Term
|
Definition
|
|
Term
|
Definition
| Selectively suppresses renin-angiotensin-aldosterone system, inhibits ACE which prevents conversion of angiotension I to angiotensin II |
|
|
Term
|
Definition
| Mild to moderate HTN, adjunctive therapy of systolic CHF, and acute MI |
|
|
Term
| Lisinopril Contraindications |
|
Definition
| Angioedema, Pregnancy (D - 2nd & 3rd trimesters), renal disease, hyperkameia, renal artery stenosis, CHF |
|
|
Term
| Lisinopril Pharmacokinetics |
|
Definition
| Onset 1 hr, peak 6-8 hrs, duration 24 hrs, half life = 12 hrs |
|
|
Term
|
Definition
| Vertigo, Fatigue, chest pain, hypotension, sinus tachycardia, angioedema, proteinuria, renal insufficiency, sexual dysfunction |
|
|
Term
| Lisinopril & Hyperkalemia |
|
Definition
| specifically with potassium sparing diuretics, potassium supplements |
|
|
Term
| Lisinopril drug/food interactions |
|
Definition
| high-potassium diet should be avoided or hyperkalemia may occur. Avoid bananas, orange juice, avocados, nuts, spinach |
|
|
Term
|
Definition
| A loop diuretic (prototype) |
|
|
Term
|
Definition
| Inhibits Na/K/2Cl transporter in the ascending Loop of Henle - reduces reabsorption of NaCl and increases urinary output |
|
|
Term
|
Definition
| Increases urinary excretion of NaCl, K+, Ca++, and Mg++ |
|
|
Term
|
Definition
| Hypokalemic metabolic alkalosis, hypomagnesemia, hypochloremia, hyperuricemia, ototoxicity |
|
|
Term
| Clinical uses of Furosemide |
|
Definition
| Common uses: Edematous conditions, acute pulmonary edema, CHF (reduces LV filling pressures), HTN. Also: acute hyperkalemia or hypercalcemia, anion overdose |
|
|
Term
|
Definition
| May interfere with actions of loop diurectics such as furosemide |
|
|
Term
| Furosemide Pharmacokinetics |
|
Definition
| Rapid absorption, eliminated by kidneys, duration of effect is 2-3 hrs, half life dependent on renal function |
|
|
Term
| What are contraindications to furosemide? |
|
Definition
| hypersensitivity to furosemide or sulfonamides, hepatic cirrhosis, anuria |
|
|
Term
|
Definition
| Patients often require this supplement when taking furosemide |
|
|
Term
|
Definition
| Angiotensin Receptor Blocker (ARB) (commonly end in –sartan) |
|
|
Term
|
Definition
| Interfere with binding of angiotensin II to its receptor (AT1) |
|
|
Term
|
Definition
| Pregnancy category X, cough less common than ACEI with ARB’s, but will still commonly occur, angioedema, hyperkalemia, renal impairment |
|
|
Term
| How effective is Lorsartan? |
|
Definition
| As effective as beta blockers, calcium channel blockers, diuretics and ACE inhibitors |
|
|
Term
| What type of monitoring should be done with an ARB? |
|
Definition
| BP it will take 4-6 weeks before the full therapeutic effect, and potassium- it can cause an increase in potassium |
|
|
Term
| Lorsartan Clinical Applications |
|
Definition
| Hypertension and heart failure |
|
|
Term
| How is Lorsartan renal protective? |
|
Definition
| Decrease BP and lower intragolmerular pressure results in decreased albumin excretion, slowing chronic renal failure. However, be careful in pt’s with low fixed renal blood flow (renal artery stenosis, CHF) because renal function is angiotensin dependent and decreasing can lead to acute renal failure. |
|
|
Term
| Verapamil medication class |
|
Definition
|
|
Term
|
Definition
| inhibits influx of calcium into arterial smooth muscle cells |
|
|
Term
| Cardiac effects of Verapamil |
|
Definition
| decreases HR and cardiac output, dilates coronary arteries |
|
|
Term
| Effects of Verapamil toxicity |
|
Definition
| Bradycardia, AV block, heart failure |
|
|
Term
| Verapamil adverse effects |
|
Definition
| Constipation, flushing, dizziness, nausea, peripheral edema |
|
|
Term
| Propanolol MOA (an "olol") |
|
Definition
