Pharmacology Antihypertensives Review Flashcards
pt ha CHF, low CO, edematous, ascities, poor cardiac function.
which should not be used? Amiloride Furosemide Hydrochlorothiazide Mannitol Spironolactone
amiloride: potassium sparing diuretic - indicated in HF
furosemide: loop diuretic - indicated
HCTZ/spironolactone - both indicated in HF
- mannitol: answer, diuretic that is “osmotic” increases the osmolality (pulls water out of tissues and increases blood volume) [note: could be given with furosemide as well]
32 y/o male with stage 2 HTN treated with ACEI and thiazide. what is an untoward outcome of thiazide that has to be monitored closely.
could cause fall of BP sufficient to cause syncope - both of these agents are antihypertensives, this must always be considered as a SE
ACEI has similar effect to ALDO receptor blockers, thus would increase K+, hyperkalemia
how does losartan differ from lisinopril?
ARB vs ACEI?
Lisinopril effectively inhibits synthesis of angiotensin II, losartan does not
when do you not prescribe an ACEI or ARB?
if there is bilateral renal artery stenosis –> hypoperfusion of the kidney
patient with BPH and hypetension? Causes reflex tachycardia, doesn’t affect bronchi, causes pupils of eyes to constrict…
Captopril Hydrochlorothiazide Labetalol Prazosin Propranolol
alpha antagonist - prazosin
contraindications of of ACEI?
pregnancy
potassium sparing diuretic?
Amiloride Bumetanide Hydrochlorothiazide Metolazone Torsemide
epelerenone, spironolactone (aldo antagonist)- aldo has wider effects other than kidney
Amilordie, triamterene (ENaC inhibitor) - this primarily works on kidney
triamterene + lisinopril - what happens?
Abrupt rise in blood pressure Blood pressure control with an increased risk of hyperkalemia Hypernatremia Increased cardiac output Worsening of the ACE inhibitor cough
K+ sparing (ENaC inhibitor) + ACEI = blood pressure control w/ increased risk of hyperkalemia
Both are due to effects of aldosterone/ENaC channels at the CD
non sulfa diuretic?
ethacrynic acid
diuretic not used to tx diabetes? may unmask hyperglycemia?
Acetazolamide Amiloride Chlorothiazide Spironolactone Triamterene
Thiazide diuretics
make it harder for pt. to control glucose levels if have DM = chlorothiazide
diuretic used to tx glaucoma or acute mountain sickness
acetazolamide
hypotension due to hypovelemia, which diuretic would cause this? excessive diuresis….
Loop diuretics - furosemide
what do you tx with adrenal cortical tumor?
aldosterone receptor antagonist
nonDHPS CCBs
cause significant dose-dependent slowing of AV nodal velocity (as opposed to DHP CCBs) - promoting smooth mm. relaxation in vasculature and affecting the heart rate
DHP’s only act in vasculture, and will cause reflex tachycardia
mannitol
“osmotic diuretics”
Increases plasma osmolality initially until it is excreted by glomerular filtration
Increased plasma osmolality withdraws water from the extracellular space and parenchymal cells into the blood
If renal function is normal, renal blood flow and GFR rise and mannitol is eventually excreted
If cardiac function is normal and adequate, circulating the extra volume is not a problem (up to a limit)
***With low cardiac output or compromised renal perfusion, increased blood volume and pressure may cause acute heart failure due to the additional volume and difficulty ejecting that volume against a higher afterload
