Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Pharmacology > Antihypertensive Drugs > Flashcards

Antihypertensive Drugs Flashcards

1
Q

Major groups of antihypertensive drugs

A

Diuretics (thiazide, loop, potassium-sparing), sympatholytic, angiotensin inhibitors and vasodilators

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Thiazide and related diuretics - MoA

A

Mechanism of decrease BP stems from their ability to increase sodium and water excretion.
When they are first administrated, the drug decreases blood volume and thereby decreases cardiac output. When adm is continued over weeks and months they also decrease peripheral vascular resistance (PVR), and this appear to account for much of their long term antihypertensive effect. The decrease PVR may result from a reduction in the sodium content of arteriolar smooth muscle cells, which decrease muscle contraction in response to vasopressor agents such as norepinephrine and angiotensin.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Thiazide and related diuretics - Adverse effects

A

Hypokalemia –> cardiac arrhythmias and muscle weakness.
Elevate plasma levels of: glucose, uric acid and lipids in some pat.
Hematologic toxicity
Aggravate hepatic disease and diabetes
Compensatory increase in renin secretion
Blood cell deficiencies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Thiazide and related diuretics - Interactions

A

Increase serum levels of lithium. Hypotensive effect decreased by NSAIDs and augmented by ACE inh.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Thiazide diuretics

A

Hydrochlorothiazide
Indapamide
Chlorthalidone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Hydrochlorothiazide - Indication

A

Initial treatment of persons with mild to moderate hypertension.
Thiazide diuretic most often used to treat hypertension.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Indapamide - Indication and benefit

A

Hypertension and the risk of stroke and MI.

Causes vasodilation via calcium channel blockade

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Loop diuretics - MoA

A

Greater natriuretic effect.
Less effective than thiazide, they are reserved for use in hypertensive pat who have poor renal function and serum creatinine level greater than 2,3mg/dL.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Potassium - sparing diuretics - MoA

A

Mild natriuretic effect and they reduce renal potassium excretion –> prevent hypokalemia by thiazide drugs/ loop diuretics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Potassium - sparing diuretics - Adverse effects

A

Hyperkalemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Potassium - sparing diuretics - Interactions

A

Hyperkalemic effect increased by ACE inh and potassium supplements.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Potassium - sparing diuretics

A

Amiloride
Spironolactone
Eplerenone
Triamterene

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Spironolactone and Eplerenone - Indication

A

Hypertension that cannot be controlled with combinations of three or more other agents.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Alpha-adrenoceptor antagonists

A

Doxazosin
Prazosin
Terazosin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Alpha-adrenoceptor antagonists - MoA

A

Effectively inhibit sympathetic stimulation of arteriolar contraction –> vasodilation and decrease vascular resistance, BUT several disadvantages.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Alpha-adrenoceptor antagonists - Indication

A

Not recommended for the initials treatment of hypertension, but can be added with other drugs when BP is not adequately controlled.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Alpha-adrenoceptor antagonists - Adverse effect

A 
Reflex activation of SNS: increased HR, contractile force, circulating NE --> increased myocardial oxygen requirements
Orthostatic hypotension
“first dose” syncope
Dizziness
Fluid retention
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Alpha-adrenoceptor antagonists - Interactions

A

Hypotensive effect increased by beta-blockers and potassium supplements.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Beta-Adrenoceptor antagonists

A 
Nonselective:
Nadolol
Pindolol
Propranolol
Timolol
Selective:
Atenolol
Esmolol
Nebivolol
Mixed alpha and beta: Carvedilol and labetalol
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Beta-Adrenoceptor antagonists - MoA

A

Blockade of beta1 receptors reduces cardiac output by decreasing the heart rate and contractility. Block of these receptors in renal juxtaglomerular cells inhibit renin secretion –> reduces the formation of Angiotensin II and the release of Aldosterone.
The drugs also appear to reduce sympathetic outflow from the central nervous system.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Beta-Adrenoceptor antagonists - Indication

A

Beneficial in hypertensive persons with other cardiovascular diseases. In coronary heart disease- reduce myocardial ischemia and lower risk of MI.
In persons with previous MI they are cardioprotective- prevent sudden death, by decreasing HR and the risk of ventricular arrhythmias.
In heart failure: improves symptoms and survival.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Beta-Adrenoceptor antagonists - Adverse effects

A

Fatigue, depression, vivid dreams, decreased exercise capacity
Bradycardia
Bronchoconstriction
Impaired glycogenolysis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Beta-Adrenoceptor antagonists - Contraindications and Interactions

A

Contraindications:
Nonselective: Contraindicated in pt with asthma or COPD
In diabetics, delay recovery from hypoglycemia by blocking glycogenolysis and mask symptoms of hypoglycemia.

