Quiz 1 Antihypertensives Flashcards
Generic Name: Atenolol
BETA BLOCKER
Brand name: Tenormin
Indication(s): Angina pectoris Chronic, HTN, AMI
General Mechanism of Action: Atenolol is a cardio selective beta-adrenergic that decreases AV nodal conduction in supra-ventricular tachycardias and blockade of catecholamine-induced dysrhythmias
Pregnancy Category: D
Human data suggest risk in 2nd and 3rd trimesters
Contraindications: Hypersensitivity to atenolol, sinus bradycardia, 2nd- or 3rd-degree AV block, overt heart failure or cardiogenic shock
Black Box Warnings (if applicable): Avoid abrupt withdrawal
Key patient counseling points: Take on an empty stomach. Avoid abrupt discontinuation; exacerbations of angina may occur. Report signs/symptoms of bradycardia, hypotension, heart failure, or exacerbation of angina with initial dosing and dose changes. May cause dizziness or drowsiness. Diabetic patients to carefully follow blood sugar levels as β-blockers may mask symptoms of hypoglycemia. Drug may cause sexual side effects, fatigue, and depression.
Generic Name: Metoprolol
BETA BLOCKER
Brand name: Lopressor, Troprol XL
Indication(s): Angia, Heart failure with reduced ejection fraction, HTN, AMI
General Mechanism of Action: Metoprolol is a cardio selective beta-adrenergic blocker used in arrhythmias, HTN, angina pectoris, and heart failure. It is also effective in decreasing post-MI mortality.
Pregnancy Category: Human data suggest risk in 2nd and 3rd trimesters
Contraindications: Hypersensitivity; severe bradycardia, 2nd- or 3rd-degree AV block, sick sinus syndrome; decompensated heart failure; cardiogenic shock
Black Box Warnings (if applicable): Ischemic heart disease with abrupt withdrawal
Key patient counseling points: Take on an empty stomach and avoid alcohol. Avoid abrupt discontinuation, exacerbations of angina may occur. Instruct patients to report signs/symptoms of hypotension, heart failure, or exacerbation of angina with initial dosing and dose changes. Advise diabetic patients to carefully follow blood sugar levels as beta-blockers may mask symptoms of hypoglycemia.
Generic Name: Nebivolol
BETA BLOCKER
Brand name: Bystolic
Indication(s): HTN
General Mechanism of Action: Nebivolol is a long-acting B1-adrenoceptor antagonist without intrinsic sympathomimetic activities. The mechanism of action of the antihypertensive response of nebivolol Is not fully understood. Possible mechanisms include decreased HR, decreased myocardial contractility and vasodilation, and decreased peripheral vascular resistance.
Pregnancy Category: Human data suggest risk in 2nd and 3rd trimesters
Contraindications: Hypersensitivity to nebivolol; severe bradycardia, 2nd- or 3rd-degree AV block, sick sinus syndrome; decompensated heart failure, cardiogenic shock; severe hepatic impairment
Black Box Warnings (if applicable): None
Key patient counseling points: Report signs/symptoms of hypotension, worsening heart failure, or bronchospastic disease. Diabetic patients should carefully monitor blood sugar levels as beta-blockers may mask symptoms of hypoglycemia. Do not discontinue drug abruptly, as this may cause rebound angina or, in some cases, AMI.
Generic Name: Propanolol
BETA BLOCKER
Brand name: Inderal, Inderal LA, Inderal XL
Indication(s): Angia pectoris, chronic, cardiac dysrhythmia, HTN, Migraine, prophylaxis
General Mechanism of Action: Propranolol is a nonselective β-adrenergic blocker that competitively blocks β1 and β2 receptors, thereby preventing β-adrenergic stimulation. The mechanism of its antihypertensive and anti-migraine effects is not completely understood.
