Pharm Cardio HTN Flashcards by Laney Gammons

what are the three components needed to lower blood pressure

reduce blood volume
reduce cardiac output
reduce systemic vascular resistance

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what class of medications work to lower blood volume

diuretics

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what class of medications reduce cardiac output

beta blockers

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what class of medications reduce systemic vascular resistance

alpha blockers

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what are the three main types of diuretics

loop
thiazide
potassium-sparing

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what is an example of an osmotic diuretic

mannitol

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when is mannitol used

reduction of intracranial pressure in the ICU

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what is the mechanism of action of thiazide

works in the kidneys
mildly blocks reabsorption of sodium in the kidneys

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how do loop diuretics work

works in the kidneys to significantly block the reabsorption of sodium

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how do potassium-sparing medications work

manipulates sodium and potassium exchange
blocks aldosterone

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how much do loop diuretics lower BP by

15.8/8.2mmHg

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how much do thiazide diuretics lower BP by

15.3/9.8 mmHg

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what are the two potassium-sparing medications

tiamterene
spironolactone

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what is the first line hypertension medication of choice for black patients

calcium channel blocker
thiazide

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what is the first line hypertension medication for nonblack patients under 60 years

ARB or ACE inhibitor

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what is the hypertension medication of choice for a nonblack patient over 60 years

CCB
thiazide
diuretic
ACEI
ARB

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what is the hypertension medication of choice for diabetes

ARB or ACEI

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what is the hypertension medication of choice for patients with chronic kidney disease

ARB or ACEI

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what is the weakest diuretic

carbonic anhydrase inhibitors

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what is the risk with using a loop diuretic

hypokalemia because it is a potent diuretic

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indications for loop diuretics

edema (primarily)
HTN
pulmonary edema from CHF

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indication for use of thiazide diuretics

first line treatment for HTN in black populations

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indication for use of triamterene

peripheral edema, HTN

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indication for use of spironolactone

severe heart failure
cirrhosis/edema
CHF

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what is the difference between spironolactone and triamterene

spironolactone is an aldosterone inhibitor

what is the BBW for triamterene

risk of hyperkalemia so need to monitor electrolyte levels

what is a helpful side effect of hydrochlorothiazide

hypercalcemia - especially in patients with osteoporosis

how do angiotensin converting enzyme inhibitors work

block the conversion of angiotensin I to angiotensin II

what effects do angiotensin II have on the body

increases blood pressure through increasing: sympathetic activity increases reabsorption of Na+, Cl-, and water retention increases aldosterone secretion causes arteriolar vasoconstriction

what are the two ACEI medications

lisinopril captopril

what is the BBW for lisinopril

fetal toxicity

what are the indications for lisinopril

patients with diabetes primary hypertension in non-black patients under 60 CKD who have HTN

what medication to you prescribe to patients with chronic kidney disease

lisinopril

what are the side effects of lisinopril

dry cough and angioedema

what is the safety warning for ACEI

do not take with an ARB due to renal dysfunction

what are the indications for use for captopril

ACEI HTN, CHF, MI, and diabetic patients for nephroprotection

what are the side effects for captopril

c - cough a - angioedema p - potassium excess t - taste changes o - orthostatic hypotension p - pregnancy contraindication/pressure drop r - renal failure/rash i - indomethacin inhibition l - leukopenia

how do angiotensin receptor blockers work

blocks the conversion of angiotensin II to vascular receptors

what is the ARB medication

losartan

what are the indications for use for losartan

ARB potential alternative to those that cannot tolerate ACE, HTN, stroke prevention, diabetic neuropathy

why would an ARB be preferred over an ACEI

less cough

mechanism of action of alpha blockers

decrease in systemic vascular resistance by blocking alpha receptors which then cause systemic vasodilation

