Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
52 Cards in this Set
- Front
- Back
|
Hydrochlorothiazide (HYDRODIURIL)
|
Tabs: 25, 50, 100 mg
Caps: 12.5 mg (Brand name: MICROZIDE) Decreases Na+, K+ , Mg2+ ; Increases Ca2+ |
|
|
as “Thiazide-Like” diuretics
|
√ Indapamide (LOZOL),
√ Chlorthalidone (HYGROTON) longest acting 24hrs and =potent 90% of the time used √ Metolazone (ZAROXOLYN) ADD ON DIURETIC |
|
|
Triamterene & Hydrochlorothiazide (DYAZIDE)
|
Potassium sparing plus potassium wasting diuretic
Caps: 37.5 mg – 25 mg |
|
|
Furosemide (LASIX)
|
Tabs: 20, 40, 80 mg
Solution: 10 mg/ml; Inj. Loop Diuretics Decreases Na+, K+, Mg2+, Ca2+ Contrast Loop diuretics with thiazides Compliance with Potassium Rx |
|
|
LASIX 40mg = BUMEX ?mg
LASIX 40mg = DEMADEX ?mg how many X more powerful |
BUMEX 1mg 40x
DEMADEX 20 mg 2x Loop Diuretics Bumex (Bumetanide) |
|
|
Ethacrynic Acid (EDECRIN)
|
Rarely used loop diuretic
Non-Sulfonamide Tabs: 25 & 50 mg, IV WORST for Potential for fluid imbalance and ototoxicity. |
|
|
Amiloride (MIDAMOR)
|
Potassium Sparing DIURETIC
|
|
|
Triamterene (DYRENIUM)
|
Potassium Sparing DIURETIC
|
|
|
spironolactone (ALDACTONE):
|
Aldosterone antagonists
Potassium Sparing DIURETIC Aldosterone is a Keytone - all end in -tone. cheap generic - can cause gynomastitis |
|
|
Eplerenone (INSPRA)
|
Aldosterone antagonists
Potassium Sparing DIURETIC no generic. alda |
|
|
Spironolactone (ALDACTONE)
|
DIURETICS-K + sparing
Tabs: 25, 50, 100 mg used as an add-on to increase diuretic but save the K+ HTN dose (Example: 25 mg BID) Cirrhosis dose (Example: 50 mg TID) high because you are trying to get the fluid (ascites) out of the body by combining with a loop diuretic. Combination with HCTZ: ALDACTAZIDE |
|
|
Eplerenone (INSPRA)
|
DIURETICS-K + sparing
Tabs: 25 and 50 mg BID Indication: Post MI, CHF, HTN Advantage: Less risk of gynecomastia expensive and limited usage |
|
|
Beta-ADRENOCEPTOR–BLOCKING AGENTS ending in - .....
|
ending in - olol
first-line drug therapy for HTN Reduce BP primarily by decreasing cardiac output Decrease sympathetic outflow from the CNS and inhibit the release of renin from the kidneys: decreases formation of A-II and the secretion of aldosterone. Calms you down but makes you too carefree. loss of intensity due to fat soluble B blockers that go into the brain |
|
|
Propranolol (INDERAL)
|
Beta-ADRENOCEPTOR–BLOCKING AGENTS both B-1 & B-2 receptors (NON-SELECTIVE)
FAT SOLUABLE Tabs: 10, 20, 40, 60, 80 mg Sustained release Caps: 60, 80,120, 160 mg Generic solution: 4 mg/ml, 8 mg/ml, 40 mg/ml; Injection: 1 mg/ml Use: HTN, Tx of MI, Angina, Migraine prophylaxis, Essential tremor, Akathisia (restlessness) Bronchospasm warning (non-selective: blocks B-2 receptors in lungs) Membrane stabilizing effect. May mask hypoglycemia symptoms. |
|
|
Metoprolol (LOPRESSOR)
What is the Formulary? |
Selective B-1 blockers most commonly prescribed.
NOT lipophilic THE FORMULARY IS TOPROL-XL: long acting formulation – Q 24 H dosing Tabs: 25, 50, 100, 200 mg (Can be broken in half) |
|
|
Compare Propranolol (INDERAL) to other NON selective beta blockers:
|
Nadolol (CORGARD): Long-acting, renally eliminated if poor liver function cant use propranol
Pindolol (VISKEN) – has “ISA” intrinsic sympathomimetic activity |
|
|
Atenolol (TENORMIN)
|
Selective B-1 blockers most commonly prescribed.
