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57 Cards in this Set
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-Used in management of MILD to SEVERE HTN in Pts
with a wide variety of Traits and Concomitant Diseases. Particularly useful in treating patients with coexisting: -Chronic Renal Dz -DM -Heart Failure -MI |
(ACEI)
Angiotensin-converting enzyme inhibitors Particularly useful in treating patients with coexisting: 4ct |
Particularly useful in treating patients with coexisting:
-Chronic Renal Dz -DM -Heart Failure -MI |
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What drugs are (ACEI)
angiotensin-converting enzyme inhibitors (2ct) |
Enalapril
lisinopril |
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Name the Specific Rx
-Used in diabetic patients who exhibit early signs of renal impairment to reduce progression of renal failure. |
Enalapril
What Class is it? |
ACEI
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Treatment of
heart failure or the related indication of postinfarction LV dysfunction use __________? specific Rx. |
Lisinopril
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~ acute renal failure
~ angioedema ~ cough ~ Fetal / Neonatal: Injury & Death ~ hyperkalemia ~ loss of taste ~ neutropenia ~ rash are adverse effects of what class? |
ACE inhibitors
S/E ARE: (8ct) |
~ acute renal failure
~ angioedema ~ cough ~ Fetal / Neonatal: Injury & Death ~ hyperkalemia ~ loss of taste ~ neutropenia ~ rash |
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What antihypertensives are contraindicated in pregnant women?
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ACEI
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As effective as ACE inhibitors but only rarely cause the dry cough that occurs w/ ACE inhibitors
Less likely assoc W/ skin rashes or angioedema Some have been shown to increase insulin sensitivity |
Arbs
Can increase what type of sensitivity |
Can increase Insulin Sensitivity
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This Class of Rx may cause:
Hyperkalemia Neutropenia & Elevated serum levels of Hepatic aminotransferase enzymes |
ARBS
ARIIBS This Class of Rx may cause: 3ct |
-Hyperkalemia -Neutropenia -Elevated Hepatic aminotransferase enzymes |
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This Drug:
-Increase sodium and water excretion -Decreases blood volume Over weeks to months -Decrease PVR -Appear to offer protection against osteoporosis by decreasing the urinary excretion of calcium |
Thiazide diuretics:
(hydrochlorothiazide) Appear to offer protection against: ? |
osteoporosis
by decreasing the urinary excretion of calcium |
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Adverse:
hypo K+ hypo Mg2+ hypo Na+ hyper Ca2+ hyperglycemia hyper LDL hyper uric acid hyper triglycerides; .... Blood cell deficiencies .......... erectile dysfunction .....................................rash |
Thiazide diuretics:
(hydrochlorothiazide) Adverse S/E: 11ct |
hypo K+
hypo Mg2+ hypo Na+ hyper Ca2+ hyperglycemia hyper LDL hyper uric acid hyper triglycerides; .... Blood cell deficiencies .......... erectile dysfunction .....................................rash |
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-Effective in patients with impaired kidney function
-Including serum creatinine level > 2.3 mg/dl HOWEVER: -Less effective than Thiazide diuretics in the Tx of HTN Pts with normal renal function. |
Loop Diuretics:
(furosemide) |
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Adverse:
They may lead to volume depletion more readily than the thiazides and have a short duration of action Same adverse effects as thiazides but higher risk of excessive diuresis and electrolyte imbalance Increases calcium excretion. |
Loop Diuretics:
(furosemide) Adverse S/E: ? |
Same adverse effects as thiazides
but higher risk of : ~Excessive diuresis and ~Electrolyte imbalance ~Increases calcium excretion. |
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-Exert a mild natriuretic and antihypertensive effect
-Reduce renal potassium excretion and thereby prevent HYPOKALEMIA ADVERSE S/E:: -Hyperkalemia -Gynecomastia -Metabolic Acidosis |
Potassium-sparing diuretics:
ARAs Name them 2ct What are the Adverse S/E 3ct |
Spironolactone
Triamterene Adverse S/E: -Hyperkalemia -Gynecomastia. -Metabolic Acidosis |
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Hydrochlorothiazide
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Thiazide diuretic
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Furosemide is a (type of Rx)
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Loop Diuretic
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Spironolactone
triamterene |
Potassium-sparing diuretics =
