10. Antihypertensive Medications Flashcards
1
Q
- What are the 3 mechanisms to controlling blood pressure?
- Crisis is present when a patients blood pressure rises greater than ____________.
- Which anatomical sites are responsible for BP control in the human body?
A
- Changes in CO, Changes in vasomotor tone and Changes to plasma volume
- 180/120 mmHg.
- Kidneys, Heart, Precapillary arterioles, Postcapillary venules and Adrenal cortex
2
Q
- What are the 5 different drug therapies that can be used for treating hypertension?
- What is the definition of a Hypertensive Crises?
- What are the two classifications of this type of crises?
A
- Diuretics, Sympatholytics, Vasodilators, Angiotensin-converting enzyme (ACE) inhibitors and Angiotensin II receptors blockers (ARBs)
- Systolic BP >180mmHg and/or a Diastolic BP >120mmHg
- Hypertensive urgency and Hypertensive emergency
3
Q
- When managing a hypertensive urgency, when is this considered an urgent situation?
- The hypertension is corrected over how many hours?
- What are the 4 manifestations of a hypertensive urgency?
A
- when BP is elevated but there are no signs/symptoms of acute organ compromise
- 24-48 hours
- Severe headaches, Shortness of breath, Nosebleeds, and Severe anxiety
4
Q
- What is the definition of a hypertensive emergency?
- What are the 6 manifestations of a hypertensive emergency?
- What is the first step (goal) in treating hypertensive emergencies? second step? third step?
A
- ↑ BP accompanied by acute progressing target organ injury requiring immediate treatment
- Encephalopathy, Intracranial hemorrhage, Severe retinopathy, Renal failure, Unstable angina, and Acute LV failure
- ↓ MAP by no more than 25% within first hour, THEN BP further ↓ to ~ 160/100 mmHg over 2-6 hrs, THEN BP gradually normalized over 24-48 hrs
5
Q
- Adrenergic drugs interfere with? which 4 components?
2. Where can the effects be seen on the body?
A
- neurotransmission –> Central nervous system, Autonomic ganglia, Sympathetic nerve endings, and Adrenergic receptors
- centrally or peripherally
6
Q
- What is the other drug name for Methyldopa?
- What type of drug is Methyldopa? What does this treat?
- What is required by the body in order for this drug to produce an effect? What is the end product called after this process?
- What are the two MOA of this drug?
A
- Aldomet
- Centrally acting a2- agonist prodrug; treats mild to moderate HTN
- Metabolic activation –> a-methylnorepinephrine
- ↓ sympathetic outflow from medullary vasomotor centres (tricks body into thinking there is lots of circ. epi/norepi)
- Binding at a2-adrenergic receptors on pre-synaptic membranes of peripheral neurons (fully saturated receptors = stops prod. epi/norepi)
- ↓ sympathetic outflow from medullary vasomotor centres (tricks body into thinking there is lots of circ. epi/norepi)
7
Q
- What are the precautions for Methyldopa? (4)
- What is the other drug name for Clonidine?
- What type of drug is Clonidine?
- What are the 3 net results when taking this drug?
A
- Risk of orthostatic hypotension*, Gradual withdrawal when stopping agent to minimize rebound HTN, Na+ retention with long-term use, and Anticholinergic-like side effects
- Catapres
- Mechanism similar to methyldopa –> centrally acting a2- adrenergic agonist (Depresses medullary vasomotor centres)
- ↓ HR, ↓ CO, and ↓ tone of capacitance vessels
8
Q
- When is the use of Clonidine specifically indicated?
- What are this drugs 2 off- label uses?
- What is needed when considering stopping this drug?
A
- for moderate to severe hypertension (Second-line treatment due to side effects)
- Nicotine symptom withdrawal and Pain management
- Tapered withdrawal needed
9
Q
- What are the 5 anti-cholinergic side effects of centrally acting agents?
- What are the 5 CNS side effects of centrally acting agents?
- Peripherally acting sympatholytic drugs interfere with? Which 3 components are involved with this?
A
- Sedation, Blurred vision, Dry mouth, Constipation, Urinary retention
- Drowsiness, Headaches, Depression, Psychosis, Nightmares
- neuronal activity at various sites of action –> Autonomic ganglia, Postganglionic neurons, and Adrenergic receptors*
10
Q
- What is the other drug name for Propranolol?
- What type of drug is this?
- MOA?
- 4 net effects of this drug?
A
- Inderal
- peripherally acting b-blocker
- non-selective catecholamine antagonist causing b-adrenergic blockade
- ↓ HR, ↓ CO, ↓ SVR, ↓ renin release
11
Q
- What are the 3 indications for taking Propranolol?
- What are the 4 contraindications for taking this drug?
- What are the 3 precautions?
A
- HTN management as part of a combination therapy, Unstable angina, and Control of cardiac arrhythmias
- Variant angina, classic angina, Asthma, and Acute CHF
- Transient rise in BP –> unopposed a-response , ↑ airway resistance, and Upregulation of b receptors with prolonged use
12
Q
- b-blockers cannot be ____ ___________.
