AntiHTN Flashcards by Eric Sun

What are the 3 strategies to reduce BP?

Reduce CO
Reduce TPR
Reduce body fluid volume

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What else does ACEI inhibit, which results in?

Inhibit breakdown of bradykinin—>dry cough

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What receptors do ARB block?

AT-1 receptors

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What are the drug endings for ACEI and ARB? and what does aliskiren do?

ACEI—>”pril”
ARB—>”sartan”
Aliskiren—>block renin

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What else do ACEI and ARB used for besides HTN?

Diabetic nephropathy
CHF
chronic kidney disease

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How does ACEI and ARB cause hyperkalemia?

ACEI and ARB decrease level of aldosterone—>aldosterone is K+ wasting—>thus hyperkalemia

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What are the side effects of ACEI and ARB?

Angioedema (facial area)
Hyperkalemia
Dry cough (ACEI)
Acute renal failure with bilateral renal stenosis

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Can you use ACEI and ARB for pregos?

No—->they are teratogen

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How are ACEI and ARB renal protective and why can they cause acute renal failure with bilateral renal stenosis?

ACEI and ARB dilate efferent arterioles (constricted by aldosterone)—>decrease GFR—>protect kidneys from hyperfiltration
ACEI and ARB lower GFR significantly with bilateral renal stenosis—>renal failure

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How can chronic use of NSIADs affect the kidneys?

Prevent production of PGE2—>afferent arteriole constriction—>renal failure

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What is the mechanism of calcium channel blockers?

Block L type Ca2+ channel in blood vessels and heart—>lower Ca2+—>lower CO and TPR—>lower BP

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What are the dihydropyridine and non-dihydropyridine? and what are their selectivity on Ca channel?

Calcium channel blocker:
Dihydropyridine—>nifedipine and amlodipine (“dipine”)—>traget Ca2+ channel in blood vessel
Non-hyhydropyridine—>verapamil and diltiazem—>target Ca2+ in the heart

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Which Ca2+ channel blockers would increase HR?

Dihydropyridine (“dipine”)—>reflex tachycardia

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What are the Ca2+ channel blockers that are antiarrthymia?

Verapamil and diltiazem

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What are the 3 drugs that cause gingival hyperplasia?

Phenytoin/cyclosporine/dihydropyridine (“dipine”)

Gum swollen/bleed

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What are some common drugs that cause constipation?

Opioid/antimuscarinic/verapamil

What are some side effects of beta blockers?

Rebound HTN (if stop abruptly)/increase LDL and TGs/fatigue/sexual dysfuntion

How can beta blocker affect diabetic pts?

Mask hypoglycemia

What are the alpha 1 antagonists? they can cause what affect when giving for the first time?

“zosin”/first dose syncope—>titrate up

Side effects of “zosin”?

Orthostatic HoTN/urinary incontinence (increase urination)/increase HDL and decrease LDL

What are the 2 alpha 2 agonists? What is their mechanism?

Clonidine and methydopa/decrease symp

What are the uses for clonidine and methydopa?

HTN
Clonidine—>opiate withdraw
Methydopa—>HTN in pregnancy

Side effects of alpha 2 agonists?

Methydopa—>hemolytic anemia (positive Coombs test)

CNS depression—>fatigue

What is hydralazine? and side effects?

Direct arteriole vasodilator via NO—>anti HTN
Used especially for preeclampsia HTN
Lupus like symptoms

What drug is used to prevent and treat eclamptic seizure?

Magnesium sulfate

What is nitroprusside? and side effects?

Vein and arteriole vasodilator via NO--->anti HTN (emergency) Side effects--->long term use cause cyanide poisoning

What drugs are used to treat cyanide poisoning?

Sodium or amyl nitrite--->convert Hb into MetHb--->CN binds to MetHb to form cyanomethemoglobin Sodium thiosulfate--->enhance metabolism of CN via rhodanase Hydroxycobalamin--->binds with CN--->B12

What is used to treat MetHbnemia?

Methylene blue--->reduce MetHb

What is HTN emergency and how do we treat it?

HTN severe enough to cause end organ damage--->lower BP slowly Start with nitroprusside--->then change to labetalol or fenoldopam

What are minoxidil and diazoxide? and what are their mechanism and side effects?

Open K channel--->hyperpolarization of smooth muscle--->arteriole dilator--->anti HTN Diazoxide--->decrease insulin release--->insulinoma Minoxidil--->baldness

What else should be given with long term use of arteriole dilator for HTN?

Diuretics (for edema)/beta blocker (for reflex tachy)

Which 2 kind of drugs are contraindicated for HTN with hihg lipid?

Beta blocker and thiazide

What are drugs for pul HTN and what are their mechanism?

Bosentan--->block endothelin (vasoconstrict)A receptor--->no pregos Epoprostenol--->PGI2 analog Sidenafil--->PDE5 inhibitor--->increase cGMP--->pul artery relaxation