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Terms in this set (70)
Relaxes smooth muscle—- dilating arterioles
Decrease BP, activation of baroreceptors, results in a compensatory increase in sympathetic outflow—- increase in HR, CO, and renin release
A patient is severely hypertensive and pregnant
Hydralazine is most often combined with _____ in HF and should be considered in patients with both ____ and _____ especially in AA patients.
ADE of hydralazine
Ha, nausea, flushing, hypotension, palpitations, tachycardia, dizziness, angina
Drug induced lupus syndrome
How can hydralazine cause MI?
Increased O2 demand induced by the baroreceptor reflex induced stimulation of the SNS
No effect on capacitance vessels
A renal artery vasodilator
What should be given with minoxidil?
A diuretic and beta blocker
A patient has a severe drug resistance form if HTN?
ADE of minoxidil
Significant Na and water retention
Edema, CHF exacerbation
Increase in HR, myocardial contractility, and myocardial O2 consumption
RARE: STEVENS- JOHNSON SYNDROME IS
Topical agent of minoxidil?
Rogaine for hair growth
What parenteral vasodilators are used to treat HTN emergencies?
What are first line agents and very effective mono therapy as a vasodilator?
MOA for CCB?
Inhibit influx of Ca across the cell membrane into arterial smooth muscle cells with less reflex tachycardia and fluid retention than other vasodilators
Ischemia causes increased _____ influx, leading to depletion of energy stores and worsens ____.
Is it safe to combine CCB with BB?
No caution because there is an increased risk of HB with these combos
Subclasses of CCBs
Dihydropyridines: more vasodilator activity and less cardiac AV node effect
Nondihydropyridines: greater SA and AV node activity, less vasodilation
Verapamil and diltiazem are what kind of CCB?
Decreases cardiac contractility and O2 demand
Decrease cardiac contractility and O2 demand less than verapamil
Used for coronary artery spasm (vasospastic angina)
ADE of nondihydropyridines
Nifedipine (Procardia) and amlodipine are what kind of CCB
Nifedipine (Procardia) and amlodipine are _____ vasodilators with minimal effects on conduction and heart rate. Used for ____ and ____. Do not use short acting ____.
ADE of nifedipine and amlodipine
Reflex tachy with marked peripheral vasodilation
A centrally acting alpha agonists
A patient has HTN and has been resistant to >2 agents, what would you prescribe?
A centrally acting alpha agonist used as a first line agent for gestational HTN?
MOA of methyldopa?
Stimulates alpha adrenergic receptors in the brain and reduces sympathetic outflow from vasomotor center
ADE of methyldopa that is important to consider
Abrupt cessation of central alpha agonists may lead to rebound HTN
Must be tapered gradually to discontinue
Na and water retention
Angiotensin converting enzyme inhibitors (ACE I)
Inhibits conversion of angiotensin I to angiotensin II
Decrease CV risk
Patient has HtN and has type 1 diabetes and proteinuria or renal insufficiency, what do you prescribe?
An ACE I
ACE inhibitors indications other than HTN?
Diabetic nephropathy and non diabetic kidney disease
HF with systolic dysfunction
ADE of ACE inhibitors
Hyperkalemia- caution with K sparing diuretics
Acute kidney injury
What patients should not take ACE inhibitors
Pregnancy (fetal renal toxicity)
Renal artery stenosis
Hx of angioedema for any reason
Caution in renal dysfunction
Why can't patients with renal artery stenosis take ACE inhibitors
Cause hypotension and acute increase in serum creatinine
What needs to be monitored with ACE inhibitors ?
Baseline and ongoing renal function /electrolyte monitoring
Hyperkalemia-monitor more often if also on potassium- sparing diuretic
Commonly prescribed ACEI
Angiotensin receptor blockers
Directly block the AT receptor that mediates effects of angiotensin II
They do not block breakdown of bradykinin
ADE of ARBs
Renal insufficiency/acute kidney injury
Angioedema (less than ACEI)
Cough (much decrease risk than ACEI)
What patients should not be prescribed ARBS?
Renal artery stenosis
Caution in renal insufficiency
Can you give ARBs with ACEI?
A direct renin inhibitor
MOA of aliskiren (Tekturna)?
Blocks conversion of angiotensinogen to angiotensin 1, blocks the RAAS at the point of action
Can you combine DRIs with ACEI and ARBS?
ADE of DRI?
Hypotension, Angioedema, renal insufficiency, STEVEN JOHNSON SYNDROME, cough, diarrhea
Condraindications for use of DRI?
Same as ARBs and ACEI
Neprilysin inhibitor- Sacubitril
Decreases natriuretic peptide degradation
Neprilysin inhibitor - Valsartan (Entresto)
Selective angiotensin II receptor blocker (ARB)
ADE of neprilysin inhibitors
Increase in serum creatinine
People who are ____ or have history of ____ should not take Neprilysin inhibitors (sacubitril and valsartan). There should be caution when using with patients with _____ or ____. DO NOT GIVE WITH ___ and ____.
Renal artery stenosis
Is cardiac glycosides (Digoxin) first line?
MOA of dig?
Inotrope, increase VEF, increase CO, and increase renal perfusion
A patient has A FIB chronic HF and they are maxed out on other therapies. What should you prescribe?
What is a special consideration when prescribing Dig?
Toxicity because of a narrow therapeutic index
Organic nitrates are used to treat all kinds of ____ and are given ____ route to avoid _____. Bio activated with release of _____.
MOA of organic nitrates?
Smooth muscle relaxer leading to vasodilation
A patient has been taking organic nitrates for often and for a long period, what are you concerned about?
Need a nitrate free interval
A patient recently took a medication for ED. They are in for chest pain. What is a valid question to ask the patient?
How long has it been since you took the medication for ED?
Needs to be at least 6 hours
Could lead to severe hypotension
MOA of Ranolazine (Ranexa)
Decrease intracellular Ca concentration
Reduces diastolic tension
Decreases cardiac work
What are some antiarrhythmic drugs?
Na channel blockers
Potassium channel blockers
What is a first line treatment for HTN and is effective mono therapy?
MOA of CCB?
Blocks Ca channels causing smooth muscle dilation, negative inotrope
The CCB that has a more vasodilator effect and less cardiac AV node effect
Dihydropyridines (nifedipine and amlodipine)
The CCB that has more effect on AV and SA node vasodilation?
Nondihydropyridine (verapamil and diltiazem)
A centrally acting alpha agonists like ____ and ______ stimulates alpha 2 receptors to decrease sympathetic output resulting in vasodilation.
Which centrally acting alpha agonist is used for resistant HTN?
Which centrally acting alpha agonist is 1st line for PIH?
What is the number one consideration when prescribing centrally acting alpha agonists?
Abrupt cessation results in rebound HTN, taper gradually
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