Anti-hypertensives II Flashcards
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Non selective alpha blockers are primarily used for ___ resulting from excess catecholamines
Alpha 1 blockers are reserved primarily for ___
Alpha 1a blockers are only used for ___
Non selective alpha blockers are primarily used for hypertensive emergencies resulting from excess catecholamines
Alpha 1 blockers are reserved primarily for pts with BPH + hypertension
Alpha 1a blockers are only used for BPH
Name 2 miscallaneous drugs used to treat hypertension
Minoxidil
Hydralizine
What are the side effects of minoxidil?
Reflex tachycardia (patients often need concomitant beta blocker)
Peripheral edema (patients often need concomitant diuretic)
Pericardial effusions
**Drug MOA: something to do with K+ channel opening >> somehow affecting Ca2+ closure**
**Also used to rx alopecia - active ingrediant in Rogaine**
Why can hydralazine be combined with nitrates for HTN treatment?
Works as an antioxidant to combat free radicals so helps reduce tolerance to nitrate therapy
**note that this drug is mostly beneficial for heart failure**
What is the effect of inhibiting the RAAS?
Direct vasodilation
Increased Na+ and water elimination
Describe the mechanism of action of ACE inhibitors
ACE inhibitors block the conversion of Ang I to Ang II, and also cause increased bradykinin/inhibit bradykinin breakdown
What is the MOA of Angotensin II blockers?
ARBS inhibit binding of ANGII to the AT1 receptors >> Na+ and water elimination >> lowers blood pressure
What are the adverse effects of ACE inhibitors and ARBs?
Hypotension
Hyperkalemia (via aldosterone decrease >> increased intracellular K+)
Renal dysfunction
Teratogens
How do ACE inhibitors alter GFR? How can using ACE inhibitors or ARBs cause acute kidney injury?
Acute kidney injury caused by significant drop in GFR in conditions where afferent arteriole is already constricted + using an ACE inhibitor or ARB e.g. in renal artery stenosis, using NSAIDS
Two systems that can be impacted in heart failure with reduced ejection fraction are ___ and ___
Two systems that can be impacted in heart failure with reduced ejection fraction are RAAS and Atrial Natriuretic Peptide system
**RAAS impact: activation of RAAS leading to increased blood pressure**
**Natriuretic peptide system = opposite**
Describe the combined Ang II inhibitor/Neprolysin inhibitor effects on treatment of heart failure with reduced ejection fraction
Valsartan is an ace inhibitor/Sacubitril is an neprolysin inhibitor
Both work to improve heart failure with reduced ejection fraction
Describe the role of aldosterone in the kidney and in smooth muscle vasculature
In the kidney, Aldosterone basically works to promote sodium retention and K+ excretion which (increases blood pressure)
In vascular smooth muscle, aldo promotes vasoconstriction
Aldosterone antagonists, __ and __, directly bind to the mineralocorticid receptor and inhibit aldosterone effects, thereby lowering BP
Aldosterone antagonists, spironolactone and eplerenone, directly bind to the mineralocorticid receptor and inhibit aldosterone effects, thereby lowering BP
What are the adverse effects of aldosterone antagonists?
Hyperkalemia
Gynecomastia
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**see below**
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What is the mechanism of loop diuretics?
Loop diuretics inhibit the Na+/K+/2Cl pump in the ascending loop of Henle
**mainly used for volume control**
What is the mechanism of action of thiazide diuretics and how do they reduce hypertension?
Inhibit the Na/Cl co transporter in the distal convoluted tubule
Anti-HTN mechanisms: diuresis and direct vasodilation
What is the MOA of K+ sparring diuretics and when would you use them?
Block Na+ channels in DCT >> decreased function of Na/K+ ATPase
Mainly used in combo w/ thiazide diuretics to prevent hypokalemia
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**see below**
What are some mechanisms of resistance to diuretics?
Decreased renal perfusion
Compensatory reabsorption between doses
Compensatory sodium reabsorption at distal sites
Neurohormonal respose to decreased plasma volume