| non-selective Beta1=Beta2 antagonist; highly lipid soluble; block effects of catecholamines (NE & EPI) at Beta1 receptors in the heart and Beta2 receptors of respiratory, vascular, & uterine smooth muscle; has local anesthetic action |
|
|
Term
|
Definition
| Primarily by decreasing CO, but also by decreased HR and decreased renin release, causes decreased BP; initial increase in PVR, but long term decrease in PVR; increases airway constriction (caution in asthma); decreases intraocular pressure; impaired recovery from hypoglycemia (caution in Type I diabetes); |
|
|
Term
|
Definition
| depression, impotence, fatigue, impaired recovery from hypoglycemia, bronchoconstriction, sedation, sleep disturbances. Abrupt withdrawal can precipitate myocardial ischemia due to hypersensitivity to catecholemines which could lead to angina, acute MI, vent. arrhythmia, death. |
|
|
Term
| propanolol caution in discontinuation |
|
Definition
| 1) reduce dose gradually over 1-2 weeks & monitor (esp. w/ ischemic heart disease; 2) transfer to alternative Beta blocker directly w/ comparable doses |
|
|
Term
|
Definition
| HTN; CHF; angina; post MI; arrhythmias; migraine prophylaxis; situational anxiety; decreases mortality re:to bleeding in cirrhosis; long term use post MI prolongs survival |
|
|
Term
|
Definition
| undergoes extensive hepatic (1st pass) metaboelilism (low & dose-dependent bioavailability); T1/2=3.5-6 hrs; lipophilic & readily crosses BBB; elimation may be prolonged in liver disease, decreased hepatic blood flow; or hepatic enzyme inhibition |
|
|
Term
|
Definition
Tachycardia, palpitations, angina, and edema when concomittent loop diuretic and beta blocker therapy are inadequate
Common: HA, sweating and hypertrichosis (abnormal hair growth) |
|
|
Term
| Minoxidil MOA and Pharmacokinetics |
|
Definition
| Hyperpolarization of smooth muscle membrane through opening of potassium channels; may cause reflex sympathetic stimulation and Na and fluid retention; must be used in combination with a Beta-blocker and loop diuretic; does not cause orthostatic hypotension or sexual dysfunction |
|
|
Term
|
Definition
| Vasodilator for treatment of HTN (dilates arterioles, not veins) |
|
|
Term
|
Definition
| Antagonism of the L-type calcium channels in cardiac and vascular smooth muscle cells. Muscle contractility is dependent on calcium influx across these channels. The end result is relaxation of the vascular muscle (vasodilation) and decreased cardiac contractility. |
|
|
Term
| Nifedipine Special Considerations |
|
Definition
| Reflex sympathetic activation can cause slight tachycardia. Short-acting oral nifedipine should not be used for treatment of chronic HTN; has been shown to have an increased risk of MI and death. |
|
|
Term
|
Definition
| Decreased PVR (vasodilation); may have slight increase in HR. |
|
|
Term
| How are Calcium Channel-Blockers Differentiated? |
|
Definition
Dihydropyridines (Vascular Effect > Cardiac Effect)
vs. Non-dihydropyridines (Cardiac Effect > Vascular Effect) |
|
|
Term
| Nifedipine is the prototype of which family of Calcium Channel-Blockers? |
|
Definition
| The dihydropyridine family; this makes Nifedipine more selective for calcium channels in vascular smooth muscle than in cardiac muscle. |
|
|
Term
| What are the side effects of Nifedipine? |
|
Definition
| Hypotension, dizziness and headache. Bronchodilation can lead to cough, decreased motility in the GI tract can cause nausea or obstruction. |
|
|
Term
|
Definition
| Vasodilator that causes nitric oxide release resulting in vasodilation and reduction of vascular resistance |
|
|
Term
| Hydralazine Pharmacokinetics |
|
Definition
| Low bioavailability because rapidly metabolized by liver |
|
|
Term
| Hydralazine Clinical Uses |
|
Definition
| Used in severe hypertension, usually used with other hypertensive drugs |
|
|
Term
