Hypertension Systolic Dysfunction Drugs

Front 1

test

Back 1

test

Front 2

test 1

Back 2

test 2

Front 3

Diuretics
Thiazide - moa

Back 3

Inhibit Na/Cl transporter at distal tubules

Front 4

Diuretics
Thiazide - indication

Back 4

Most effect to reduce BP
-only use in CrCl>30 ml/min
-good for AA (resistance to BB and ACEi)

Front 5

Diuretics
Thiazide - precaution

Back 5

-HypoK
-Gout (increase Uric acid)
-HyperCa (big concern CKD)

Front 6

Diuretics
Thiazide -CI

Back 6

-Sulfa allergy
-ClCr < 30 ml/min

Front 7

Diuretics
Thiazide - ADRs

Back 7

-HypoK, Mg
-Hyper (Ca, glycemia, lipid, uricemia)
-Sexual dysfunction

Front 8

Diuretics
Thiazide - dose
Hydrochlorothiazide (HydroDiuril)

Back 8

12.5-50 mg (50) POQD

Front 9

Diuretics
LOOP - moa

Back 9

Block Na/K/Cl co-transporter in loop henle.

Front 10

Diuretics
LOOP - indication

Back 10

Pt with poor renal function (Cl<30 ml.min) and fluid overload

Front 11

Diuretics
LOOP - precaution

Back 11

HypoK
HypoCa

Front 12

Diuretics
LOOP - ADR

Back 12

-Hypo (K, Mg, Ca)
-Hyper: (glycemia, lipid, uricemia)
-Sexual dysfunction.
-Ototoxicity

Front 13

Diuretics
LOOP Furosemide (Lasix)
dose
Bumetanide (Bumex)
Torsemide (Demadex)

Back 13

20-40 mg BID (160 ex fluid; 80 HTN)

Front 14

Diuretics: K-sparing
moa

Back 14

Inhibit Na channel in distal tubule and collecting duct.

Front 15

Diuretics: K-sparing
indication

Back 15

-Weak anti-HTN
-Good for hypoK with thiazide/loop. (K<4)

Front 16

Diuretics:
K-sparing - ADR

Back 16

Hyper K

Front 17

Diuretics:
K-sparing: name brand/generic
Amiloride
Triamterence

Back 17

(Midamor)
(Dyrenium)

Front 18

Diuretics:
Aldosterone Ant - moa

Back 18

Competitively block aldosterone at receptor site.

Front 19

Diuretics:
Aldosterone Ant - indication

Back 19

-Decent diuretic
-reduce morbidity and mortality (stage III and IV HF) and Post MI w. LVD

Front 20

Diuretics:
Aldosterone Ant - CI

Back 20

-Eplerenone
men: Cr >2.0 mg/dl
women: Cr>1.8
-Type II DM w proteinuria.

-Spironolactone:
Men: Cr> 2.5 mg/dl
Women: Cr> 2.0

Front 21

Diuretics:
Aldosterone Ant - ADRs

Back 21

-Hyper K
-Gynecomastia (spironolactone)
-HyperTG (epleronone)

Front 22

Diuretics:
Aldosterone Ant: dose
Eplerenone (Inspra)
Spironolactone (Aldactone)

Back 22

50 mg QD-BID (100)

25-50 mg QD-BID (100)

Front 23

Beta blocker - moa

Back 23

Antagonize β1 receptor on the heart.
(decrease HR decrease contractivity decrease in CO decrease BP)

-antagonize β receptors in the kidney
(decrease rennin RAAS and decrease Na and water retention.

Front 24

Beta blocker- indication

Back 24

First line for compelling indication
-Post MI
-Acute Coronary syndromes
-High coronary artery disease risk
-HF

Front 25

Beta blocker - precaution

Back 25

-Asthma
-COPD
-Diabetes
-Peripheral artery disease

*** Agents AVOID in Hepatic Failure
1. Metoprolol
2. Propanolol
Renal failure:
1. Atenolol
2. Nadolol
Most lipophillic (CNS: cross BBB. Use for GI disorder and sclerosis)
1. Propanolol
Least lipophilic
1. Atenolol

Good for HF:
-metoprolol (ER), bisoprolol, carvedilol.

Front 26

Beta blocker - CI

Back 26

Cardiogenic Shock (BP<90/50 or Hypotension)
-Decompensated Heart Failure (class IV heart failure)
-2nd and 3rd degree AV block.

Severe (Asthma and COPD)

Front 27

Beta blocker - ADR

Back 27

-Brady cardia (HR<50 bpm)
-2nd and 3rd degree AV block.
-Worsening class IV HF
-Hypotension (BP<90/50)

CNS:
Dizziness (all BB)
Depression and fatigue (propranolol: lipophilic agent)

Endocrine: may increase cholesterol and glucose (rare)

Front 28

Beta blocker name and dose:
CARDIO SELECTIVE
Atenolol

Bisoprolol
Metoprolol
Metoprolol ER

NON-selective
Propranolol
Propranolol LA

ISA (intrinsic sympathomimetic activity) DO NOT USE!!!

