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56 Cards in this Set
- Front
- Back
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Name the thiazide diuretics
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Hydrochlorothiazide (HCTZ)
Chlorthalidone Metolazone Indapamide |
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What are the side effects of Thiazide Diuretics?
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low potassium
low magnesium low sodium hyperglycemia gout dehydration (hypovolemia) rash (b/c of sulfur) |
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Which diuretics are the most potent for producing urine?
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1. Loop diuretics
2. Thiazide diuretics 3. K+ sparing diuretics |
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What is the mechanism of action for thiazide diuretics?
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inhibits Na+ absorption at the distal tubule
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What is the mechanism of action for loop diuretics?
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inhibit Na+/Cl- absorption at ascending loop of henle
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What is the mechanism of action for K+ sparing diuretics?
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inhibit K+ exchange at distal renal tubules
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What category of diuretic do aldosterone antagonists fit into?
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K+ sparing diuretics
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What are the aldosterone antagonists?
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spirolactone
eplerenone |
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Name the K+ sparing diuretics
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Spironolactone
Eplerenone Triamterene Amiloride |
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What are the side effects of spironolactone?
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Hyperkalemia
Gynecomastia (happens in 10% of men because the androgen receptors are blocked) |
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What are the side effects of eplernone?
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hyperkalemia
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What are the side effects of Triamterene and Amiloride?
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hyperkalemia
rash |
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Why are aldosterone antagonists used over other K+ sparing diuretics?
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because they prevent the progression of systolic heart failure, left ventricular dysfunction and decrease atherosclerosis
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What is the good standard loop diuretic for HTN?
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Furosemide (lasix)
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What are the side effects of loop diuretics?
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low potassium
low magnesium low sodium hyperglycemia gout dehydration (hypovolemia) rash |
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Which loop diuretic does not have sulfur in it?
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Ethacrynic Acid
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Name the loop diuretics
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furosemide
bumetanide torsemide ethacrynic acid |
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What type of diuretic do you use for systolic heart failure?
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Loop diuretics
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What should you use to treat HTN in pts with renal dysfunction (creatinine <30)?
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USE loops
they work better than thiazides |
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Which thiazide diuretic is the most potent?
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Metolazone... it is most commonly used in conjunction with other drugs
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What actions do ACE Inhibitors block?
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They block the reactions of Angiotensin Converting Enzyme a.k.a. Kininase II
- block the break down of bradykinin to inactive peptides |
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What do bradykinins do when they binds to the bradykinin II receptor?
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Nitric Oxide
Vasodilation |
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What are the effects of Angiotensin II?
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Increase vasoconstriction
Increase aldosterone Increase vasopressin Increase Sympathetics |
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Name the ACE Inhibitors
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Captopril
Enalapril Lisinopril Ramipril Benazepril Fosinopril Moexipril Perindopril Quinapril Trandolapril |
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What is Ramipril used for?
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- treat HTN and improve suvival
- decrease vascular events - improve survival in atherosclerosis - good in Heart Failure ... it is a twice a day drug |
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When is captopril used?
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captopril is the shortest acting of the ACE inhibitors... good for in hospital use
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When is enalapril used?
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- great for vaculopathies that are secondary to diabetes
- good for LV dysfxn - give once a day to tx HTN - give twice a day to tx HF - the only ACEI available in IV formulation |
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When is lisinopril used?
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- a once a day ACEI (70% peak/trought ratio)
- good for LV dysfunction - use to tx HTN to prevent vascular complications |
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if it ends in -sartan,
then it is a ... |
ARB
Angiotensin Receptor Blocker |
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Characteristics of ARBs
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- All are once a day drugs
- Downsides of these drugs… expensive - Prevent vascular complications with DM - Good for HTN - ACE inhibitor without the cough |
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What are the classes of drugs that deal with the RAS system and HTN?
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ACE Inhibitors
ARBs Renin Inhibitors |
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Aliskiren
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- Renin Inhibitor
- binds to renin and blocks conversion of Angiotensinogen to Angiotensin I - Primary indication is HTN |
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Adverse Reactions
for ACEI, ARB, Renin Inhibitors |
- Hyperkalemia
- ↑ serum creatinine/AcuteRenalFailure - Cough (ACEI only) - Angioedema |
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What causes the cough associated with ACEI?
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prevention of the breakdown of bradykinins
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What are the contraindications for
ACEI, ARB, Renin Inhibitors? |
- Bilateral Renal Artery (b/c you need to maintain adequate filtration)
- Stenosis - Pregnancy - Angioedema to other ACEIs Hyperkalemia (K+>5meq/L) |
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Adverse Reactions
for ACEI, ARB, Renin Inhibitors |
- Hyperkalemia
- ↑ serum creatinine/AcuteRenalFailure - Cough (ACEI only) - Angioedema |
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What causes the cough associated with ACEI?
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prevention of the breakdown of bradykinins
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What are the contraindications for
ACEI, ARB, Renin Inhibitors? |
- Bilateral Renal Artery (b/c you need to maintain adequate filtration)
- Stenosis - Pregnancy - Angioedema to other ACEIs Hyperkalemia (K+>5meq/L) |
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What are the side effects of Beta Blockers?
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drowsiness
lethargy confusion bronchoreactive events AV nodal blockade/bradycardia may mask signs of hypoglycemia (the tachycardia and weakness, not the sweating) |
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Which Beta blockers have low lipid solubility?
Moderate? High? |
Low?
- atenolol Moderate? - metoprolol, labetalol, carvediol High? - propranolol (the more lipid soluble, the more CNS effects) |
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Name the beta blockers that are also alpha-1 receptor blockers.
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Labetalol
carvedilol |
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What are contraindications for Beta blockers?
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- Symptomatic Bradycardia/Hypotension
- Decompensated HF (b/c sympathetics are keeping the CO going, the beta receptor activity is responsible for the contractility) - Use with caution: asthma, diabetes |
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Which calcium channel blockers decrease AV node conduction and contractility with minimal effects on the SVR?
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Verapamil
Diltiazem |
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Which calcium channel blockers decrease the SVR?
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Nifedipine, Nicardipine, Isadipine, Nisoldipine, Felodipine, Amlodipine
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What are the compelling indications for use of dihydropyridine?
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angina
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What are the compelling indications for use of nondihydropyridine?
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angina
Afib w/ Rapid Ventricular Response |
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What are the contraindications for use of dihydropyridine?
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Hypertensive Emergency
Acute MI |
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What are the contraindications for use of nondihydropyridine?
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bradycardia
systolic heart failure |
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Name the Alpha-1 Receptor Blockers
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-azosin
Terazosin Doxazosin Prazosin |
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When do you use Alpha-1 Receptor Blockers?
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in males who are already on HTN meds who have benign prostatic hypertrophy
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What are the adverse effects of alpha-1 receptor blockers?
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1st dose syncope
dizziness lethargy |
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Should the alpha-1 receptor blockers be used as monotherapy?
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increase in cardiovascular events when used as monotherapy
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Alpha-2 receptor agonist
Action |
Decrease SNS outflow .: lower BP
Decrease catecholamine release |
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Alpha-2 receptor agonist
Side Effects |
Drowsiness, sedation, dry mouth
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Alpha-2 receptor agonist
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- Clonidine, methyldopa
- Use with diuretic - Available as transdermal preparation. - Used as add-on therapy |
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Name the Vasodilators
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- Hydralazine and Minoxidil
- Use with diuretic and beta-blocker to counteract compensatory changes - potent... but poor compliance... minoxidil can cause hair growth and Na retension |
