Week 5 Flashcards
what drugs are alpha 2 agonist- central acting
Clondine and Methyldopa
What class is clondine
Alpha 2 Agonist- Central Acting
What class is methyldopa
Alpha 2 Agonist- Central Acting
Route of Clonidine
Po/ transdermal patch
route of methyldopa
PO
mechanism of action of alpha 2 agonist (clonidine and methyldopa)
Activates Alpha2 receptors in medulla of the brain → decreases sympathetic tone (HR / BP)
decreases sympathetic outflow to heart, kidneys and blood vessels
uses for clondine
HTN (2nd or 3rd line), ADHD, opioid withdrawal and tourettes
uses of methyldopa
FIRST LINE for pregnant moms
contraindication to clonidine
MI, renal function impairment, bradycardia, sinus node dysfunction
contraindication to methyldopa
MI, hepatic disease, MAOI use
side effects of clonidine
cognitive impairment, depression
is clonidine and methyldopa monotherapy
NO
labs to check for clonidine and methyldopa
liver and kidney function, can cause rebound HTN if stopped abruptly
DDI of methyldopa and clonidine
NO BETA BLOCKERs, MAOIs and TCAs
which drugs are selective alpha 1 adrenergic antagonists
doxazosin, prazosin, terazosin
what class is doxazosin
selective alpha 1 adrenergic antagonists (original sin)
what class is prazosin
- BOLDED* selective alpha 1 adrenergic antagonists
what class is terazosin
selective alpha 1 adrenergic antagonists
how do selective alpha 1 adrenergic antagonists work? (prazosin)
block postsynaptic alpha1 receptors in vascular smooth muscle and smooth muscle in bladder, neck, and prostate.
Decrease in arterial and venous vasoconstriction
what are Selective Alpha 1 Adrenergic Antagonists used for?
HTN and BPH
what is prazosin used for?
HTN but NOT BPH, also PTSD
side effects of Selective Alpha 1 Adrenergic Antagonists (prazosin)
Syncope
Reflective tachycardia
Orthostatic hypotension
Intraoperative floppy iris syndrome (during cataract surgery)
Parasympathetic symptoms
how is prazosin metabolized?
in the liver, but does not cause reflex tachycardia
how to stop taking Selective Alpha 1 Adrenergic Antagonists like prazosin?
DO NOT STOP ABRUPTLY
what drugs are nonselective beta blockers
PROPANOLOL and nadolol
what does it mean to be a nonselective beta blocker?
blocks both beta 1 and 2
what class is propanolol?
nonselective beta blocker
what drugs are selective beta blockers?
metoprolol and atenolol
how do beta blockers work?
B1 blocks receptors at SA node decrease HR & contractility—
slows conduction at AV junction.
B1 blocker: reduces renin release in RAS, lowers BP: Less angiotensin II.
B2 Blocker: inhibits bronchodilation receptors in lungs— causes bronchoconstriction.
Angina: Decrease myocardial o2 demand
what is propanolol used for
Angina
HTN: Not first line
Post MI prophy for arrhythmia
Migraine (not acute- needs wean on & Off)
(+Angina w. Hypertrophic subaortic stenosis)
Acts on thyroid prevents conversion of t4-t3
contraindications of propanool
AV BLOCK
Peripheral vascular disease
1st gen Caution CHF
Asthma or other resp conditions
difference between metoprolol and propanolol
propanolol is nonselective (blocks B1 and B2), metoprolol works more on B1
uses for metoprolol
Angina
HTN: Not first line
Post MI prophy for arrhythmia
contraindications of metoprolol
AV BLOCK
Asthma: can be considered
side effects of beta blockers
Most common:
CV: Brady & Hypotension (Watch for fatigue, drowsiness, weakness), orthostatic.
Caution: DM, Masks symptoms of hypoglycemia & hyperthyroidism
-Abrupt w/d can cause:
thyroid storm, Severe angina, MI, Ventricular arrhythmia,
-CNS: anx, dep, drowsy, nightmare, AMS
-GI: motility ( Anorexia, N/V/D, Constipation,
-Decreased libido= nonadherence to med.
ALL BB WEAN ON & OFF
lab considerations with all betablockers
watch all renal and liver labs
what is considered a 3rd generation beta blocker?
CARVEDILOL, labetalol
how do 3rd generation betablockers differ from other generations?
Selective alpha1 and nonselective beta blockers. Decrease BP and PVR by increasing vasodilation, decreasing myocardial oxygen demand, and CO.
Alpha 1 blockage is predominant (less likely to cause brady or decrease CO and decrease the reflex vasoconstriction).
common uses of carvedilol
HTN
Reduce progression of heart failure
Ventricular dysfunction s/p MI
Off-label: cirrhosis, gastroesophageal varices, a-fib, and Nstemi
side effects of 3rd generation betablockers
Hypotension, bradycardia, bronchospasm & hypoglycemia (In DM due to masking sx)
It pt has peripheral vascular disease → may cause aggravation of arterial insufficiency.
contraindication of labetalol?
bronchospastic disease
considerations of 3rd gen beta blockers (cardivilol and labetalol)
Do not stop abruptly in CAD pts → angina exacerbation, MI, v-fib / v-tach.
