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Pharmacology Test #2 > 04 hypertension > Flashcards

04 hypertension Flashcards

1
Q

what drug is a front line agent for both hypertension and benign prostate hypertrophy?

A

Prazosin

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2
Q

Prazosin (Terazosin, Doxazosin, Tamsulosin, [-osin]

A
  • selective alpha 1-receptor blocker
  • does not produce reflex tachy cardia
  • also for benign prostate hypertrophy
  • postural hypotension
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3
Q

phenoxybenzamine:

A
  • irreversible alpha 1 receptor blocker, long acting
  • reflex tachycardia effect, postural hypotension
  • therapeutic value in pheochromocytoma, HT crisis
  • postural hypotension
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4
Q

Phentolamine

A

(non-selective alpha-receptor blocker)

  • reflex tachycardia, not used for HT
  • postural hypotension
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5
Q

what are the alpha-adrenoceptor antagonists that can be used for hypertension and what is the main side effect

A
  • Phenoxybenzamine (main use pheochromocytoma, HT crisis)
  • Prazosin (also for benign prostate hypertrophy
  • Phentolamine (Not really used for HT)
  • Adverse effect: postural hypotension (all)
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6
Q

which drug is a direct vasodilator?

A

hydralazine

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7
Q

hydralazine:

A

Use: HT, HF,

  • direct vasodilator, mainly arterioles, decr TPR can cause reflex tachycardia,
  • SE: reflex increase SNS, flushing, palpitations, lupus
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8
Q

if a patient has a lupus-type reaction

A

hydralazine, prokinemide(?)

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9
Q

minoxidil

A
  • ‘rogaine”
  • opens K+ channels in smooth muscle
  • stabilizing of membrane at it resting potential, contractionless likely
  • dialtes arterioles but not veins, thus anti HT
  • SE: reflex sympathetic stimulation (used with beta blocker)
  • SE: fluid retention, hypertrichosis
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10
Q

sodium nitroprusside

A

-vasodilator
-used for acute emergency (short time)hypertension and CHF
-used IV (cyanide toxicity via oral admin)
-activation of guanylyl cyclase (direct and/or via release of NO–> incr in cGMP–>dephosphor of myosin light chain
-dialtes both arterial and venous vessels
-decr venous return to the heart, reflex tachycardica
SE: reflex incr HR, sever HT, cyanide liberation–>cyanide toxicity

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11
Q

cyanide toxicity is an adverse effect of what drug?

A

sodium nitroprusside

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12
Q

Fenoldopam

A
  • Dopamine agonist (D1A)
  • acute HTN (emergency), renal failure
  • one of the DOC for HT crisis
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13
Q

what is/are the adverse effects of fenoldopam?

A

-increased HR, increase ocular pressure and decrease K+

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14
Q

what drugs could be used for an acute hypertensive emergency?

A

Nitroprusside or Fenoldopam or diazoxide

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15
Q

what drug opens K+ channels -stabilizing membrane potential?

A

Diazoxide and minoxidil (Rogaine)

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16
Q
  • used for acute hypertensive crisis
  • opens K+-channels - stabilizes membrane potential
  • dilates arteriolar vessels
    decrease TPR –> reflex incre HR –> incre CO
  • inhibits insulin release (via opening K+-channels on beta cell membrane)
  • similar structure as thiazides but no diuretic effect
A

Diazoxide

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17
Q

vasodilators cause a decrease in TPR, this activates the reflex causing an increase in fluid retention negative the effect of the drug. Thus, vasodilators are often combined with_____ to decrease the sympathetic activity

A

beta blockers, or thiazides

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18
Q

what drugs/classes are vasodilators?

A

Calcium channel blockers, hydralazine, minoxidil

19
Q

Clonidine

A
  • centrally acting sympatholytic agent
  • alpha 2 selective agonist
  • hypertension, opioid withdrawal
  • not frontline
  • it decreases sympathetic outflow
20
Q

what is the preferred agent for HT in pregnancy?

A

alpha-methyldopa

-it decreases sympathetic outflow

21
Q

what are the adverse effects of clonidine and alpha-Methyldopa?

A
  • dry mouth, drowsiness, lightheadedness, dizziness, impotence
  • abrupt withdrawl effect (rebound HT, esp. clonidine)
22
Q

what two drugs are ganlionic blocking agents?

A

Trimethaphan and Mecamylamine

  • they block ganglionic nicotinic receptors (SNS, PNS)
  • first effective antihypertensive class
  • currently not used for chronic HT
  • DRUGS OF LAST RESORT
23
Q

Trimethaphan

A
  • ganglionic-blocking agent
  • i.v. injection, rapid, short half life
  • hypertensive crisis (CNS mediated), controlled hypotension during surgery
24
Q

which ganglionic blocking agent is effective orally and which one is given by i.v.?

A

mecamylamine-oral

trimethaphan-i.v.

25
Q

which drug can be used during surgery for controlled hypotensive (which will reduce bleeding)?

A

timethaphan

26
Q

which drug inhibits uptake of NE into storage vesicles and leads to depletion of transmitter stores in the nerve terminal? Adverse effects?

A

Reserpine (antihyptensive agent)

  • agent of last resort
  • SE: severe sedation, metal depression, parkinsonism, increases gastric acid secretion
27
Q

which drug decreases the release of NE from nerve terminals causing a gradual depletion of NE stores? and what are its side effects?

A

Guanethidine (antihyptensive agent)

  • agent of last resort
  • adverse effects: marked postural hypotension, diarrhea, impaired ejaculation
28
Q

if a patient is diabetic, what drug for HT?

A

use an ACEI/ARBs/Aliskiren improve renal function

29
Q

what effect does smoking have on effectiveness of HT agents?

A

beta blockers are less effective with chain smokers

30
Q

what agents are less effective in blacks than whites?

A

beta-blockers and ACEI/ARBs

31
Q

what effect does age have on efficacy of agents?

A

beta-blockers and ACEI/ARB efficacy may decrease with age (>70 yrs)

32
Q

if someone is taking NSAIDS chronically, what effect can it have on what HT agents?

A

decrease the response to diuretics, ACEI, and beta-blockers

33
Q

which drugs are contraindicated in pregnancy?

A

ACEI/ARBs/Aliskerin

-also atenolol

34
Q

HT agents recommended during pregnancy:

A

main one: alpha-methyl dopa

-others include beta-blockers (not atenolol), prazosin, nifedipine, labetalol, hydralazine

35
Q

what class of agents typically have the adverse effect of postural hypotension (HT)?

A

alpha agonists

36
Q

to counter the reflex cardiac stimulation by vasodilators, what is typically taken in combination?

A

beta-blockers

37
Q

sympatholytics and vasodilators cause fluid retention, what can be taken in combination to counter this?

A

thiazides

38
Q

thiazides cause hypokalemia, what agents are used in combination to counter this?

A

ACEIs/ARBs/K-sparing agents

39
Q

which two drug classes should NOT be used in combination therapy?

A

Beta-blockers and ACE inhibitors

40
Q

if someone has HT and has had previous heart failure, what drug would you give them?

A

beta blocker

41
Q

if someone has HT and diabetes…give them

A

an ACE inhibitor or an ARB

42
Q

if someone has HT and has had a previous heart failure, what drug class should they avoid?

A

Calcium channel blockers

43
Q

which class of drugs can cause angioedema and glossitis

A

-ACEI

Pharmacology Test #2 (7 decks)

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