Antihypertensive therapy Flashcards
What are the two broad categories of CCBs?
Dihydropyridnes and non-dihydropyridines.
Where do DHPs act?
On vascular smooth muscle - peripheral
Where do non-DHPs act?
On the heart
What class of drugs are amlodipine, nifedipine, clevidipine, nicardipine, and nimodipine?
DHPs calcium channel blockers.
What class of drugs are diltiazem and verapamil?
Non-DHPs calcium channel blockers.
How do calcium channel blockers work?
Block voltage-dependent L-type calcium channels of the heart/smooth muscle. Decrease contractility.
What kinds of things can DHPs be used for?
HTN, angina (inc Prinzmetal), Raynauds. Not nimodipine
What is nimodipine especially used for?
Subarachnoid hemorrhage; prevents cerebral vasospasm.
What is clevedipine especially used for?
hypertensive urgency or emergency
What are non-DHPs used for?
hypertension, angina, a-fib/flutter
What are the toxicities associated with non-DHPs?
Cardiac depression, AV block
What are the toxicities associated with DHPs?
peripheral edema, flushing, dizziness, constipation, gingival hyperplasia
What weird toxicity is associated with verapamil?
hyperprolactinemia
What is the mechanism of hydralazine?
Increase cGMP, leads to smooth muscle relaxation.
Does hydralizine work preferentially on arterioles or veins?
Arterioles –> vasodilation –> decr afterload.
What is the clinical use of hydralizine?
Severe hypertension (particularly acute). HF (with organic nitrate). Safe to use during pregnancy.
What is hydralizine frequently administered with and why?
With a beta blocker to prevent reflex tachycardia.
What are clevidipine, fenoldopam, labetalol, nicardipine, and nitroprusside all used for?
Hypertensive emergency.
How does nitroprusside work?
Short acting. Increases cGMP via direct release of NO.
What is an important side effect of nitroprusside?
Cyanide poisoning - releases cyanide.
How does fenoldopam work?
Dopamine D1 receptor agonist - causes peripheral, renal, and splanchnic vasodilation. Decreases BP, Increases natriuresis.
How do nitrates work?
Increase NO in vascular smooth muscle, increases cGMP and smooth muscle relaxation. D
Do nitrates work on veins or arteries preferentially?
Veins. Decrease preload.
What is the clinical use for nitrates?
Angina, acute coronary syndrome, pulmonary edema.
What are toxicities of nitrates?
Reflex tachy (give BBlockers), hypotension, flushing, headache
What is the “monday disease” effect of nitrates?
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.
What are the main treatments for primary (essential) hypertension?
Thiazide diuretics, ACEis, ARBs, DHP CCBs
What are the main treatments for hypertension with heart failure?
Diuretics, ACEis/ARBs, B-blockers (compensated HF), and aldosterone antagonists
What are the main treatments for hypertension with diabetes?
ACEis/ARBs, CCBs, thiazide diuretics, B-blockers
Which hypertensive medication is protective against diabetic nephropathy?
ACEis/ARBs
Which are main treatments for hypertension in pregnancy?
Hydralizine, labetalol, methyldopa, nifedipine