Pregnancy Category: Human data suggest risk in 2nd and 3rd trimesters
Contraindications: Hypersensitivity to propranolol; asthma; sinus bradycardia, AV block, sick sinus syndrome, cardiogenic shock
Black Box Warnings (if applicable): Avoid abrupt withdrawal
Key patient counseling points: Take immediate-release tablets on an empty stomach; ER can be taken with or without food but consistently. Avoid alcohol. Avoid abrupt discontinuation; exacerbations of angina may occur. Report signs/symptoms of hypotension, CHF, or exacerbation of angina with initial dosing and dose changes. This medicine may cause dizziness. Diabetic patients should carefully follow blood glucose as beta-blockers may mask symptoms of hypoglycemia.
Generic Name: Carvedilol
ALPHA/BETA BLOCKER
Brand name: Coreg, Coreg CR
Indication(s): Heart failure with reduced ejection fraction, HTN, Impaired ventricular function post-MI
General Mechanism of Action: Carvedilol is a selective alpha1 and nonselective beta-adrenergic blocker that can decrease AV nodal conduction in supra-ventricular tachycardias and blockade of catecholamine-induced dysrhythmia.
Pregnancy Category: Human data suggest risk in 2nd and 3rd trimesters
Contraindications: Hypersensitivity, bronchial asthma, severe sinus bradycardia, 2nd- or 3rd-degree AV block, sick sinus syndrome, overt heart failure, cardiogenic shock, severe hepatic impairment
Black Box Warnings (if applicable): N/A
Key patient counseling points: Take carvedilol with food or milk. Report signs/symptoms of heart failure, bradyarrhythmias, bronchospasm, hypotension, syncope, or exacerbation of angina with initial dosing and dose changes. Avoid abrupt discontinuation, may cause rebound HTN. Avoid driving, using machinery, or doing anything else that could be dangerous if not alert. Diabetic patients should carefully follow blood sugar levels as beta-blockers may mask symptoms of hypoglycemia.
Generic Name: Labetalol
ALPHA/BETA BLOCKER
Brand name: Normodyne
Indication(s): HTN
General Mechanism of Action: Carvedilol is a selective alpha1 and nonselective beta-adrenergic blocker that can decrease AV nodal conduction in supra-ventricular tachycardias and blockade of catecholamine-induced dysrhythmia.
Pregnancy Category: Human data suggest low risk
Contraindications: Hypersensitivity, bronchial asthma, severe sinus bradycardia, 2nd-or 3rd degree AV block, sick sinus syndrome, overt heart failure, cardiogenic shock, severe hepatic impairment
Black Box Warnings (if applicable): N/A
Key patient counseling points: Report signs/symptoms of hypotension with initial dosing and dose changes. Avoid alcohol while taking drug. May cause dizziness. Instruct patient to rise slowly from a sitting/supine position, as labetalol may cause orthostatic hypotension. Report signs/symptoms of bronchospasm, slow HR, hepatotoxicity, or syncope. Advise diabetic patients to carefully follow blood sugar levels as beta-blockers may mask symptoms of hypoglycemia. Advise patients against sudden discontinuation of drug as this may cause rebound HTN.
Generic Name: Clonidine
ALPHA BLOCKER
Brand name: Catapres, Kapvay
Indication(s): ADHD, HTN
General Mechanism of Action: Clonidine simulates presynaptic alpha2-adrenergic receptors and blocks postsynaptic alpha2-adrenergic receptors in the CNS by activating inhibitory neurons to decrease sympathetic outflow. Clonidine is not a complete agonist, so some of its effects might result from antagonist actions at presynaptic alpha-receptors. These actions reduce peripheral vascular resistance, renal vascular resistance, HR, and BP.
Pregnancy Category: limited human data - animal data suggests risk (pregnancy). Limited human data - probably compatible (breastfeeding)
Contraindications: Hypersensitivity
Black Box Warnings (if applicable): Epidural Use
Key patient counseling points: Avoid alcohol, CNS depressants. Use caution with driving and other tasks requiring alertness. May cause nausea, vomiting, insomnia, constipation, fatigue, or dry mouth. Swallow extended-release tablet whole. Apply patch to hairless area of intact skin on upper outer arm or chest; rotate patch location. If patch loosens during the 7-d wearing, secure adhesive cover. Report signs/symptoms of hypotension, exacerbation of angina peripheral edema, fatigue, hypotension, or hepatic dysfunction with initial dosing and dose changes. Avoid abrupt discontinuation to avoid rebound HTN.
