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59 Cards in this Set
- Front
- Back
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Behavioral changes to treat HTN should be used for ____ months before adding pharm agent
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3-6
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Antihypertensive drugs: Nonpharmacological therapy
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Sodium restriction
Weight reduction Exercise Stress reduction Elimination of risk factors Cholesterol Tobacco Alcohol |
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Loop diuretics
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Furosemide (Lasix)
Ethacrynic acid (Edecrin) |
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Diuretics: Potassium-sparing
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Amiloride (Midamor)
Spironolactone (Aldactone) Triamterene (Dyrenium) |
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Diuretics: MOA
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Produce a moderate but persistent decrease in extracellular fluid and plasma volume
Initial reduction in BP is due to reduced CO Later long-term BP reduction due to autoregulation which reduces TPR |
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Diuretics: Advantages
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Effective in large number of patients as mono- or combination therapy
Inexpensive Few side effects Good experience and knowledge base in medical community |
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Diuretics: Disadvantages
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Electrolyte imbalances can occur
Can elevate serum lipids Can produce metabolic alkalosis Carbohydrate metabolism can be impaired Hyperuricemia can occur or increase |
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Diuretics are effective first-line therapy in what pts?
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Effective first-line therapy in obese, elderly or black patients
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when is diuretic dose given?
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Dose patient once a day, early in the morning to decrease the incidence of nocturia
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Uses of diuretics other than BP
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Decrease intracranial pressure
Reduce intraocular pressure Reduce edema/pulmonary edema Treat congestive heart failure |
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Most common problems with diuretics
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Loss of electrolytes is usually the most common problem
Dizziness Cramps Nausea Postural hypotension Effects usually diminish after few days |
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What is spironolactone?
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Aldosterone antagonist
Weak progesterone |
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Bad effects of spironolactone?
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Hyperkalemia can occur due to reduced K excretion
Gynecomastia (may or may not be reversible) |
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Cautions with diuretics and renal, gout, and DM pts
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Thiazides reduce GFR - do not use in patients with decreased renal function
May precipitate gout by decreasing secretion of uric acid Use cautiously in diabetics - can produce hyperglycemia |
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Include triameterine and amiloride
Do not antagonize aldosterone Effective regardless of aldosterone status More reliable than spironolactone May produce hyperkalemia |
Potassium-sparing diuretics: Direct-acting agents
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Work at the loop of Henle
Urine volume is greater than with other agents May cause hyperuricemia Misuse can be life-threatening |
Loop diuretics
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CNS antihypertensive drugs
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Methyldopa (Aldomet)
Clonidine (Catapres) Guanabenz (Wytensin) Guanfacine (Tenex) |
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Mechanism of methyldopa
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Must be taken up into the neuron
Methyldopa is converted to methylNE and acts as false transmitter Stimulates central alpha-2 receptors to decrease SNS outflow |
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Methyldopa: Side effects
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Sexual dysfunction
Orthostatic hypotension Adverse effects on lipid profiles Somnolence is common especially during initial weeks of therapy Depression may be unmasked or exacerbated |
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Methyldopa: Drug interactions
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Haloperidol - dementia and sedation
Lithium - Lithium toxicity Levodopa - hypotension Propranolol - paradoxical hypertension Sympathomimetics - hypertension Tolbutamide - hypoglycemia |
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Clonidine mechanism
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Direct alpha-2 receptor agonist
(Can stimulate alpha-1 receptors in the periphery and elevate BP) |
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Clonidine: Side effects
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Dry mouth
Dizziness Sedation Constipation Orthostatic hypotension Sexual dysfunction Incidence of side effects lower with cutaneous patch Skin reactions with patch more frequent in women and patients with fair complexions Insomnia Depression Nervousness Agitation Restlessness Anxiety |
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Clonidine: Unlabeled uses
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Alcohol withdrawal
Methadone/opiate detoxification Smoking cessation Menopausal flushing |
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Clonidine: Drug interactions
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Beta blockers - increased severity of withdrawal syndrome
Tricyclic antidepressants - block hypotensive effects of clonidine |
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Actions similar to clondine
Duration of action may be longer Side effect incidence appears to be less than with clonidine Unlabeled uses include treatment of heroin withdrawal and migraine |
Guanfacine
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What is withdrawal syndrome related to stopping CNS acting BP drugs?
