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56 Cards in this Set

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Name the thiazide diuretics
Hydrochlorothiazide (HCTZ)
Chlorthalidone
Metolazone
Indapamide
What are the side effects of Thiazide Diuretics?
low potassium
low magnesium
low sodium
hyperglycemia
gout
dehydration (hypovolemia)
rash (b/c of sulfur)
Which diuretics are the most potent for producing urine?
1. Loop diuretics
2. Thiazide diuretics
3. K+ sparing diuretics
What is the mechanism of action for thiazide diuretics?
inhibits Na+ absorption at the distal tubule
What is the mechanism of action for loop diuretics?
inhibit Na+/Cl- absorption at ascending loop of henle
What is the mechanism of action for K+ sparing diuretics?
inhibit K+ exchange at distal renal tubules
What category of diuretic do aldosterone antagonists fit into?
K+ sparing diuretics
What are the aldosterone antagonists?
spirolactone
eplerenone
Name the K+ sparing diuretics
Spironolactone
Eplerenone
Triamterene
Amiloride
What are the side effects of spironolactone?
Hyperkalemia
Gynecomastia (happens in 10% of men because the androgen receptors are blocked)
What are the side effects of eplernone?
hyperkalemia
What are the side effects of Triamterene and Amiloride?
hyperkalemia
rash
Why are aldosterone antagonists used over other K+ sparing diuretics?
because they prevent the progression of systolic heart failure, left ventricular dysfunction and decrease atherosclerosis
What is the good standard loop diuretic for HTN?
Furosemide (lasix)
What are the side effects of loop diuretics?
low potassium
low magnesium
low sodium
hyperglycemia
gout
dehydration (hypovolemia)
rash
Which loop diuretic does not have sulfur in it?
Ethacrynic Acid
Name the loop diuretics
furosemide
bumetanide
torsemide
ethacrynic acid
What type of diuretic do you use for systolic heart failure?
Loop diuretics
What should you use to treat HTN in pts with renal dysfunction (creatinine <30)?
USE loops
they work better than thiazides
Which thiazide diuretic is the most potent?
Metolazone... it is most commonly used in conjunction with other drugs
What actions do ACE Inhibitors block?
They block the reactions of Angiotensin Converting Enzyme a.k.a. Kininase II

- block the break down of bradykinin to inactive peptides
What do bradykinins do when they binds to the bradykinin II receptor?
Nitric Oxide
Vasodilation
What are the effects of Angiotensin II?
Increase vasoconstriction
Increase aldosterone
Increase vasopressin
Increase Sympathetics
Name the ACE Inhibitors
Captopril
Enalapril
Lisinopril
Ramipril
Benazepril
Fosinopril
Moexipril
Perindopril
Quinapril
Trandolapril
What is Ramipril used for?
- treat HTN and improve suvival
- decrease vascular events
- improve survival in atherosclerosis
- good in Heart Failure

... it is a twice a day drug
When is captopril used?
captopril is the shortest acting of the ACE inhibitors... good for in hospital use
When is enalapril used?
- 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
When is lisinopril used?
- a once a day ACEI (70% peak/trought ratio)

- good for LV dysfunction

- use to tx HTN to prevent vascular complications
if it ends in -sartan,
then it is a ...
ARB
Angiotensin Receptor Blocker
Characteristics of ARBs
- All are once a day drugs
- Downsides of these drugs… expensive
- Prevent vascular complications with DM
- Good for HTN
- ACE inhibitor without the cough
What are the classes of drugs that deal with the RAS system and HTN?
ACE Inhibitors
ARBs
Renin Inhibitors
Aliskiren
- Renin Inhibitor
- binds to renin and blocks conversion of Angiotensinogen to Angiotensin I
- Primary indication is HTN
Adverse Reactions
for
ACEI, ARB, Renin Inhibitors
- Hyperkalemia
- ↑ serum creatinine/AcuteRenalFailure
- Cough (ACEI only)
- Angioedema
What causes the cough associated with ACEI?
prevention of the breakdown of bradykinins
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)
Adverse Reactions
for
ACEI, ARB, Renin Inhibitors
- Hyperkalemia
- ↑ serum creatinine/AcuteRenalFailure
- Cough (ACEI only)
- Angioedema
What causes the cough associated with ACEI?
prevention of the breakdown of bradykinins
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)
What are the side effects of Beta Blockers?
drowsiness
lethargy
confusion
bronchoreactive events
AV nodal blockade/bradycardia
may mask signs of hypoglycemia (the tachycardia and weakness, not the sweating)
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)
Name the beta blockers that are also alpha-1 receptor blockers.
Labetalol
carvedilol
What are contraindications for Beta blockers?
- 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
Which calcium channel blockers decrease AV node conduction and contractility with minimal effects on the SVR?
Verapamil
Diltiazem
Which calcium channel blockers decrease the SVR?
Nifedipine, Nicardipine, Isadipine, Nisoldipine, Felodipine, Amlodipine
What are the compelling indications for use of dihydropyridine?
angina
What are the compelling indications for use of nondihydropyridine?
angina
Afib w/ Rapid Ventricular Response
What are the contraindications for use of dihydropyridine?
Hypertensive Emergency
Acute MI
What are the contraindications for use of nondihydropyridine?
bradycardia
systolic heart failure
Name the Alpha-1 Receptor Blockers
-azosin
Terazosin
Doxazosin
Prazosin
When do you use Alpha-1 Receptor Blockers?
in males who are already on HTN meds who have benign prostatic hypertrophy
What are the adverse effects of alpha-1 receptor blockers?
1st dose syncope
dizziness
lethargy
Should the alpha-1 receptor blockers be used as monotherapy?
increase in cardiovascular events when used as monotherapy
Alpha-2 receptor agonist
Action
Decrease SNS outflow .: lower BP
Decrease catecholamine release
Alpha-2 receptor agonist
Side Effects
Drowsiness, sedation, dry mouth
Alpha-2 receptor agonist
- Clonidine, methyldopa
- Use with diuretic
- Available as transdermal preparation.
- Used as add-on therapy
Name the Vasodilators
- 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