Antihypertensive Agents

Question 1

Metoprolol uses:

Answer 1

• Use for rapid HR, Contractility, and CO control –> therefore, decreases BP
• Used for treatment for MI

Question 2

Propranolol drug class &; MOA:

Answer 2

Beta blocker;

Nonselective Beta-1 and Beta-2 antagonist

Question 3

Labetalol effects:

Answer 3

Decreases HR and BP simultaneously;

BP reduction causes decreased CO and PVR.

Can depress cardiac contractility.

Minimally affects CBP or ICP

Question 4

Propranolol effects:

Answer 4

• Decreases BP; due to decrease in myocardial contractility, HR, CO;
• Therefore causes decrease in myocardial oxygen demand.

Question 5

Metoprolol (___)

Answer 5

(Lopressor)

Question 6

Hydralazine primary effect:

Answer 6

Decreases BP with increase in HR, SV, and cardiac output.

Question 7

Labetalol drug class &; MOA:

Answer 7

Primarily considered a Beta Blocker;

Nonselective beta-1 and beta-2; with selective alpha-1adrenergic antagonist.

Question 8

Metoprolol —> primary reason for giving this?

Answer 8

Similarly to propranolol, this has a prolonged half-life; give when Esmolol works, but tachycardia keeps coming back.

Question 9

Labetalol c/i:

Answer 9

Contraindicated in:

Bronchospastic disease ; (beta-2 antagonism causes bronchoconstriction).
Impaired cardiac conduction or underlying resting bradycardia

Question 10

Esmolol primary use:

Answer 10

Decreases HR only

Question 11

V2 receptor —> location of effect:

Answer 11

Renal

Question 12

V1 receptor —> location of effect:

Answer 12

CV effects

Question 13

Esmolol (___)

Answer 13

(Brevibloc)

Question 14

Labetalol uses:

Answer 14

Acute and chronic HTN in pregnant pts.

Treat increases in BP and HR from stimulation (intubation)

Question 15

Propranolol (_____)

Answer 15

(Inderal)

Question 16

Metoprolol drug class and MOA:

Answer 16

Beta blocker;

Selective Beta-1 adrenergic receptor antagonist;

Prevents inotropic and chronotropic responses to Beta stimulation.

Question 17

Hydralazine MOA:

Answer 17

Direct systemic arterial vasodilator causing relaxation of arterial smooth muscle;

Blocks calcium release from sarcoplasmic reticulum.

Decreases BP with increase in HR, SV, and cardiac output (CO).

Question 18

Esmolol uses:

Answer 18

Treats perioperative tachycardia;

Pre-treatment during intubation/extubation.

Question 19

Esmolol c/i:

Answer 19

Contraindicated in
- Bradycardia,
- Heart block,
- Cardiogenic shock,
- Heart failure

Question 20

Hydralazine —> primary reason we give this:

Answer 20

Dr. R’s go-to when she has given labetalol, it worked, but HTN came back.

Question 21

Hydralazine (_______)

Answer 21

Apresoline

Question 22

Propranolol —> use caution in which patients?

Answer 22

Careful use in bronchospastic disease.
AV block, and bradycardia.

Question 23

Labetalol (___)

Answer 23

(Trandate)

Question 24

V3 receptor —> location of effect:

Answer 24

Pituitary

Question 25

Hydralazine uses:

Answer 25

HTN Heart failure Eclampsia

Question 26

Propranolol uses:

Answer 26

Treat Anxiety/ Panic attacks Angina Pheochromocytoma Acute MI HTN

Question 27

Hydralazine ---> caution in which patients??

Answer 27

Potential for increased ICP, careful/contraindicated in CAD.

Question 28

Propranolol ---> primary reason why it is given:

Answer 28

Maybe labetalol works, but **tachycardia** keeps coming back ---> give this for longer duration of action Or, if the patient did not take their BB the AM prior to surgery and you want them to have something, we may give this in preop.

Question 29

Labetalol primary use:

Answer 29

Simultaneously decreases BP & HR

Question 30

Esmolol effects:

Answer 30

Decreases HR, myocardial contractility, CO, and some decrease in BP; No rebound effects.

Question 31

Esmolol drug class and MOA:

Answer 31

Beta blocker; Rapid-onset and short-acting **Selective Beta-1** antagonist

Question 32

Hydralazine dose: onset: duration:

Answer 32

2.5-5 mg IV titrated every 20-30 mins. onset: 15-30 mins duration: 4-6 hours *start with 2.5 mg, wait 15 mins, if no response -----> give 2.5 mg more *for OB eclampsia ---> give labetalol, then hydralazine, then nipride.

Question 34

Metoprolol dose: Half-life:

Answer 34

1-5 mg IV (up to 15 mg) half-life: 3-4 hrs

Question 35

Propranolol dose: Onset: Duration:

Answer 35

1-3 mg IV (no more than 1 mg/min) **titrated to effect**. onset: around 2-3 mins Duration: up to 4-6 hrs (depending on the source) *Dr. R gives 1 mg in preop, lets that kick in and assesses further in OR *not a first-line drug due to longer onset (use labetalol first)

Question 36

Esmolol dose: Infusion: Onset: Duration:

Answer 36

10 mg boluses IV, Infusion of 50 mcg/kg/min **after a 0.5 mg/kg bolus onset: RAPID Duration: 10-15 mins (d/t metabolism by **plasma esterases**)

Question 37

Which two antihypertensive agents are most commonly used for periop HTN and why?

Answer 37

Labetalol & Esmolol ---> d/t fast onset.

Question 38

Labetalol dose: Onset: Duration:

Answer 38

5-20 mg boluses IV Onset: 1-2 mins Duration: up to 6 hrs *Dr. R usually starts by giving 10 mg, waits, reassesses, can give 10 mg more

Question 39

What are 7 potentially reversible causes of hypertension?

Answer 39

Pain Hypothermia Anxiety Increased ICP Bladder distention Poorly controlled HTN Lack of anesthesia

Question 40

Progression of treatment for OB eclampsia:

Answer 40

Labetalol, hydralazine, nipride

Question 41

Esmolol metabolism:

Answer 41

Rapidly metabolized by plasma esterases -----> why it can be given as an infusion