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AntihypertensiveDrug
Diuretics, ACEI, ARBs, Direct Vasodilators, CCB, BB, AB
Question | Answer |
---|---|
to treat intracranial/intraocular pressure | mannitol |
to treat acute renal failure | mannitol, furosemide (loop) |
side effect: hypovolemic hypernatremia | mannitol |
side effect: hyperchloremic metabolic acidosis | acetazolamide (CAI) |
side effect: kidney stones | acetazolamide (CAI), triamterene (K-sparing) |
to treat open angle glaucoma | dorzolamide (CAI) |
to treat edema patients with metabolic alkalosis | acetazolamide (CAI) |
to treat acute mountain sickness | acetazolamide (CAI) |
increases calcium excretion | furosemide (loop) |
inhibits Na-K-2Cl cotransport | furosemide (loop) |
to treat edema | furosemide (loop), hydrochlorothiazide (thiazides) - in combo with loops, acetazolamide (CAI) |
to treat hypercalcemia | furosemide (loop) |
side effects: ototoxicity | ethacrynic acid > furosemide |
side effects: hypokalemia | acetazolamide (CAI), furosemide (loop), hydrochlorothiazide (thiazide) |
side effects: hypokalemia, hyponatremia, hypomagnasemia, hypocalcemia | furosemide (loop) |
side effects: hypokalemia, hyponatremia, hypomagnasemia, HYPERcalcemia | thiazide |
classify: indapamide | thiazide |
classify: metolazone | thiazide |
classify: methclothiazide | thiazide |
classify: chlorthialidone | thiazide |
classify: torsemide | loop |
classify: bumetanide | loop |
classify: brinzolamide | CAI |
classify: methazolamide | CAI |
alpha blockers used | prazosin, terazosin, doxazosin |
classify: hydralazine | direct vasodilator |
classify: minoxidil | direct vasodilator |
non-DHPs | verapamil, diltiazem |
to treat ascites | spironolactone, maybe combo w/ loop |
side effect: hyponatremia, HYPERkalemia | K-sparing |
side effect: hypokalemic metabolic alkalosis | loop & thiazide diuretics |
side effect: metabolic acidosis | K-sparing, mannitol |
side effect: dehydration, allergy, gout, hyperglycemia | furosemide (loop) |
If patient has allergies to fuorsemide, what do you use instead? | ethacrynic acid |
to treat hypertension & osteoporosis | thiazide |
to treat nephrolithiasis | thiazide |
to treat nephrogenic diabetes insipidus & hypertension | thiazide |
If GFR is < 30-40 ml/min, what thiazide can you use? | metolazone |
side effect: gynecomastia | spironolactone |
to treat hirsutism/acne/polycystic ovary syndrome | spironolactone |
to treat primary & secondary aldosteronism | K-sparing |
MOA for treating aldosteronism | K-sparing: too much aldosterone can cause vessel injury, cardiac remodeling, CV dz, etc. K-sparing helps prevent that. |
Drug for hypertensive pregnant women | methyldopa (alpha-2 blocker) |
Classify: methyldopa | alpha-2 agonist |
classify: clonidine | alpha-2 agonist |
Drug for hypertension & raynaud's syndrome | calcium channel blocker |
Drug for prostatism & hypertension | tamsulosin, alfuzosin (alpha-1 blocker) |
Drug for hypertension & migraines | beta-blocker |
Drug for essential tremor & hypertension | beta-blocker |
Drugs for acute/post MI & hypertension | ACE inhibitor, beta blocker |
Drug for aortic dissection & hypertension | beta-blocker |
Drug for hypertension & pheochromocytoma | non-selective alpha-blocker? |
Preferred drug for african americans with hypertension | diuretic 1st, then CCB |
Drug for hypertension & atrial tachyarrhythmia or atrial fibrillation | beta-blocker |
Drug for cerebrovascular disease or stroke | ACE inhibitor, thiazide diuretic |
Drug for hypertension and thyrotoxicosis | beta blocker |
Drugs for hypertensive urgencies/emergencies | beta blocker: propranolol, esmolol ACE inhibitor: enalapril CCB (DHP): nicardipine, clevidipine alpha blocker: phentolamine lebetalol clonidine hydralazine nitroprusside |
1st line drugs for hypertension | diuretics beta antagonists calcium channel blockers ACE inhibitors Angiotensin II Receptor blockers renin inhibitor |
2nd line drugs for hypertension | alpha antagonists alpha/beta antagonists centrally acting alpha-2 agonists adrenergic neuron blocking agents direct vasodilators |
1st line therapy for hypertension | thiazide diuretics |
acute effect of diuretics | increase Na, H2O excretion --> decrease blood vol --> decrease CO |
chronic effect of diuretics | decrease Na in smooth muscle cells --> decrease PVR (CO returns to normal) |
Drug for reduced renal function or sever hypertension when drugs that retain Na are being used | loop diuretics |
disadvantage to loops | short half life |
Drugs to avoid in patients with gout | thiazides, loops |
Drugs to avoid in patients with asthma | beta blockers, labetalol |
Drugs to avoid in patients with AV block | beta blocker |
Drugs to avoid in patients with acute CHF | beta blocker, CCB, ACEI, ARBs |
Drugs to avoid in patients with history of angioedema | ACE inhibitors |
Drugs to avoid in patients with renal artery stenosis | ACE inhibitors, ARBs (no constriction of efferent arteriole --> decrease GFR even more) |
Drugs to avoid in patients with pheochromocytoma | beta blockers |
Drugs to avoid in patients using cocaine | beta blockers |
Drugs to avoid in pregnant women & sexually active teens | ACE inhibitors, ARBs |
Will esmolol be used to treat chronic hypertension? | NO! short half life, IV drug (can use in htn emergencies) |