- Asthma and COPD patients should use what type of b-blocker?
- patients with liver failure should use what type of b-blocker?
- Patients with PIH (pregnancy induced hypertension) need what type of b-blocker? example?
A
- used interchangeably
- cardio-selective
- one that is NOT metabolized in the liver
- one that WON’T compromise fetal BF –> Labetalol
13
Q
- What is the other drug name for Metoprolol?
- What type of drug is this?
- Dominant effects at which receptors in the body?
- Indicated for patients with which 2 conditions? Can also be used to control what?
A
- Betaloc
- Peripherally acting, cardio-selective b-blocker
- b1 receptors in the heart
- asthma and peripheral vascular disease (PVD), can be used to control cardia arrhythmias
14
Q
- What is the other drug name for Nadolol?
- What type of drug is this?
- NOT metabolized in the ______.
- How do we get rid of this drug in the body?
- This drug is ideal for patients with?
A
- Corgard
- peripherally acting b-blocker
- body
- excreted in the urine
- hepatic dysfunction
15
Q
- What is the other drug name for Labetalol
- What type of drug is this?
- This drug has ____ ________ effects. Can you describe the two effects?
- This drug is primarily used to treat which condition? Why? (3 reasons)
A
- Normodyne
- peripherally acting b-blocker
- dose dependent –> low dose = b-blockade, high dose = a-blockade
- pregnancy induced HTN (PIH) because…..
- Does not ↓ uterine/fetal BF
- Does not inhibit uterine contraction
- Compatible with breast feeding
16
Q
- What is the other drug name for Prazosin?
- What type of drug is this?
- When is this drug typically given with treating HTN?
- This drug selectively blocks which receptors?
- What are the 3 net results of this drug?
A
- Minipress
- peripherally acting a- adrenergic blocker
- typically in combination
- post synaptic a1-receptors
- ↓ SVR through arterial and venous dilation, ↓ preload , and ↓ afterload
17
Q
- Can you describe the “first dose” phenomenon with Prazosin?
- What are the 6 side effects associated with this phenomenon?
- How can this phenomenon be avoided?
- What are the 2 precautions when using this drug?
A
- sudden severe drop in BP after given the first does of the medication
- Orthostatic hypotension, Palpitations, ↑ HR,
Dizziness, headaches, and syncope - doses should be slowly increased
- Na+ retention leads to expansion of plasma volume (concurrent diuretic therapy needed) and
Compensatory mechanisms contribute to observed first dose phenomenon
18
Q
- What is the other drug name for Doxazosin?
- What type of drug is this?
- This drug has a favorable effect on _________ profile. What 3 effects does this lead to?
- This drug has a minimal effect on? Especially?
A
- Cardura
- peripherally acting a-blocker
- lipoprotein profile leading to –> ↓ triglycerides and LDL, ↑ HDL, and Enlarged prostates/urinary issues in men
- electrolytes, especially Na+
19
Q
- Vasodilators should be which line of treatment when treating HTN?
- Vasodilators act on which muscle in the body? What does this prevent? What effect does this have and how does it do this?
- What other vessels in the body can vasodilators act on? what does this lead to?
A
- second line therapy
- vascular smooth muscle preventing contraction –> decreases SVR by arteriolar vasodilation
- capacitance vessels and thereby decreasing venous return
20
Q
- Vasodilator therapy triggers which 3 compensatory mechanisms? What can help to reduce these effects?
- What is the other drug name for Hydralazine?
- What type of drug is this?
- Which vessels are the effects of this drug seen? What 2 net effects does this lead to?
A
- Baroreceptor reflex, ↑ HR, and RAAS (used in combination to help reduce these effects)
- Apresoline
- vasodilator
- resistance vessels (after the load/precapillary vessels) –> ↓ SVR with no change in venous return, and C.O. may not change as much
21
Q
- Hydralazine is very potent, what does this mean? What 3 effects does this lead to?
- This drug is typically given with which 2 other drugs?
- What are the 3 MOA’s of this drug?
- What 2 formulations are available for taking this drug?
A
- leads to profound activation of baroreceptors –> reflex tachycardia, renin release, and ↑ in cardiac output
- b- blockers and diuretics
- ↓ SVR by a direct action on vascular smooth muscle, ↑ intracellular concentrations of cGMP, and Leads to vascular smooth muscle relaxation
- PO and IV
22
Q
- What is the other drug name for Nitroprusside?
- What type of drug is this?
- What is this drug typically used to treat?
- Which vessel(s) does this drug dilate?
- What are the 4 net effects of this drug? What severe result can this ultimately lead to in a patient?
A
- Nipride
- Vasodilator (Nitrate)
- hypertensive emergencies
- arterioles and veins
- ↓ afterload, ↓SVR, ↓ venous return, and ↓ preload–> can lead to severe hypotension
23
Q
- Calcium channel blockers act just like which type of drug?
- What vessel(s) does this drug dilate to decrease BP?
- MOA?
- What is the prototype drug calcium channel blocker?