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Occurs after abrupt discontinuation of CNS acting antihypertensives
BP is elevated and may exceed pretreatment levels Anxiety, tremors, tachycardia and excessive SNS activity also observed Typically occurs 18-36 hrs following drug discontinuation May involve a central opioidergic component |
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Nonselective Beta blocking drugs
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Propranolol (Inderal)
Nadolol (Corgard) Timolol (Blocadren, Timoptic) Penbutolol (Levatol) |
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Beta-1 selective Beta blocking drugs
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Atenolol (Tenormin)
Acebutolol (Sectral) Metoprolol (Lopressor) Bisoprolol (Zebeta) Betaxolol (Kerlone) |
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ISA
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intrinsic sympathomimetic activity
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Non-selective + ISA Beta blocking drugs
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Pindolol (Viskin)
Carteolol (Cartrol) |
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Vasodilatory beta blocking drugs
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Celiprolol (Selecor)
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Beta blocking drugs: MOA
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Beta blockade - decreases CO
Adrenergic blocking action Taken up by presynaptic neuron Displaces NE Acts as ‘false transmitter’ Acts in CNS to reduce SNS outflow Inhibits renin release (MOST OF US THINK THIS INFO IS INCORRECT) |
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problems with propranolol
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Highly protein bound (= side effects)
Subject to first pass metabolism (compare to Nadolol Long half-life Not extensively protein bound) |
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Timolol can be used to treat what eye problem
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glaucoma
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Side effects of Excessive beta blockade
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Bradycardia
Hypotension Heart failure Pulmonary dysfunction |
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CNS effects of beta blocking drugs
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Depression
Nightmares Insomnia |
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Beta blockers and DM problem
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May mask signs of hypoglycemia in diabetics
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Mixed blocking agents
Combines alpha-1 and beta-1 blockade |
Labetolol (Normodyne, Transdate) and Carvedilol (Coreg)
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Nonselective beta blockade more of a problem with carvedilol than ________
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labetolol
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Alpha antagonists
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Prazosin (Minipress)
Terazosin (Hytrin) Doxazosin (Cardura) |
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Alpha blockers are good to treat what male precancerous condition?
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Useful in the treatment of benign prostatic hyperplasia (BPH)
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Sympatholytics
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Rauwolfia (Raudixin)
Reserpine (Serpasil, Serapase, Sandril) Guanethidine (Ismelin) Guanadrel (Hylorel) |
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Depletes NE from neuron by preventing storage of NE in granules
Inhibits amine transport system of granules |
Reserpine
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Adrenergic neuronal blockade due to:
Inhibition of action potential induced release of NE Inhibition of NE reuptake Displacement of NE |
Guanethidine
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Vasodilators (2)
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Hydralazine (Apresoline)
Minoxidil (Loniten) |
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Hydralazine:
Side effects related to extensions of pharmacological effect or immune system Tachycardia Fluid retention Headaches Flushing Hypotension AND WHAT ELSE? |
Lupus (at dosages >400 mg/day)
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Minoxidil side effects
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Fluid and water retention
Activation of reflexes Hypertrichosis |
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Angiotensin converting enzyme (ACE) inhibitors
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Captopril (Capoten)
Enalapril (Vasotec) Enalaprilat Lisinopril (Prinivil, Zestril) Quinapril (Accupril) Benazepril (Lotensin) Ramipril (Altace) Fosinopril (Monopril) Moexipril (Univasc) |
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ACE inhibitors: Side effects
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Hypotension (exacerbated by diuretics, low salt intake, high renin levels)
Cough Angioedema (rare, but can lead to death) Taste disturbances Avoid in patients taking potassium sparing diuretics - can produce hyperkalemia |
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AII antagonists
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Losartan (Cozaar)
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Side effects of AII antagonists
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diarrhea, dyspepsia, myalgia
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Calcium antagonists
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Verapamil (Calan, Isoptin)
Nifedipine (Procardia, Adalat) Diltiazem (Cardizem) Nimodipine (Nimotop) Nicardipine (Cardene) Isradipine (DynaCirc, Lomir, Prescal) Amlodipine (Norvasc) Felodipine (Plendil) Nisoldipine Nitrendipine Bepridil (Vascor) |
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CCB with greatest effect on cardiac conduction (dromotropic effect)
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Verapamil
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CCB with minimal side effects
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Diltiazem
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uses of CCB
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Angina
Hypertension Arrhythmias (verapamil) Raynaud’s disease Hypertrophic cardiomyopathy |
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Side effects of CCBs
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Cardiodepression
Hypotension Peripheral edema (unresponsive to diuretics) Constipation, dyspepsia, nausea Headache Facial flush, tingling, burning |
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Good effects of CCBs
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Do not alter blood lipids
Maintain or increase GFR Do not interfere with exercise May induce slight natriuresis |
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_____and _______shown to increase digoxin levels
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Verapamil and nifedipine
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What CCB should not be used with beta blocking drugs due to synergistic cardiodepression
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Verapamil
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