ARAs (aldosterone receptor antagonists) Name the ARAs |
-Spironolactone
-Triamterene (suffix) ......NEs |
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Propranolol
atenolol metoprolol |
Beta-blockers
Which ones are selective & non-selective |
Propanolol
is non-selective, atenolol & metoprolol are selective |
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-Safe and effective in most patients
-Particularly useful in patients who suffer from angina or -Particularly useful in Pts who have Hx of MI -Cardioprotective Only Rarely Cause/Produce : -Orthostatic hypotension -Hepatic toxicity -Hematopoietic toxicity -Renal toxicity |
Beta-blockers
Name them? 3ct Their Rare S/E are: (4ct) |
atenolol
metoprolol propranolol Rare S/E: -Orthostatic hypotension -Hepatic toxicity -Hematopoietic toxicity -Renal toxicity |
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This Rx Class Inhibits Renin Secretion
(from renal juxtaglomerular cells which in turn reduces the formation of angiotensin II and Subsequent release of aldosterone) The drugs also appear to reduce sympathetic outflow from the CNS. |
Beta-blockers
Name Them? 3ct |
propranolol
atenolol metoprolol (Carvedolol) |
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Usually not used in asthmatic patients because they can induce bronchoconstriction by blocking the bronchodilation effect of circulating epinephrine.
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Beta-blockers
(representative drugs:?) can induce bronchoconstriction by |
atenolol
metoprolol propranolol Blocks the bronchodilation effect of circulating epinephrine. Therefore causing Bronchorestriction. |
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Less lipophilic than propranolol and usually causes fewer CNS side effects.
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Atenolol
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Adverse S/ E are: (Rx Class)
-Nasal Congestion -Raynaud's -CNS symptoms of: = Confusion = Decrease HDL = Depression = Excitement = Fatigue = Impotence = Lethargy = Nightmares = Triglycerides Incr (Increased Plasma TriGs) |
Beta-blockers
What is the Suffix for BB? Adverse S/E are:? 3ct +9 sub-ct |
Olols
-Nasal Congestion -Raynaud's -CNS symptoms of: = Confusion = Decrease HDL = Depression = Excitement = Fatigue = Impotence = Lethargy = Nightmares = Triglycerides Incr (Increased Plasma TriGs) |
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A direct renin inhibitor
( DRI ) recently approved for use as monotherapy or combination therapy for hypertension. |
Aliskiren
What Class? How does it work-What cascade does it inhibit? |
Direct Renin Inhibitor,
Decreases plasma renin activity .... inhibiting conversion of Angiotensinogen to Angiotensin I. |
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Aliskiren
Inhibits what? |
Renin inhibitor
Direct or Indirect |
Direct
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-Reduce PVR Periphrial Vascular Resistance
with little change in CO or blood volume -Inhibit the renin-angio-system -Useful in treating patients w -Chronic Renal Dz -DM -Heart Failure -MI Shown to: -Increase CO -Increase Pt survival w heart failure. |
(ACEI)
name them? Name the Dz that it amiliorates? 4ct |
~Enalapril
~Lisinopril -Chronic Renal Dz -DM -Heart Failure -MI |
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-Used in ""DM Pts"" who
-exhibit early signs of renal impairment -to reduce progression of renal failure - If treatment with __?Rx?__ is withdrawn - progression of neuropathy resumes quickly. |
Enalapril
Used in what Pts? |
-Used in ""DM Pts"" who
-exhibit early signs of renal impairment -to reduce progression of renal failure - If treatment with __?Rx?__ is withdrawn - progression of neuropathy resumes quickly. |
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What Rx/Class (inhibitor) is recommended for
treatment of: heart failure or postinfarction LV dysfunction. (Brenner 105 Table 10-6) |
Lisinopril
ACEI |
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Blocks aldosterone through the R-A-A-S
(Renin-Angio-II-Aldo System) |
Arbs
Representative Rx? What is the suffix:? |
Losartan
Valsartan suffix = tan |
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Unlike ACE inhibitors
these drugs are less likely assoc W/ skin rashes or Angioedema Less risk of Dry Cough -Have been shown to increase insulin sensitivity. |
(arbs)
Angiotensin II receptor blockers What is the suffix Name the Rx 2ct |
Valsartan
Losartan |
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Produced a greater reduction in:
-left ventricular hypertrophy -risk of stroke -new onset diabetes than did ATENOLOL. |
Losartan
Is what drug class? |
ARIIBs
ARBs |
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What Rx Class May cause :
