Week 3 Flashcards
What order should hypertensive medications be prescribed in?
- Thiazide diuretics
- ACE inhibitors
- Angiotensin Receptor blockers
- Calcium channel blockers
(beta blockers)
Which hypertensive medication is best for a patient with diabetes?
ACE inhibitors. They prevent or delay micro and microvascular complications.
What is the best hypertensive medication to use in pregnant women?
Labetalol
Mechanism of action for thiazides?
Block sodium and chloride (Na/Cl) channels in the distal convoluted tubule of the nephron and inhibit the reabsorption of sodium and water. This also causes a loss of potassium and calcium ions.
Mechanism of action for ACE inhibitors
Reduce levels of angiotensin II by inhibiting angiotensin converting enzyme. This causes vasodilation and decrease in blood volume. This also causes an increase in levels of bradykinin by inhibiting kinase II.
Mechanism of action for Angiotensin receptor blockers (ARBS)
Block angiotensin II receptors on blood vessels and in the heart causing dilation of arterioles and veins. There is also a decrease in release of aldosterone which increases renal excretion of Na+ and H20.
Mechanism of action for Calcium Channel Blockers
Block calcium channels and decrease electrical velocity which slows down the heart rate, causes vasodilation, reduces arterial pressure, increases coronary perfusion, decreases the force of contraction.
Mechanism of action for Beta Blockers
Block the action of epinephrine to slow down the heart rate, reduce the force of contraction, and cause vasodilation.
What drug class is recommended for african americans with hypertension?
Diuretics have been shown to reduce morbidity and mortality. CCBs, beta blockers and thiazde diuretics are recommended for treatment.
What drug class is recommended for African Americans with hypertension?
Diuretics have been shown to reduce morbidity and mortality. CCBs, beta blockers and thiazide diuretics are recommended for treatment.
Beta blockers and ACEi should be used if they are strongly indicated for a comorbid condition (type 1 diabetes with proteinuria or hypertensive nephrosclerosis)
Prescribing considerations when carbamazepine is prescribed with warfarin
Carbamazepine (anti seizure medication) decreases the effects of warfarin by inducing drug metabolizing enzymes which increases the dose of warfarin needed to keep the INR within a therapeutic range.
Beta blockers and nitroglycerin for treating angina
- Beta blockers are the first line of medications for stable angina they block the action of epinephrine to slow down the heart and reduce contractile force. Nitroglycerin is used during stable angina when the heart requires more oxygen and causes relaxation of smooth muscle cells resulting in vasodilation and reduced venous return.
- With both of these drugs there is the possibility of reflex tachycardia, when the BP drops the heart compensates by pumping faster to circulate blood. This negates the effectiveness of the nitroglycerin. Resting does not slow heart rate when the baroreceptor reflex is the cause of the tachycardia.
What are two types of beta blockers? Give examples of each.
Cardio selective
- Atenolol
- Metoprolol
Non-cardio selective
- Coreg
- Labetalol
- Nadolol
- Propranolol
- sotalol
The risk for what is increased when discontinuing a beta blocker suddenly?
Angina, MI and death
What happens when beta blockers are given to patients with asthma?
Increase airway reactivity and cause airway narrowing and asthma attack due to blockage of the beta receptors
Mechanism of action for Loop Diuretics
Inhibit reabsorption of Na and Cl in the proximal, distal convoluted tubules and the thick ascending loop of Henle (prevents passive reabsorption of water – tied to the Na)
Mechanism of action for Angiotensin receptor inhibitors (ARIs)
Blocks the receptors that angiotensin acts on in the heart, blood vessels and kidneys causing vasodilation, aldosterone suppression, increased diuresis.
Mechanism of action for Aldosterone receptor agonists
Blocks the effects of aldosterone by attaching to receptors. Blocks aldosterone in the distal nephron to retain K+ and excrete Na+.
Conditions in which thiazide diuretics are contraindicated?
- gout
- diabetes
- hyperlipidemia
Monitoring needs for patients taking diuretics
- VSS
- Daily weight
- Electrolytes (Na, Cl, K, Cr, BUN)
- Kidney function
- dehydration
- hypotension
What type of medication should be prescribed to patients with heart failure who experience fibrotic changes?
Aldosterone antagonists cause fibrotic changes.
Aldosterone agonists can be added to ARBs, ACEs, DRIs to eliminate residual effects of aldosterone which these meds do not block entirely.
One example is spironolactone
What effects do cardiac glycosides have and give an example.
Increases the force of ventricular contraction by the heart thereby increasing cardiac output
Digoxin
What happens when quinidine and digoxin are combined?
Quinidine is an anti-dysrhythmic drug. When used together it causes digoxin plasma levels to rise which could result in toxicity. Do not use together.
What is the atherosclerotic cardiovascular disease risk score?
- Risk assessment tool that helps determine the patient’s absolute risk for developing clinical coronary disease over the next 10 years
- used to guide decision-making for many preventive interventions, including lipid and blood pressure management.
When should the the atherosclerotic cardiovascular disease risk score be used?
When patients have risk factors that are modifiable or treatable to help prevent disease.
What ages can statin drugs be prescribed for?
10-75
What is ezetimibe (Zetia)?
Drug that acts on the cells of the brush border of the small intestine to inhibit dietary cholesterol absorption. Inhibits reabsorption of cholesterol secreted into the bile. Reduces LDL, TG, and apolipoprotein B, small increase in HDL.
When would ezetimibe (Zetia) be prescribed?
Adjunct to diet modification for reducing LDL, and apolipoprotein B in patients with primary hypercholesterolemia. Can be used alone or with a statin.
Mechanism of action for nitrates
Decrease cardiac oxygen demand by dilating veins which decreases preload and increases oxygen supply by relaxing coronary vasospasm.
Contraindications for ranolazine
Ranolazine is an anti-anginal drug that causes QT prolongation.
It is not for use in patient with preexisting QT prolongation or for those taking other drugs that can prolong QT interval
Not for use with CYP3A4 inhibitors (grapefruit juice HIV protease inhibitors, macrolide antibiotics, azole antifungals and some CCBs).
