Integrated Science-Antihypertensives

Front 1

Hydrochlorothiazide -HCTZ (Hydrodiuril)
Chlorthalidone (Hygroton)
Metalazone (Zaroxolyn)

What is the therapeutic use of these drugs?
Class?
MOA?
How do they effect BP?
AE?
CI?

Back 1

Hydrochlorothiazide -HCTZ (Hydrodiuril)
Chlorthalidone (Hygroton)
Metalazone (Zaroxolyn)

They are diuretics used to treat mild to moderate hypertension. Antihypertensives

Class: Thiazide diuretics

MOA: Inhibit reabsoprtion of Na+ and water in the DCT

Effect: decreased blood volume thereby decreasing BP. Also used in management of CHF & edema (slow onset, weak diuretic effect)

AE: fluid and electrolyte imbalance, hypotension, hypokalemia, hyponatremia, hypomagnesemia, hypercalemia, orthostatic hypotension, frequent urination, increased blood lipids, glucose, and cholesterol

CI: severe renal impairment, sensitivity (allergy) to sulfonamide antibiotics, liver disease

Front 2

Furosemide (Lasix)

What a common therapeutic use of this drug?
Class?
Effect on cardiovascular system?
MOA?
AE?
CI?

AE?
CI?

Back 2

Furosemide (Lasix)

Diuretics used to treat hypertension. Antihypertensives. Other uses as diuretic

Class: Loop diuretic

CV effects: Management of BP, edema (from heart failure) * most potent diuretic

MOA: Inhibits Na+ reabsorption in the ascending loop, increase Ca++ excretion

AE: *ototoxcity*, Decreased fluid, electrolytes (hypokalemia, hyponatremia, hypomagnesemia), and CO.Hypotension, dizziness, hypersensitivity, allergy

CI: Anuria, poor renal function

Front 3

Name the K+ sparing diuretics?

Back 3

Triamterene (Dyrenium)
Triamterene w/ HCTZ (Maxzide, Dyazide)
Spironolactone (Aldactone)

Front 4

Triamterene (Dyrenium)
Therapeutic cardiac use?
Class?
MOA?
AE?
CI?

Back 4

Triamterene (Dyrenium)

Antihypertensive. Diuretic used to decrease BP, prevents loss of K+ in tubular fluid, decrease edema

Class: K+ sparing diuretic

MOA: Inhibits exchange of Na+ and K+ in DCT

AE: Hyperkalemia, arrhythmias, fluid loss, electrolyte inbalance, nephrotoxic, headache, N/V/D

CI: Sensitivity to triamterene, use of other K+ sparing diuretics, Hyperkalemia, anuria, liver disease

Front 5

Triamterene w/ HCTZ (Maxzide, Dyazide)

Therapeutic cardiac use?
Class?
MOA?
AE?
CI?

Back 5

Triamterene w/ HCTZ (Maxzide, Dyazide)

Used to treat HTN and edema for pts at risk for hypokalemia

Class: K+ sparing diuretic

MOA: Inhibits exchange of Na+ and K+ in DCT

AE:Hyperkalemia, arrhythmias, fluid loss, electrolyte inbalance, nephrotoxic, headache, N/V/D

CI: Sensitivity to triamterene, use of other K+ sparing diuretics, Hyperkalemia, anuria, liver disease

AE:

Front 6

Spironolactone (Aldactone)

Therapeutic cardiac use?
Class?
MOA?
AE?
CI?

Back 6

Spironolactone (Aldactone)

Used to treat HTN, edema when avoiding/treating hyopkalemia

Class: K+ sparing diuretic

MOA: Inhibits binding of aldosterone preventing Na+/K+ exchange (aldosterone antagonist, sympathetic steroid)

AE: Gynomastia (enlarged breast tissue) Hyperkalemia, arrhythmias, fluid loss, electrolyte inbalance, nephrotoxic, headache, N/V/D

CI: use of other K+ sparing diuretics, Hyperkalemia, anuria, liver disease

Front 7

Beta blockers -olol drugs

Propanolol (Inderal)
Nadolol (Corgard)
Atenolol (Tenormin)
Metoprololol (Lopressor)
Esmeolol (Brevibloc)
Carvedilol (Coreg)
Labetalol (Normodyne)
Sotalol (Betapace)

Which ones are nonselective?( 2)
β1 selective? (3)
β1, β2 select & α1 antagonists? (2)
Which is β1, β2 & works as a antidysrhythmic? Which class?

Back 7

Nonselective
Propanolol & Nadolol

β1 selective:
Atenolol, Metoprololol, Esmeolol

Which is β1, β2 & antidysrhythmic
Sotalol (Betapace) Class III antidysrhythmic

Front 8

Nadolol (Corgard)
Atenolol (Tenormin)
Metoprololol (Lopressor)
Esmeolol (Brevibloc)
Carvedilol (Coreg)
Labetalol (Normodyne)
Sotalol (Betapace)

AE for all Beta blockers?
CI?
What is an AE of stimulation of β2?

Back 8

AE: Weakness, Diarrhea, Sexual dysfunction, bradycardia, arrhythmia, heart failure

Always monitor HR, BP

CI: Severe bradycardia, airway diseases (asthma, COPD), uncompensated cardiac failure

Stimulation of β2 causes bronchodilation

Front 9

Name ACE inhibitors? (4)
What do they end in?
What are they used for?
MOA?
Most common AE?

