Pharmacology

Question 1

What is the mechanism of action of beta blockers?

Answer 1

• decrease cardiac output
• decrease PVR by decreasing renin release to lower angiotensin II LEVLES and blocking norepinephrine in CNS
• block RAAS- decrease caridac output and PVR
• some block alpah 1 receptors in vasculature to decrease PVR

Question 2

Which medications are cardioselective beta blockers? which receptors do they block?

Answer 2

• atenolol
• metoprolol
  These medications block B1 receptors

Question 3

which beta blockers are vasodilating nonselective beta blockers? which receptors do they block?

Answer 3

• cavedilol
• Labetalol
  These medications block A1, B1, B2

Question 4

when should you use BP medications for secondary prevention?

Answer 4

recurrent CVD events in patients with clincial CVD and average BP >130/80mmHg

Question 5

when should you use BP medications for primary prevention?

Answer 5

1. patients with an estimated 10 year risk ASCVD > 10% and average BP > 130/80mmHg
2. stage II hypertension

Question 6

what are first line agents for hypertension?

Answer 6

thiazide diuretics, calcium channel blockers (dihydropyridine) and ace inhibitors or ARBs

Question 7

Which medications are RAAS inhibitors?

Answer 7

ACEi, ARBs, DRI

Question 8

In black adults with HTN but without HF or CKD, including those with DM, initial treatment should include?

Answer 8

Thiazide-type diuretic or CCB

Question 9

Women with hypertension who become pregnant should avoid?

Answer 9

ACEi, ARBS, ARNI or direct renin inhibitors

Question 10

What is the mechanism of action of ACE inhibitors?

Answer 10

Decrease production of angiotensin II and decrease the release of aldosterone

Question 11

what is the mechanism of action of ARBs?

Answer 11

Competitive antagonism of angiotensin II receptors

Question 12

what is the mechanism of action of direct renin inhibitors?

Answer 12

block release of renin form juxtoglomerular cells

Question 13

which medication are Ace inhibitors

Answer 13

• captopril
• enalapril
• lisinopril

Question 14

which medications are ARBs?

Answer 14

Losartan
valsartan
candesartan

Question 15

in which patients are ACEi beneficial? what are there contraindications?

Answer 15

• beneficial in patients with MI, HF, CKD, DM, proteinuria
• contraindications: bilateral renal stenosis, pregnancy, history of angioedema (ARBs have same contraindication)

avoid combining with other RAAS inhibitors, potassium sparing diuretics

avoid using with potassium supplements or salt substitutes

Question 16

what are some side effects of ACEi

Answer 16

• hypotension
• renal dysfunction
• hyperkalemia
• cough
• angioedema
• taste changes

avoid in pts with symptomatic hypotension, or salt-depletion

Question 17

• effective as monotherapy, most commonly used as second agent in combo wiht thiazide
• do not use with other RAAS inhibitors or with drugs that increase risk for hyperkalemia
• same contraindications (pregnancy, BRS) and drug interactions as ACE, ARBs
• side effects: hypotension, hyperkalemia, diarrhea, abdominal pain, low risk of angioedema and cough

Answer 17

DRI (aliskerin)

Question 18

which medications are thiazides? thiazide like? potassium sparing?

Answer 18

• thiazides: hydrochlorothiazide, chlorothiazide
• thiazide like: chlorthalidone, indapamide
• potassium sparing: amiloride, triamterene

Question 19

mechanism of action of diuretics?

Answer 19

1. initally decrease preload and cardiac output
2. decrease PVR (MOA is unknown)

Question 20

• increasing dose does not increase BP lowering effect
• Avoid in renal dysfunction
• contraindication: anuric patients, sulfa allergy, gout
• side effects: hypotension, mild metabolic acidosis, hyperlipidemia, hyperuricemia, impotence
• use cautiously with NSAIDS, digoxin, lithium, antidiabetic meds
• monitor BUN/Scr and potassium levels after initiation
• prevent hypokalemia

Answer 20

thiazide

Question 21

• least potent diuretic
• slight (amiloride) to no (triamterene) antihypertensive effecs
• avoid in severe renal dysfuntion
• contraindications: anuric, hyperkalemia

Answer 21

Potassium sparing diuretics

Question 22

What is the mechanism of action of calcium channel blockers?

