What is the difference between clonidine and guanfacine?

A

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

27
Q

When is methyldopa most often prescribed?

A

Pregnancy with hypertension

28
Q

What is the mechanism of action for reserpine?

A

Blocks VMAT, preventing NE concentration in vesicles

29
Q

What side effects are associated with reserpine?

A

Depression/suicidal ideations

Nasal congestion

30
Q

What is phenoxybenzamine used for?

A

Treating HTN in patients with Pheochromocytoma

31
Q

What is the mechanism of action of Prazosin?

A

Selective alpha 1 antagonist

32
Q

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

A

Terazosin and doxazosin have longer half lives than prazosin

33
Q

What is the mechanism of action of the beta blockers?

A

Decreased

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

34
Q

What are the most commonly used beta blockers?

A

Metoprolol

Atenolol

35
Q

What is the major difference between metoprolol and atenolol?

A

Metoprolol crosses the BBB, atenolol does not

36
Q

What are the side effects of all beta blockers?

A 
Bradycardia
Impotence
Increased TGs
Decreased HDLs
Hyperglycemia
Impaired exercise tolerance
37
Q

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

A

Increased airway resistance

38
Q

What are the side effects of the lipophilic beta blockers?

A

Insomnia

Chronic fatigue

39
Q

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

A

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

40
Q

What drugs are vasodilators used for treating HTN?

A

Hydralazine
Minoxidil
Nitroprusside

41
Q

When are vasodilators used for?

A

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

42
Q

Side effects of hyralazine

A

Tachycardia
Angina aggrevation
Fluid retention
NSAIDs can reduce effectiveness

43
Q

What is a unique side effect of nitroprusside?

A

Cyanide poisoning

44
Q

What are the ACE inhibitor drugs?

A

Captopril
Enalapril
Lisinopril

45
Q

What advantages does lisinopril have over enalopril?

A

Easily absorbed

Not metabolized, excreted unchanged by kidney

46
Q

Side effects of ACE inhibitors

A

Hyperkalemia
Dry cough
Angioedema

47
Q

Contraindications of ACE inhibitors

A

Pregnancy

Bilateral renal stenosis

48
Q

How do ACE inhibitors affect renal function in diabetics?

A

Preserve renal function

49
Q

Mechanism of action for Losartan

A

Angiotensin II receptor blocker

Mediates vasoconstriction and sodium retention

50
Q

What is the major contraindication for losartan treatment?

A

Pregnancy

Causes fetal renal failure

51
Q

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

A

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

52
Q

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

A

ACEi’s with K+ sparing diuretics

ACEi’s with ARBs have no advantage in diabetics

MHD/Pharm Block 4 (25 decks)

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