Interactions:
Cardiac depression increased by diltiazem and verapamil.
Hypotensive effect decreased by NSAID

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Labetalol - Indication

A

Treats both chronic hypertension and hypertensive emergencies.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Carvedilol and Labetalol - Adverse effects
Orthostatic hypotension
26
Esmolol - Indications
Treat hypertension in surgical procedures and in persons with hypertensive emergencies.
27
Nebivolol - Indications
Hypertension in pat with heart failure, diabetes and cardiac arrhythmias.
28
Centrally acting drugs
Clonidine Guanfacine Methyldopa
29
Centrally acting drugs - MoA
Reduce sympathetic outflow from the central vasomotor center to the circulation primarily through the activation of alpha2 adrenoceptors in the brain stem medulla Lower BP by reducing vascular resistance, while having little effect on HR and CO
30
Centrally acting drugs - Adverse effects
Sedation Dry mouth Impaired mental acuity Severe rebound hypertension can occur if they are discontinued abruptly
31
Centrally acting drugs - Interactions
Hypotensive effect decreased by tricyclic antidepressants Sedative effect increased by CNS depressants
32
Clonidine - Indication
Hypertensive urgencies in the outpatient setting (slowly reduced BP with one single oral dose) Reduce SNS symptoms of alcohol, opioid or nicotine withdrawal.
33
Methyldopa - MoA
Has to be converted to an active metabolite (methyl norepinephrine) by central neurons, which then activates alpha2.
34
Methyldopa - Indication
Hypertension in pregnant women.
35
Methyldopa - Adverse effects
Immunologic effects including: Coombs positive hemolytic anemia Autoimmune hepatitis Lupus-like syndrome
36
Methyldopa - Interactions
Hypotensive effect increased by levodopa
37
Angiotensin-Converting enzyme inhibitors
``` Benazepril Captopril Enalapril Fosinopril Lisinopril Quinapril Ramipril ```
38
Angiotensin-Converting enzyme inhibitors - MoA
``` Act by binding to zinc atom at the enzyme’s active site. Lower BP by reducing vascular resistance. Decrease both arterial and venous pressure --> reduced CO and cardiac preload. By reducing angiotensin-stimulated aldosterone secretion: ACE inhibitors prevent the compensatory increase in sodium retention and plasma V that can occur with some other antihypertensive drugs. Inactivated bradykinin (vasodilator) --> act partly by inhibiting its degradation Decreases stimulation of growth factors of cells --> decreases cardiac remodeling ```
39
Angiotensin-Converting enzyme inhibitors - Indication
Mild to severe hypertension Protect against stroke and MI Hypertension in pat with coexisting heart failure, MI, chronic kidney disease or diabetes mellitus. They increase cardiac output and survival in persons with heart failure. Reduce incidence of overt heart failure and increase survival in pt with MI and significant left ventricular dysfunction Renoprotective effect in diabetic pt who exhbit early signs of renal impairment (albuminuria, increaser serum creatinine). Reduce risk of primary and secondary stroke
40
Angiotensin-Converting enzyme inhibitors - Adverse effect
Hyperkalemia Hyponatremia Dry cough (due to increase of bradykinin) Angioedema (swollen lips, face and throat) Rash Abnormal taste sensation Neutropenia Fetal and neonatal injury Renal failure in patients with bilateral renal artery stenosis(due to their dependency on angiotensin II to maintain renal blood flow and glomerular filtration)
41
Angiotensin-Converting enzyme inhibitors - Interaction and Contraindications
Interactions Augmented by diuretics and CCB. Can interact with potassium sparing diuretics and supplement to increase potassium levels -->hyperkalemia They also increase lithium levels --> lithium toxicity NSAIDs (esp Ibuprofen) can impede the effect of ACE inh. Contraindications: Pregnancy because of fetal and neonatal injury Bilateral renal artey stenosis because it can cause renal failure due to the dependency on angiotensin II to maintain renal blood flow and glomerular filtration
42
Enalapril - Indication
Pt with left ventricular failure
43
Angiotensin receptor blockers - MoA
