Anti-Hypertensives Flashcards
Activates central a2 adrenoreceptors in medulla oblongata
Dec central sympa outflow
Dec NE from noradrenergic nerve endings
Methyldopa
Clonidine
Guanabenz/Guanfacine
Methyldopa SE (7)
Sedation Nightmare Depression EPS Hemolytic anemia Drug fever Hepatitis
Clonidine SE (4)
Dry mouth
Sedation
Depression
Rebound hypertension
Drug that should be avoided in elderly
Clonidine
Sympatho and parasympathoplegia
Competitively blocks nicotinic receptors on post ganglionic neurons
Ganglion blockers
Hexanethonium
Mecamylamine
Ganglion blocker SE
OH Sexual dysfxn Constipation Urinary retention Glaucoma No longer used
Reduces all sympathetic effects
Nerve terminal blocking
Reserpine
Guanethedine
Blocks vesicular amine transporter in noradrenergic nerves
Reserpine
Replaces NE in vesicles
Dec sympathetic effect
Guanethedine
Nerve terminal blocker SE (8)
Mild diarrhea GI cramps Inc gastric acid secretion Sedation Lassitude Nightmare Severe mental depression EPS
Alpha 1 Receptor sites (4)
Peripheral bv
Eye
Sex organs male
Bladder neck
Alpha 2 receptor site
Presynaptic neurons
Beta 1 receptor sites (2)
Myocardium
Kidney
Beta 2 receptor sites (5)
Peripheral blood vessel Bronchial smooth muscle Uterus Liver Skeletal muscle
Alpha 1 and 2 blocker
No value in chronic hypertension bec of excessive tachycardia
Phenoxybenzamine
Phentolamine
Nonselective alpha blocker indication
Pheochromocytoma
Clonidine withdrawal
Effective when combined with beta blocker/diuretic
Blocks vasoconstriction
Alpha 1 selective blocker
Terazosin
Prazosin
Tamsulosin
Alpha 1 selective blocker
Hypertension
BPH
Alpha 1 selective blocker SE
OH
+ ANA, SLE prazosin
No clinical indication
Found in energy drinks/far burner/workout supplement
Blocks vasodilation inc BP
Alpha 2 selective blocker
Yohimbine
Dec CO
Dec renin and SNS receptor activity
Beta blocker
Beta blocker SE (3)
Bronchospasm
Erectile dysfunction
Excessive cardiac dysfunction
Non selective beta blockers
Propranolol Nadolol Carteolol Carvedilol Pindolol Penbutalol
Selective beta blocker
Betaxolol Bisprolol Acebutalol Nebivolol Esmolol
Beta blockers with long half lives and need dose adjustment in renal and liver disease
Nadolol
Carteolol
Betaxolol
Bisoprolol
Advantageous in asthma, DM, PVD
Used in HTN and HF
Metoprolol
Atenolok
Partial agonist
Intrinsic sympathetic activity
Msy cause bradyarrhythmia and PVD
Pindolol
Acebutalol
Penbutalol
Combined alpha and beta blocking activity
Reduced mortality in HF
Inc endothelial release of nitric oxide
Labetalol
Carvedilol
Nebivolol
Very short half life Intraoperative and Postoperative hypertension IV - immediate dec in HR For severe tachycardia in OR
Esmolol
Inhibits calcium influx into arterial smooth muscle cell
Calcium ch blocker
More selective as vasodilators
Acts mainly on blood vessels
Reflex SNS activation with slight tachycardia
Dihydropiridine Amlodipine Nicardipine Nifedipine Felodipine Nimodipine
Contraindicates in MI
Nifedipine short acting
Dihydropiridine SE (2)
Constipation
Edema
Cardiac depressant
Contraindicated in heart failure
Affects blood vessel and heart
Non Dihydropyridine
Verapamil
Diltiazem
Dilates arteriole not veins
Combining it with nitrate is effective in HF
Hydralazine
Hydralazine SE
SLE Headache Nausea Anorexia Palpitation Sweating Flushing
Dilates both arterial and venous vessel Activates guanylyl cyclase Inc cGMP Relaxes vascular smooth muscle Rapid action, short duration, photosensitive
Nitroprusside
Nitropruside SE
Severe hypotension
Cyanide toxicity
Tx of cyanide tox
Sodium thiosulfate
Causes hyperpolarization or opening of K channel
Dilates arteriole but not veins
Used in combination with beta blocker and loop diuretic
Minoxidil
Minoxidil SE (4)
Hypertrichosis
Hirsutism
Headache
Sweating
Hyperpolarization of membrane opening of K ch
Rapid fall in systemic vascular resistance and MAP
Similar chemically to thiazide but without diuretic activity
Inhibits insulin release from pancreas (insulinoma)
Diazoxide
Diazoxide SE (2)
Hypotension
Hyperglycemia
Dilation of peripheral arteries and natriuresis
hypertensive emergencies and post op hypertension
Inc intraocular pressure CI:glaucoma
Fenoldopam
Fenoldopam SE (4)
Reflex tachycardia
Headache
Flushing
Hypotension
Inhibits converting enzyme peptidyl dipeptidase that hydrolyzes angiotensin I to angiotensin II
ACE Inhibitors
ACEI causes cough bec
Inactivates bradykinin releasing NO and prostacyclin (vasodilator)
ACE I can be used in
HTN
CKD
HF
POST MI
ACE I are all prodrugs and converted in metabolites in the
liver
ACE I are eliminated in
Kidney
except Moexipril and Fosinopril
ACE I/ARB SE (6)
Hyperkalemia Dry cough Angioedema AKI Severe hypotension Neutropenia
ACE I contraindication
Pregnancy
Blocks angiotensin II type 1 (AT1 receptor)
ARB
Losartan Valsartan Candesartan Eprosartan Irbesartan Telmisartan Olmesartan
ARB duration of action
6-8 hours
