Pharma CVS /Diuretics Flashcards
HTN drugs
Diuretics 2
1 HCTZ
- DCT : inhibit Na/Cl transporter
- wof: sulfa allergy
2 Furosemide. Bumetanide. Torsemide. Ethacrynic acid.
- PTAL : na/k/2cl inhibitor
- SE hyperGLUC
- WOF sulfa allergy except Ethacrynic acid.
- WOF ototoxicity, don’t mix with aminoglycosides.
Drug classes used in hypertension mgt 5
1 diuretics
2 vasodilators: CCB, parenteral vasodilators, older oral drugs
3 angiotensin antagonists: ACEi, receptor blockers
4 renin inhibitor
5 sympathoplegic blockers of: CNS sympa outflow, Ganglia, Nerve terminals, alpha or beta receptors
HTN drugs
Sympathathetic outflow blockers
1 CNS outflow blockers - inhibit A2 aka alpha2
Clonidine and Methyldopa
2 Ganglion blockers
3 Nerve terminal blockers - Reserpine inhibits NE storage
4 Adrenergic blockers: alpha 1 or nonselective alpha & beta
HTN drugs
Vasodilators
1 older vasodilators:
- Hydralazine. Alters Ca metab. Relaxes ARTERIOLES.
- Minoxidil. SE hypertrichosis so used for alopecia.
2 calcium blockers
- non dihydropyridine: block L type Ca channel. Heart >vascular
VERAPAMIL, AMLODIPINE
- dihydropyridine: block L type Ca channel. Vascular>heart
AMLODIPINE, NIFEDIPINE
“DIhydropiridine ay - DIPINEs” :)
3 Parenteral vasodilators
- Nitroprusside dilates BOTH venues and arterioles
- Fenoldopam D1 agonist parang low dose dopamine
Dilates afferent and efferent arterioles kidney
Drugs causing lupus
It’s HIPP to have lupus!
Hydralazine
Isoniazid
Procainamide
Penicillamine
Blocked by ARBs
Angiotensin 1 receptor
Renin antagonist
Aliskiren
Agonist of renin
1 JG cells of afferent arteriole with signal from macula densa of
DCT
2 B1 promotes renin production of JG cells
Action of angiotensin on kidney
Constricts efferent > afferent arterioles.
Good in renal artery stenosis coz of overall increase in GFR.
Site of action prostaglandin on kidney
Afferent arterioles, promotes vasodilation increasing GFR and kidney perfusion.
SE Nitroprusside
Cyanide toxicity. It’s metabolite, THIOCYANINE blocks cytochrome c aka complex IV of ETC in inner mitochondria.
Treated with AMYL NITRATE. SE methemoglobinemia “chocolate blood” treated with METHYLENE BLUE.
Angina drugs
1 Vasodilators
A. Nitrates : Release NO, Inc cGMP so relax vascular smooth ms
- Amyl nitrate Ultra short acting.
- Nitroglycerin ex ISMN or ISDN
B. Calcium channel blockersn
- nifeDIPine: vascular > heart
- non dihydropyridine: Heart >vascular: verapamil, amlodipine
2 Beta blockers
Drugs that cause Gingival Hyperplasia
Nifedipine
Cycloposporine
Phenytoin - MC
Verapamil
Headache from nitrate intake
Due to meningeal artery vasodilation
Phosphodiesterase inhibitors
Sildenafil, Verdenafil, Tadalafil
Phosphodiesterase normally breaks down cGMP promoter of smooth muscle relaxation ie erectile tissue, blood vessel. Phosphodiesterase inhibitor prolongs relaxation of erectile tissue/erection and relaxation of vessels.
Nitrate + phosphodiesterase inhibitor = profound hypotension :(
