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38 Cards in this Set

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MOA of Diuretics
ACUTE EFFECT:
Diuretics ↑ Na+ and Water Excretion by the kidney --> ↓BV & ↓CO --> ↓BP

CHRONIC: CO returns to pretreament value, ↓PVR --> ↓BP**
Which diuretics ↓ serum K+ levels?
Loop Diuretics and Thiazide Diuretics
Spironolactone and Eplerenone are what types of drugs?
Aldosterone Receptor Blockers (K+ Sparing Diuretics)
Targets of: Thiazide, Loop and K+ Sparing Diuretics?
Thiazide: DCT

Loop: Loop of Henle

K+ Sparing: Collecting Duct
What is the first line tx for hypertension?
Thiazide Diuretics
MOA: NA+ Channel Blockers
(K+ Sparing Diuretics)
Blocking Na+ Channels in Collecting Tubule stops the efflux of K+ into the lumen (Sparing K+)
Which type of diuretic is Used for hypertension in patients who have reduced renal function, or for those with severe hypertension when drugs that retain Na+ are being used?
Loop Diuretics
"-olol" & NO BEAM
Non-Selective, Competitve β Antagonists - Reversible
"-olol" + BEAM
Selective, Competitive
β1 Antagonists -
Reversible
ACUTE AND POST MI (2 drugs)
Administer __ within the first 24 hours of an acute MI and continue indefinitely unless contraindicated.

Reduces mortality post-MI.
β Blocker or ACE INHIBITOR
Rebound hypertension upon withdrawal of tx.?
β Blockers and Clonidine
MOA: β BLOCKERS
Block β1's on the heart:
↓ heart rate
↓ contractility

Block β1's in the CNS:
↓ sympathetic discharge
=↓ blood pressure

Block β1's on the kidney:
↓ renin
↓ ang II
↓ aldosterone
= ↓ blood pressure
Which drug is bystolic? β1 selective at 10 mg or less
At >10 mg, or in those who are poor metabolizers, it becomes a non-selective β antagonist.

Works by stimulating endothelial NO activity.
Nebivolol
MOA of Ca++ Channel Blockers ? **Non-DHP**
BLOCK L-TYPE, VOLTAGE GATED CA2+ CHANNELS - important for contraction of both vascular smooth muscle and cardiac myocytes.
MOA of Ca++ Channel Blockers? **DHP**
Block L-type Ca2+ channels - important for contraction of just vascular smooth muscle.
Does not cause reflex tachycardia - the affect on the heart BLUNTS the reflex tachycardia generated by the changes in the PVR.
Verapimil (Ca++ Channel Blocker- Non-DHP)
What are the two Non-DHP Ca++ Channel Blockers covered in class?
Verapimil and Diltiazem
Side effect: Constipation
Particularly Verapimil
Absolutely contraindicated in pt's with Heart Failure
Ca++ Channel Blockers- Non-DHP
(Verapimil and Diltiazem)
These Ca++ Blockers particularly affect the heart and peripheral vasculature
Ca++ Blockers- Non-DHP
(Verapimil and Diltiazem)
"-dipine"
DHP Ca++ Channel Blockers
What drug is somewhat selective for cerebral arterioles, making it useful for the treatment of SUBARACHNOID HEMORRHAGES?
Nimodipine
(Ca++ Channel Blocker-DHP)
Which type of Ca++ Channel Blocker vasodilates ONLY peripheral vasculature?
Ca++ Channel Blocker-DHP
"-pril"
ACE INHIBITORS
MOA: ACE INHIBITORS?
**Inhibits the production of Ang II**

**Inhibits the breakdown of bradykinin*

Ang II vasocontricts and Bradykinin Vasodilates

↓ vasoconstrictor & ↑ vasodilator → dilation of arterioles → ↓ PVR
What drug class would you use for diabetic and non-diabetic nephropathy?
ACE INHIBITORS --> Prevent renal damage

They decrease extracellular matrix accumulation, the generation of reactive oxidation species, TGF-β production, and the hypertrophy of mesangial cells
Contraindicated in those with previous history of angioedema.

Absolutely contra-indicated in those with bilateral renal artery stenosis or renal artery stenosis in a sole kidney.

Absolutely contra-indicated in those who are pregnant or could become pregnant
ACE INHIBITORS
Explain why you should avoid ACE INHIBITORS in pt's with renal insufficiency
ACE INHIBITORS ↓↓↓ GFR

Pt's with renal insufficiency already have ↓ GFR ---> need Ang II to balance GFR
Name an adverse effect of an ACE INHIBITOR causing ↑ bradykinin levels
Angioedema/Cough
(Especially in Blacks)
Explain hyperkalemia with use of ACE INHIBITORS
Patients w/ renal insufficiency taking K+ Sparing diuretics can have a large volume of serum K+ because:

ACE I's ↓ Aldosterone levels (Aldosterone ↓K+)
"-artan"
Angiotensin II Receptor Blockers
(ARBs)
MOA: ARBs
AT1 receptor antagonists

Blocks the effects of Ang II:
-Smooth muscle contraction
-Increased sympathetic activity
-Aldosterone release

DOES NOT AFFECT BRADYKININ
You are considering putting a pt. with hypertension on an ACE INHIBITOR until you realize they have ANGIOEDEMA. What should you use instead?
Use an ARB

ARBs do not effect bradykinin (VD) levels so there will be no exacerbation of angioedema/cough
"-ren"
Renin INHIBITOR
Aliskren is what class of drug?
Renin INHIBITOR
MOA: Renin INHIBITOR
Inhibits the production of Ang I from renin

Similar effects to ACE I's and ARBs

NO EFFECT ON BRADYKININ
Would you use an ARB or Renin INHIBITOR on a pt. with bilateral renal artery stenosis and is pregnant?
NO!
MOA: Diuretics
Diuretics Increase Na+ and Water Excretion which lowers BV, PVR and eventually BP