| Hydralazine Adverse Reactions |
|
Definition
| Headache, n/v, palipitations, sweating and flushing. With high dosages patients can develop arthralgia, myalgia, skin rashes, and fever that resembles lupus erythematosus |
|
|
Term
|
Definition
| A synthetic steroid that acts as a competitive agonist to aldosterone. Binds to mineralocoricoid receptors and blunt aldosterone activity. |
|
|
Term
| Spironolactone Pharmacodynamics |
|
Definition
| Potassium-sparing diuretic that reduces sodium absorption in the collecting tubules and ducts (potassium absorption and secretion at this site are regulated by adosterone). Has a slow onset of action. |
|
|
Term
| Spironolactone Clinical Uses |
|
Definition
| Diuretic whis is also useful in states of mineralosorticoid excess or hyperaldosteronism (aldosteronism). Examples of primary or secondary hyperaldosteronism are Conn's syndrome, hepatic cirrhosis. |
|
|
Term
| Spironolactone Considerations |
|
Definition
| Can be inhibited by NSAIDSs. Hyperkalemia is greatly increased in patients with renal insufficiency. |
|
|
Term
|
Definition
| Selectively inhibits NaCl reabsorption in the thick ascending limb in the loop of henle. |
|
|
Term
|
Definition
| Toxicity: hypokalemic metabolic acidosis, ototoxicity, hyperuricemia, hypomagnesemia, severe dehydration, occasionally allergic reactions (most loop diuretics are sulfonamides) |
|
|
Term
| Furosemide clinical indications |
|
Definition
| Acute pulmonary edema, acute hypercalcemia, acute renal failure, anion overdose |
|
|
Term
|
Definition
|
|
Term
| Furosemide pharmacokinetics |
|
Definition
| Orally administered, absorption occurs within 2-3 hours, duration of effect 2-3 hours. T1/2 depends on renal function, eliminated by kidneys |
|
|
Term
| Furosemide contraindications/precautions |
|
Definition
| Patients allergic to sulfonamides may exhibit allergic cross-reactivity (rare). Excessive use in patients with hepatic cirrhosis, boderline renal failure, or heart failure can be dangerous |
|
|
Term
|
Definition
| Potassium Sparing Diuretic |
|
|
Term
|
Definition
Competitive Aldosterone Antagonist-
*Binds to mineralocorticoid receptors to block/blunt aldosterone activity.
*Prevents K+ secretion and decreases Na+ absorption by blocking aldosterone in collecting tubules |
|
|
Term
| Sprinonolactone pharmacokinetics |
|
Definition
*Slow onset of action- takes several days to see full therapeutic effect
*Inactivation of spironolactone occurs in the liver |
|
|
Term
Spironolactone
Clinical Uses |
|
Definition
***MOST IMPORTANT USE: Used with other hypertensives to allow body to HOLD ONTO POTASSIUM (since other hypertensive drugs deplete the body of potassium***
*This drug is not a 'great' diuretic
Other Uses:
1. Hyperaldosteronism/Aldosteronism: state of aldosterone (mineralocorticoid) excess
a) Conditions of Primary Hyperaldosteronism (hypersecretion):
-Conn's Syndrome
-Ectopic adrenocorticotropic hormone production
b) Conditions of Secondary Hyperaldosteronism (d/t other diseases that result in elevated aldosterone):
-Heart Failure
-Hepatic Cirrhosis
-Nephrotic Syndrome
2. Use of other types of diuretics (thiazides, loop diuretics) can lead to Hyperaldosteronism
-Spironolactone may be used in these situations to assist body to blunt/block K+ secretory response and b/c this drug is an aldactone antagonist |
|
|
Term
|
Definition
-Hyperkalemia
-Hyperchloremic Metabolic Acidosis
-Gynecomastia/impotence/BPH
-Acute Renal Failure
*Rarely used in pts w/ renal insufficiency
*Monitor closely in pts w/ liver disease |
|
|
Term
|
Definition
| ACE inhibitor; ↓ angiotensin II; ↓ vasoconstriction; ↓ aldosterone secretion; ↑ bradykinin; ADRs=cough, angioedema, hyperK+, renal impairment, teratogen |
|
|
Term
|
Definition
Used to treat hypertension and with combination of other antihypertensives to treat CHF.
