Pharm Need to Knows (Anti-HTN, Anti-Hyperlipidemics & Arrhythmics) Flashcards
How does Angiotensin II raise BP?
Systemic vasoconstriction (effect seen w/n 10 sec. of exogenous injection, acts on resistance arterioles)
What is the MOST important class of Angiotensin antagonists?
ACE inhibitors (end in -pril)
What are the BEST drugs to use for HTN in pts w/ chronic kidney disease, diabetes and heart failure post MI?
ACE inhibitors
What is the MOST common SE of ACE inhibitors? What causes it? What is the other main SE we need to know?
- Dry cough (d/t ↑ bradykinin which is usually metabolized by ACE)
- angioedema
What drugs were we told to remember reduce renin secretion?
β-Blockers!
What drug has the common SE of a cough that is NOT mediated by bradykinin?
Aliskiren (one and only approved Renin inhibitor)
What drug is associated w/ “Lupus Erythematous-like” SE?
Hydralazine (oral vasodilator)
What vasodilator drug dilates arterioles ONLY w/ no effect on veins?
Minoxidil
What is a common SE of Minoxidil? Who should you not give this drug to?
Hypetrichosis (increased hair)- (FYI: Minoxidil is the main ingredient in Rogaine)
CAUTION in heart failure
What drug has a SE profile of hypotension, metabolic acidosis, arrhythmias, death (assoc. w/ the release of cyanide)? What is the antidote?
Nitroprusside (parenteral vasodilator)
Antidote=thiosulfate and hydroxocobalamin
All calcium channel blockers inhibit which calcium channel?
L-type and cause relaxation of arterial smooth muscle (not venous)
What calcium channel blocker has the common SE of constipation?
Verapamil
What centrally acting sympathoplegic agent is SAFE to use during pregnancy?
Methyldopa
Why does Clonidine (centrally acting sympathoplegic agent) initially cause an increase in BP when given IV?
It stimulates vascular a2b
discontinue slowly to avoid hypertensive crisis
What is the MOST important SE of propranolol?
bronchospasm (induces asthma)
What drugs’ cardioselectivity makes them good for treating pts w/ HTN and asthma, diabetes or peripheral vascular disease?
Metoprolol and Atenolol
What is the BEST drug to use in hypertensive emergencies assoc. w/ tachycardia? Why?
Esmolol (IV)
Because it is a β1 selective blocker that is rapidly metabolized. Once crisis is over, stop infusion and normal heart function resumes almost immediately.
What should you always give in combo w/ α1-adrenergic antagonists (Prazosin, Terazosin, Doxazosin)? Why?
Common SE is salt and water retention= give in combo w/ β-blocker or diuretic.
Random: What is a common secondary cause of HTN Fuchs told us to remember?
Licorice
Why should you give any HMG CoA Reductase inhibitor w/ a t(1/2)<4hrs as a single dose at bedtime?
b/c max rate of cholesterol synthesis from 12-2am
ALL STATINS are candidates for drug-drug interactions w/ drugs that alter what 2 enzymatic activities?
CYP3A4 or OATP1B1 (less true for pravastatin)
What 2 statins are NOT administered as β-hydroxy acid form? Why?
lovastatin and simvastatin (because they are pro-drugs).
Why don’t bile acid sequestrants have systemic SE?
b/c the resins are NOT absorbed from the gut
What should you caution your pt about when giving a bile acid sequestrant? How do you prevent this SE?
Impaction: blockage of digestive tract – minimized w/ fluids, fiber in diet or Metamucil as a stool softener.