Back 9

Captopril (Capoten)
Ramipril (Altace)
Enalapril (Vasotec)
Lisinopril (Prinivil)

All end in -pril

Used as 1st line antihypertensives

MOA: block conversion of angiotensin 1 to angiotensin 2 (potent vasoconstrictor)-->decrease vasoldilation, reducing resistance & lowering BP. Also decrease release of aldosterone-->decreasing reabsorption of Na+ (& H2O) which lowers blood volume & BP

AE: *cough*; can also cause fatigue, hyperkalemia & hypotension

Front 10

What are 2 Non-dihydropyridine Calcium channel blockers?
When are they indicated?

MOA?

AE & Considerations?

CI?

Back 10

Verapamil (Calan)
Diltiazem (Cardizem)

Indicated as 1st line antihypertensive when pt has arrhythmia. Also used with angina.
Multiple sites of action thus multiple effects on hemodynamics: decrease CO and BP, decrease rate and force of cardiac contraction
*decrease workload of the heart

MOA: 1. Prevents Ca++ influx into vascular smooth muscle 2. Dilates peripheral and cardiac vessels
3. Prevents Ca++ influx into cardiac tissue, decreasing cardiac excitability

AE: 1. constipation, dizziness, headache, nausea, hypotension, ventricular arrhythmias, muscle cramps
2. monitor BP, alcohol intake, liver and renal function, EKG, hypotension, educate pt on constipation prevention and rise slowly OOB; Significant 1st pass effect, eliminated by kidneys & liver

CI: heart block, hypotension, CHF, cardiogenic shock, use cautiously in pts with imparied liver function and renal disease

Front 11

Name the dihydropyridine Calcium Channel blockers? (3)

Why use these over the non-diphyros?
AE for all?
AE specific to nefedipine (Procardia)?
CI?

Back 11

Nifedipine (Procardia)
Amlodipine (Norvasc)
Amlodipine/Atorvasatin (Caduet)

Used bc they have selective vasodilating effects, are more useful in tx angina, HTN

AE all: dizziness, headache, muscle cramps

AE nefedipine (Procardia): same as others + flushed skin, peripheral edema
CI: severe hypotension, caution in pts with renal or liver impairment

Front 12

Terazosin (Hytrin)
Doxazosin (Cardura)
* note -sin ending
Class?
Indication?
MOA?
AE/Considerations?

Back 12

Terazosin (Hytrin)
Doxazosin (Cardura)

Class: α1 antagonists

Indication: Antihypertensive; Decrease peripheral resistance and produce vasodilation, used for benign prostatic hypertrophy (increase urinary flow)

MOA: Blocks epinephrine and NE at α1 receptors on vascular smooth muscle , decrease vasoconstriction

AE & considerations: First-dose syncope, dizziness, lightheadedness, headache, hypotension, somnolence—monitor BP, assist ambulation, educate about dizziness
Extensive metabolism in liver, excretion via GI tract in feces-use cautiously in pts with renal or hepatic impairment

Front 13

Clonidine (Catapres)
Methyldopa (Aldomet)

Class?
Indication/therapeutic use?
AE?
When do you often see methyldopa used?

Back 13

Clonidine (Catapres)
Methyldopa (Aldomet)

Class: Centrally acting α2 agents
Indication: HTN; Stimulate central α2 receptors which decrease sympathetic flow (inhibit release of NE from synaptic terminals) 2. Decrease vasoconstriction, CO, renin, aldosterone, and catecholamine release

MOA: stimulates central a2 receptors, decreasing SNS action, decreasing vasodilation

AE: Dry mouth, drowsiness, dizziness, sedation, constipation, somnolence, rebound HTN --monitor BP before/after, bowel habits, drug history (MAO), CNS depressant

Methlydopa frequently used in pregnany, esp pg asthmatics bc pg category B and doesn't cause bronchodilation, but CI w/MAOi use

Front 14

Nitroprusside (Nipreside)
Hydralazine (Apresoline)
Isosorbide dinitrate/Hydralazine (BiDil)

Therapeutic use?
Class?
MOA?
Which is associated w cynaide toxicity & systemic lupus erthymematosus?

Which is commonly used w b blockers and/or diuretics to counteract reflex activity?
?

How are all metabolized/excreted

Back 14

Antihypertensives
Class: Direct acting vasodilators

MOA: Directly relaxes vascular smooth muscle, decrease peripheral resistance, decreasing BP

Nitroprusside (Nipreside) is associated w cynaide toxicity & systemic lupus erthymematosus

Hydralazine Used in conjunction with beta blocker and/or diuretic to counteract reflex activity

Nitroprusside releases NO, relaxing arterioles & venuoles, increasing vasodilation and increasing plasma renin activity.

Metabolized by liver, excreted by kidneys

Front 15

Losartan (Cozaar)
Valsartan (Diovan)
Candesartan (Atacand)
Irbesartan (Avapro)
Olmesartan (Benicar)

Note all end in -stan

Class?
Indication?
MOA?
CI/Considerations?

Back 15

Class: ARBs-Angiotensin II blocking agents

Indication: Antihypertensive.

MOA: Pro-drug
1. selectively blocks angiotensin II binding to angiotensin II receptors in smooth muscle and adrenal medulla
2. Decreased vasoconstriction
3. Prevent effects of aldosterone

CI/Considerations:Hypersensitivity to drug, Pregnancy category C & D, bilateral renal artery stenosis—monitor BP, serum K+ levels, rise slowly OOB. Expensive, not 1st line antihypertensive.



AE: Hypotension, diarrhea, dizziness, upper respiratory infection, hyperkalemia