Answer 22

1. decrease PVR
2. decrease cardiac output by decreasing heart rate and contractility

Can cause reflex tacchycardia and peripheral edema

Question 23

which medications are dihydropyridine calcium channel blockers?

Answer 23

• Nifedipine
• amlodipine

Question 24

which medications are non-dihydropyridine calcium channel blockers

Answer 24

Verapamil
diltiazem

decrease PVR, decrease HR

have negative inotropic and chronotropic effects

Question 25

What are some side effects of calcium channel blockers?

Answer 25

* hypotension, HA, flushing, constipation, peripheral edema, angina, worsening HF sysmptoms (non-DHP), gingival hyperplasion (DHP)

Question 26

* Vasodilating lower BP more than other in this class * add to first line therapy for these indications * selection shoud be based on liver and/or renal function, co-morbid conditions, and need for cardioselectivity * side effects: **hypotension, bradycardia, AV block fatigue, masks signs of hypoglycemia, hyperlipidemia, impotence, SOB, feeling cold** * **must taper over 1-2 weeks rather than D/C abruptly**

Answer 26

Beta blocker | contraindication: Asthma/COPD, high degree AV block, sick sinus syndrome

Question 27

* receptors located in vascular smooth muscle, urethra, prostate, and bladder sphincter * **MOA: selectively block post-synaptic receptors to cause peripheral vasodilation of ateries and veins** * potent vasodilators so can cause tacchycardia and RAAS * side effects: first dose phenomenon, orthostatic hypotension, syncope, peripheral edema, nasal congestion * start low, taper slowing, administer 1st dose at bedtime

Answer 27

alpha blockers

Question 28

which medications are alpha blockers?

Answer 28

* doxazosin * prazosin * terazosin

Question 29

* mixed group of drugs that work in the CNS to inhibit SNS (norepinephrine activity)

Answer 29

Central acting agents | Methyldopa, clonidine

Question 30

MOA: converted to alpha-methyl norepinephrine, a false neurotransmitter that stimulates central alpha-2 receptors to reduce sympathetic outflow from CNS (little effect on CO)

Answer 30

methyldopa

Question 31

MOA: reduce sympathetic tone within brainstem by stimulating alpha-2 receptors to inhibit outflow of impulses (slight effect on CO)

Answer 31

Clonidine

Question 32

* use as third-fourth line agents due to side effects- **combine with a diuretic to minimize edema** * most useful in patients with hard to control BP and during hypertensive urgencies * side effects- bradycardia, hypotension, dizziness, orthostatic hypotension, edema, sedation, dry mouth, constipation, impotence * **one med has withdrawal or rebound hypertension due to short half life (taper)**

Answer 32

central agents (clonidine, methyldopa) | taper clonidine. methyldopa can cause drug induce hepatitis

Question 33

Group of drugs that directly vasodilate arteries, rather than inhibiting a vasoconstricting mediator or blocking a receptor channel hydrazaline: relaxes vascular smooth muscle possibly by increasing the concentration of nitric oxide minoxidil: opens potassium channels in vascular smooth muscle

Answer 33

direct vasodilator | use in combo with BB to minimize reflex tach. and loop to minimize edema

Question 34

* indication: resistant HTN due to primary aldosteronism * bp lowering benefit also seen in patients with normal aldosterone * other indications: obesity related HTN, high sodium diet * Spironolactone (nonselective) and eplernone (selective) * **MOA: decrease cardiac output and decrease preload** * contraindications: CKD * side effects: hyperkalemia, dizziness, hypotension, (spirogynecomastia, breast tenderness, hisutism, mestrual changes)

Answer 34

Aldosterone antogonist

Question 35

which medications are aldosterone antagonists?

Answer 35

spironolactone, epelernone

Question 36

which medications are direct vasodilators?

Answer 36

hydralazine minoxidil