These drugs selectively block AT1 receptors in various tissues and thereby reduce vasoconstriction, aldosterone secretion, sodium reabsorption by the proximal tubule and norepinephrine release from sympathetic nerve terminals.
44
Angiotensin receptor blockers - Adverse effects and contraindication
Hyperkalemia, neutropenia, elevated serum levels of hepatic aminotransferase Fetal injury and death Contraindication: pregnancy Rarely cause dry cough that occurs with ACE inh.
45
Angiotensin receptor blockers - Interactions
Serum levels increased by cimetidine and decreased by phenobarbital
46
Angiotensin receptor blockers
``` Candesartan Irbesartan Losartan Telmisartan Valsartan ```
47
Losartan - Indication
Greater reduction of left ventricular hypertrophy and risk of stroke and new-onset diabetes
48
Telmisartan - MoA
Increase insulin sensitivity by activating peroxisome proliferator-activated receptor-gamma.
49
Direct renin inhibitor
Aliskiren
50
Aliskiren - MoA
Binds to the active site of renin, preventing cleavage of angiotensinogen and formation of angiotensin I. Lowers plasma renin activity and levels of angiotensin I and angiotensin II. Can protect against compensatory increases in angiotensin II evoked by other drugs. Equal or superior BP-lowering ability compared with other drugs and a placebo-like side effect profile.
51
Aliskiren - Indication and adverse effects
High blood pressure | Hyperkalemia
52
Aliskiren - Interactions
Reduces serum levels of furosemide | Cyclosporine increases levels of aliskerin
53
Calcium channel blockers - MoA
By blocking calcium ion channels in the plasma membranes of smooth muscle, the ccbs relax vascular smooth muscle and causes vasodilation. They have greater effect on arteriolar smooth muscle then venous, effect on BP is mainly because a reduction in PVR.
54
Calcium channel blockers - Indication
``` Hypertension Angina pectoris Peripheral vascular disorders Cardiac arrhythmias Hypertension in Asthma Protect against: stroke, coronary heart disease, kidney disease. ``` Hypertensive pt who have asthma or are of African heritage
55
Calcium channel blockers - Adverse effects
Dihydropyridine CCB: Reflex tachycardia Gingival hyperplasia in persons with poor dental care Dizziness, edema, headache
56
Calcium channel blockers - Interaction
Serum levels increased by azole antifungal agents, cimetidine and grapefruit juice
57
Calcium channel blockers
``` Diltiazem Verapamil Amlodipine Felodipine Isradipine Nicardipine Nifedipine ```
58
Diltiazem and Verapamil - MoA and Indication
Significant effect on cardiac tissue and can reduce heart rate and cardiac output. Reduce protein excretion in patients with kidney disease and may be used with ACE inh or ARB for this purpose.
59
Diltiazem and Verapamil - Adverse effects
AV block, bradycardia, constipation, dizziness, edema, gingival hyperplasia, headache, heart failure
60
Diltiazem and Verapamil - Interactions
Increases serum levels of carbamazepine, digoxin, theophylline. Decreases serum levels of lithium
61
Nicardipine - Indications
Hypertensive emergencies
62
Vasodilators
Hydralazine Minoxidil Nitroprusside Fenoldopam
63
Hydralazine | Minoxidil - Indication
Moderate to severe hypertension resistant to other drugs, in combo with other antihypertensive drugs. Minoxidil: alopecia
64
Hydralazine | Minoxidil - Adverse effects
Reflex tachycardia Fluid retention Precipitate angina in susceptible patients. --> these side effects when given alone, therefor given with diuretics and beta blockers. Hydralazine- lupus like syndrome Minoxidil- hypertrichosis(excessive hair growth)- given topical for alopecia.
65
Hydralazine | Minoxidil - Interactions
Hypotensive effect decreased by NSAIDs
66
Nitroprusside - Indications
Management of Hypertensive emergencies
67
Nitroprusside - Adverse effect
``` Dizziness Headache Increased intracranial pressure Methemoglobinemia Thiocyanate and cyanide toxicity ```
68
Fenoldopam - MoA and Indication
Activates vascular dopamine D1 receptors and produces vasodilation in systemic vascular beds including coronary, renal and mesenteric vessels. Hypertensive emergencies
69
Fenoldopam - Adverse effects
Hypokalemia Headache Nausea

Pharmacology (55 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions