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Hypertension
Pharmacology Exam 1
| Question | Answer |
|---|---|
| Chlorathalidone: - Type of Drug - Class - Indication | - Thiazide - Diuretic - Tx: HTN, Peripheral Edema, Heart Failure |
| Hydrochlorothiazide: - Type of Drug - Class - Indication | - Thiazide - Diuretic - Tx: HTN, Peripheral Edema, Heart Failure |
| Chlorothiazide: - Type of Drug - Class - Indication | - Thiazide - Diuretic - Tx: HTN, Peripheral Edema, Heart Failure |
| Indapamide: - Type of Drug - Class - Indication | -Thiazide-like - Diuretic - Tx: HTN, Peripheral Edema, Heart Failure |
| Metolazone: - Type of Drug - Class - Indication | - Thiazide-like - Diuretic - Tx: HTN, Peripheral Edema, Heart Failure |
| Thiazide (MOA): Inhibit ___ reabsorption in the early ___ ___ ___ resulting in decreased ___ and ___ retention. Thiazide diuresis is dependent on _____ function. Allergic precaution to _S_____ _m_____. | sodium, distal convoluted tubule, NA, water, renal, sula moiety |
| Thiazide (Side Effects): ___kalemia, __natremia, ___chloremia, ____magnesemia, ___CALCEMIA, ___glycemia, ___lipidemia, ___uricemia, ___ hypertention, ___sensitivity | HYPOkalemia, HYPOnatremia, HYPOchloremia, HYPOmagnesemia, HYPERcalcemia, HYPERglycemia, HYPERlipidemia, HYPERuricemia, ORTHOSTATIC htn, PHOTOsensitivity |
| Bumetanide: -Type of Drug -Class -Indication | - Loop - Diuretic - HTN, peripheral edema, ACUTE PULMONARY EDEMA, heart failure |
| Furosemide: - Type of Drug - Class - Indication | - Loop - Diuretic - HTN, peripheral edema, ACUTE PULMONARY EDEMA, heart failure |
| Torsemide: - Type of Drug - Class - Indication | - Loop - Diuretic - HTN, peripheral edema, ACUTE PULMONARY EDEMA, heart failure |
| Ethacrynic Acid (NOT FDA indicated): - Type of Drug - Class Indication | - Loop - Diuretic - HTN, peripheral edema, ACUTE PULMONARY EDEMA, heart failure |
| Loop Diuretics (MOA): Inhibit __/__/__ cotransporter in the thick __ limb of the ___ ___ ___. Increase in urinary excretion than ____. Generally reserved for ____ HTN, e____, C___ associated volume overload. Allergies to _s___ _m___ EXCEPT for ___ ___. | NA/K/Cl, ascending, Loop of Henle, Thiazides, HYPERvolemic, edema, CHF, Sulfa Moiety, Ethacrynic Acid |
| Loop Diuretics (Side Effects): same as Thiazides EXCEPT ___calcemia, acute ___volemia, ____toxicity w/ large doses, photosensitivity/skin reactions EXCEPT ___ ___. | HYPOcalcemia, HYPOvolemia, OTOtoxicity, Ethacrynic Acid |
| Amiloride: - Type of Drug - Class - Indication | - Potassium Sparing - Diuretic - HTN, HYPOKALEMIA, peripheral edema |
| Triamterene: - Type of Drug - Class - Indication - Special Side Effect | - Potassium Sparing -Diuretic - HTN, HYPOKALEMIA, peripheral edema -Fetal abnormalities |
| Spironolactone: - Type of Drug - Class - Indication* additional indications - Black box - Special Side Effects | - Potassium sparing - Diuretic - HTN, HYPOKALEMIA, peripheral edema, ADDITIONAL INDICATIONS as an ALDOSTERONE ANTAGONIST for CHF and PRIMARY HYPERALDOSTERONISM - Tumor risk - Endocrine effects, Fetal abnormalities |
| Potassium Sparing Diuretics (MOA): Inhibit __ reabsorption in the __ and __ tubules. Reserved for patients who develop __kalemia. ____ blood pressure lowering effect. | NA, distal, convoluted, HYPOkalemia, Modest |
| Potassium Sparing Diuretics (Side Effects): ___kalemia, EXAGGERATED with concomitant A__, N__, __ supplements, or __ insufficiency. __natermia, | HYPERkalemia, ACEI, NSAIDS, K, RENAL. HYPOnatremia |
