(THER) Antihypertensives I and II Flashcards

1
Q

Hydralazine MOA and Indication

A

Arteriole vasodilator

Ind: Resistant hypertension; pregnancy induced hypertension

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2
Q

Spironolactone should not be used in combination with which drugs?

A

Drugs that inhibit the RAA system (ACE Inhibitors, ARBs, or BBs)

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3
Q

Thiazides are not as useful in patients with…

A

Renal insufficiency

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4
Q

What is the effect of Calcium Channel Blockers?

A

Relax peripheral arterial vascular smooth muscle and decrease total peripheral resistance.

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5
Q

What effect do calcium channel blockers have on cardiac output/contractility?

A

Decrease calcium-induced calcium release from myocyte SR and can reduce CO

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6
Q

Nifedipine MOA and Side effects

A

Relatively selective vasodilator

AEs: Acute tachycardia; peripheral edema

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7
Q

Diltiazem Effects and Adverse Effects

A

Effects: Reduces both CO and peripheral resistance

AEs: bradycardia

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8
Q

Patients taking short-acting nifedipine, diltiazem or verapamil were 1.6 times more likely to… as compared to patients on other hypertensives.

A

Have an MI than patients on other antihypertensives.

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9
Q

MOA and Effect for Sympatholytic Drugs

What does it mean that they are centrallyy acting agents?

A

Reduce sympathetic drive to heart/blood vessels

They reduce this sympathetic output from vasopressor centers in the brainstem.

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10
Q

Clonidine MOA and AEs (3)

Drug interaction?

A

Alpha-2 agonist: decreases sympathetic outflow from CNS

AE: sedation, dry mouth, contact dermatitis

May interact with other CNS depressants, potentiating their action

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11
Q

In what way should you withdraw patients off of Clonidine and why?

A

Withdraw slowly to prevent rebound hypertension

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12
Q

How does Guanfacine differ from Clonidine?

A

It has similar effects but a longer half-life

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13
Q

Methyldopa MOA (2)

A
  1. Agonist at a-2 adrenergic receptor (decreases sympathetic tone, dropping BP)
  2. Competes for DOPA decarboxylase preventing production of dopamine and subsequent NE/Epi
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14
Q

Methyldopa AEs and key interaction

A

AE: sedation

Interaction: reduces L-dopa therapeutic effects

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15
Q

Which drug is probably the most extensively used hypotensive agent in management of hypertension in pregnant women?

A

Methyldopa

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16
Q

Reserpine MOA

A

Disrupts NE vesicular storage, leading to the eventual digestion of NE by MAO. Overall drop in sympathetic stimulation.

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17
Q

Function of Alpha Adrenergic Antagonists

A

Block arterial and venous constriction

18
Q

Indication for phenoxybenzamine

A

Used in patients with hypertension due to pheochromocytoma

19
Q

Prazosin is similar to which 2 drugs which are more commonly prescribed?

A

Terazosin and Doxazosin

20
Q

Prazosin function (2)

A
  1. Alpha Adrenergic Antagonist
  2. Also causes beneficial decease in LDL/HDL ration
21
Q

Prazosin AEs

A
  1. First dose produces precipitous fall in BP
  2. Fluid retention
  3. Can promote postural hypotension
22
Q

How do B-blockers lead to vasodilation?

A

By increasing NO release or blocking a-adrenergic receptors

23
Q

Nadolol selectivity? Half-life?

A

Non-selective B-blocker; longer half-life

24
Q

Labetolol MOA

Is it more lipophilic or lipophobic?

A

Mixed beta/alpha receptor antagonist (beta/alpha blocker)

Lipophilic

25
Q

Carvedilol MOA/effect

A
  1. Non-selective B-blocker
  2. Some alpha receptor antagonist properties
  3. Vasodilatory
26
Q

B-blocker AEs and Drug interactions

A
  1. Bradycardia
  2. Increased serum triglycerides/decreased HDL levels
  3. Insomnia
  4. Hyperglycemia

Drug Interactions: CCB’s increased risk of conduction disturbances

27
Q

Drug interactions for B-blockers

A

Calcium Channel Blockers (CCBs) increase risk of conduction disturbances when combined with B-blockers

28
Q

Hydralazine Side Effects (3)

A

Tachy; aggravation of angina; fluid retention

29
Q

Hydralazine Contraindication

A

CAD

30
Q

Minoxidil Indication and AEs

A

Indication: Resistant hypertension

AE: tachycardia; aggravation of angina; fluid retention

31
Q

Nitroprusside Indication/ AEs

A

Indication: Hypertensive emergencies

AE: cyanide poisoning

32
Q

Lisonopril falls under what umbrella of drugs?

A

ACE Inhibitors

33
Q

Side Effects/ Drug Interactions for ACE Inihibitors

A

AEs: hyperkalemia; dry cough; angioedema

Interactions: can exacerbate hyperkalemia when given with potassium sparing diuretics

34
Q

ACE Inhibitor COntraindication

A

Should not be given to pregnant women, as Ang II is important in fetal renal development, particularly in the 2nd and 3rd trimesters

35
Q

Key point about ACE Inhibitors and Diabetic Patients

A

ACE-I’s preserve renal function in patients with diabetes

36
Q

Losartan MOA and AEs

A

Selective Angiotensin I receptor Blocker (ARB)

37
Q

Losartan Drug interactions and contraindications are the same as what other drug?

A

ACE inhibitors

38
Q

Why are ACE-I and K+ sparing diuretics a poor drug combination?

A

They both promote hyperkalemia

39
Q

For Black patients, what are the best first line options for hypertension? In what context should the other drugs be used for the best effect?

A

Diuretics or Calcium Channel Blockers (CCBs) should be used as first line treatment in uncomplicated hypertension for AA patients.

Other drugs (BBs, ACEIs or ARBs) should be used in combination w/ diuretics for best effect.

40
Q

Which drugs are best for patients with Diabetes mellitis who are hypertensive? (3)

A

ACEI, alpha antagonists and CCBs