Cadiovascular IPC Exam 1

What is the class for the following drugs?

propranolol, bucindolol, carteolol, Nadolol, penbutolol, timolol, pindolol, and labetolol

NON SELECTIVE Beta Blockers

What is the class for the following drugs?

Acebutolol, atenolol, bexaxolol, bisoprolol, esmolol, metoprolol, SR

What is the MOA and site of action of beta blockers?

blocks beta 1 and 2 (non selective) or just beta 1 (selective

What is the place in therapy for beta blockers?

Monotherapy

Reduce cardiac output

reduce renin release

Used in hypertensive patients with coronary insufficiency

cheap

What are side effects of beta blockers?

NON SELECTIVE - never use for asthma patients

decreased exercise tolerance

bradycardia

sleep disturbance

CNS effects - dizziness, confusion, or depression

peripheral vascular disease + diabetes

What is the class for the following drugs

What is the class for the following drugs?

Chlorothiazide

Thiazide diuretics

What is the site of action and MOA of diuretics?

Site: the thick ascending limb of the loop of henle

MOA: inhibit the luminal Na+/K+/2Cl symporter

What are the side effects/contraindications of diuretics?

Hypokalemia, hyperuricemia, hypersensitivity rxns

What is the diuretic place in therapy?

reduces the plasma volume, used as an add on to other HTN drugs

What is the class for the following drugs?

Amlodipine, nifedipine, nicardipine

Dihydropyridine Calcium Channel Blockers

What is the class for the following drugs?

Diltiazem

Benzothiazepine Calcium Channel Blockers

What is the class for the following drugs?

Verapamil

Phenylalklyl Amine Calcium Channel Blockers

What is the place in therapy for Calcium channel blockers?

mild to moderate hypertension STAGE 1

What is the site of action and moa of calcium channel blockers?

MOA: decrease in intracellular calcium = decrease in cardiac contractivity = increase in vasodilation = drop in blood pressure

What are side effects of calcium channel blockers?

edema, hypotension, tachycardia, dizziness, headache

usually well tolerated

What is the class for the following drugs?

Captopril, Enalaprilat, Lisinopril

ACE Inhibitors

What is the MOA and site of aciton for ACE inhibitors?

MOA: inhibits the SYNTHESIS of angiotension II

What is the ACE inhibitor place in therapy?

Initial choice for stage 1 HTN

DOC for hypertension due to diabetes

Efficacy is best with diuretic use

What are the side effects of ACEi?

hypotension, cough

What is the class for the following drugs?

Losartan, Valsartan, Ibesartan, Olmesartan medoxomil, eprosartan, telmisartan, candesartan cilexetil

ARBs

What is the MOA and site of action for ARBs?

MOA: Prevents the BINDING of angiotension II

What is the place in therapy for ARBs?

1st line alone or in combination with other agents

Useful for hypertension secondary to CHF

NO COUGH

What are side effects of ARBs?

hypotension, hyperkalemia, GI upset, fatigue, upper respiratory tract infection, back pain

What is the class for the following drugs?

Phentolamine, Phenoxybenzamine, dibenamine

NONSELECTIVE Alpha blockers

What is the class for the following drugs?

Prazosin, Doxazosin, Terazosin

SELECTIVE Alpha blockers

What is the MOA of alpha blockers?

MOA: block vascular alpha adrenergic receptors

Inhibits vasoconstriction

Decrease total peripheral resistance

What is the place in therapy for Alpha blockers?

HTN cases caused by pheochromocytoma

mono or adjunct therapy

Use with diuretic due to fluid retention

What are side effects of alpha blockers?

dizziness, hypotension, nasal congestion, reflex tachycardia (nonselective), fluid retention (USE WITH DIURETIC)

What is the class for the following drugs?