Generic Name: Prazosin
ALPHA BLOCKER
Brand name: Minipress, Prazin, Prazo
Indication(s): hypertension
General Mechanism of Action: Prazosin inhibits the postsynaptic alpha1-adrenoceptors. This inhibition blocks the vasoconstriction effect of catecholamines on the vessels, leading to peripheral blood vessel dilation through blood vessel constriction by adrenergic receptor activation, epinephrine and norepinephrine normally try to increase blood pressure
Pregnancy Category: C
Take if benefits outweigh the risk to the fetus.
Contraindications: MINIPRESS is contraindicated in patients with known sensitivity to quinazolines, prazosin, or any of the inert ingredients.
Black Box Warnings (if applicable): N/A
Key patient counseling points: Do not take more or less of it or take it more often than prescribed by your doctor.
Your doctor will probably start you on a low dose of prazosin and gradually increase your dose.
Prazosin controls high blood pressure but does not cure it. Continue to take prazosin even if you feel well. Do not stop taking prazosin without talking to your doctor.
Take this medication by mouth with or without food, usually two or three times daily or as directed by your doctor. If stomach upset occurs, take with food or milk. The dosage is based on your age, medical condition and response to therapy.
Generic Name: Amlodipine
CALCIUM CHANNEL BLOCKER
Brand name: Norvasc
Indication(s): HTN, Stable angina, variant angina
General Mechanism of Action: Amlodipine is a long-acting dihydropyridine calcium-channel bloacking drug with potent arterial and coronary vasodilating properties
Pregnancy Category: Limited Human data - animal data suggests moderate risk
Contraindications: Hypersensitivity to amlodipine
Black Box Warnings (if applicable): None
Key patient counseling points: Instruct patient to report signs/symptoms of hypotension or exacerbation of angina with initial dosing and dose changes. Avoid alcohol while taking drug. Report signs/symptoms of peripheral edema, fatigue, hypotension, or hepatic dysfunction. This medicine may cause dizziness. Avoid activities that could be dangerous if dizziness occurs at initiation of therapy. Dizziness may be worse if too much water is lost from the body due to excessive sweating, diarrhea, or vomiting.
Generic Name: Nifedipine
CALCIUM CHANNEL BLOCKER
Brand name: Adlat CC, Procardia XL
Indication(s): HTN, Stable chronic angia, variant angia
General Mechanism of Action: Nifedipine is a calcium ion influx inhibitor that selectively inhibits the transmembrane influx of calcium ions into cardiac muscle and smooth muscle. Nifedipine does not alter serum calcium concentrations.
Pregnancy Category: N/A
Contraindications: Hypersensitivity, cardiogenic shock, STEMI, concomitant use of CYP3A4/5 inducers
Black Box Warnings (if applicable): None
Key patient counseling points: Take Adalat CC on an empty stomach. Report signs/symptoms of hypotension, exacerbation of angina, peripheral edema, fatigue, or hypotension. Avoid sudden discontinuation of drug as this may cause rebound HTN. May cause dizziness; avoid driving or using hazardous machinery until effects are known. Avoid grapefruit juice. May see tablet or shell of dosage form in stool.
Generic Name: Hydralazine
PERIPHERAL VASODILATOR
Brand name: Apresoline
Indication(s): HTN
General Mechanism of Action: Hydralazine is a vasodilator that reduces total peripheral resistance by direct action on vascular smooth muscle, with an effect greater on arterioles than on veins.
Pregnancy Category: Human data suggest risk in 3rd trimester
Contraindications: Hypersensitivity to hydralazine; dissecting aortic aneurysm; coronary artery disease; mitral valve rheumatic heart disease
Black Box Warnings (if applicable): None
Key patient counseling points: Patient should not drink alcohol while taking drug. Advise patient against sudden discontinuation of drug as this may cause rebound HTN. This medicine may cause dizziness. Patient should report chest pain, palpitations, signs/symptoms of tachyarrhythmia, hypotension, agranulocytosis, systemic lupus erythematosus, or hepatotoxicity.