| Diuretics (Drug Interactions): D____, L____, N____, ototoxic drugs like ____. Agents that raise potassium levels like _____. | Digoxin, Lithium, NSAIDS, Loop Diuretics, Potassium Sparing Diuretics. |
| Diuretics (Monitoring Parameters): ___/___, e____ @ baseline, then periodically. Periodic evaluation of g___ and u___ a___ in sensitive patients. H____ status. | BUN/Creatinine, electrolytes, glucose, uric acid, Hydration |
| Diuretic Pearls: Take ____ 3pm, not recommended in p__ patients, can cause e___ imbalance, assess ___ function prior to prescribing (a__ contraindicated) | before, pregnant, electrolyte, renal, anuria. |
| Thiazide/Loop Pearls: Can challenge patients with ___ allergy. ___sensitivity and __ reactions. Thiazides cause ___calcemia, Loops cause __calcemia. ___ NOT effective at CrCl < __mL/min. Caution in pts with D__, g__, __lipidemia. | sulfa, PHOTOsensitivity, skin, HYPERcalcemia, HYPOcalcemia, Thiazides, < 20mL/min, DM, gout, HYPERlipidemia |
| Potassium Sparing Pearls: Avoid in patients with ___ impairment and ___ may have endocrine effects. | Renal, Spironolactone |
| Aliskiren (Tekturna), (Valturna), (Tekturna HCT), (Tekamlo), Amturnide): - Type of Drug - Class - Indication | - Direct Renin Inhibitor - Renin Angiotensin-Aldosterone System - HTN |
| Direct Renin Inhibitor (MOA): Inhibits __ and decreases ___ ___ activity which reduces ___ and ___ levels. Metabolism through the __ partially. High ___ meals ___ drug exposure so do not take it with this. Effects peak within __ weeks. Mon Par: __/__, __ | Renin, plasma renin, angiotensin I, angiotensin II, liver, fat, reduces, 2. BUN/Cr, K+ |
| Direct Renin Inhibitor (Side Effects): __edema, diarrhea, __kalemia, __ abnormalities, nephro___, increased __/__. Precautions Scr >/= to __ in males or Scr >/= to __ in females or d___. Preg Categ __. Drug Interactions: 3A4 and P-glycoprotein ____, | ANGIOedema, HYPERkalemia, fetal, nephroLITHIASIS, BUN/Cr, 1.7, 2.0, dialysis. X, inhibitors |
| Benazepril, Captopril, Enalapril, Fosinopril, Lisinopril, Moexipril, Perindorpil, Wuinapril, Ramipril, Trandolapril: -Type of Drug - Class - Indications | - Angiotensin Converting Enzyme Inhibitors (ACE1) -Renin-Angiotensin-Aldosterone System - HTN, CHF, DIABETIC NEPHROPATHY, ACUTE MI, CARDIOVASCULAR EVEN PREVENTION |
| Enaliprilat (only __ formation): -Type of Drug - Class - Indication | - (IV) - Angiotensin Converting Enzyme Inhibitor (ACE1) -Renin-Angiotensin-Aldosterone System - HTN, CHF, DIABETIC NEPHROPATHY, ACUTE MI, CARDIOVASCULAR EVENT PREVENTION |
| Angiotensin Converting Enzyme Inhibitor (ACEI) MOA: Inhibit the conversion of ___ to ___. Reduction in ___ prevents ____ and leads to a reduction in _____. ACEI also inhibits breakdown of ____. PK excreted by the ___. Dose adjust in ___ impairment. | - Angiotensin I, Angiotensin II, Angiotensin II, vasoconstriction, aldosterone. Bradykinin. Kidney. Renal |
| Angiotensin Converting Enzyme Inhibitors (ACE1) Side Effects: Most unique ______. 1st dose ___. Preg Categ __, ___kalemia, D/C when SCr increases to > __% baseline in two months. ___ failure with renal artery stenosis. | COUGH, HYPOtension, x (fetal harm), HYPERkalemia, 30%, Renal |
| Angiotensin Converting Enzyme Inhibitors (ACE1): Contraindications in ____, bilateral renal artery ___, SC > ___. Drug Interactions with same indications, L___, N____. Monitoring for: __/__, __. | Pregnancy, stenosis, 3.0 or 30% baseline. Lithium, NSAIDS, BUN/CR, K+ |