Methyldopa, Clonidine, Moxonidine, Rilmenidine, Guanabenz, Guanfacine

CNS Alpha adrenergic receptor agonists (Sympatholytics)

What is the MOA of CNS sympatholytics?

prevent NE release

What is the place in therapy of CNS sympatholytics?

use with diuretic to prevent fluid retention

effective in all patients

What are side effects of CNS sympatholytics?

hypotension

SEDATION

dry mouth

vivid dreams

tachycardia

autoimmune: lupus, leukopenia

reduced mental acuity

What is the class for the following drugs?

Metyrosine, Guanethidine, Reserpine

Peripheral Alpha drenergic receptor agonists (sympatholytics)

What is the MOA of peripheral sympatholytics?

limits the rate-limiting enzyme for NE synthesis (tyrosine hydroxylase)

Guanethidine - prevents NE release in vesicle

Reserpine - prevents accumulation of NE into vesicle

What is the place in therapy for peripheral sympatholytics?

rarely used

What is the class for the following drugs?

hydralazine, minoxidil

Direct acting vasodilators

What is the MOA of direct acting vasodilators?

Hydralazine - liberate NO from vascular enothelium

Minoxidil - K+ channel opener, reduces smooth muscle contractility

What is the direct acting vasodilator place in therapy?

not used as monotherapy

long duration of action (24 hours)

SEVERE or refectory hypertension

What are side effects of direct acting vasodilators?

tachycardia, fluid retention, hypertrichosis

What class are the following drugs part of?

spironolactone, amiloride, triamterene

potassium sparing diuretics

What drug is specifically useful for resistant hypertension (as an add on)?

Spironolactone

A BP of 120/80 or less is…

Normal

A BP of 120-129/<80 is…

elevated

A BP of 130-139/80-89 is…

Stage 1

A BP of 140/90 or higher is…

Stage 2

What should patients avoid 30 minutes before BP is taken?

caffeine, exercise, smoking

What should the patient’s body look like when BP is taken?

feet flat on floor, arm at heart height, relaxed for 5 minutes, no talking

How many measurements should be taken and how far apart?

at least 2, 1 minute apart

What does the acronym SCARED mean?

Secondary causes:

S - sleep apnea

C - coarctation of the aorta

A - adrenal: primary aldosteronism

R - renal: CKD

E - endocrine: hyper/hypothyroid, hypercalcemia, acromegaly

D - drugs

What tests should be taken when hypertension is suspected or confirmed?

CBC

Serum sodium, potassium, and calcium

Serum creatine with estimation of GFR

Lipid profile

Fasting blood glucose or Hemoglobin A1c

Thyroid-stimulating hormone

urinalysis

urine albumin to creatinine ratio, urine protein to creatine ratio

Electrocardiogram

What is the goal BP for patients with HTN?

less than 130/80

A hypertensive emergency is…

severe BP elevations WITH ORGAN DAMAGE

A hypertensive urgency is…

High HTN with NO ORGAN DAMAGE

What drugs are common secondary causes of HTN?

corticosteroids, decongestants, Estrogen containing birth control, NSAIDs

What are some street drugs and food causes of HTN?

Cocaine

Sodium, alcohol, black licorice

Urgency HTN crisis should be treated…

PO, low and slow

Emergency HTN Crisis should be treated…

IV and fast BP reduction by 25% at a time, hospital admission

Urgency or Emergency:

Aortic dissection (surgery), vasodilators, adrenergic inhibitors (labetolol, nitroglycerin, etc.)

Emergency

What is the MOA, use in therapy, and warnings for Sodium Nitroprusside?

MOA: direct venous and aterial vasodilation

Therapy: acute hypertension, IV infusion

Warning: cyanide toxicity - prolonged use

What is the MOA, place in therapy, and warnings for Nitroglycerin?

MOA: vasodilator effect to peripheral veins and arteries

Therapy: IV for fast response, use in cardiac ischemia

Adverse: headache

What is the class for the following drugs?

Nitroglycerin, amyl nitrite

Organic nitrates

What is the MOA of organic nitrates?

vasodilating effect of oxygen nitrate on the veins, decreasing preload and after load

What is a key adverse effect for Organic Nitrates?

Dizziness