Works by dialating the arterioles by releasing nitric oxide causing a decrease in vascular resistance. |
|
|
Term
|
Definition
| reflex tachycardia, angina, Lupus-like symptoms (aches/pains/skin rash/fever) |
|
|
Term
| Hydralazine (pharmacokinetics) |
|
Definition
| Administered orally, rapid 1st pass metabolism by liver, |
|
|
Term
|
Definition
| Calcium Channel blocker used to treat HTN and CP |
|
|
Term
| Nifedipine: Contraindications |
|
Definition
| Do not use this drug for patients in cardiogenic shock or other medications that use P450 for metabolism |
|
|
Term
| Nifedipine: Pharmacokinetics |
|
Definition
| Metabolized by the liver P450. First pass metabolism |
|
|
Term
|
Definition
| Decreases intracellular calcium levels in cardiac and smooth muscle cells resulting in dilitation of coronary and peripheral arteries |
|
|
Term
|
Definition
| Vasodilator. Hyperpolarization of smooth muscle through opening of K+ channels |
|
|
Term
|
Definition
|
|
Term
|
Definition
reflex sympathetic stimulation and Na+/fluid retention
(with inadequate doses of beta blockers and diuretics): Tachycardia, palpitation, angina, edema
(common in women): Headache, sweating, hair growth |
|
|
Term
| Minoxidil treatment consideration |
|
Definition
Minoxidil causes reflex sympathetic stimulation and Na+/fluid retention so it MUST be combined with:
*Beta blocker & Loop diuretic*
Minodixil should replace hydralize when:
- Max dose of hydralize are not effective
-Renal failure or severe HTN do not respond to hydralize |
|
|
Term
|
Definition
Calcium Channel Blocker (Class 4 antiarrhythmic): SLOWS the SA node automaticity and AV node conduction velocity; DECREASES cardiac contractility (and CO); REDUCES blood pressure
--greater cardio than vascular effects |
|
|
Term
|
Definition
| SVT's, HTN, Angina, CHF, Reynauds |
|
|
Term
|
Definition
|
|
Term
|
Definition
| (ARB), angiotensin II receptor antagonist, irreversible, non-competitive. It deters vasoconstriction and aldosterone-secreting effects by specifically intercepting the binding of angiotensin II to the AT(1) receptor. |
|
|
Term
|
Definition
| Hypertension, heart failure, renal protection |
|
|
Term
|
Definition
Hypotension; (thrombocytopenia, rhabdomyolysis, and angioedema are rare).
Pregnancy category X |
|
|
Term
|
Definition
| Beta-Adrenoceptor-Blocking Agent |
|
|
Term
|
Definition
| Non selective beta-blocker; decreases blood pressure by decreasing cardiac output; reduces chronotropic, inotropic and vasodilator responses to beta-adrenergic stimulation by competing for available binding sites that stimulate the beta-adrenergic receptors; depresses renin secretion also preventing vasodilation of cerebral arteries. |
|
|
Term
| Propranolol Clinical Uses |
|
Definition
| Chronic Angina, cardiac dysrhythmia, essential tremor, hypertension, migraines, postmyocardial infarction |
|
|
Term
|
Definition
| CHF, Heart block, Stevens-Johnson Syndrome, Asthma, Bronchospasms, hypotension, bradycardia, agranulocytosis |
|
|
Term
| Propranolol Pharmacokinetics |
|
Definition
| Oral or IV, Metabolized in Liver, T 1/2 approx. 4 hours |
|
|
Term
|
Definition
| Synthetic steriod that acts as a competitive aldosterone antagonist and a weak estrogen agonist |
|
|
Term
| Spironolactone Adverse Reactions |
|
Definition
| Hyperkalemia, gynecomastia, impotence, benign prostatic hyperplasia (very rare), acne, decreased libido, menstrual irregularities |
|
|
Term
| Spironolactone Pharmacokinetics |