| Azilsartan, Candesartan, Eprosartan, Irbesartan, Losartan, Olmesartan, Telmisartan, Valsartan: - Type of Drug - Class - Indication | - Angiotensin Receptor Blockers (ARB) - Renin-Angiotensin-Aldosterone System - HTN, CHF, Diabetic nephropathy, Acute MI, Cardiovascular even prevention |
| Angiotensin Receptor Blockers (ARB) MOA: Inhibit the ___ and ___-secreting effects of ___ by competitively blocking ___ and ___ receptors. | vasoconstriction, aldosterone, Angiotensin II, Angiotensin I and Angiotensin II. |
| Angiotensin Receptor Blockers (ARB) Side Effects: Same as ____, EXCEPT no ___, less ____. Contraindications/Interactions: same as ___. Such as p__, bilateral renal artery __, SCr > __. Monitoring: __/__, __. | ACEI. COUGH, Angioedema, ACEI, pregnancy, stenosis, 3.0 or 30%, BUN/Cr, K+ |
| ACEI + ARB (Pearls): ___ only IV formulation. Preferred initial agents in ___ disease, D__, H__, C__. unless contraindications exist. ____ DECREASE effectiveness. Transient increase in ___ ok are actually ___ protective. Monitoring Parameters: __/__, __ | Enaliprilat, Chronic Kidne, DM, HF, CAD. NSAIDS. SCr, RENOprotective. BUN/Cr, K+ |
| Eplerenone and Spironolactone: - Type of Drug -Class - Indication | - Aldosterone Antagonists - Renin-Angiotensin-Aldosterone System - HTN, CHF, PRIMARY HYPERALDOSTERONISM (Spironolactone) |
| AA (MOA): Compete with ___ for the mineralocorticoid receptor which results in n___ and d___. Spironolactone: ___ binding to androgen & __ receptors. Blocks ___ in the __ nephron. Retention of __ increase excretion of __. Binds with receptors of other_ _. | aldosterone, natriuresis, diuresis. NONselective, Progesterone. Aldosterone, Distal. K+, Na . Steroid hormones. |
| Eplerenone MOA: ___ blockade of ___ receptors. Greater ___ for the mineralocorticoid receptor. | (Aldosterone Antagonists): SELECTIVE, aldosterone. SPECIFICITY |
| Aldosterone Antagonists (Side Effects): H___, g___, ___ irregulations. More so in ___ compared to ___. __ disturbances, __kalemia, __natremia, Black box: ___ for this drug___. Contraindications: __ failure (CrCl < __), Type __ DM w/ micro___. ___kalemia | Hirsuitism, gynecomastia, mentrual. Spirolactone, Eplerenone. GI, HYPERkalemia, HYPOnatremia, TUMOR RISK, Spirolactone. Renal, < 50 ml/min, 2, microALBUMINURIA. HYPERkalemia ( >5.5) |
| Aldosterone Antagonists (Drug Interactions): ___ of CYP3A4 especially in the drug ____. Drugs that raise ___ levels. Caution when combined with ____. Monitoring Parameters: ___/___, ___. | INHIBITORS, Eplerenone. Potassium. Lithium. BUN/Cr, K |
| Subcat are BB, A/B blockers, Alpha1 blockers, Centrally acting alpha2 agonists, Adrenergic neuron blockers: - Type of Drugs - Class - Site of Action: Primarily exert their effect by ___ the influence of the ___ nervous system on the ___ and ___ vessel | - Antiadrenergic Drugs - Sympatholytics - Suppressing, sympathetic, heart, blood |
| Atenolol, Betaxolol, Bisoprolol, Metoprolol Tartrate, Metoprolol Succinate, Nadolol, Propranolol, Timolol, Nebivolol, Esmolol: - Type of Drugs - Class - Indications | - Beta Blockers (BB) - Sympatholytics - HTN, Arrhythmias, HF, MI, PERFORMANCE ANXIETY, GLAUCOMA, MIGRAINE prophylaxis, ESSENTIAL TREMOR |
| Acebutolol, Penbutolol, Pindolol: - Type of Drugs - Class - Indications: stimulates ___ receptor ___, mild activation. Potential benefit in ___ ____. | - ISA (intrinsic sympathomimetic activity) - BB, Antiadrenergic drugs, Sympatholytics - Beta, less. sinus bradycardia (COPD, asthma?) |
| Carvedilol, Labetalol: - Type of Drugs - Class - Indications | - Combined (mixed) alpha and beta BB - BB, antiadrenergic drugs, sympatholytics - (last line BB), HTN, arrhythmias, HF, MI, PERFORMANCE ANXIETY, GLAUCOMA, MIGRAINE prophylaxis, ESSENTIAL TREMOR |
