www.pharmteacher.com Antihypertensives, ADRs, MOA, concepts
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| Adverse effects of ACE inhibitors include… | hyperkalemia, dry cough, rash, angioedema
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| Adverse effects of alpha1 blockers include… | orthostatic hypotension, syncope, drowsiness, nasal congestion
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| Adverse effects of ARBs include… | hyperkalemia; they are less likely to cause dry cough, rash, angioedema but still can rarely
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| Adverse effects of cardioselective beta blockers include… | bradycardia, AV block, fatigue, sexual impairment, acute heart failure, masking signs/symptoms of hypoglycemia
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| Adverse effects of carvedilol include… | same side effects as cardioselective B1 blockers PLUS nonselective B1, B2 blockers PLUS A1 blockers
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| Adverse effects of loop diuretics include… | dehydration, hypokalemia, hyponatremia, orthostatic hypotension
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| Adverse effects of nonselective B1, B2 blockers include… | all the adverse effects of cardioselective B1 blockers PLUS bronchoconstriction, prolonged hypoglycemia, worsening of peripheral vascular disease
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| Adverse effects of spironolactone include… | hyperkalemia, gynecomastia
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| Adverse effects of the “pine” CCBs include… | peripheral edema (blood pools in lower legs), constipation, flushing, headache, gingival enlargement, sometimes reflex tachycardia.
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| Adverse effects of thiazide diuretics include… | dehydration, hypokalemia, hyponatremia, orthostatic hypotension
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| Adverse effects of verapamil and diltiazem include… | peripheral edema, constipation, flushing, headache, gingival enlargement, bradycardia, AV block, acute HF, fatigue
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| Antihypertensive is available in patch form… | clonidine
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| Cardioselective B1 blockers are safer than nonselective B1, B2 blockers in patients with a history of… | asthma, COPD, PVD, and diabetes
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| How are verapamil and diltiazem different from the “pine” CCBs? | Verapamil and diltiazem are vasodilators like “pine” CCBs plus they reduce HR and force of contraction (negative inotropes).
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| List some drugs that INCREASE BP | corticosteroids, NSAIDs, hormonal contraceptives, nicotine, oral decongestants, amphetamine, anabolic steroids, etc
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| List some foods high in potassium… | fruits (bananas, tomatoes, apples) and other foods
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| List the bradykinin related adverse effects associated with ACE inhibitors | cough, rash, angioedema
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| The main therapeutic use of carvedilol is… | CHF
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| The most powerful type of diuretic at fluid removal is… | loop diuretics
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| Therapeutic uses of ACE inhibitors include… | HTN, CHF, slow progression of renal disease in diabetics (same uses as ARBs)
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| Therapeutic uses of ARBs include… | HTN, CHF, slow progression of renal disease in diabetics (same uses as ACE inhibitors)
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| Therapeutic uses of beta blockers include… | HTN, chronic angina, post MI, CHF, atrial fibrillation, tachycardia, glaucoma
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| Therapeutic uses of diltiazem and verapamil include… | HTN, angina, tachycardia, and atrial fibrillation.
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| Therapeutic uses of loop diuretics include… | moderate/severe edema including edema of the lungs, CHF related edema, and edema/HTN in patients with severely impaired kidney function
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| Therapeutic uses of spironolactone include… | CHF, post MI, prevent hypokalemia from other diuretics, reduce portal vein hypertension
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| Therapeutic uses of the “pine” CCBs include… | HTN and angina.
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| Therapeutic uses of thiazide diuretics include… | HTN, mild/moderate edema
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| This class of antihypertensives can treat symptoms of BPH… | alpha1 blockers
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| What can happen if beta blockers are stopped suddenly after chronic use? | Withdrawal symptoms including rebound HTN, tachycardia, angina, MI, and death.
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| What does “ACE inhibitor” stand for… | Angiotensin converting enzyme inhibitor. ACE is an enzyme that converts angiotensin1 to its more active form, angiotensin2.
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| What does the renin angiotensin aldosterone system (RAAS) normally do… | in response to low BP, low blood volume, or dehydration, the kidney releases more renin. Renin converts angiotensinogen into angiotensin1. ACE converts ang1 to ang2. Ang2 causes vasoconstriction and fluid retention thus increasing BP.
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| What is aldosterone? | Part of the RAAS. Aldosterone causes the kidneys to retain sodium and fluid and to waste potassium
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| What is bradykinin? | Bradykinin an inflammatory mediator. Like many inflammatory mediators, it causes vasodilation. It is released in the lungs in response to inhaled irritants and results in increased cough reflex.
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| What is the goal BP for most adults? | <140/90
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| What is the goal BP for patients with angina, diabetes, past MI, or CHF? | <130/80
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| What is the mechanism of action of the “pine” CCBs? | They dilate blood vessels by blocking calcium entrance to the smooth muscle surrounding the blood vessels. Less calcium within the muscle cells, relaxes the muscle.
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| What is the mechanism of action of the loop diuretics? | Loop diuretics block sodium and fluid reabsorption in the loop of Henle.
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| What is the mechanism of action of the thiazide diuretics? | Thiazide diuretics block sodium and fluid reabsorption in the distal convoluted tubule PLUS they have vasodilator properties.
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| Why are many of the adverse effects of verapamil and diltiazem similar to those of the beta blockers? | The CCBs, verapamil and diltiazem, have “beta blocker like” effects on the heart.
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| Why do beta blockers TREAT chronic HF, but they can CAUSE acute HF in some patients? | B1 blockers are negative inotropes; they weaken cardiac muscle thus can sometimes induce acute HF. However, because they relax the heart and prevent overstimulation, they “protect” the heart from the body’s harmful compensatory mechanisms.
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| Why do thiazides work better for HTN even though they are weaker diuretics than the loops? | Thiazides are also vasodilators; loops are not.
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