Tabs: 25, 50, 100 mg. Also Injection β1 selective in low doses Not lipophilic (The most water soluble) |
|
|
Carvedilol (COREG)
|
Alpha-BETA BLOCKERS
Tabs: 3.125, 6.25, 12.5, 25 mg Twice daily dose (Brand & generic) Coreg CR Capsules: One daily (Brand only) MOA: Nonselective β-blocker & α1 blocker which opens up blood vessels in arms and legs Frequency: BID with FOOD Avoid in patients with COPD CHF indication (mild to severe), also HTN indication Note: Consult physician if worsening CHF (weight gain, SOB) Take with food to slow the rate of absorption & reduce orthostasis |
|
|
Labetalol (NORMODYNE)
similar to COREG |
Oral: HTN in combination
IV: Control of BP in severe hypertension in the ER mainly. |
|
|
ACE inhibitors, ACEIs (The “prils”)
|
(The “prils”)
Recommended when the preferred first-line agents (diuretics or beta-blockers) are contraindicated or ineffective. They lower BP by reducing peripheral vascular resistance without reflexively increasing cardiac output, rate, or contractility. They block the ACE that cleaves angiotensin I to form the potent vasoconstrictor angiotensin II. ACE also responsible for the breakdown of bradykinin, a potent vasodilator. Vasodilation occurs as a result of the combined effects of lower vasoconstriction caused by diminished levels of angiotensin II and the potent vasodilating effect of increased bradykinin. By reducing AT-II levels, ACEIs also decrease the secretion of aldosterone, resulting in decreased Na+ & water retention. |
|
|
ACE inhibitors, ACEIs
Therapeutic uses: |
Most effective in white, young HTN patients
When used in combination with a diuretic, effectiveness is similar in all races Along with ARBs, they slow progression of diabetic nephropathy Effective in treating CHF |
|
|
ACE inhibitors, ACEIs
Adverse effects: |
Dry cough (may have to go to an ARB or a different ACE inhibitor)
Rash Altered taste, Hyperkalemia (Monitor K+) Angioedema Toxic to fetus Contraindicated in BILATERAL renal artery stenosis |
|
|
Captopril (CAPOTEN)
|
ACE inhibitors, ACEIs
Tabs: 12.5, 25, 50, 100 mg MOA: Inhibits Angiotensin II formation, reducing aldosterone (Review R.A.A. system) Potassium sparing (watch salt substitutes) Frequency: BID - TID FETOTOXIC: ACEIs or ARBs NOT for pregnant patients, esp. in 2nd and 3rd trimesters (can cause fetal harm or death) CHF: Use lower doses HTN: Use higher doses ASA - possible reduction of anti-HTN effect (?) ACEIs: They decrease nephrotoxicity SE: Potassium sparing (watch salt substitutes: KCl) Cough, angioedema (swelling of vessels, apparent around the mouth, tongue & nasal folds, possible laryngeal edema) Look for red color around mouth, tongue, nasal folds |
|
|
Ramipril (ALTACE)
|
ACEIs
capsules- can be opened & taken with applesauce |
|
|
Fosinopril (MONOPRIL)
|
ACEIs tablets- eliminated 50% in urine and feces (advantage in renally impaired)
|
|
|
Enalapril (VASOTEC)
|
Prodrug
|
|
|
other ACEIs:
|
o
Lisinopril (ZESTRIL, PRINIVIL) Zestoretic: Very commonly used Benazepril (LOTENSIN) Quinapril (ACCUPRIL) Perindopril (ACEON) Trandolapril (MAVIK) Trandolapril with Verapamil (TARKA)ther ACEIs: |
|
|
Losartan (COZAAR)
|
Tabs: 25, 50, 100 mg
MOA: Blocks angiotensin II at type AT1 receptor NOT ON TEST SE: √ Less potential for cough √ Pregnancy warnings Sometimes used synergistically with ACEIs |
|
|
Losartan/HCTZ (HYZAAR)
Compare to: Valsartan (DIOVAN) Combination with HCTZ: Valsartan/HCTZ (DIOVAN HCT) |
Tabs: 50/12.5,100/12.5, 100/25 mg
Compare to: Valsartan (DIOVAN) Tabs: 40, 80, 160, 320 mg Combination with HCTZ: Valsartan/HCTZ (DIOVAN HCT) Tabs: 80/12.5 mg, 160/12.5 mg, 160/25 mg, 320/12.5 & 320/25 |
|
|
Renin Inhibitor:
|
Aliskiren (TEKTURNA)
150 & 300 mg tablets, once a day, also with HCTZ Alone or in combination: for HTN Direct Renin Inhibitor Caution: Angioedema Contraindicated in pregnancy |
