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C. Cardiovascular Drugs > Anti-hypertensive Medications > Flashcards

Anti-hypertensive Medications Flashcards

1
Q

Antihypertensive therapy

A
  1. Diuretics
  2. ACEI / AT1-R antagonist
  3. Ca-blocker
  4. Beta-blocker
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2
Q

Examples of ACEI

A
  1. Captopril
  2. Enalapril
  3. Ramipril
  4. Lisinopril
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3
Q

MOA of ACEI

A

Mechanism of action: inhibition of ACE → ↓ conversion of angiotensin I to angiotensin II

Main effects:

  1. ↓ Angiotensin II
    - ↓ Vasoconstriction → ↓ blood pressure
    - ↓ Secretion of aldosterone → ↓ reabsorption of Na+ and water → ↓ blood pressure
    - Dilation of efferent arteriole → ↑ renal plasma flow → ↓ GFR → ↓ filtration fraction
    - ↑ Renin secretion (due to lack of feedback inhibition) → ↑ angiotensin I
  2. ↓ Breakdown of bradykinin → ↑ production of arachidonic acid metabolites → ↑ vasodilation → ↓ blood pressure
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4
Q

Clinical uses of ACEI

A
  1. Hypertension
  2. Cardiac failure
  3. Following myocardial infarction
  4. Renal insufficiency
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5
Q

Adverse effects of ACEI

A
  1. severe hypotension
  2. acute renal failure
  3. hyperkalemia
  4. angioedema & dry cough
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6
Q

Contraindication of ACEI

A

pregnancy

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7
Q

Examples of Ang II Receptor (AT1) blockers (ARB)

A
  1. Lorsartan
  2. Valsartan
  3. Candesartan
  4. Eprosartan
  5. Irbesartan
  6. Telmisartan
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8
Q

MOA of ARB

A

Mechanism of action: inhibition of angiotensin II receptor type 1 (AT1 receptor)

Main effects:

  • ↓ Vasoconstriction → ↓ blood pressure
  • ↓ Secretion of aldosterone → ↓ reabsorption of Na+ and water → ↓ blood pressure
  • ↑ Renin secretion (compensatory) → ↑ angiotensin I → ↑ angiotensin II
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9
Q

Adverse effects of ARB

A

Less/no dry cough (unlike in ACEI)

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10
Q

Contraindication of ARB

A

Pregnancy

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11
Q

Examples of non-selective beta-blockers

A
  1. Proponolol
  2. Pindolol
  3. Carvedilol
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12
Q

Examples of cardioselective beta-blockers

A
  1. Atenolol
  2. Bisoprolol
  3. Metoprolol
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13
Q

Beta-blockers approved to treat heart failure

A
  1. Bisoprolol
  2. Metoprolol
  3. Carvedilol
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14
Q

Clinical uses of beta-blockers

A
  1. Hypertension
  2. Cardiac failure
  3. Following myocardial infarction
  4. Abnormal heart rhythm
  5. Anxiety disorders
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15
Q

Adverse effects of beta-blockers

A
  1. Hypotension
  2. Bradycardia
  3. AV nodal block
  4. Reduced exercising capacity
  5. Bronchoconstriction (esp. asthmatics)
  6. CNS: vivid dreams, clinical depression
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16
Q

MOA of beta-blockers

A
  1. Anti-ischemic effect: β1 blockade → ↓ heart rate and ↓ cardiac contractility → ↓ blood pressure (BP) and ↓ oxygen consumption by the heart → anti-ischemic effect
  2. Antiarrhythmic effect: β1 blockade → ↓ AVN conduction, ↑ AVN refractory time, and ↓ heart rate → anti-arrhythmic effect
  3. Anti-remodeling effect
17
Q

Examples of Calcium Channel Blockers

A
  1. Nifedipine (DHP)
  2. Amlodipine (DHP)
  3. Verapamil
  4. Diltiazem
18
Q

MOA of DHP CCB

A

CCBs bind to and block L-type calcium channels in cardiac and vascular smooth muscle cells → decreased frequency of Ca2+ channel opening in response to cell membrane depolarization → decreased transmembrane Ca2+ current

Effects of decreased Ca2+ influx:
1. Vascular smooth muscle relaxation → vasodilation → decreased peripheral vascular resistance → decreased afterload → decreased blood pressure

  1. Decreased cardiac muscle contractility (negative inotropic action) → decreased cardiac output → decreased blood pressure
  2. Decreased SA node discharge rate (negative chronotropic action) → decreased heart rate (bradycardia) → decreased cardiac output → decreased blood pressure
  3. Decreased AV node conduction (negative dromotropic action) → termination of supraventricular arrhythmias
19
Q

Clinical use of CCB

A
  1. Antiarrhythmic (Class IV), anti-angina, anti-hypertension
  2. Anti-HTN: all equally effective
    
Vasodilator: Nifedipine (preferred choice for vasopastic angina) > diltiazem > verapamil
  3. Cardiac depressant: verapamil > diltiazem > nifedipine
20
Q

Adverse effects of CCB

A
  1. Hypotension
  2. Heart failure
  3. Myocardial infarction

C. Cardiovascular Drugs (6 decks)

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