-hyperkalemia -neutropenia & elevated serum levels of -hepatic aminotransferase enzymes |
ARIIBs
ARBs Name the Rxs |
losartan
valsartan |
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This drug has reemerged in the Tx of:
HTN particularly in resistant Pts & is a helpful addition to most other antihypertensive Rx Effective at lowering B/P in all HTN Pts regardless of renin level. |
Spironolactone
What Rx Class? (not an ARB {Angiotensin II Receptor Blocker}) |
an ARA
(Aldosterone Receptor Antagonists ) |
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Plays a central role in target organ damage
including the development of -organ damage -renal fibrosis -ventricular hypertrophy -vascular hypertrophy Counteracting/Treating this internal chemical ameliorates health to some extent independently of effects on B/P. |
Aldosterone
Causes what conditions: ? 4ct info + |
-organ damage
-renal fibrosis -ventricular hypertrophy -vascular hypertrophy Ameliorate + to make or become better, more bearable, or more satisfactory; improve; meliorate. |
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Vasodilators used to Tx
-Angina -Arrhythmias -HTN -Peripheral vascular disorders -Most widely recommended drugs for the initial Tx of high B/P -Are often combined w/ diuretics or -Angiotensin system inhibitors. |
Calcium-channel blockers
Vasodilators used to Tx 4ct 1-INFO |
-Angina
-Arrhythmias -HTN -Peripheral vascular disorders -Most widely recommended drugs for the initial Tx of high B/P |
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Effective as
-A SINGLE DRUG THERAPY .... in approx 60% of Pts in all demographic groups & ALL GRADES of HTN Protect against: -Coronary Heart Dz -Renal Dz -Stroke |
Calcium-Channel-Blockers
CCBs Protect against: ? 3ct |
-Coronary Heart Dz
-Renal Dz -Stroke |
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Particularly useful in treating HTN Pts who have
Asthma or are Negroid |
Calcium-channel blockers
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Which type of calcium channel blockers can
Slow down the heart rate and cardiac output? Which calcium channel blockers do not? |
Non-dihydropyridine CCBS
(decrease Rate \ Output) Dihydropyridine CCBS (DO-NOT slo-dwn or (-) C/O ) |
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This class of drugs Adverse Effects are:
dizziness edema flushing frequency urinary GI disturbances H/A (sxs of) Vasodilation causing palpitations peripheral edema. |
Dihydropyridines:
Name them 2ct: (H+: DiHydros S/E list starts w-D Non-DiHydros start with A ) Adverse Effects are: 8ct |
Nifedipine
Amlodipine dizziness edema flushing frequency urinary GI disturbances H/A (sxs of) Vasodilation causing palpitations peripheral edema. |
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This Rx-Class S/E are:
(list Rx 2ct) AV Block Bradycardia CHF Dizziness Edema Frequency-Urinary GI disturbances H/A |
Non Dihydropyridines:
diltiazem & verapamil This particular Rx__________- also causes constipation in elderly What are the Adverse S/E: A-H |
AV Block
Bradycardia CHF Dizziness Edema Frequency-Urinary GI disturbances H/A -Verapermil |
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Inhibits sympathetic stimulation of arteriolar contraction
leading to vasodilation and decreased vascular resistance Is not preferred for initial tx in most hypertension pts. What class of receptor? and Agonist or antagonist? |
Alpha1-Antagonist
Name it? 1ct |
Prazosin
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-May evoke reflex activation of sympathetic N.S.
therefore causing increases in: -heart rate increase -contractile force increase -circulating norepinephrine increase -Does not protect the heart against V-Arrhythmias -Not used in pts with ischemic heart disease What class of Rx is it? |
Alpha1-blocker
(Representative Rx?) -Does not protect the heart against: ? -Not used in pts with: ? |
prazosin
-heart rate increase -contractile force increase -circulating norepinephrine increase -(does not protect the heart against): V-Arrhythmias -(not used in pts with): Ischemic Heart Disease |
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Activates the rennin-angiotensin-aldosterone system resulting in increased fluid retention
(give w/ diuretic) can cause orthostatic hypotension Class & Rx |
Alpha1-blockers
prazosin |
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Syncope in some pts
Syncope Can be prevented by beginning tx with a low dose of __(Rx class)__ at bedtime & withholding the diuretic for 1 day |
The first dose phenomenon that can be seen with
alpha1-blockers Name the Rx ? & what Class Rx is withheld? |
Prazosin
Diuretics are with held for 24 hrs. |
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Centrally Acting Sympatholytic drugs.