|
|
ARBs
|
Irbesartan (AVAPRO)
Tabs: 75, 150, 300 mg (Big mg doses) Irbesartan with HCTZ (AVALIDE) Tabs: 150/12.5mg, 300/12.5 mg Candesartan (ATACAND) (Small mg doses) Tabs: 4, 8, 12, 16 mg Candesartan with HCTZ (ATACAND HCT) Tabs: 16/12.5 mg, 32/12.5 mg Olmesartan (BENICAR) Tabs: 5, 20, 40 mg Teveten, Teveten HCT, Micardis, Micardis HCT These are less commonly used |
|
|
Calcium channel blockers (CCBs)
|
less constriction of smooth muscles, vasodialators and stop some conduction in the heart
|
|
|
Verapamil (CALAN, ISOPTIN,VERELAN, COVERA-HS) covera is important
|
Calcium channel blockers (CCBs)
Regular Tabs: 40, 80, 120 mg Tabs SR: 120, 180, 240 mg SR tabs: -take with food -can be broken when needed SE: Constipation (caused by calcium blockade in gut smooth muscles, NOT anticholinergic) COVERA-HS: Controlled Onset Verapamil Tabs: 180, 240 mg Controlled onset works after patient is asleep 4 to 5 hour delay in drug delivery Results in Cmax of Verapamil in AM HS is at bedtime |
|
|
Diltiazem (CARDIZEM, DILACOR XR,
TIAZAC, CARTIA XT, DILTIA XT) |
Regular Tabs: 30, 60, 90, 120 mg
Caps SR (12 hrs): 60, 90, 120 mg Caps CD (24 hrs): 120, 180, 240, 300, 360, 420mg Cardizem LA tabs Also Injection Diltiazem’s action lies between Verapamil & Nifedipine The structure of each of three CCB classes is different - Only within dihydropyridine group is there similarity among members Counsel: Compliance, diet, exercise SE: Some Constipation (not as much as Verapamil) |
|
|
Nifedipine (PROCARDIA, ADALAT CC)
|
Regular Caps (PROCARDIA): 10, 20 mg
Extended release Tabs (PROCARDIA XL, ADALAT CC)30, 60, 90 mg Note: ADALAT CC – Core-coated Dihydropyridine (DHP) class Potent peripheral vasodilator SE: Pedal edema, dizziness, GINGIVAL HYPERPLASIA |
|
|
Nifedipine (PROCARDIA, ADALAT CC)
Compare to: |
NORVASC: Long duration, commonly used
DYNACIRC: Infrequently used PLENDIL: Tabs are extended release SULAR: Long duration, less common CARDENE: Regular and long acting ------------------------------------------------------ -NORVASC: Frequency QD (long acting) -PLENDIL: Frequency QD (made long acting via delayed release tabs) |
|
|
Dihydropyridine calcium channel blockers
|
Counsel: Grapefruit juice interaction
(CYP-450 inhibitor Increased effects) Other uses: Angina HTN Treatment of peripheral vascular problems & relaxes esophageal spasms |
|
|
Amlodipine and Atorvastatin (CADUET)
|
COMBINATION DRUGS WITH DHP CCBs:
-BP and lipid tx in single product Tabs: 2.5/10; 5/10 mg; 5/20 mg; 5/40 mg; 5/80 mg CADUET Coranary Art Disease Duet 2 10/10 mg; 10/20 mg; 10/40 mg; 10/80 mg |
|
|
Amlodipine and Benazepril (LOTREL)
|
-BP control via two different MOA in single product
Caps: 2.5/10 mg; 5 /10 mg; 5 /20 mg; 10/20 mg LOTREL Low doses control |
|
|
Terazosin (HYTRIN), Doxazosin (CARDURA)
|
Alpha-1 blockers
HYTRIN: 1, 2, 5, 10 mg CARDURA: 1, 2, 4, 8 mg MOA: Long acting, alpha-1 antagonist (QD dosing) Caution: Alpha-1 blockers increase risk of retrograde ejaculation Alpha-1 receptors found in trigone, urethra, sphincter and prostate. (As well as in blood vessels) When blocking these receptors, muscarinic or cholinergic influence predominates, increasing urine flow and relieving obstruction from BPH. Uses: BPH and HTN (adjunct in HTN) NOT appropriate anti-hypertensive agent for an elderly female SE: First dose syncope- stand up slowly Take about 8 PM (can take in AM, but cautiously) Caution: OTC meds Adrenergic agonists (SUDAFED) & anticholinergics (BENADRYL) decrease urine flow: Urinary obstruction |
|
|
CENTRALLY ACTING ADRENERGIC AGONISTS
|
Alpha-2 agonist: diminishes central adrenergic outflow.(reducing the flow of norepi out of the brain good as an add-on
|
|
|
Clonidine (CATAPRES)
|
