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PHAR121 > 3.A-Final HTN Drugs > Flashcards

3.A-Final HTN Drugs Flashcards

1
Q

How do direct-acting vasodilators work?

A

they interfere with muscle contraction

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2
Q

Describe the basics of muscle contraction.

A

contraction is initiated by an increase in cytoplasmic Ca
-permits interaction between myosin and actin
-contraction=vasoconstriction
-many triggers (ex: NE via B1 receptors)\
relaxation results from decreases in cytoplasmic Ca
-cGMP is another intracellular messenger for relaxation via
decreases in Ca
-relaxation=vasodilation

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3
Q

Describe how dihydropyridine calcium channel blockers work.

A

they are arterial vasodilators
-inhibit L-type Ca channels
-this results in a decrease in intracellular Ca in vascular
smooth muscle
-promotes vasodilation in arteries more so than veins

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4
Q

What is a major advantage of DHP type CCBs?

A

the lack of impact on heart rate (also little impact on preload)
all other vasodilators cause reflex tachycardia due to low stretch on baroreceptors

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5
Q

What would happen when there is low stretch on baroreceptors/low pressure in vessels?

A

baroreceptors will increase SNS outflow:
-increase in HR
-increased CO
-vasoconstriction

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6
Q

What would happen when there is high stretch on baroreceptors/high pressure in vessels?

A

baroreceptors will decrease sympathetic response:
-decrease in HR
-decrease in stroke volume
-high vagal outflow

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7
Q

True or false: reflex tachycardia is not a desirable characteristic of cardiovascular drugs

A

true

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8
Q

What do all DHP type CCB end in?

A

-pine

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9
Q

What are some examples of DHP type CCBs?

A

amlodipine
felodipine
nifedipine

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10
Q

What are a couple of direct acting vasodilators?

A

hydralazine
minoxidil

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11
Q

How do direct acting vasodilators work?

A

they directly act in arteriolar smooth muscle to relax it
-Ca mechanism for hydralazine
-K activation for minoxidil

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12
Q

What occurs due to the actions of direct acting vasodilators?

A

reflex tachycardia and fluid retention

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13
Q

Why does fluid retention occur from direct acting vasodilators?

A

results from reduced blood pressure leading to the kidney
-low blood pressure in the kidney always triggers fluid
retention

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14
Q

Who typically uses direct acting vasodilators? Is this a monotherapy treatment?

A

people with high bp that dont respond to first line treatment
never used as monotherapy, combination with beta blockers for the tachycardia and diuretics for the fluid retention

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15
Q

What does cGMP do?

A

it activates cGMP-dependent protein kinase in a muscle cell to decrease Ca

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16
Q

Which enzyme degrades cGMP?

A

phosphodiesterase (PDE)

17
Q

What are some PDE-5 inhibitors?

A

tadalafil (Cialis)
sildenafil (Viagra)
vardenafil (Levitra)

18
Q

Where would you find PDE-5 enzymes?

A

vascular smooth muscle cells of the penis

19
Q

What is the concern of taking a PDE-5 inhibitor and nitrates together?

A

severe hypotension (bp can decrease more than 25mmHg)
-pass out
-falls
-poor blood flow

20
Q

What happens for there to be a drug interaction between PDE-5 inhibitor and nitrates?

A

the drug interaction seems to allow the drugs to bypass their specificity for certain vascular beds (nitrates start to act on arteries)

21
Q

What are examples of non-DHP CCBs?

A

diltiazem
verapamil

22
Q

Where do non-DHP CCBs act? What is the response?

A

cardiac smooth muscle (remember DHP CCBs act on vascular smooth muscle)
response is decreased contractility and decreased HR

23
Q

What is the general expectation in regards to decreases in blood pressure from BP drugs?

A

-10/-5

24
Q

What are the first line antihypertensives?

A

ACEI and ARBs
TZD diuretics
DHP CCBs

25
Q

What are situations where non-DHP CCBs are useful?

A

tachycardia
myocardial demand is high
(effective at reducing BP but not commonly used for uncomplicated hypertension)

26
Q

What is the impact of DHP CCBs on preload and heart rate?

A

little impact
the major impact is on blood pressure

27
Q

If a man just used a PDE5 inhibitor, how long should he wait before he can use his nitrate for angina?

A

24 hours
-tadalafil is 48hrs

28
Q

Are non-DHP CCBs used for hypertension?

A

they are not commonly used for uncomplicated hypertension

29
Q

What are some general side effects with anti-hypertensives?

A

erectile dysfunction
dizziness
unsteadiness
falls
fatigue
electrolyte changes

30
Q

Which body system is highly dependent on blood pressure?

A

renal function

31
Q

When are non-DHP CCBs considered dangerous?

A

HR is already low
severe systolic dysfunction

32
Q

What makes DHP CCBs so unique to other arterial vasodilators?

A

minimal effect on heart rate

PHAR121 (17 decks)

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