|
Definition
| Rather slow onset of action, requiring several days before full therapeutic effect is achieved. Substantial inactivation of spironolactone occurs in the liver. |
|
|
Term
| HCTZ (Hydrochlorothiazide) MOA |
|
Definition
| An Antihypertensive and diuretic that affects elecrolyte reabsorption at the distal renal tubule (thiazides) increasing sodium and chloride excretion; potassium is excreted in the distal loop of henle and stops reabsorption of water thereby increasing urine output, increasing potassium excretion, and decreasing blood pressure. |
|
|
Term
|
Definition
| excreted - renal, avoid in renal failure, 1/2 life = 5-15 hrs. |
|
|
Term
|
Definition
| Hypotension, dehydration, headache, muscle cramps, brisk diuresis, phototoxicity, tachycardia, vertigo, hyponatremia, hypercalciiemia, hypokalemia, hypomagnesemiam, cardia dysrhythmias, renal failure, avoid use with breastfeeding |
|
|
Term
|
Definition
| Opens potasium channels in smooth muscel membrains, which leads to vasodilation. The increased potassium permeability reduces contractions and dilates arteries, but not veins. |
|
|
Term
| Minoxidil Pharmacokinetics |
|
Definition
| Must be taken with a beta blocker and loop diuretic because of reflex sympathetic stimulation and sodium/fluid retention. |
|
|
Term
|
Definition
| Treatment of sever hypertension for those who do not respond well to hydralazine. Also can be used to treat hair loss. (Rogaine) |
|
|
Term
| Minoxidil Adverse Effects |
|
Definition
| Hypotension, tachycardia, palpitations, angina, edema, and hypertrichosis (excessive hair groth). |
|
|
Term
|
Definition
| Inhibition of the Na/K/2Cl transporter in the ascedning limb of Henle's loop. (Loop diuretic) |
|
|
Term
| Furosemide pharmacokinetics |
|
Definition
| Rapidly absorbed, eliminated by kidney through glomerular filtration and tubular secretion. Reductioin in the secretion of loop diuretics may be as a result of NSAIDS or probenecid which compete for weak acide secretion in the proxminal tube. |
|
|
Term
| Furosemide Adverse effects |
|
Definition
| ototoxicity, hypovolemia, k wasting, hyperuricemia, hypomagnesemia, skin rash, |
|
|
Term
|
Definition
| Pulmonary edema, peripheral edema, hypertension, acute hypercalcemia or hyperkalemia, acute renal failure, anion overuse |
|
|
Term
|
Definition
| Calcium Channel Blocker of the dihydropyrines (DHP); has a greater effect on the vascular calcium channles than the cardiac calcium channels |
|
|
Term
| Nifedipine Pharmacokinetics |
|
Definition
| Reduces vascular resistance and this prolonged relaxation leads to vasodilation and decreased BP. Orally lasts 4-6 hours. |
|
|
Term
|
Definition
| hypertension, angina, prophalxis of angina, Reynauds |
|
|
Term
| Nifedipine Adverse Effects |
|
Definition
| constipation, peripheral edema, hypotension, baroreceptor reflex tachycardia |
|
|
Term
|
Definition
| causes release of nitric oxide, resulting in arterial vasodilation and a decrease in vascular resistance |
|
|
Term
| Hydralazine Clinical Uses |
|
Definition
| Hypertension. Hydralazine is also effective for heart failure in combination with nitrates. |
|
|
Term
| Hydralazine Pharmacokinetics |
|
Definition
Rapidly metabolized by liver during first pass.
Low bioavailability (25%).
Half-life of 1.5-3hrs.
Vascular effect persists longer than blood concentration. |
|
|
Term
|
Definition
tachycardia, headache, nausea, anorexia, palpitations, sweating, flushing.