where do the selective alpha blockers work

alpha 1 receptors in vascular smooth muscle, bladder neck, and prostate gland

what are the four alpha blockers

prazosin terasozin doxasozin tamsulosin

what are the indications for use with prazosin

off label nightmares and PTSD, mostly benign prostate hypertrophy, and HTN

what are indications for use with terazosin

HTN and BPH simultaneously

what are the indications for use with doxazosin

mostly HTN, can also do BPH

what are the indications for tamsulosin

BPH and nephrolithiasis DO NOT USE FOR HTN

what condition should tamsulosin never be used for

hypertension

what is the brand name of tamsulosin

flomax

what is the important safety thing to remember when prescribing alpha blockers

do not use with a PDE5 inhibitor because it will cause profound hypotension

how do beta blockers work

beta blockers work on decreasing sympathetic stimulation, therefore decreasing cardiac output and systemic resistance

what does B1 do on the heart

when stimulated, decreases cardiac output

what are the 2 selective beta blockers

atenolol and metoprolol

what are the two non-selective beta blockers

labetalol propranolol

what are the side effects of beta blockers

bradycardia, fatigue, dizziness, and heart block

what are the indications to use labetalol

HTN emergency and crisis

what medications are contraindicated for use in 2/3rd AV heart blocks

beta blockers because they slow the heart down a lot

what beta blocker can you use in pregnancy

labetalol

what condition should you avoid using a non-selective BB in?

asthma/COPD need to choose a selective BB

what are the two types of calcium channel blockers

dihydropyridines and non-dihydropyridines

what are the non-dihydropyridines

diltiazem and verapamil

what are the dihydropyridines

amlodipine and nicardipine

how do dihydropyridines work | these are calcium channel blockers

inhibit calcium influx on vascular smooth muscle, specifically the myocardium

how do non-dihydropyridines works

inhibit calcium influx on vascular smooth muscle AND heart to decrease contractility, rate, and condution

what calcium channel blocker is safe to use during pregnancy

diltiazem

what calcium channel blocker can you use in an IV form

diltiazem

what are the indications for use with amlopidine

HTN, chronic stable angina, and vasospastic angina

what are the indications for use for nicardipine

HTN and chronic stable angina

what are the indications for use with diltiazem

PSVT, cocaine abuse, and atrial fibrillation/flutter

what are the indications for use with verapamil

PSVT, cocaine abuse, and atrial fibrillation/flutter

what are the two centrally acting adrenergic agents

clonidine methyldopa

what is the mechanism of action for the centrally acting adrenergic agents

reduce the release of catecholamines which are epi and norepi

what are the indications for use for clonidine

off-label use in psychiatric disorders tourette's HTN

what are the indications for use with methyldopa

moderate to severe HTN

what medication is a centrally acting adrenergic agent that is safe to use during pregnancy

methyldopa

what are the side effects of clonidine

somnolence, headache, hypotension, and nightmares

what are the side effects of methyldopa

sedation and headache

what are the side effects of dihydropyridines

peripheral edema dizziness nausea | dihydropyridines are amlodipine and nicardamine

what are the side effects of non-dihydropyridines

hypotension, bradycardia, and hepatotoxicity

what are the BBW of beta blockers

do not discontinue abruptly

how much do calcium channel blockers lower BP by

15.3/10.5 mmHg

what do inotropes effect

contractility decreasing or increasing Ca2+ ions

what do chronotropic medications affect

heart rate they modulate the parasympathetic or sympathetic NS

what do dromotropic medications effect

speed of conduction (mostly in the AV node)

where in the kidney do thiazide diuretics work

distal convoluted tubules

how long do IV diuretics take to work

5-20 minutes

what is the most potent diuretic

loop diuretics because they also work on the loop of Henle, PCT, and DCT

what is the most frequent adverse effect of the loop diuretic

hypokalemia

how can hypokalemia from a loop diuretic be managed

add a potassium-sparing medication like triamterene or spironolactone

what is the first line treatment for a caucasion male with hypertension

ACEI - lisinopril, captopril

patient comes into the clinic, she has her hypertension managed but she is complaining of a cough. what is the likely medication?

ACEI - lisinopril or captopril

when should prazosin most likely be prescribed

at night - it is an alpha blocker - helps with PTSD and nightmares