Caution with bronchospastic disease (but can give)
Less likely for orthostatic hypotension and exercise-induced reflex tachycardia
when is 3rd gen beta blockers preferred?
preferred for HTN in pts with severely damaged hearts d/t sympathetic drive
what drugs are ACEIs
end in PRIL
what class is lisinopril?
ACEI
how do ACEIs work?
Angiotensin-converting enzyme (ACE) inhibitors prevent the enzyme ACE from converting angiotensin I into angiotensin II. Angiotensin II is a vasoconstrictor that can cause high blood pressure by narrowing blood vessels and releasing hormones that raise blood pressure. Captopril has the shortest half-life.
common use for lisinopril?
HTN, post MI, heart failure
contraindications of ACEIs
Bilateral renal artery stenosis, angioedema, pregnancy, hyperkalemia
common side effects of ACEIs
Hypotension, dizziness, fatigue, DRY HACKING COUGH, HYPERkalemia
some may cause photosensitivity, rash and neutropenia in high doses
who are ACEIs drug of choice for?
younger, white, diabetes, HF and MF
cautions and CIs for ACEIs
ANGIOEDEMA** no ACEs to be used again (higher risk in Asian and black populations), prevents remodeling post MI,
adverse reaction usually w/i first few doses
caution with hypovolemia, hyponatremic and hepatic impairment
drug interactions of ACEIs
NSAIDs, OTC drugs (cold remedies), lithium , antihypertensives, nitrates, alcohol, phenothiazines
what drugs are ARBs (angiotensin receptor blockers?
end in SARTAN (losartan), candesartin, olmesartan, telmisaratan, valsartan
how do ARBS work?
Angiotensin II receptor blockers (ARBs) work by binding to and inhibiting the angiotensin II type 1 receptor (AT1). This inhibits the renin-angiotensin system, which can cause arteriolar contraction and sodium retention
what is lorsartan used for?
HTN, stroke reduction, diabetic nephropathy
caution and contraindications of losartan?
Bilateral renal artery stenosis, angioedema, pregnancy, hyperkalemia
side effects of losartan
Hypotension, dizziness, fatigue, photosensitivity, HYPERkalemia
DDI of losartan and ARBs
LOWERS INHIBITORS OF CYP450, Antacids, allopurinol, capsaicin, probenecid, rifampin, fluconazole, indomethacin, digoxin, cimetidine, phenobarbital, diuretics
why do people switch from ACEI to ARB
less likely to be coughing
what drug class is digoxin?
cardiac glycoside
how does digoxin work
Inhibit sodium pump
Na and Ca build up in cell
Positive inotropy
High VD in skeletal muscle
how is digoxin used?
Rate control AFTER BB is ineffective afib/svt
HFrEF < 40% (not first line)
contraindications of digoxin
Contraindicated in AV block & ventricular arrhythmias (uncontrolled)
side effects of digoxin
Low therapeutic index
Toxicity, low GFR
Lab levels and patient presentation
“Green halo and yellow vision”
how is digoxin metabolized?
kidney
drug interactions of digoxin
MANY- food slows absorption, (amiodarone, dilt, quindine), electrolyte abn, albumin bound
What drug is a class 1A anti-arrhythmic
dispyramide
what is disopyramide used for
VT, reduced LVEF
what drug is a class 1 B anti-arrhythmic
mexilente
what is mexilente used for
exercise induced VT
what drugs are class 1C anti-arrhythmic
flecainide and propafenone
what are flecainide and propafenone used for?
anti-arrhythmic for ppl who dont respond to less toxic drugs, AF/VT and VF
what drug is a class 2 anti-arrhythmic
propanolol (also beta blocker)
what is propanolol used for in the sense of anti-arrhythmic
SVT
what drugs are class 3 anti-arrhythmic
amiodarone, dronedarone and sotalol
what is amiodarone used for
SVT and VT
what is dronedarone used for
AF (not long term)
what’s sotalol used for
beta blocker also used for VT
what drugs are class 4 anti-arrhythmic
diltiazem and verapamil (also CCB)
what are dilt and verapamil used for in sense of anti-arrhythmic
rate control, reentry SVT and AF
what class is hydralazine
acts on NO2
what drug acts on NO2
hydralazine
what drug is a K channel stimulator
minoxidil
what class is minoxidil
K channel stimulator
how does hydralazine and minoxidil work?