Angina or ischemic arrhythmias may be provoked by reflex tachycardia and sympathetic stimulation in patients with ischemic heart disease. |
|
|
Term
|
Definition
Angiotensin receptor blocking agent that blocks
angiotensin II type 1 (AT₁) receptors; has no effect on bradykinin so is a more
selective blocker of angiotensin effects than ACE inhibitors |
|
|
Term
| Losartan pharmacokinetics |
|
Definition
Oral half-life 1-2 hours; active metabolite half-life 3-4 hours. Bioavailability
36%. No dose adjustment required in
renal insufficiency. |
|
|
Term
| Losartan clinical applications |
|
Definition
| hypertension and heart failure |
|
|
Term
|
Definition
Reduce angiotensin II levels which reduces vasoconstriction and aldosterone secretion. This leads to decreased peripheral vascular
resistance and decreased sodium and water retention, thus decreasing blood
pressure. |
|
|
Term
|
Definition
| angioedema, hyperkalemia, renal impairment, teratogenic (similar to ACE inhibitors) |
|
|
Term
|
Definition
| An angiotensin-converting ezyme inhibitor, reduces angiotensin II by inhibiting conversion ffrom angiotensin I to angiotensin II |
|
|
Term
| Lisinopril pharmacokinetics |
|
Definition
| Oral, half life is 2-4 h but given in large doses so duration is 12-24 h, the lysine analog of enalapril |
|
|
Term
| Lisinopril Clinical Applications |
|
Definition
| HTN, Diabetic renal disease, CHF, Acute MI |
|
|
Term
| Lisinopril Adverse Reactions |
|
Definition
| cough, hyperkalemia, angioneurotic edema, dark urine, decreased urine, difficlty swallowing or breathing, hoarseness, yellowing of skin and eyes, |
|
|
Term
|
Definition
Arteriolar and venous dilation
reduces aldosterone secretion
reduces cardiac remodeling |
|
|
Term
|
Definition
| nonselective betablocker, highly lipid soluable, inhibits the stimulation of renin production by catecholoamines, acts on peripheral presynaptic beta adrenoceptors which will inhibit sympathetic nerve activity |
|
|
Term
|
Definition
| decreases: BP, HR, release of renin, intraoccular pressure, HDL, CNS depression, Increases: airway resistance Misc: sleep disturbances, impairs recognition and recovery of hypoglycemia |
|
|
Term
|
Definition
| depression, impotence, fatigue, blocks s/s of hypoglycemia, abrupt withdrawl can cause miocardial ischemia |
|
|
Term
| Propranolol Clinical Uses |
|
Definition
| HTN, CHF, Angina, Post MI, Arrhythimias, Migraines, Situational Anxiety |
|
|
Term
| Propranolol Phramacokinetics |
|
Definition
| Beta blocking effects= bradycardia, and decrease in HR during exercise. Use these clinical parameters to adjust dosage. May be given BID also is available as extended slow release |
|
|
Term
|
Definition
| Calcium channel blocker, MOA = Inhibition of calcium influx into the arterial smooth muscle cells. More effective as a cardiac depressant vs vasodilator. Will decrease heart rate and cardiac output. |
|
|
Term
|
Definition
| Half-life = 4 to 6 hours; Bioavailability is 22%; Suggested starting does is 180mg/d with a maintenance dose of 240-480mg/d. Renal insufficiency does not impact dosage. |
|
|
Term
|
Definition
| Angiotensin-converting enzyme (ACE) inhibitor. Inhibits the converting enzyme peptidyl dipeptidase that hydrolyzes angiotensin I to angiotensin II. These drugs reduce angiotenisin II levels, reduce vasoconstriction and aldosterone secretion and increase bradykinin. |
|
|
Term
| Clinical uses of Lisinopril |
|
Definition
| Hypertension, heart failure, and diabetes |
|
|
Term
| Adverse effects of Lisinopril |
|
Definition
| Cough, severe hypotension after initial dose, angioedema, hyperkalemia, acute renal failure, and teratogenic |
|
|
Term
|
Definition
| Vasodilator-decreases systemic vascular resistance d/t arterial smooth muscle relaxation. Must be given with beta bl. and loop diuretic d/t reflex sympathetic stimulation. There is an increase in renin and there for an increase in h2o and na retention. Increase in sympathetic tone leads to increase in HR, Contractility and CO. This causes increased O2 demand on heart which may lead to ischemia in patients with limited reserve. ADR: Headache, sweating, and hypertrichosis |
|
|
Term
|
Definition
| Works in the Loop of Henle, called a loop diuretic. These are the most commonly prescribed diuretic for HTN, CHF, Pulmonary , Hepatic or renally caused edema. |