A
- vasodilators
- peripheral arterioles
- Inhibit Ca2+ influx into vascular smooth muscle to block contraction
- verapamil
24
Q
- What is the other drug name for Diltiazem?
- What type of drug is this?
- Where are the effects of this drug primarily exerted?
- This drug has sympathetic antagonism effects, what does this cause compared to other drugs of this class?
- This drug does NOT alter which 2 profiles? Therefore, this drug is well suited for which 2 patient populations?
A
- Cardizem
- Calcium channel blocker
- on capacitance vessels
- Less reflex tachycardia than other Ca2+ blockers
- lipid or carbohydrate profiles –> good for diabetes and/or hyperlipidemia
25
Q
- What is the other drug name for Nicardipine?
- What type of drug is this? What does this drug cause?
- From the previous question, what are the 3 net effects of this drug?
- This drug has fewer ____ __________.
A
- Cardene
- 2nd generation calcium channel blocker causing arteriolar vasodilation
- ↑ blood flow, ↓ myocardial oxygen demands, and ↓ cardiac depression than diltiazem
- drug interactions
26
Q
- In the RAAS, what is renin normally released in response to? (3)
- Where is the macula densa located in the kidneys? What does it sense?
A
- ↓ renal perfusion pressure, Sympathetic stimulation, and [Na+] in distal tubules
- close to distal tubule and senses amount of Na+ there (decreased conc = release of renin)
27
Q
- What is the other drug name for Captopril?
- What type of drug is this?
- How can this drug help to control HTN?
- What are the 3 reasons as to why there is no reflex tachycardia when taking this drug?
- What does this drug also help to prevent?
A
- Capoten
- ACE inhibitor
- controls HTN caused by excess renin release
- ↓ BP due to fall in SVR while HR & CO unchanged
- inactivation of bradykinin (powerful vasodilator)
28
Q
- If angiotensin II is inhibited by an ACE inhibitor such as Captopril, how does this specifically help treat HTN?
- If the enzyme Kininase is inhibited with the drug Captopril, how does this specifically help treat HTN?
- What are the 3 indications for using Captopril?
A
- we decrease the amount of vasoconstrictor (angiotensin II) which in turn decreases BP
- leads to increased amounts of bradykinin which is a vasodilator in turn causing a decrease in BP
- HTN caused by ↑ plasma renin, Concurrent ischemic heart disease, and refractory cases when pt unresponsive to –> Sodium restricted diet, Diuretics, Sympatholytics, or Vasodilators
29
Q
- What are the 5 adverse reactions when taking Captopril?
- What is the other drug name for Enalapril?
- What type of drug is this?
- This is a _____. Therefore meaning?
A
- Bone marrow suppression, Proteinuria, Persistent cough (ACE cough), Angioedema – increased vessel permeability from vasodilation, and Drug interactions with NSAIDs and lithium (treating bipolar)
- Vasotec
- long acting (24hr) ACE inhibitor taken OD for compliance
- Prodrug –> needs to be hydrolyzed into active metabolite once taken
30
Q
- Enalapril has a low incidence of?
- This drug is suitable for? Can also be used?
- What is the other drug name for Ramipril?
- What type of drug is this?
A
- adverse effects
- monotherapy for HTN and can be used in combination for more severe cases
- Altace
- commonly prescribed long acting (24hr) ACE inhibitor
31
Q
- What are the 3 indications for using Ramipril?
- What are the 7 adverse effects?
- Angiotensin II can be generated via which 2 pathways? What does this mean?
A
- Heart failure post-MI, Hypertension, and ↓ risk of stroke, MI and death from CV disease
- Angioedema, Cough, Jaundice, Hyperkalemia, Hypersensitivity, Hypotension/syncope, and ↓ renal function
- non-renin and non-ACE mediated pathways meaning other substances can mediate angiotensin production therefore ACE inhibitors can NOT completely block vasoconstriction via angiotensin II (considered 2nd line treatment)
32
Q
- What is the other drug name for Losartan? For Telmisartan? For valsartan?
- What type of drugs are these?
- MOA?
- What does the MOA prevent with these drugs? What does this decrease? (2)
A
- Cozaar, Micardis, and Diovan
- Angiotensin II receptor blockers
- ARBs competitively antagonize angiotensin II at receptors found on –> Myocardial tissue and Vascular smooth muscle
- prevents constriction –> decreasing vascular resistance and BP
33
Q
- Why are Losartan, Telmisartan, and Valsartan less potent anti-HTN than ACE inhibitors?
- There is less incidence of?
- What are the 3 indications for using this class of drugs?
- What are the 6 adverse effects when taking either of these drugs?
A
- Cannot inhibit bradykinin inactivation to further ↓ BP
- Less incidence of a cough
- Refractory HTN, refractory heart failure, and
when adverse effects of other drugs are not tolerated - Orthostatic hypotension, Hyperkalemia , Nephrotoxicity, Fetotoxicity , ↑ serum [digoxin], and Possible drug interactions (NSAIDs & lithium)