Antihypertensive drugs part 2

Question 1

Where are alpha 1 receptors?

Answer 1

arterial smooth muscle
venous smooth muscle
prostatic smooth muscle
trigone

Question 2

Pazosin lowers bp?

Answer 2

alpha 1 receptors on arteries to cause vasodilation and decrease PVR

block the alpha receptor, prevent binding of NE or EPI

alpha 1 selective, reversible

Question 3

Type of alpha 1 receptor on prostate and base of bladder?

Answer 3

Alpha 1 a

Question 4

Alpha antagonists and their use for hypertension?

Answer 4

Second line drugs for chronic treatment of hypertension

not that effective as diuretic in preventing cardiovascular events and heart failure

Question 5

Alpha antagonists?

Answer 5

Prazosin
Terazosin
Doxazosin

Question 6

Chronic use of alpha blocker?

Answer 6

CO and plasma renin activity return to pretreatment levels

reduction in blood pressure is achieved via vasodilation induced decrease in PVR

Question 7

Describe what happens when vasodilate a vein?

Answer 7

decrease venous return, decrease cardiac output

Question 8

Describe what happens when vasodilate an artery?

Answer 8

decrease PVR, reflex tachy/ reflex Na and water retention– increase in CO

Question 9

Besides hypertension, what else alpha blockers treat?

Answer 9

Benign Prostatic hyperplasia

Raynaud’s disease

Question 10

Why not use tamsulosin, alfuzosin, and silodosin for hypertension?

Answer 10

they are more slective for alpha one in the prostate and do not affect the alpha one receptors on vascular smooth muscle

Question 11

Alpha one receptor subtype found on vascular smooth m?

Answer 11

alpha 1 D

Question 12

Raynaud’s disease?

Answer 12

cold precipitates vasospasm of blood vessels in fingers and toes

Question 13

Use non selective alpha blockers?

Answer 13

Pheochromocytoma
Adrenal medulla tumor, make catecholamines (Epi, NE) increase BP
Or
Hypertensive urgencies/emergencies

Question 14

non selective alpha blockers?

Answer 14

Phenoxybenzamine (irreversible)

Phentolamine

Question 15

Adverse effects alpha antagonists?

Answer 15

Orthostatic hypotension from first dose effect, little during long term treatment
reflex tachycardia
edema
headache, weakness, dizziness

Question 16

What antihypertensive drug will help alpha antagonist counter Na and water retention?

Answer 16

diuretic

Question 17

Alpha and beta antagonists

Answer 17

Labetalol
Carvediol
Bucindolol

Question 18

Labetalol MOA?

Answer 18

Partial agonist for beta 2, antagonist for alpha 1 and beta 1

for beta 2 partial agonist and block alpha 1 cause vasodilation on arteries

for beta 1 on the heart, cause little effect on HR and CO

Question 19

Lebetalol and clin use for hypertension?

Answer 19

second line drug for chronic treatment of hypertension

Hypertensive urgencies/ emergencies

Question 20

Side effects Lebetalol?

Answer 20

Bronchospasm, prolong hypoglycemia, hypotension, nausea/ vomit, orthostatic hypotension, sexual dysfunction

Question 21

Centrally acting alpha 2 agonists?

Answer 21

Methyldopa
Clonidine

lipid soluble, work in CNS

Question 22

Clonidine MOA?

Answer 22

alpha 2 receptors in CNS, decrease sympathetic outflow, decrease PVR/ decrease HR and CO

Question 23

Clonidine and hypertension treatment?

Answer 23

Second line drug for chronic treatment of hypertension
transdermal patch is better tolerated
hypertensive urgencies/emergencies

Question 24

Methyldopa and hypertension treatment?

Answer 24

Hypertension in pregnancy

Question 25

Central acting alpha 2 agonists adctivate receptors in CNS?

Answer 25

sedation, dry mouth, depression, impotenece

more in clonidine than methyldopa

Question 26

Central acting alpha 2 agonist adverse effects?

Answer 26

Sodium and H20 retention

transdermal clonidine contact derm

Question 27

adverse effects of methyldopa?!

Answer 27

pos Coombs test(for autoimmune hemolytic anemia), hemolytic anemia, hepatotoxicity

Question 28

Adverse effects of Clonidine?

Answer 28

abrupt withdrawl
rebound hypertension
nervousness, tachycardia, headache, and sweating

Question 29

Direct vasodilators?

Answer 29

Hyradalzine
Minoxidil
Nitroprusside

Question 30

Minoxidil MOA?

Answer 30

activate was K channels on arterial vascular smooth muscle
Hyperpolarization
Arterial smooth muscle relaxation

Question 31

Hydralazine and Minoxidil Antihypertensive action?

Answer 31

Artery, cause vasodilation, decrease PVR, decrease BP

Question 32

Decrease PVR?

Answer 32

increase renin, increase Ang II, increase Aldosterone, salt and water retention
Activate SNS, reflex tachycardia, increase CO
Vasoconstriction, increase BP, increase CO

Question 33

Drugs to block reflex tachy and fluid retention?

Answer 33

diuretic and beta blocker

Question 34

Hydralazine and minoxidil clinical use?

Answer 34

orally

chronic therapy for severe hypertension

Question 35

Hydralazine clin use?

Answer 35

IV, hypertensive emergencies

Question 36

Adverse effects Hydralazine and minoxidil?

Answer 36

excessive vasodilation and hypotension
Hydra- lupus like syndrome, fever, arthralgia, skin rash
Min- Hypertrchosis

Question 37

Nitroprusside MOA?

Answer 37

Sodium nitroprusside, causes nitric oxide, increases cGMP, arterial and venous, arterial and venous vasodilation

Question 38

Nitroprusside on artery and vein?

Answer 38

Artery- vasodilate, decrease PVR

Vein- reduced venous return

Question 39

Nitroprusside clinical use?

Answer 39

Hypertensive emergencies titrate blood pressure, produce controlled hypotension during surgery

Question 40

Nitroprusside adverse effects?

Answer 40

Cyanide and thiocyanate

Hypotension

Question 41

End result of alpha antagonists?

Answer 41

chronic use, heart rate and plasma renin levels return to pretreatment levels
reduction in blood pressure is achieved via vasodilation induced decrease in PVR