Antihypertensive

Question 1

Digoxin

Answer 1

Pharm class: Cardiac glycoside
therapeutic class: Anti arrhythmic; inotropic
MOA: vagatonic effect slows AV conduction; increases Ca influx increasing inotropy
Indications: CHF; afib/flutter
P’dynamics:
P’kinetics:
Tox: w/ VFib, hypertrophic cardiomyopathy, AV block, WPW, sinus node disease; N/V, visual changes; agitation
Interactions: additive w/ AV nodal effects quinidine= decreased renal clearance;
considerations:

Question 2

hydrocholothiazide

Answer 2

Pharm class: thiazide diuretic
therapeutic class: diuretic, antihypertensive
MOA:
Indications: hypertension, volume overload
P’dynamics: blocks Cl/Na reuptakes, lowers BP 10-15 mm
P’kinetics: F~70%; excreted unchanged; oral only
Tox: Sulfa allergies, K/Mg depletion, Na/Cl depletion, metabolic alkalosis, volume depletion, worsened hyperuricemia
Interactions: additive w/ most antihypertensives

Question 3

lisinopril

Answer 3

MOA: ACE inhibitor
Indications: antihypertensive, CHF, preserve renal function, acute MI, LV function s/p MI
P’dynamics: inhibits AT1=>AT2 conversion; reduces vasoconstriction; reduces RAAS activation
P’kinetics: excreted unchanged
Tox: orthostatic hypotension, caution w/ impaired renal function, diuretics, aortic/renal stenosis;
Interactions: additive w/ most antihypertensives; NSAIDs reduce efficacy

Question 4

losartan

Answer 4

MOA: angiotensin receptor blocker
Indications: HTN, CHF, renal function preservation
P’dynamics: blocks AT1 receptor stimulation by angiotensin II; reduce vasoconstriction and RAAS activation
P’kinetics: f~30%, extensive first pass effect; active metabolite is more potent
Tox: dizziness, orthostatic hypotension, worsening renal failure
Interactions: additive w/ anti-HTN

Question 5

nitroprusside

Answer 5

MOA: vasodilator
Indications: anti HTN, CHF, PulmHTN, controled hypotension in surgery
P’dynamics: metabolized to NO =>activates genital cyclase=> cGMP => vasodilation;
P’kinetics: IV only, short half life, rapid titration; CN=> SCN by liver, renal excretion
Tox: excessive hypotension, CN + SCN toxicity, headache, decreased cerebral flow
Interactions:additive w/ most hypertensives
ICU + art line; short term use only

Question 6

hydralazine

Answer 6

MOA: direct vasodilator; induces endothelium to produce NO
Indications: HTN
P’kinetics:PO/IV/IM; extensive, GI+hepatic metabolism; renal excretion F~40%
Tox: dangerous w/ renal disease, hx of stroke, angina; hypotension, edema, lupus
Interactions: additive w. antiHTN
Ømonotherapy

Question 7

verapamil

Answer 7

MOA: L type Calcium channel blockers. nodal
Indications:
P’dynamics:
P’kinetics: 35% bioavailable Hepatic; renal excretion
Tox:
Interactions:
considerations:

Question 8

nifedipine

Answer 8

MOA: Calcium entry blocker
Indications: HTN, anti anginal
P’dynamics: inhibits Ca entry in L channels => dilates peripheral arteries; negative inotropic effect; reduces afterload and vasospasm
P’kinetics: F~65-90%; hepatic metabolism, urinary excretion inactive metabolites
Tox: hypotension, AV block, worsening CHF, bradycardia,
Interactions: additive w/ most antihypertensives

Question 9

amlodipine

Answer 9

MOA: Calcium entry blocker
Indications: HTN, anti anginal
P’dynamics: inhibits Ca entry in L channels => dilates peripheral arteries; negative inotropic effect; reduces afterload and vasospasm
P’kinetics: F~65-90%; hepatic metabolism, urinary excretion inactive metabolites
Tox: hypotension, AV block, worsening CHF, bradycardia,
Interactions: additive w/ most antihypertensives
considerations: shorter acing nifidipine

Question 10

diltiazem

Answer 10

MOA: 
Indications: 
P'dynamics:
P'kinetics:
Tox:
Interactions:
considerations:

Question 11

nicardipine

Answer 11

MOA: Calcium entry blocker
Indications: HTN, anti anginal
P’dynamics: inhibits Ca entry in L channels => dilates peripheral arteries; negative inotropic effect; reduces afterload and vasospasm
P’kinetics: F~65-90%; hepatic metabolism, urinary excretion inactive metabolites
Tox: hypotension, AV block, worsening CHF, bradycardia,
Interactions: additive w/ most antihypertensives

Question 12

methyldopa

Answer 12

MOA: 
Indications: 
P'dynamics:
P'kinetics:
Tox:
Interactions:
considerations:

Question 13

reserpine

Answer 13

MOA: Rauwolfia alkaloid
Indications: HTN
P’dynamics: binds NE/5-HT vesicles; prevensts uptake; depletes neurons of NE/5-HT
P’kinetics: good bioavailability oral; 2-3 weeks to effect
Tox: dizziness, orthostatic hypotension, depression
Interactions: additive with AntiHTN
considerations:

Question 14

terazosin

Answer 14

MOA: Alpha-1 Antagonist;
Indications: HTN, BPH
P’dynamics: inhibits NE mediated vaso/venoconstriction
P’kinetics: PO + transdermal F~60%; hepatic metabolism; onset 2h; duration 12-24h
Tox: orthostatic hypotension, esp w/ diuretics; syncope
Interactions: additive w/ most antihypertensives; esp diuretics
considerations: BP, weight edema; start gradually at bed time; R/O carcinoma for males w/ BPH

Question 15

doxazosin

Answer 15

MOA: Alpha-1 Antagonist;
Indications: HTN, BPH
P’dynamics: inhibits NE mediated vaso/venoconstriction
P’kinetics: PO + transdermal F~60%; hepatic metabolism; onset 2h; duration 12-24h
Tox: orthostatic hypotension, esp w/ diuretics; syncope
Interactions: additive w/ most antihypertensives; esp diuretics
considerations: BP, weight edema; start gradually at bed time; R/O carcinoma for males w/ BPH

Question 16

prazosin

Answer 16

MOA: Alpha-1 Antagonist;
Indications: HTN, BPH
P’dynamics: inhibits NE mediated vaso/venoconstriction
P’kinetics: PO + transdermal F~60%; hepatic metabolism; onset 2h; duration 12-24h
Tox: orthostatic hypotension, esp w/ diuretics; syncope
Interactions: additive w/ most antihypertensives; esp diuretics
considerations: BP, weight edema; start gradually at bed time; R/O carcinoma for males w/ BPH

Question 17

Spironolactone

Answer 17

Aldesterone receptor blocker