Back 28

cardio selective
(Tenormin) dose 25-100 mg QD (100)
(Zebeta)
2.5-10 mg QD (10)
(Lopressor)
25-100 BID (200)
(Lopressor)
25-100 BID (200)
(Toprol XL) 50-200 QD (200)
non-selective
(Inderal) 40-160 mg BID (320)
(long acting) (Inderal LA, InnoPran XL)
80-160 QD (160)

Front 29

ACEI - moa

Back 29

Inhibit the conversion of angiotensin I to angiotension II (potent vasoconstrictor)
-inhibit the breakdown of bradykinin and stimulate synthesis of PgE2 and prostacyclin (potent vasodilation)

Front 30

ACEI - indication

Back 30

Thiazide is first line (for non-compelling),
ACEs: second line to diuretics in most HTN pt.

Good for compelling indication:
DM
HF
CKD
Stable CAD
Post MI
Stroke (prevention)

Front 31

ACEI - precaution

Back 31

Renal Insufficiency
(except fosinopril and ramipril)

Front 32

ACEI - CI

Back 32

Bilateral renal artery stenosis
-pregnancy
-HO angioedema
-HO allergic rxn bee sting
-HyperK

Front 33

ACEI - ADRs

Back 33

-HyperK (due to reduce of aldosterone secretion)
-Dry Cough (due to bradykinin)
-Angioedema (most in smoker and AA)
-Increase SCr: (Due to decrease GFR)
(continue : SCr is rise <35% from baseline or < 1 mg/dL) Consider use of fosinopril or ramipril
Rare: neutropenia, and agranulocytosis.
DDI*****
Increase K
1. K supplements
2. K-sparing
3. Aldosterone ant
4. ARBs
NSAID (nephrotoxicity)
Lithium (increase lithium)

Front 34

ACEI - name: dose
Benazepril
Captopril
Enalapril
Fosinopril
Lisinopril
Ramipril

Back 34

(lotensin)
10-40 mg QD-BID (40)
capoten) sulfa allergy
6.25-50 mg BID-TID (450)
(Vasotec)
2.5-40 mg QD-BID (40)
(Monopril)
10-40 mg QD (40)
(Prinivil, Zestril)
10-40 mg QD (40)
(Altace) (best to reduce morbidity and mortality due to CHD.)
2.5-10 mg QD-BID (20)

Front 35

ARBs - moa

Back 35

Directly block the angiotensin II type 1 receptor.
-Leaves angiotensin II free to agonize type 2 receptor (beneficial effects)

Front 36

ARBs - indication

Back 36

Use for pt intolerance to ACEIs (dry cough)
-Lowest incidence of side effects compare to other Anti-HTN agents.

Good for:
Type 2 DM with nephropathy (better than ACEs)
HF
HTN (equal to ACEs)
Post MI (equal to Aces)

Front 37

ARBs - precaution

Back 37

-angioedema (real life)

Front 38

ARBs - CI

Back 38

-Pregnancy
-HyperK
-Bilateral renal artery Stenosis
-angioedema.(exam only)

Front 39

ARBs - ADRs

Back 39

-HyperK
-Angioedema
-Renal Insufficiency
-Orthostatic Hypotension

DDIs: same ACEs
Increase K
1. K supplements
2. K-sparing
3. Aldosterone ant
4. ARBs
NSAID (nephrotoxicity)
Lithium (increase lithium)

Front 40

ARBs - name: dose
Candesartan
Irbesartan
Losartan
Valsartan

Back 40

(Afacand)
4-32 mg QD-BID (32)
(Avapro)
150-300 QD (300)
(Cozaar)
25-100 QD-BID (100)
(Diovan)
80-320 mg QD (320)

Front 41

Hydrochlorothiazide

Back 41

(HydroDiuril)

12.5-50 mg (50) POQD

diuretics

Front 42

Furosemide

Back 42

(Lasix)

20-40 mg BID (160 ex fluid; 80 HTN)

Loops

Front 43

Amiloride (dose not need know)

Back 43

(Midamor)

K-sparing

Front 44

Triamterene (dose not need know)

Back 44

(Dyrenium)

K-sparing

Front 45

Eplerenone

Back 45

(Inspra)
50 mg QD-BID (100)
Aldosterone ant.

Front 46

Spironolactone

Back 46

(Aldactone)
25-50 mg QD-BID (100)
Aldosterone ant.