CAS |
Methyldopa and clonidine
what kind of Rx are they? |
Centrally Acting Sympatholytic drugs.
CAS Centrally Acting Sympathetic N.S. Lysing drug |
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Adverse Rx effects include
-Autoimmune hemolytic anemia -dry mouth -fatigue -hepatitis -lupus like syndrome -rebound HTN -sedation What particular Rx? |
Methyldopa
Adverse Rx effects include 7ct |
-Autoimmune hemolytic anemia
-dry mouth -fatigue -hepatitis -lupus like syndrome -rebound HTN -sedation |
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Single Rx Name...
Adverse effects include : dry mouth fatigue rebound hypertension sedation |
Clonidine
Adverse effects include :? 4ct |
dry mouth
fatigue rebound hypertension sedation |
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Name 2 direct vasodilators
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Hydralazine and minoxidil
What is their effect on the body? |
Direct Vasodilators
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Reasons why Thiazide diuretics and beta-blockers have historically been the usual first choice drugs for patients who need pharmacologic therapy for hypertension. (2)
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-Can be combined with other htn drugs
Thiazides are -safe & -inexpensive. |
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Because it appears that
ACE inhibitors and ARBs - in the absence of concomitant diuretics - are less effective in blacks than in whites, initial therapy should generally be a diuretic or a diuretic combination: (another way of stating it from class): it appears that ACEI and ARBS (w/o a Diuretic) in the absence of concomitant Diuretics—are less effective in blacks than in whites initial therapy for Blacks should therefore generally be? 3ct |
a Diuretic
or a Diuretic Combo plus a CCB Additional verification info H+ |
http://www.health.am/hypertension/more/treatment-of-diabetic-hypertensive-patients/
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Because this Rx Class' beneficial effects in
diabetic nephropathy it should be part of the INITIAL-treatment-regimen. (Not a CCB) |
ARBs
(ARIIBs) (Renin-angiotensin II inhibitors) Rx Class' beneficial effects in |
diabetic nephropathy
it should be part of the INITIAL-treatment-regimen. |
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Most DIABETICS
require combinations of three to five agents to achieve target blood pressure usually including what ~3 drug classes? |
~ARBs
~CCBs ~Diuretics Pts w/ __(Dz)__ require combinations of three to five agents to achieve target blood pressure? |
DM
(Most DIABETICS) |
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Patients Dx w this can benefit from
ACEs ARAs BBs Diuretics ARAs (Aldo Receptor Antagonists) |
Heart failure
What are the 4ct class of Rx-s |
ACEs
ARAs BBs Diuretics |
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Patients diagnosed with post-what, can benefit from
ACEs Aldo Receptor Antagonists (ARAs) BBs |
Post MI
What are the Rx classes & Specific Rx? |
ACEs
~Enalipril ~Lisinopril Aldo Receptor Antagonists (ARAs) ~Spironolactone ~Triamterene aka (K sparing Diuretic) BBs ~Carvedilol ~Metoprolol XL |
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Patients diagnosed with this can benefit from
BB CCB |
Angina
What are the Rxs that Pts can benifit from when they have Angina? |
-BB
-CCB |
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Patients diagnosed with _______ can benefit from
~ACEs ~ARBs ~BBs ~CCBs ~Diuretics |
DM
DM pts can benefit from: |
~ACEs ~ARBs ~BBs ~CCBs ~Diuretics |
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Patients diagnosed with this non-cardiac Dz can benefit from
ACEs & ARBs |
Chronic Renal Dz
Patients diagnosed with -Chronic Renal Dz can benefit from |
- ACEs
- ARBs |
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What group of patients can benefit from ccbs and diuretics?
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Black patients
can benefit from what Rx(s) |
-ccbs
-diuretics |