Peripheral vasodilator: direct dilation of arteriolar smooth muscle decreased PVR
Do not dilate Coronaries
Do not relax venous smooth muscle
used for hydralazine and minoxidil
HTN (not first line) and PVD
contraindications of hydralazine and minoxidil
caution of CVD, PAH, does not dilate coronary arteries
side effects of minoxidil and hydralazine
Decreased peripheral and pulmonary vascular resistance
Tachycardia + increased contractility
Water retention
HA
tachyphylaxis
Does not cause orthostatics and ED like most other antihypertensives.
which drugs are dihydropyridine CCBs?
nifedipine, amlodipine, felodipine
how do CCBs work?
binding to and blocking the L-type calcium channels in the heart, vascular smooth muscle, and pancreas, preventing calcium from entering the cells.
Calcium is necessary for the muscular linings of blood vessels to contract, and for the heart’s muscle to contract
what drugs are non-dihydropyridine CCBs?
verapamil and diltiazem
what is nifedipine used for
Angina, HTN, Raynaud’s
what is verapamil used for?
HTN, angina and a. Fib rate control, SVT, migraine prophy, antiarrhythmic!
what is amlodipine used for
HTN, angina
what is diltiazem used for?
Angina, HTN, esophageal spasm, Antiarrhythmic!
what are contraindications of dihyrdopyridine CCBs?
(nifidepine, amlodipine)- cause peripheral edema, reflex tachycardia
what are contraindications of non-dihydropyridine CCBs?
(verapamil and diltiazem)- Avoided in HF, can worsen bradycardia, no WPW syndrome patients
side effects of dihydropyridine CCBs
Reduction in BP causes dizziness, headache, hypotension, syncope, GI symptoms, hyperglycemia, photosensitivity
side effects of non-dihydropyridine (Verapamil)
Constipation, Bradycardia, Heart Block
side effects of non-dihydropyridine
Photosensitivity, Bradycardia, Heart Block
what drugs are thiazide diuretics?
hydrocholorthiazide, chlorothalidone and metolazone
drug interactions of most CCBs
CYP3A4 involved in metabolism: GRAPEFRUIT JUICE, additive effect with other hypertensives, watch NSAIDs
what class is hydrochlorothiazide?
thiazide diuretics
what is the mechanism of action of thiazide?
Distal renal tubule to inhibit sodium reabsorption (longer lasting and cause less brisk diuresis)
Decreases plasma volume, and CO. (though effects return to baseline, Peripheral vascular resistance remains ([mechanism unknown]).
What is hydrochlorothiazide used for?
HF, HTN (first line)
contraindications of hydrocholorthiazide?
hypokalemia, gout/renal calculi and hyperuricemia
side effects of hydrochlorothiazide?
Electrolyte imbalance, photosensitivity, hypotension, severe hyponatremia, hyperglycemia, GI upset, tinnitus/hearing loss
DDI with hydrochlorothiazide
drugs that decrease BP, avoid using with ACEi and ARB
what drugs are loop diuretics?
furosemide and bumetanide
how do loop diuretics work?
Inhibit Na reabsorption in ascending loop of henle
(short acting and cause large natriuresis)
Decreases plasma volume, and CO. (though effects return to baseline, Peripheral vascular resistance remains ([mechanism unknown]).
what is lasix and bumex used for
HF and HTN
side effects of lasix/bumex
Electrolyte imbalance, photosensitivity, hypotension, severe hyponatremia, hyperglycemia, GI upset, tinnitus/hearing loss
what drugs are potassium sparing diuretics?
spironolactone and amiloride
how does spironolactone work?
Inhibit excretion of potassium distally
Decreases plasma volume, and CO. (though effects return to baseline, Peripheral vascular resistance remains ([mechanism unknown]).
what are all diuretics used for (context of this week)
HF, HTN
c/i of spironolactone
hyperkalemia
side effects of spironolactone
Gynecomastia (50%)
Electrolyte imbalance (HYPERk)
In pts with gout → hyperuricemia
Hypotension
Occasional GI upset (take meal)
Tinnitus/ hearing loss
which drugs cause hyperkalemia
ACEi, ARB, renin inhibitors
what drug may cause lower extremity edema and constipation
amlodipine
which beta blocker is known to reduce mortality and HF
carvedilol
what is most accurate about the mechanism of furosemide when being used to induced diuresis in a patient with edema or fluid overload
Antagonizes Na+/K+/2Cl- transporter, which then blocks about 20 to 30% of sodium reabsorption by the nephron
what MOA applies to digoxin
Inhibits the sodium potassium ATP pump in the cardiac myocyte leading to an increase in the force of contraction
Which anti-rhythmic agents should generally be avoided in heart failure because of their inability to prevent cardiac remodeling
diltiazem
Which ECG abnormalities is most likely to occur in with the use of amiodarone or sotalol, especially in patients with hypokalemia
QT prolongation
which diuretic agents typically do not need potassium supplementation
aldosterone inhibitors
when should diuretics be taken?
upon awakening
how does chronic use of BB treat HTN
Reducing peripheral vascular resistance
What dermatological issue is linked to amiodarone?
Progressive change of skin tone toward a blue spectrum wtf
consequences of rapid BB withdrawal
angina and coronary artery disease
