12 - Drugs for hypertension Flashcards
1
Q
blood pressure goal in hypertensive patients with:
no comorbidities?
diabetes mellitus?
ckd?
A
<140/90
<130/80
<130/80
2
Q
Drugs used in hypertension
A
diuretics
sympathoplegics - blockers of:
- cns sympathetic outflow
- ganglia
- nerve terminals
- alpha or beta receptors
vasodilators
- older oral vasodilators
- ca blockers
- parenteral vasodilators
angiotensin antagonists
- ace inhibitors
- receptor blockers
renin inhibitors
3
Q
HYDROCHLOROTHIAZIDE class similar drugs moa uses se
A
- thiazide diuretic
- chlorthalidone, indapamide, metolazone
- inhibit na/cl transporter in distal convoluted tubule, cause moderate diuresis and reduced excretion of calcium
- hypertension (first line), heart failure, hypercalciuria, renal calcium stones, nephrogenic diabetes insipidus
- hypokalemic metabolic alkalosis, dilutional hyponatremia, potassium wasting, hyperglycemia, hyperlipidemia, hyperuricemia, sulfa allergy
4
Q
FUROSEMIDE class similar drugs moa uses se
A
- loop diuretic
- bumatenide, torsemide, ethacrynic acid
- inhibit na/k/2cl transporter in thick ascending limb of loop of henle, cause powerful diuresis and increased Ca excretion
- heart failure, pulmonary edema, hypertension, hypercalcemia, acute renal failure, anion overdose
- hypokalemic metabolic alkalosis, potassium wasting, dehydration, ototoxicity, sulfa allergy, hyperuricemia, hypomagnesemia, nephritis
5
Q
CLONIDINE class similar drugs moa uses se
A
- sympathetic outflow blocker
- none
- activates a2 adrenergic receptors
a2 decreases central sympathetic outflow - hypertension, cancer pain, opioid withdrawal
- sedation, rebound hypertension, xerostomia
taper use prior to discontinuation to avoid rebound hypertension. to treat rebound hypertension, use phentolamine
6
Q
METHYLDOPA class similar drugs moa uses se
A
- sympathetic outflow blocker
- guanabenz, guanfacine
- activates a2 adrenergic blockers
a2 decreases central sympathetic outflow - pre-eclampsia
- sedation, hemolytic anemia (coombs test +)
7
Q
HEXAMETHONIUM class similar drugs moa uses se
A
- ganglion blocker
- trimethaphan, mecamylamine
- competitively blocks Nn nicotinic Ach receptors
- hypertension (obsolete), hypertensive emergencies
- postural hypotension, xerostomia, BOV, constipation, sexual dysfunction
8
Q
RESERPINE class similar drugs moa uses se
A
- nerve terminal blocker
- none
- irreversibly blocks the VMAT
- hypertension (obsolete)
- sedation, severe psychiatric depression, suicidal ideation
9
Q
GUANETHIDINE class similar drugs moa uses se
A
- nerve terminal blocker
- guanadrel
- inhibit vesicular release of NE from the presynaptic neurons
- hypertension (obsolete)
- sedation, severe psychiatric depression, suicidal ideation
10
Q
PRAZOSIN class similar drugs moa uses se
A
- adrenergic antagonist a1 selective
- doxazosin, terazosin, tamsulosin, silodosin, alfuzosin
- selectively blocks a1 adrenergic receptors
- BPH, hypertension
- first dose orthostatic hypotension, reflex tachycardia (less chance)
tamsulosin is most selective for prostatic smooth muscle
11
Q
PROPANOLOL class similar drugs moa uses se
A
- adrenergic antagonist b nonselective
- pindolol, timolol, labetalol, carvedilol, nadolol, levobunolol, metipranolol
- blocks b1 and b2 receptors, blocks sympathetic effects on heart and bp, reduces renin release
- angina prophylaxis, hypertension, arrhythmias, migraine, performance anxiety, hyperthyroidism
- bronchospasm, av block, heart failure, cns sedation, erectile dysfunction
masks symptoms of hypoglycemia in diabetics, carvedilol and labetalol has combined a and b blockade (may be used in pheochromocytoma)
12
Q
what drugs are used to control BP in pheochromocytoma?
A
phenoxybenzamine
phentolamine
labetalol
carvedilol
13
Q
HYDRALAZINE class similar drugs moa uses se
A
- vasodilator
- none
- alters intracellular ca++ metabolism, relaxes arteriolar smooth muscle causing vasodilation, decreases afterload
- hypertensino, heart failure (in combination with ISDN), pre-eclampsia
- edema, reflex tachycardia, MI, drug induced lupus
combination treatment with isdn for heart failure is more effective than ACEIs in blacks
14
Q
MINOXIDIL class similar drugs moa uses se
A
- vasodilator
- diazoxide
- opens k+ channels in vascular smooth muscle causing hyperpolarization, muscle relaxation, and vasodilatoin
- hypertension, alopecia
- edema, reflex tachycardia, angina, pericarditis, pulmonary hypertension, hypertrichosis
15
Q
VERAPAMIL class similar drugs moa uses se
A
- non-dihydropyridine ca ch blocker
- diltiazem
- block voltage gated L-type ca ch (cardiac>vascular)
- angina, hypertension, supraventricular tachycardia, migraine
- constipation, pretibial edema, nausea, flushing, dizziness, gingival hyperplasia, heart failure, av block, sinus node depression