| Beta Blockers (MOA) part 1: release of n___ from ____ nerve endings by blockage of pre-snaptic beta receptors. Blockade of cardiac ___ adrenergic receptors ____ heart rate and ___ thereby decreasing cardiac output and ____ ____. | - norepinephrine, adrenergic. beta-1, decreases, contractility, blood pressure. |
| Beta Blockers (MOA) part 2: Suppress ___ tachycardia caused by ____. Reduces release of ___ from juxtaglomerular cells. ___selectivity affinity for __ >__. Less likely to provoke ___. | reflex, vasodilation. renin, CARDIOselectivity, B1 > B2, BRONCHOSPASM. |
| Mixed B and A (MOA): Selectively ___ alpha 1 adrenergic receptors; ___ beta 1 and beta 2 adrenergic receptors ( selective ___ and non-selective __ __). Carvedilol: available in ___ and controlled/extended release. Labetalol: ___ > than in ratio of _ to _. | Antagonizes, Antagonizes, Alpha, Beta Blocker, Immediate release. Carvedilol > Labetolol in ratio of BETA to ALPHA. ALPHA BLOCKADE PRODUCES MORE ORTHOSTATIC HYPERTENSION! |
| Beta Blocker (Side Effects): F___, weakness, exercise ___, ___cardia, heart___, ___ antrioventricular conduction, ___ contractility. R___ phenomenon, bronchospasm with ____ drugs. D___, mask sxs of ___glycemia, ___ dysfxn. | Fatigue, intolerance, BRADYcardia, heartBLOCK, Decreased, Reduced. Raynaud, NON-selective, Depression, HYPOglycemia, SEXUAL dysfunction |
| Beta Blocker (Contraindications): A___, __ and __ degree heart block, __ failure exacerbation, ___ syndrome, DM, HR < __, Black Box: Avoid ___ ___. Drug Interaction: other ___tensives, CCBs (v__ and d__), D__, __glycemic agents. | ASTHMA, 2nd and 3rd, Heart, Raynaud's, 60bpm, ABRUPT CESSATION. HYPOtensives, Verapamil and Diltiazem), DIGOXIN, HYPOglycemic agents. |
| Beta Blocker part 1 (Pearls): Avoid in severe reactive ___ disease. ___selective safer in a__, C__, P__, and D__. Reduce morbidity and mortality in C__ and M__. __selectivity lost at __ doses. Suppress __ tachycardia caused by ___. | airway, CARDIOselective, asthma, COPD, PVD, DM. CHF, MI. CARDIOselectivity, HIGH, reflex, vasodilation. |
| Beta Blockers Part 2 (Pearls): Cessation of therapy ___ symptoms from ___ overactivity and additional upregulated ___ receptors. A__, i__, sudden death in patients with underlying C__. ___ ___ before discontinuation. Metoprolol PO to IV __:__. | Withdrawal, sympathetic, beta, angina, infarction, CAD. Taper slowly, 2.5:1. |
| Amlodipine, Felodipine, Isradipine, Nicardipine IR, SR, Nifediprine IR, LA, Nisoldipine, Clevidipine ( ___ formulation): - Type of Drugs - Class - Indications | (IV formulation) - Dihydropyridines - Calcium Channel Blockers (CCBs) - HTN, CAD, MIgraine px (verapamil), ANTIDYSRHYTHMIC AGENT (Non-DHP), Angina |
| Diltiazem CR, ER, and Verapamil IR, LA: - Type of Drugs - Class - Indications - Verapamil also used for (___ px) | - Non-dihydropyridines - Calcium Channel Blockers (CCBs) - (Antidysrhythmic agent), HTN, CAD, Angina - Migraine |
| CCBs (MOA): Inhibit the influx of __ in vascular smooth muscles resulting in relaxation of c__ and p__ a__. Dihydropyridines act primarily on ___. Non-DH act on ___ AND on the __ resulting in __, reduced arterial pressure, and __ coronary p___. | calcium, CORONARY, Peripheral Arteries. ARTERIOLES. arterioles and HEART, vasodilation, increased, perfusion. |
| Dihydropyridines (CCB): primarily __. While the Non-DHP (CCB): primarily negative i__ and negative c___. | vasodilation, inotropes, chronotropes. |