Tabs: 0.1, 0.2, 0.3 mg (BID-TID)
Patches: CATAPRES TTS-1,-2,-3 (Releases 0.1, 0.2 or 0.3 mg/day throughout the week) Transdermal Therapeutic System (TTS) MOA: -Central alpha-2 agonist (autoreceptor agonist, decreases NE) -Also alpha-2 receptor agonist on cholinergic receptor, reducing release of ACh. -(This makes it responsible for causing constipation & dry mouth) -Not typical antimuscarinic Patch Frequency: Q7D (once a week) - Rotate sites 2 patches: 1 drug (small) & 1 overlay (large,white) SE: Dry mouth, constipation Counsel: Sugarless gum, drink fluids, Metamucil, fiber, prunes, etc. Abrupt D/C predisposes to serious rebound HTN Other uses: Neuropathic pain, ADHD, smoking, drug withdrawal and more ------------------------------------------------------ Similar product: Guanfacine (TENEX): QD dosing (1 to 2 mg HS) |
|
|
Methyldopa (ALDOMET)
*** |
Alpha-2 agonist
Tabs: 250, 500 mg Injection Centrally acting alpha-2 agonist (decreases NE flow) Beers List: Bradycardia, depression Importance of blood tests (LFT, potential for anemia) It is used ONLY to treat HTN in pregnant patients |
|
|
What is used to treat HTN in pregnant patients
|
Methyldopa (ALDOMET)
Centrally acting alpha-2 agonist (decreases NE flow) |
|
|
Hydralazine (APRESOLINE)
|
VASODILATORS
Tabs: 10, 25, 50, 100 mg; Also injection Arteriolar vasodilator (Only arteries) Decreases afterload -------------------------------------------------- Drug-induced SLE symptoms (high doses) - reversible upon discontinuation of drug - also occurs with high doses of Hydralazine, Procainamide, INH and Chlorpromazine -------------------------------------------------- Can be used for HTN in pregnant patients If given alone can increase the workload on the he APRESOLINE |
|
|
a patient has a drug induces Lupus, what drug may be involved
|
Hydralazine (APRESOLINE)
|
|
|
Minoxidil (LONITEN)
|
Vasodialator
Causes dilation of resistance vessels (arterioles) but not of capacitance vessels (venules). Administered orally for treatment of severe to malignant hypertension that is refractory to other drugs Reflex tachycardia may be severe and require the concomitant use of a diuretic and a beta-blocker. It causes serious sodium and water retention, leading to volume overload, edema, and congestive heart failure. It also causes hypertrichosis (the growth of body hair). OTC product applied topically to treat male pattern baldness. (ROGAINE) |
|
|
Goals of pharmacologic intervention in HF
|
Alleviate symptoms
Slow disease progression Improve survival |
|
|
Six classes of drugs have been shown to be effective
|
1) Inhibitors of the renin-angiotensin system
2) Beta-adrenoreceptor blockers 3) Diuretics 4) Inotropic agents 5) Direct vasodilators 6) Aldosterone antagonists (Figure 16.1). |
|
|
Underlying causes of HF
|
arteriosclerotic heart disease
myocardial infarction hypertensive heart disease valvular heart disease dilated cardiomyopathy congenital heart disease Left systolic dysfunction secondary to coronary artery disease is the most common cause of HF |
|
|
Beneficial effects of pharmacologic intervention:
|
Reduction of the load on the myocardium
Decreased extracellular fluid volume Improved cardiac contractility Slowing of the rate of cardiac remodeling |
|
|
Therapeutic strategies in HF
|
Patients with HF complain of dyspnea on exertion, orthopnea, paroxysmal nocturnal dyspnea, fatigue, and edema.
Reduction in physical activity, low dietary intake of sodium (<1500 mg/day), treatment of co-morbid conditions, and judicious use of diuretics, inhibitors of the renin-angiotensin system, and inotropic agents. Drugs that may precipitate or exacerbate HF, (non steroidal anti-inflammatory drugs, alcohol, calcium channel blockers, and some antiarrhythmic drugs), should be avoided if possible. |