|
|
Term
|
Definition
| MOA-blocks reabsorbtion of NA+ and CL- in thick segment of Loop of henle and therfore the passive reabsorption of H2O. |
|
|
Term
|
Definition
| ADRs- HypoNA, HypoCL, Dehydration, HypoK, hypotension, ototoxicity, hyperglycemia, increased LDLs and decreased HDLs |
|
|
Term
|
Definition
| Drug interactions- Digoxin- K+ loss can make it higher risk for dysrythmias, NSAIDs can interfere with prostaglandin production in kidney by decreasing the renal blood flow, Lithium- loss of Na+ can lead to toxic levels. |
|
|
Term
|
Definition
| Potassium sparing diuretic that antagonizes the effects of aldosterone, thus preventing K+ secretion. ADR: hyperkalemia, hyperchloremia metabolic acidosis, gynecomastia, acute renal failure, renal calculi. Caution use in patients with chronic kidney disease and liver impairment or also taking other medications that may increase K+ (ACEI, ARB, BB, supplements). |
|
|
Term
|
Definition
| Calcium-channel blocker used in HTN treatment and angina control. MOA: decrease impulse conduction through the AV node; relax smooth muscles, dilating blood vessels. Increases O2 supply to the heart and slows electrical activity, controlling heart rate. Oral absorption is high but bioavailability is low (due to first pass metabolism. Half-life is 5-12 hours. Metabolized by liver, excreted by urine. Present in human milk (discontinue use if breast feeding). |
|
|
Term
|
Definition
| HA, facial flushing, dizziness, swelling, increased urination, galactorrhea, constipation, gingival hyperplasia. |
|
|
Term
|
Definition
| An oral vasodilator that works by relaxing smooth muscle in the arterioles, thus reducing systemic vascular resistance. In particular, hydralazine dilates arterioles but no veins. Can be combined with a nitrate drug to manage heart failure. Absorbed well after PO administration. Hepatic elimination. ADR include: headache, nausea, anorexia, palpitations, sweating, and flushing. May have reflex tachycardia if pt has ischemic heart disease. Lupus like symptoms, although rare, may also occur if pts with slow drug metabolism and dosages over 400mg/day. |
|
|
Term
|
Definition
| Angiotensin receptor blocking agent (ARBs), interferes with the binding of angiotensin II to its receptor AT1, noncompetitive antagonist, more selective blocker of angiotensin effects as compared to ACE inhibitors, does not increase bradykinin |
|
|
Term
| Losartan Pharmacokinetics |
|
Definition
| Half life 1-2 hours, 36% bioavailability, suggested dose 50mg a day, range of doses between 25-100mg per day, do not need to adjust with renal insufficiency-the drug is renal protective |
|
|
Term
| Losartan Monitoring and ARB |
|
Definition
| BP (full effect in 4-6 weeks), potassium elevation, less cough, angioedema, pregnancy category X, less effective in black patients do to less renin. |
|
|
Term
|
Definition
|
|
Term
|
Definition
| Vasodilator-decreases systemic vascular resistance d/t arterial smooth muscle relaxation. Must be given with beta bl. and loop diuretic d/t reflex sympathetic stimulation. There is an increase in renin and there for an increase in h2o and na retention. Increase in sympathetic tone leads to increase in HR, Contractility and CO. This causes increased O2 demand on heart which may lead to ischemia in patients with limited reserve. ADR: Headache, sweating, and hypertrichosis |
|
|
Term
|
Definition
| Prototype B-blocker. Non-selective at B-receptors. Decrease BP by decreasing CO, slowing AV conduction, and decreasing renin release. Does not typically lower BP in normotensive patiens. Propanolol is lipophilic and can cross the BBB. Used to manage HTN, ischemic heart disease, cardiac arrythmias, heart failure (especially after MI); also hyperthyroidism, migraines, stage-fright, and glaucoma. ADRs include bradycardia, worsening of asthma/ lung conditions. |
|
|
Term
|
Definition
| Inhibition of NA/CL transporter in distal tubules. |
|
|
Term
| HCTZ clinical applications |
|
Definition
| Hypertension, mild heart failure, nephrolithiasis, nephrogenic diabetes insipidus. |
|
|
Term
| HCTZ pharmacokinetics/toxicity |
|
Definition
| Oral, duration 8-12 hours. Hypokalemic metabolic alkalosis, hyperuricemia, hyperglycemia, hyponatremia |
|
|
