Anti-Hypertensives Flashcards by Denisse Tiangco

Activates central a2 adrenoreceptors in medulla oblongata
Dec central sympa outflow
Dec NE from noradrenergic nerve endings

Methyldopa
Clonidine
Guanabenz/Guanfacine

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Methyldopa SE (7)

Sedation
Nightmare
Depression
EPS
Hemolytic anemia
Drug fever
Hepatitis

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Clonidine SE (4)

Dry mouth
Sedation
Depression
Rebound hypertension

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Drug that should be avoided in elderly

Clonidine

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Sympatho and parasympathoplegia

Competitively blocks nicotinic receptors on post ganglionic neurons

Ganglion blockers
Hexanethonium
Mecamylamine

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Ganglion blocker SE

OH
Sexual dysfxn
Constipation
Urinary retention
Glaucoma
No longer used

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Reduces all sympathetic effects

Nerve terminal blocking
Reserpine
Guanethedine

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Blocks vesicular amine transporter in noradrenergic nerves

Reserpine

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Replaces NE in vesicles

Dec sympathetic effect

Guanethedine

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Nerve terminal blocker SE (8)

Mild diarrhea
GI cramps
Inc gastric acid secretion
Sedation
Lassitude
Nightmare
Severe mental depression 
EPS

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Alpha 1 Receptor sites (4)

Peripheral bv
Eye
Sex organs male
Bladder neck

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Alpha 2 receptor site

Presynaptic neurons

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Beta 1 receptor sites (2)

Myocardium

Kidney

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Beta 2 receptor sites (5)

Peripheral blood vessel
Bronchial smooth muscle
Uterus
Liver
Skeletal muscle

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Alpha 1 and 2 blocker

No value in chronic hypertension bec of excessive tachycardia

Phenoxybenzamine

Phentolamine

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Nonselective alpha blocker indication

Pheochromocytoma

Clonidine withdrawal

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Effective when combined with beta blocker/diuretic

Blocks vasoconstriction

Alpha 1 selective blocker
Terazosin
Prazosin
Tamsulosin

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Alpha 1 selective blocker

Hypertension

BPH

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Alpha 1 selective blocker SE

+ ANA, SLE prazosin

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No clinical indication
Found in energy drinks/far burner/workout supplement
Blocks vasodilation inc BP

Alpha 2 selective blocker

Yohimbine

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Dec CO

Dec renin and SNS receptor activity

Beta blocker

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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