Anti-Hypertensives

Question 1

Primary HTN

Answer 1

No specific cause
Associated with increased TPR, normal CO
No cure, asymptomatic, insidious

Question 2

Secondary HTN

Answer 2

caused by other cause

Curable

Question 3

Hypertensive crisis

Answer 3

Diastolic >120 mmHg

Question 4

Blood pressure regulation

Answer 4

BP=COxTPR
SNS and PNS balance
Renin-angiotensin
Kidneys

Question 5

JNC 8 Guidelines

First line agents

Answer 5

Thiazide diuretics, ACE inhibitors, ARBs, Ca channel blockers
Exhaust first line agents before you move on to third line
First line has survival benefit
combine/dose anyway to get the BP down

Question 6

Chlorthalidone

thiazide-like diuretic

Answer 6

Naturesis
Increase renal excretion of Na+ and water follow
(initial increase in TPR due to renin release)
Deplete Na+ from vasculature Na+/Ca++ exchange = cannot contract!

Question 7

Chlorthalidone dosing

What patients is this drug best for?

Answer 7

low dose 12.5-25mg monotherapy stage 1
lowers 10-15mmHg, if >25mg no change
shallow anti-hypertensive dose-dependence
synergistic effect* = can use in combo

Question 8

Furosemide

Answer 8

Loop diuretic
Brisk diuresis, short duration of action
Tx: Malignant HTN, volume-dependent renal disease
Adverse: ototoxicity, Increased urinary excretion of Ca2+ (bad for osteo)

Question 9

Catopril

Answer 9

ACE Inhibitor
No angiotensin II = increased bradykinin = vasodilation
Good for long-term = no cardiac effects, no orthostatic HTN,

Question 10

Major adverse of Catopril

Answer 10

*First dose phenomenon (BP drops significantly)
Be aware if patient already on low sodium diet
Test renin first
*angioedema
*dry cough

Question 11

Losartan

Answer 11

AT1 Receptor antagonist (angiotensin receptor)
Decreases TPR
Alternative for patients who cannot use ACE inhibitors!
No effect on bradykinin

Question 12

Eplerenone

Answer 12

Aldosterone antagonist selective

Excretion of Na+ and water, block aldosterone receptor in the kidney

Question 13

Aliskiren

Answer 13

Direct renin inhibitor
blocks conversion of antiotensinogen to AngI
alone/in combo w/ other anti-HTN

Question 14

Nifedipine, Verapimil

Answer 14

Ca++ channel blockers
Dihydropyridines (do not affect heart)
Decrease TPR — vasodilation

Question 15

Nitropusside

Answer 15

Vasodilator - NO donor (rlease non-enzymatically) no tolerance
Arterial and venous dilation
**Malignant HTN and hypotensive surgery tx - **IMMEDIATE EFFECT but short duration of action (5 minutes) after infusion stopped

Question 16

Hydralazine

Answer 16

FIRST DRUG FOR ETHNIC SUB-POPULATION in combination with isosorbide dinitrite (other vasodilator)
HTN & CHF in African americans
Nitric oxide donor

Question 17

Minoxidil

Answer 17

Opening K+ channels in VSM = vasodilation
K+ efflux from cells = hyperpolarize, reduce ability to contract
TOXICITY LEVEL HIGH, do not use unless last resort
ROGAINE!!! promote hair growth

Question 18

Treatment algorithm

Answer 18

Lifestyle changes

More agressive treatement with more drugs is better for extending life