Antihypertensive therapy

Question 1

What are the two broad categories of CCBs?

Answer 1

Dihydropyridnes and non-dihydropyridines.

Question 2

Where do DHPs act?

Answer 2

On vascular smooth muscle - peripheral

Question 3

Where do non-DHPs act?

Answer 3

On the heart

Question 4

What class of drugs are amlodipine, nifedipine, clevidipine, nicardipine, and nimodipine?

Answer 4

DHPs calcium channel blockers.

Question 5

What class of drugs are diltiazem and verapamil?

Answer 5

Non-DHPs calcium channel blockers.

Question 6

How do calcium channel blockers work?

Answer 6

Block voltage-dependent L-type calcium channels of the heart/smooth muscle. Decrease contractility.

Question 7

What kinds of things can DHPs be used for?

Answer 7

HTN, angina (inc Prinzmetal), Raynauds. Not nimodipine

Question 8

What is nimodipine especially used for?

Answer 8

Subarachnoid hemorrhage; prevents cerebral vasospasm.

Question 9

What is clevedipine especially used for?

Answer 9

hypertensive urgency or emergency

Question 10

What are non-DHPs used for?

Answer 10

hypertension, angina, a-fib/flutter

Question 11

What are the toxicities associated with non-DHPs?

Answer 11

Cardiac depression, AV block

Question 12

What are the toxicities associated with DHPs?

Answer 12

peripheral edema, flushing, dizziness, constipation, gingival hyperplasia

Question 13

What weird toxicity is associated with verapamil?

Answer 13

hyperprolactinemia

Question 14

What is the mechanism of hydralazine?

Answer 14

Increase cGMP, leads to smooth muscle relaxation.

Question 15

Does hydralizine work preferentially on arterioles or veins?

Answer 15

Arterioles –> vasodilation –> decr afterload.

Question 16

What is the clinical use of hydralizine?

Answer 16

Severe hypertension (particularly acute). HF (with organic nitrate). Safe to use during pregnancy.

Question 17

What is hydralizine frequently administered with and why?

Answer 17

With a beta blocker to prevent reflex tachycardia.

Question 18

What are clevidipine, fenoldopam, labetalol, nicardipine, and nitroprusside all used for?

Answer 18

Hypertensive emergency.

Question 19

How does nitroprusside work?

Answer 19

Short acting. Increases cGMP via direct release of NO.

Question 20

What is an important side effect of nitroprusside?

Answer 20

Cyanide poisoning - releases cyanide.

Question 21

How does fenoldopam work?

Answer 21

Dopamine D1 receptor agonist - causes peripheral, renal, and splanchnic vasodilation. Decreases BP, Increases natriuresis.

Question 22

How do nitrates work?

Answer 22

Increase NO in vascular smooth muscle, increases cGMP and smooth muscle relaxation. D

Question 23

Do nitrates work on veins or arteries preferentially?

Answer 23

Veins. Decrease preload.

Question 24

What is the clinical use for nitrates?

Answer 24

Angina, acute coronary syndrome, pulmonary edema.

Question 25

What are toxicities of nitrates?

Answer 25

Reflex tachy (give BBlockers), hypotension, flushing, headache

Question 26

What is the “monday disease” effect of nitrates?

Answer 26

Monday disease in industrial exposure: Development of tolerance for vasodilating action during the work week and loss of tolerance over the weekend –> tachycardia, dizziness, headache upon reexposure.

Question 27

What are the main treatments for primary (essential) hypertension?

Answer 27

Thiazide diuretics, ACEis, ARBs, DHP CCBs

Question 28

What are the main treatments for hypertension with heart failure?

Answer 28

Diuretics, ACEis/ARBs, B-blockers (compensated HF), and aldosterone antagonists

Question 29

What are the main treatments for hypertension with diabetes?

Answer 29

ACEis/ARBs, CCBs, thiazide diuretics, B-blockers

Question 30

Which hypertensive medication is protective against diabetic nephropathy?

Answer 30

ACEis/ARBs

Question 31

Which are main treatments for hypertension in pregnancy?

Answer 31

Hydralizine, labetalol, methyldopa, nifedipine