Generic Name: Chlorthalidone
DIURETIC/WATERPILL
Brand name: Hygroton, Thalitone
Indication(s): HTN, Edema
General Mechanism of Action: Chlorthalidone increases sodium and chloride excretion by interfering with their reabsorption in the cortical-diluting segment of the nephron.
Pregnancy Category: Compatible
Contraindications: Hypersentivity to chlorthalidone or sulfonamides;anuria
Black Box Warnings (if applicable): None
Key patient counseling points: Take in the morning with food. Instruct patient to report signs/symptoms of dyspnea, hypotension, gout, or heart failure. Avoid alcohol (may cause hypotension) and NSAIDs (may decrease effectiveness). This medicine may cause dizziness or blurred vision. Avoid driving, using machinery, or doing anything else that could be dangerous if not alert.
Generic Name: Furosemide
DIURETIC/WATERPILL
Brand name: LASIX
Indication(s): Edema related to heart failure, renal failure. HTN
General Mechanism of Action: Furosemide is a loop diuretic that is actively secreted via the nonspecific organic acid transport system into the lumen of the thick ascending limb of Henle’s loop, where it decreases sodium reabsorption by competing for the chloride sites on the Na+ -K+ -2Cl- cotransporter
Pregnancy Category: Human data suggests low risk for pregnancy. Limited human data (prob compatible) for breastfeeding
Contraindications: Hypersensitivity to furosemide; anuria
Black Box Warnings (if applicable): Fluid and electrolyte loss
Key patient counseling points: Avoid alcohol and NSAIDs. Increased risk of sun-sensitivity; use sunscreen and avoid tanning. Avoid activities requiring coordination until drug effects are realized, as drug may cause dizziness, vertigo, or blurred vision. Report signs/symptoms of hypotension, decreased urine output, or ototoxicity; severe skin reactions. Eat high-potassium foods, as directed by health-care professional.
Generic Name: Hydrochlorothiazide
DIURETIC/WATERPILL
Brand name: Various
Indication(s): Edema, HTN
General Mechanism of Action: Thiazides increase sodium and chloride excretion by interfering with their reabsorption in the cortical diluting segment of the nephron.
Pregnancy Category: compatable with pregnancy and breastfeeding
Contraindications: Hypersensitivity to hydrochlorothiazide or sulfonamide, concomitant to dofetilide therapy or anuric patients
Black Box Warnings (if applicable): N/A
Key patient counseling points: May be taken with or without food. Take early in the day to avoid nocturia, even if taken more than once/d (eg, bid administration at 8 AM and 2 PM). May cause dizziness. Report signs/symptoms of hypotension. Eat high-potassium foods during therapy. Avoid alcohol and using NSAIDs.
Generic Name: Spironolactone
DIURETIC/WATERPILL
Brand name: Aldactone, Carospir
Indication(s): Heart failure, HYHA class III-IV, Edema associated with heart failure, nephrotic syndrome, HTN, Hypokalemia
General Mechanism of Action: Spironolactone is a steroidal competitive aldosterone antagonist that acts from the interstitial side of the distal and collecting tubular epithelium to block sodium-potassium exchange, producing a delayed and mild diuresis. The diuretic effect is maximal in states of hyperaldosteronism. Excretion of sodium and chloride excretion is increased; excretion of potassium and magnesium is decreased. Spironolactone has mild antihypertensive activity and has demonstrated a beneficial effect in NYHA class III and IV heart failure.
Pregnancy Category: N/A
Contraindications: Hypersensitivity to spironolactone, anuria, acute renal insufficiency, hyperkalemia
Black Box Warnings (if applicable):
Key patient counseling points: May cause dizziness. Avoid driving, using machinery, or doing anything else that could be dangerous if not alert. Report signs/symptoms of hyperkalemia (muscle weakness, fatigue, bradycardia) and hyponatremia (confusion, dry mouth, thirst, weakness, hypotension, decreased urination). Avoid potassium supplements, foods/salt substitutes that are high in potassium. Avoid alcohol and NSAIDs.