MOA: beta blockers | block beta-1 on heart --> decrease HR, decrease contractility --> decrease CO block beta-1 on kidney --> decrease renin, ang II, aldosterone --> decrease BP block beta receptors on CNS --> decrease sympathetic discharge |
Will esmolol be used to treat chronic hypertension? | NO! short half life, IV drug (can use in htn emergencies) |
MOA: beta blockers | block beta-1 on heart --> decrease HR, decrease contractility --> decrease CO block beta-1 on kidney --> decrease renin, ang II, aldosterone --> decrease BP block beta receptors on CNS --> decrease sympathetic discharge |
side effects: bronchospasm | beta blocker |
side effect: rebound hypertension | beta blocker, clonidine |
side effect: constipation | verapamil |
Drugs causing peripheral edema | alpha blockers, CCB, alpha2 agonist, direct vasodilators |
side effect: reflex tachycardia/palpitations | alpha blocker, DHP CCD, vasodilator |
Use for K-sparing | counter K lost from thiazide/loop diuretic use |
Why does verapamil/diltiazem not cause reflex tachycardia? | These are non-DHPs that block receptors on the heart and vascular smooth muscles. On smooth muscle: relax blood vessels --> vasodilate --> decrease PVR On the heart: decrease HR, conduction, force of contraction --> decrease CO. |
Which of verapamil, diltiazem & DHPs cause adverse cardiac effects like sinus bradycardia, AV block, etc | verapamil > diltiazem >>>>DHP |
side effects: flushing, headache, dizziness, peripheral edema | calcium channel blockers |
Which will cause more peripheral edema, DHPs, or Non-DHPs? | DHPs (nifedipine) |
What would be useful to counter peripheral edema? | ACE inhibitors |
Actions of Angiotensin II | 1. release aldosterone from adrenal gland --> increase Na/H2O retension--> increase BP 2. vasoconstrict arterioles > venules 3. facilitates sympathetic activity in brain also: helps regulate GFR!, stimulates thirst, ADH release |
Ways to block Ang II effects: | renin inhibitor, ACE inhibitor, ARBs |
MOA of ACE inhibitors | inhibits Ang II production, inhibits bradykinin breakdown --> dilates arterioles --> decrease PVR also, modest drop in aldosterone & small effect on HR, CO, blood volume |
68 yo male, severe chest pain, pale gray, sweating, BP= 90/50, pulse = 110, ST elevation. Would you prescribe an ACE inhibitor? | NO, bc low BP, wait for BP to increase. |
Drug for hypertension & diabetic/nondiabetic nephropathy | ACE inhibitor/ ARBs (renoprotective) |
Why are ACE inhibitors renoprotective? | decrease BP, dilates efferent arteriole --> decrease intraglomerular hydrostatic pressure --> decrease proteinuria |
side effect: hyperkalemia | ACE inhibitor, ARBs, renin inhibitor, K-sparing diuretics |
side effect: loss of taste, metallic taste, skin rash | captopril |
side effect: anemia, hypotension, neutropenia | ACE inhibitor, ARBs |
side effect: angioedema, cough | ACE inhibitor (use ARBs instead) |
74 yo male, BP 150/94, pulse 58bpm, type 2 diabetes, MI 6 months ago, aspirin qd, low Na diet, slight ankle edema, normal Na, K, Cl, creatine. What is the most useful drug for this patient? | ACE inhibitor (post MI: use beta blocker or ACEI, no beta blocker bc low pulse, ACEI helps with diabetes, no thiazide b/c kidney & diabetes & post MI are compelling indications for other drugs) |
MOA: alpha antagonist | prazosin blocks alpha1 on arteries & veins --> vasodilation --> decrease PVR, decrease venous return |
Compensatory response activated by prazosin? | reflex tachycardia, reflex renin release (due to decrease in BP) |
side effect: orthostatic hypotension | alpha blockers, lebetalol |
MOA: labetalol | block alpha1, partial agonist of beta 2 on vessels --> vasodilation --> decrease PVR block beta1 on heart --> small effect on HR & CO |
side effect: sexual dysfunction | alpha/beta blockers, beta blockers |
MOA: decrease sympathetic outflow (decrease PVR, decrease HR, CO) | clonidine |
What drugs are lipid soluble & works in the CNS because they cross the BBB? | clonidine, methyldopa (alpha 2 agonists) |
side effects: sedation, dry mouth, depression, impotense, Na retension, contact dermatitis (if use transdermal patch) | centrally acting alpha 2 agonists (clonidine) |
What drug would require monitoring hemaocrit & show positive Coombs test? | methyldopa |
side effect: cyanide toxicity | nitroprusside |
MOA of hydralazine/minoxidil vs nitroprusside | hydralazine/minoxidil --> vasodilate arteries --> decrease PVR, decrease BP nitroprusside --> release nitric oxide, increase cGMP, vasodilates arteries & veins |
compensatory systems activated with direct vasodilators | reflex tachycardia, salt/water retension |
Drugs to counter reflex tachycardia & reflex fluid retention? | beta blocker, diuretic, respectively |
side effect: excessive vasodilation & hypotension | hydralazine, minoxidil |
side effects: lupus like syndrome (e.g. fever, arthralgia, skin rash) | hydralazine |
side effect: hypertrichosis | minoxidil |
Contradindications for labetalol | asthma, heart failure |
contraindications for captopril | renal artery stenosis, hyperkalemia |
contraindication for nicardipine | acute heart failure |
agents for treating hypertension from catecholamine excess | phentolamine, nicardipine |
characteristics of a drug for hypertensive emergency | IV, short half-life (fast-acting) |