| CCB (Side Effects): ___ tachycardia particularly in the ___ drugs. Pedal/peripheral ___. H__, F__, O__ H__, C__! esp. more so in ___ over __. NON-DHP: Sinus ___, negative i___, Cardiac s___, Heart ___. | Reflex, DHP, Edema. Headache, Flushing, Orthostatic HTN, CONSTIPATION, Verapomi, Diltiazem. Bradycardia, inotropy, suppression, block. |
| CCB (Contraindications): C___ esp. in ___ drug. Severe H___. __ and __ heart block. (Drug Interactions): 3A4 ___ and ___ of 3A4, P-GP, Beta-___ blocking agents, D__ with Non-DHP, R__ with Non-DHP. | CHF, Non-DHP, HYPOtention, 2nd and 3rd degree, INHIBITORS, SUBSTRATES, Adrenergic, Digoxin, RANOLAZINE. |
| CCB (Pearls): D___ interaction, Dual CCB therapy considered ___ line. ___ used in atrial fibrillation/flutter. ___ effective in migraine prophylaxis. ___ effective for isolated systolic HTN in the elderly. SR CCB or CCB w/ long 1/2 lives for __ HTN tx. | Digoxin, last. Non-DHP, Verapamil, DHP, Chronic. |
| Doxazosin, Prazosin, Terazosin: - Type of Drugs - Class - Indication | - Alpha-1 Antagonists - Anti-HTN - HTN, BPH |
| Alpha-1 Antagonists: Mainly used to treat ___. (MOA): ____ alpha-1 receptors in vasculature smooth muscle causing ___ and ___ smooth muscle ___. ____ peripheral vascular resistance and ___ arterial BP. Minimal change in C_, __ blood flow, G___. | BPH, Blocks, arterial, venous, relaxation. Decrease, lower. CO, renal, GFR. |
| Alpha-1 Antagonists (Side Effects): O__H__, p___, f___. ___ tachycardia, d___, nasal ___, i___, intraoperative floppy ___ syndrome (rare). | Orthostatic HTN, palpitations, fainting. Reflex, dizziness, congestion, IMPOTENCE, iris. |
| Alpha-1 Antagonists (Drug Interactions): N__, anti-h____, PDE-5 ____, Potent ___ of 3A4 (d___). Drugs that slow G__ transit (d___). | Nitrates, anti-Hypertensives, Inhibitors, Inhibitors (doxazosin), GI (doxazosin). |
| Alpha-1 Antagonists (Pearl): Useful in ___. 1st dose should be given in ___ office or at ___. First dose ____. Doses should be ___. Doxazosin: indicated for ___, caution if severe ___ narrowing, chronic ___, Rxs that ___ Gi transit. Risk IFIS during __ | BPH, MDs, Bedtime. Orthostasis. Titrated. BPH, GI, constipation, slow, cataract surgery. |
| Clonidine, Methyldopa, Guanfacine: - Type of Drugs - Class - Indication - Results in ___ heart rate, contractility and vasomotor tone. | - Alpha-2 Agonists - Anti-hypertensives - HTN, WITHDRAWAL SXS, ADHD - decreased |
| Alpha-2 Agonists (Side Effects): __ mouth, d___, l___, c___. R___ HTN if D/C abruptly. ___ before D/C. O__H___, ___toxicity (rare), hemolytic ___ (seen in ___). Drug Interactions: M___ | Dry, drowsiness, lethargy, constipation. Rebound. Taper. Orthostatic Hypotention, HEPATOtoxicity, anemia, (Methyldopa). Drug interactions with MAOI |
| Hydralazine* and Minoxidil: - Type of Drugs - Class - Indications* | - Vasodilators - Anti-hypertensives - HTN, CHF (hydralazine) |
| Vasodilators (MOA): Potent arteriolar smooth muscle ____. LIttle effect on ___ tone. | vasodilator. venous. |
| Vasodilators (Side Effects): ___ tachycardia, fluid ___, weight ___, e__. Managed with adding a ___ or ___. Headache and p___. Hydralazine: Systemic __ erythematosus-like syndrome. Minoxidil: Pericardial ___, cardiac ___, Hypertrichosis (hair growth) | Reflex, retention, gain, edema. BB, diuretic, palpitations. Lupus, Effusion, Tamponade. (rogaine) *drug interactions with other hypotensive agents. |
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mnc8
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