Anti-hypertensive Drugs

Question 1

Primary Hypertension

Answer 1

Unknown Origin
85% of cases
Treatable but incurable

Question 2

Secondary Hypertension

Answer 2

Rapid onset, more severe, and symptomatic
Most common causes include endocrine disorders, medications, renal disease, obesity, congenital heart defects, genetics, lifestyle

Question 3

Hypertensive Blood Pressures

Answer 3

Normal: 100 or >160

Question 4

Blood Pressure Components

Answer 4

BP=(CO x TPR) + CVP
TPR=Total Peripheral Resistance
CVP is negligible for our purposes

Question 5

Potassium Channel Openers

Answer 5

Vasodilator
Minoxidil, Hydralazine, Diazoxide
Targets Potassium ATP channels
Hyperpolarization of the cell by potassium eflux inhibits voltage sensitive L-type Calcium channels, reducing calcium levels.
INDIRECT INHIBITION OF L-TYPE CALCIUM CHANNELS

Question 6

Calcium Channel Blockers

Answer 6

Selectively Inhibit L-Type Calcium Channels in both vascular and cardiac muscle cells
Dihydropyridines are more vascular selective than other CCBs because of the higher resting potential of smooth muscle

Question 7

Nitrates

Answer 7

Non-selective Vasodilators
Sodium Nitroprusside
Nitroglycerin
Nitric Oxide Donors give NO, trigger cGMP -> PKG -> Miracle -> relax

Question 8

Alpha 2 Agonist

Answer 8

Uses: For HTN resistant to other treatment
Side Effects: Dampen sympathetic reflexes
Sedation - up to 50% of patients
Nausea
Withdrawal

Question 9

Clonidine

Answer 9

Direct A2-Agonist
Centrally Acting
Inhibits Sympathetic outflow from the brain

Question 10

Methyldopa

Answer 10

Prodrug A2-Agonist
Centrally Acting
Inhibits sympathetic outflow from the brain
Methyldopa-> methyldopamine-> methylnorepinephrine (active metabolite)

Question 11

Trimethaphan (Arfonad)

Answer 11

Non-depolarizing inhibitor of ganglionic nicotinic cholinergic receptors
Peripherally acting
Use: Controlled hypotension
Dampen spinal autonomic reflexes

Question 12

Prazosin (Minipress)

Answer 12

Alpha-1 Adrenergic Antagonist
Blocks the vasoconstrictor effect of sympathetic tone
Causes vasodilation
Causes vasodilation commensurate with degree sympathetic activity is involved in vasoconstriction (allows parasympathetic to overcome sympathetic control of vascular smooth muscle)

Question 13

Alpha 1 Blocker

Answer 13

Uses: Monotherapy for mild to moderate hypertension
Useful component in polytherapy strategies
SYMPTOMATIC PROSTATE HYPERTROPHY
Side Effects:
Good - Lipid profiles
Bad - First-dose phenomenon-postural hypotension

Question 14

Beta Antagonists

Answer 14

Inhibit ionotropic and chronotropic effects of SNS in the heart.
Main: Reduces cardiac output
Secondary: Inhibits SNS-mediated renin release (indirectly lowering TPR), can affect sympathetic outflow

Question 15

Propanolol

Answer 15

Non-selective beta antagonist

Can trigger asthma symptoms

Question 16

Metoprolol (Lopressor)

Answer 16

Beta-1 Selective antagonist

Question 17

Renin Inhibitors

Answer 17

Aliskirin (tekturna)

The newest drug class

Question 18

ACE Inhibitors

Answer 18

“Prils”
Lisinopril (prinivil)
Dry Cough inducers, teratogenic

Question 19

AT1-Receptor Antagonists

Answer 19

Losartan (Cozaar)

Don’t present with the dry hacking cough of ACE inhibitors

Question 20

Thiazide Diuretics

Answer 20

Diuretic

Gold standard proven in mild HTN, reduces TPR

Question 21

Potassium Sparing Diuretics

Answer 21

Use as adjuvents

Question 22

Loop Diuretics

Answer 22

Only in refractory HTN