Pharmacology - Anti-Hypertensive Drugs

Front 1

What are the effects on K and Ca of Thiazide Diuretics?

Back 1

K Wasting
Ca Sparing

Front 2

What is the use of Thiazide's in treating HTN

Back 2

Diuresis reduces BP (leter there is a PG mediated mechanism), commonly used in combination with BB's, ARB's, ACEi's

Front 3

What are the side effects of Thiazide diuretics?

Back 3

Hypokalemia
Hyponatremia
Hypercalcemia
Increased LDL/HDL levels

Front 4

What drugs contraindicate thiazides?

Back 4

NSAIDS, B-Blockers in diabetics, Digoxin, Quinidine, Anticoagulants

Front 5

What things contraindicate loop diuretics?

Back 5

NSAIDS, Digoxin, Quinidine, Steroids, Anticoagulants, Aminoglycosides

Front 6

What are the K+ sparing diuretics used in HTN?

Back 6

Spironolactone and Eplerenone

Front 7

What is the MOA of Ca-channel blockers in treating HTN

Back 7

Blocking Ca influx causes vasodilation and thus reduces BP.

Front 8

What is the primary effect of Nifedipine?

Back 8

Most selective to blood vessels, it causes vasodilation (N ot the heart one)

Front 9

What are the contraindications of Ca-channel blockers?

Back 9

Liver failure (can't then be metabolized)
Hear failure (decreased venous return further reduced CO)

Front 10

What are the side effects of Nifedipine?

Back 10

Reflex tachycardia
Edema
Headache

Front 11

What is the use of Diltiazem in HTN

Back 11

Same as Nifedipine, I suppose you could use it but its really more for HF (D middle of the road)

Front 12

When would you not want to use and Ca-channel blockers in HTN?

Back 12

MI patients (you could give them a heart attack), heart failure, liver failure

Front 13

What is the MOA of Clonidine in HTN?

Back 13

It is an A2 agonist and can override B stimulation. It will cause peripheral vasoconstriction on administration followed by central vasodilation to reduce BP

Front 14

What is the indication of Clonidine?

Back 14

Sympathetic mediated HTN

Front 15

What are the side effects of Clonidine?

Back 15

Sedation, Dry Mouth, withdrawal reflex HTN

Front 16

What is Methyldopa? What is it's use in treating HTN?

Back 16

It is an A2 agonist like Clonidine.

It the drug of choice to treat HTN in pregnancy

Front 17

What is Reserpine? What is it's use in treating HTN?

Back 17

It is a VMAT blocker (reduces NT release). It is only used in conjugation with other anti-hypertensives.

Front 18

What is Phentolamine? What is it's use in treating HTN?

Back 18

It is a non-selective A antagonist. It is used to treat the HTN associated with Pheochromocytoma.

Front 19

What are the side effects of Phentolamine?

Back 19

Orthostatic hypotension
Reflex tachycardia

Front 20

What is Prazosin? What is it's use in HTN?

Back 20

It is a selective A1 antagonist. It reduces vasoconstriction mediated by norepenephrine binding

Front 21

What are the two primarily non-selective B-Blockers used in treating HTN

Back 21

Propranolol
Nadolol

Front 22

What are contraindications to Propanolol and Nadolol?

Back 22

Asthema, CHF

Front 23

What is an advantage of Nadolol over Propranolol?

Back 23

Nadolol has twice as long of a half life allowing for once daily dosing. It is also hydrophilic so it doesn't have CNS effects

Front 24

What is Pindolol, what makes it unique from the other drugs in its class?

Back 24

It is a partial B agonist. This means it only has an effect at elevated levels of sympathetic stimulation

Front 25

What is the MOA of B-Blockers in treating HTN?

Back 25

Reduced renin release, also reduces HR and contractility.

Front 26

What is the advantage of metoprolol and atenolol over other B-Blockers in treating HTN?

Back 26

Reduced side effects due to their selectivity for B1 receptors

Front 27

What are the two B/A blocker drugs used in HTN?

Back 27

Labetolol and Carvedilol

Front 28

What are the indications for Labetolol?

Back 28

HTN
HTN in Pheochromocytoma

Front 29

What are the indications for Carvedilol?

Back 29

HTN
Post MI threapy
Chronic Heart Failure

Front 30

What are the contraindications for B/A-Blockers

Back 30

Bradycardia, heart block, cardiogenic shock, heart failure, asthma, diabetes

Front 31

What are the 3 pure vasodilators used to treat HTN?

Back 31

Hydralazine, Minoxidil, Nitroprusside (emergent cases)

Front 32

What are some of the side effects for the vasodilators?

Back 32

Tachycardia, Angina aggrevation (may cause coronary steal), nausea, vomiting, lupus like symptoms.

Don't give nitroprusside orally because it becomes cyanide!

Front 33

What are the 3 ACE Inhibitors used in the treatment of HTN?

Back 33

Captopril, Enalapril, Lisinopril

Front 34

What is the MOA of ACE inhibitors?

Back 34

Inhibition of angiotensin converting enzyme prevents ATI from becoming ATII and going to the adrenals to release Aldosterone and to the vascular endothelium to cause vasoconstritcion.

P.S. If you don't know by now you should quit med school.

Front 35

What are some of the advantages of ACE inhibitors ?

Back 35

Reduces post MI mortality and reduces remodeling of the heart in CHF and in MI

Front 36

What is a major contraindication of ACE inhibitors?

Back 36

Pregnancy

Front 37

What are the side effects of ACE inhibitors?

Back 37

Hyperkalemia
Dry Cough (increased bradykinin, a vasodilator)

Front 38

Rank the 3 ACE inhibitors in order of shortest to longest half life.

Back 38

Captopril (3-4/day), Enalapril (2/day), Lisinopril (1/day)

Front 39

What is the angiotensin receptor blocker used in HTN?

Back 39

Losartan, best used in combination with a diuretic.

Front 40

What would be your first line drug of choice in a hypertensive African American?

Back 40

Diuretics, studies show that ACEi's, B-Blockers, and ARB's don't work as well.