Anti-hypertensives

Question 1

(Hydro)Chlorothiazide

Answer 1

Thiazides
FIRST LINE THERAPY FOR HTN…↓CO and TPR by decreasing volume, takes time (weeks) for BP to be substantially lowered…cannot give these in conjunction with cardiac glycosides or acidic drugs b/c they compete for same renal transporters into lumen, low dose for systolic HTN

Question 2

List Loop Diuretics

Answer 2

Furosemide/ Bumetanide/ Ethacrynic acid/ Torsemide

Question 3

Loop Diuretics

Answer 3

decreased CO and TPR as well as increased PG12 production leading to venodilation…can also be used in patients with edema…cannot give in conjunction with cardiac glycosides or acidic drugs b/c they compete for same renal transporters into lumen

Question 4

K+-sparing diuretics

Answer 4

Spironolactone/Triamterene/Amiloride

Often combined with K+ wasting diuretics

Question 5

List Beta blockers

Answer 5

Propranolol, Atenolol, Metoprolol

Question 6

Propranolol

Answer 6

block B1 at level of the heart to decrease CO & HR…block B1 at level of kidney to decrease renin release from JG cells…leads to vasodilation (decreased TPR)…also indicated for use in treatment of angina & MI

Question 7

Atenolol/Metoprolol

Answer 7

selective B1 antagonists

Question 8

Clonidine

Answer 8

CNS a2 agonist

decrease SNS outflow to reduce HR, TPR, & MAP…can lead to sedation, confusion, orthostatic HTN (CI in elderly)

Question 9

Reserpine

Answer 9

prevents loading of NE into vesicle at pre-synaptic membrane (≈vesamicol)

Question 10

Guanethidine

Answer 10

prevents fusion of NE-vesicle
with synapse (≈botulinum)

Question 11

List CCBs

Answer 11

Nifedipine, Verapamil, Diltiazem

Question 12

Nifedipine

Answer 12

Dihydropyridine
blocks L-type voltage gated Ca2+ channels on vascular smooth muscle, inhibiting Ca2+influx and decreasing contraction…DOES NOT affect contractility of myocytes…can cause reflex tachycardia and ankle edema (from the arterial dilation)…can be used w/ Beta Blockers

Question 13

Verapamil, Diltiazem

Answer 13

Nondihydropyridine
block L-type voltage gated Ca2+channels on vascular smooth muscle as well as on myocytes…leads to arterial vasodilation AS WELL AS decreased contractility of heart…can cause reflex trachycardia and ankle edema…DO NOT USE W/ BETA BLOCKERS

Question 14

Sodium nitroprusside (-glycerin)

Answer 14

↑NO - ↑cGMP - ↑PKG - ↓contraction…this can be given IV in emergent situations (none of the nitrates can be given PO)…can cause cyanide poisoning with ↑use/dosage

Question 15

Hydralazine

Answer 15

causes selective relaxation of arterial smooth muscle (NO

works on both) leading to decreased TPR

Question 16

Minoxidil

Answer 16

causes selective relaxation of arterial smooth muscle (NO works on both) leading to decreased TPR…can cause hirsuitism (active ingredient in Rogaine)

Question 17

List ACE inhibitors

Answer 17

Captopril, Lisinopril, Enalapril, Ramipril

Question 18

ACE Inhibitors

Answer 18

promote vasodilation by inhibiting production of angiotensin II (ATII constricts arteries AND vein so these reduce preload AND afterload)… also inhibit cardiac & vascular hypertrophy, diuresis, natriuresis, and ↓SNS ouput…can cause hyperkalemia & cough from ↑bradykinin levels CONTRAINDICATED IN PREGNANCY (ATII = trophic factor)

Question 19

List ATII-1 Blockers (ARBs)

Answer 19

Losartan, Valsartan, Irbesartan, Candesartan

Question 20

ARBs

Answer 20

competitively binds to ATII-1 Receptor (mediator of constriction effects of ATII)…no cough because now bradykinin is metabolized normally

Question 21

Aliskiren

Answer 21

orally active renin inhibitor, preventing release intracellularly