Front 47

Atenolol

Back 47

Tenormin

25-100 mg QD (100)

BB cardioselective

Front 48

Bisoprolol

Back 48

Zebeta

2.5-10 mg QD (10)

BB cardioselective

Front 49

Metoprolol

Back 49

Lopressor

25-100 BID (200)

BB cardioselective

Front 50

Metoprolol ER

Back 50

Toprol XL

50-200 QD (200)

BB cardioselective

Front 51

Propranolol

Back 51

Inderal

40-160 mg BID (320)

BB nonselective

Front 52

Propranolol (long acting)

Back 52

(Inderal LA, InnoPran XL)

80-160 QD (160)

BB nonselective

Front 53

Benazepril

Back 53

lotensin

10-40 mg QD-BID (40)

ACEI

Front 54

Captopril

Back 54

(capoten) sulfa allergy

6.25-50 mg BID-TID (450)

ACEI

Front 55

Enalapril

Back 55

Vasotec

2.5-40 mg QD-BID (40)

ACEI

Front 56

Fosinopril

Back 56

Monopril

10-40 mg QD (40)

ACEI

Front 57

Lisinopril

Back 57

(Prinivil, Zestril)

10-40 mg QD (40)

ACEI

Front 58

Ramipril

Back 58

(Altace) (best to reduce morbidity and mortality due to CHD.)

2.5-10 mg QD-BID (20)

Front 59

Candesartan

Back 59

Afacand

4-32 mg QD-BID (32)

ARBs

Front 60

Irbesartan

Back 60

Avapro

150-300 QD (300)

ARBs

Front 61

Losartan

Back 61

Cozaar

25-100 QD-BID (100)

ARBs

Front 62

Valsartan

Back 62

Diovan

80-320 mg QD (320)

ARBs

Front 63

DHP-CCB - moa

Back 63

Block L-type calcium channels
-inhibit the Ca across cell membrane

-leads to coronary and peripheral vasodilation

Front 64

DHP-CCB - indication

Back 64

-Used as first line agents
-effective anti-HTN (esp in AA pop)
-Use in certain compelling indications in addition to or in replacement of, other medications. (in high coronary artery disease risk, and diabetes)
-DHP: very effective in older pt with isolated systolic HTN ( ISH) (use as add-on therapy to thiazide diuretic)

Front 65

DHP-CCB - precaution

Back 65

DHP: may cause reflex tachycardia.
HF except for amlodipine
***Not to be used as monotherapy in CKD (causing increase proteinurea)

Front 66

DHP-CCB - CI

Back 66

hypersensitivity

Front 67

DHP-CCB - ADRs

Back 67

Dizziness
Flushing
Hypotension (reflect tachycardia)
Headache
Peripheral edema.
Gingival hyperplasia
GI complaints: (not much)
Increase HR. (do not use immediate release nifedipine)

DDI:***
1. grapefruit juice (CYP 3A4 inh) may increase nifedipine

Front 68

Amlodipine

Back 68

(Norvasc) (Can use amlodipine in HF pts.)

dhp-ccb

Front 69

Felodipine

Back 69

(Plendil)
5-20 mg QD(20)

dhp-ccb

Front 70

Nifedipine long-acting

Back 70

Adalat CC, Procardia XL)
30-90 mg QD (180)

dhp-ccb

Front 71

DHP-CCB - moa

Back 71

Block L-type calcium channels
-inhibit the Ca across cell membrane

-leads to coronary and peripheral vasodilation

Front 72

DHP-CCB - indication

Back 72

-Used as first line agents
-effective anti-HTN (esp in AA pop)
-Use in certain compelling indications in addition to or in replacement of, other medications. (in high coronary artery disease risk, and diabetes)
-DHP: very effective in older pt with isolated systolic HTN ( ISH) (use as add-on therapy to thiazide diuretic)

Front 73

DHP-CCB - precaution

Back 73

DHP: may cause reflex tachycardia.
HF except for amlodipine
***Not to be used as monotherapy in CKD (causing increase proteinurea

Front 74

DHP-CCB - CI

Back 74

hypersensitivity

Front 75

DHP-CCB - ADRs

Back 75

Dizziness
Flushing
Hypotension (reflect tachycardia)
Headache
Peripheral edema.
Gingival hyperplasia
GI complaints: (not much)
Increase HR. (do not use immediate release nifedipine)

DDI:***
1. grapefruit juice (CYP 3A4 inh) may increase nifedipine

Front 76

Amlodipine

Back 76

Norvasc (can use amlodipine in HF pts.)

25-100mg QD(10)

dhp-ccb

Front 77

Felodipine

Back 77

Plendil

5-20 mg QD(20)

dhp-ccb

Front 78

Nifedipine

Back 78

long-acting (Adalat CC, Procardia XL)

30-90 mg QD (180)

Front 79

NDHP-CCB - moa

Back 79

Block L-type calcium channels
-inhibit the Ca across cell membrane

-leads to decrease contractility of myocardium (negative inotropy)

Front 80

NDHP-CCB - CI

Back 80

Bradycardia (HR<60 bpm)
Heart failure (all class of HF)
2nd and 3rd degree in atrioventricular block.

Front 81

NDHP-CCB - ADRs

Back 81

-Bradycardia
-AV block
-Heart failure exacerbation
-GI (Anorexia, nausea,
-constipation *more with Verapamil.
-Hypotension *** diltiazem: more headache.

-Peripheral edema (NOT COMMON)

DDI***
1. Verapamil and diltiazem (less) are CYP 3A4 inhibitors
Increase-cyclosporine, digoxin, lovastatin, simvastatin.
2. Combi with BB: pronounced bradycardia. (NEVER START NDHP + BB at the same time)