Anti-HTN

Question 1

What are 3 main strategies for decreasing HTN?

Answer 1

1. Decrease TPR
2. Decrease CO
3. Decrease body fluid volume

Question 2

Decreasing BP may result in homeostatic regulation which involves what potentially unwanted side effects?

Answer 2

Reflex tachycardia and edema

Question 3

Which category of anti-HTN drugs do not result in reflex tachycardia and edema? What side effect will they get instead?

Answer 3

Autonomic drugs since they are already working on dampening the sympathetic response. They are more likely to exhibit orthostatic hypotension.

Question 4

What are clonidine and methyldopa?

Answer 4

Alpha 2 agonists

Question 5

What do alpha 2 agonists do?

Answer 5

Decrease in sympathetic outflow –> less NE released –> less activation of alpha 1 and beta 1 –> decreased TPR and decreased HR

Question 6

What do we use clonidine and methyldopa for?

Answer 6

BOTH - mild to moderate hypertension
Just clonidine - opiate withdrawal
Just methyldopa - hypertensive management in pregnancy

Question 7

Why do we see hemolytic anemia as a potential side effect with methyldopa?

Answer 7

Methyldopa binds strongly to plasma proteins (one of the reasons we like to use it as anti-HTN for pregnancy) but that also means it sticks around in the blood increasing the chance of hypersensitivity reaction that leads to hemolytic anemia

Question 8

What side effects are shared by clonidine and methyldopa?

Answer 8

CNS depression and edema

Question 9

What class of drugs decrease the antihypertensive effects of alpha 2 agonists and why?

Answer 9

TCA’s because they work to increase the levels of NE (by inhibiting reuptake) and this is the opposite of alpha 2 agonists trying to decrease NE levels

Question 10

What does reserpine do?

Answer 10

Destroys vesicles - lowers NE, dopamine, and serotonin in CNS (can have side effect of severe depression)

Question 11

What are 2 side effects of reserpine besides depression?

Answer 11

1. Edema (from upregulating RAA axis from the decrease in blood pressure)
2. GI secretions (upregulated parasympathetic since we’re blocking sympathetic)

Question 12

Describe the drug interaction between guanethidine and TCA’s.

Answer 12

TCA’s block reuptake and action of guanethidine since guanethidine accumulates in nerve ending via reuptake

Question 13

What does guanethidine do?

Answer 13

Binds to vesicles and inhibits release of NE

Question 14

What are prazosin, doxazosin, terazosin (“-zosin” drugs)?

Answer 14

Alpha 1 blockers

Question 15

How do alpha 1 blockers lower BP?

Answer 15

Decrease arteriolar and venous resistance

Question 16

What are side effects of alpha 1 blocker?

Answer 16

Reflex tachycardia, orthostatic hypotension, urinary incontinence

Question 17

What do we use alpha 1 blockers for besides lowering BP?

Answer 17

BPH

Question 18

What is the main mechanism by which beta blockers decrease hypertension?

Answer 18

Decrease renin

Question 19

What are 4 side effects of beta blockers being used as anti-HTN?

Answer 19

1. Cardiac depression
2. Fatigue
3. Sexual dysfunction
4. Increase LDLs and TGs

Question 20

When are beta blockers contraindicated?

Answer 20

1. Asthmatics
2. Vasospastic disorders
3. Diabetes (can mask hypoglycemic events)

Question 21

What are 2 antihypertensives that work through NO?

Answer 21

1. Hydralazine

2. Nitroprusside

Question 22

What does it mean that hydralazine is a selective dilator?

Answer 22

Works primarily on arteriolar side

Question 23

What is a major side effect of hydralazine and why?

Answer 23

SLE-like syndrome because it is highly protein bound (used to treat HTN in pregnant women)

Question 24

Is nitroprusside a selective or nonselective dilator?

Answer 24

Nonselective - works on both arterioles and venules

Question 25

What is nitroprusside the drug of choice for?

Answer 25

Hypertensive emergencies in the hospital; given IV

Question 26

Why can you not use nitroprusside for more than 24-36 hours?

Answer 26

Cyanide toxicity (think PRUSSIDE)

Question 27

How can you decrease the cyanide toxicity of nitroprusside?

Answer 27

Coadminister with nitrites and thiosulfate

Question 28

What are minoxidil and diazoxide?

Answer 28

AntiHTN drugs that open ATP-dependent K channels causing hyperpolarization of smooth muscle causing arteriolar vasodilation

Question 29

What can minoxidil be used for other than hypertension?

Answer 29

Baldness (minoxidil is rogaine)

Question 30

Where are the K channels located that minoxidil and diazoxide act on?

Answer 30

Arterioles or the pancreas (causes decreased insulin release by the beta cells which is why hyperglycemia is a side effect of these drugs)

Question 31

Which calcium channel blockers are often used as anti-hypertensives?

Answer 31

Dihydropyridines (e.g. nifedipine) - block the L type Ca channels in the heart and blood vessels; acts strongly on the ones in the blood vessels leading to vasodilation

Question 32

Name 2 drugs that give you gingival hyperplasia?

Answer 32

1. Nifedipine | 2. Phenytoin

Question 33

What is aliskiren?

Answer 33

Renin inhibitor

Question 34

What side effect is present with ACE inhibitors but not with aliskiren?

Answer 34

With ACE inhibitors you get cough because you inhibit the inactivation of bradykinin. This doesn't happen with aliskiren so no cough.

Question 35

What is losartan?

Answer 35

Angiotensin 1 receptor blocker (ARB)

Question 36

What do we use ACE inhibitors for?

Answer 36

1. Moderate to mild HTN 2. Protective against diabetic nephropathy 3. CHF

Question 37

Why are ACE inhibitors contraindicated in the case of renal artery stenosis?

Answer 37

Because you need the effect of renin to get angiotensin II to preferentially constrict the efferent arteriole leading to increased GFR; if you block this with ACE inhibitor then you could cause renal failure

Question 38

Patient with HTN with comorbidities of diabetes and/or heart failure - which antiHTN do we want to use?

Answer 38

ACEI's and ARB's

Question 39

Patient with HTN and cardiac comorbidity (angina, heart failure, post MI) - which antiHTN do we want to use?

Answer 39

Beta blockers

Question 40

Patient with HTN and comorbidities of BPH and dyslipidemia - which antiHTN do we want to use?

Answer 40

Alpha blockers