Antihypertensives Flashcards
What are the 1st line drugs recommended for antihypertensive medication?
thiazides
ACEIs and ARBs
long acting CCBs
Why do ACEIs cause a symptom of dry cough in a patient?
Because ACE is responsible for breaking down bradykinin which can cause inflammatory response
What is the stem to remember ACEIs?
prils
Name the commonly tested drugs considered ACEIs.
lisinopril
captopril
What are the common ARBs?
losartan
What is the major stem to remember ARBs?
sartans
What is the major renin inhibitor we discussed?
aliskrien
Does the renin inhibitor alkiskrien interfere with bradykinin breakdown?
no it does not interfere with bradykinin degradation
What are the uses of ACE, ARBs, and renin inhibitors?
mild to moderate HTN (all)
Protective diabetic nephropathy (ACEI/ARBs)
CHF (ACE/ARBs)
What are the side effects of of ACEIs, ARBs, and renin inhibitors?
dry cough (ACEIs)
hyperkalemia
acute renal failure in renal artery stenosis
angioedema (mostly ACEIs)
ACE, ARBs and renin inhibitors are contraindicated in what patients?
pregnancy
How can ACEIs and ARBs be beneficial in diabetic nephropathies?
PGs dilate afferent arterioles whereas Ang II constrict efferent arterioles
Therefore NSAIDS constrict the afferent arterioles whereas ACEIs and ARBs dilate the efferent arteriole
This decreases the amount of fluid filtered, dec. GFR and dec workload and dec. proteinuria
Why the y are used in diabetics patients to control BP and save kidneys because of this decreased workload on the heart
Why are ACEIs and ARBs not beneficial when one has bilateral renal a. stenosis?
There is already afferent arteriole constriction a decreased GFR so the ACE and ARBs will further decrease the GFR that Ang II was trying to maintain. Last thing you want is to work against the Ang II which is preventing complete failure of renal system
CCBs block L-type Ca2+ channels in what organs?
in the heart or BV
Which CCBs mainly lead to decreased CO?
verapamil and diltiazem
Which CCBs lead to decreased TPR?
all CCBs
What is a stem to remember most of the CCBs? (dihydropyridines)
“dipines” dihydropyrdine family
What is the prototype dihydropyridine?
nifedipine
In order of what drugs work on heart to BV name which CCBS have most selectivity?
verapamil mostly heart
diltiazem (intermediate) heart and BV
“dipines” mostly BV
Which vasodilators specifically act on arterioles?
CCBs, hydralazine, K+ channel openers
What is a major venodilator we discussed in this chapter?
nitrates
Orthostatic (postural) hypotension results from venular dilation (not arteriolar) and mainly results from what?
a1 blockade or decreased sympathetic tone
What are the major uses of CCBs?
HTN (all drugs)
Angina (all drugs)
antiarrythmics (verapamil, diltiazem)
What are the side effects of using CCBs?
reflex tachycardia (dipines)
gingival hyperplasia (dipines)
constipation (verapamil)
Why can B blockers be dangerous for use of a person with hypoglycemia?
can cause masking in diabetics because it blocks tremors and palpitations so there is no warning sign for them other then possibly getting sweaty because that doesn’t work on β or α.
What groups of people should you use beta blockers in with caution?
asthma
vasospastic disorders
diabetics
What are other drugs that can be used for HTN that alter sympathetic activity?
beta blockers,
alpha 1 blockers like prazosin, doxazosin, terazosin,
and alpha 2 agonists clonidine and methyldopa
What is the indication for using beta blockers for HTN?
not 1st line but good for hypertensive patients with selective comorbidities such as stable angina, CHF, and post-MI
Some major side effects of Beta blockers?
CVS depression
fatigue
sexual dysfunction
inc. LDLs and TGs
What are the side effects of alpha 1 blockers?
1st dose syncope (dizziness),
orthostatic hypotension,
urinary incontinence
What are the advantages of using alpha 1 blockers on metabolic function?
good lipid profile inc. HDL, dec. LDL
What are some uses of alpha 2 agonists?
mild to moderate HTN
Opiate withdrawal (clonidine)
hypertensive management in pregnancy (methyldopa)
What are the side effects of alpha 2 agonist?
- positive Coombs test (methyldopa) (rarely hemolytic anemia though)
- CNS depression (fatigue) (both)
- edema (both) compensation for dec. in BP
- May get rebound HTN if abruptly stop because of upreg of sympathetic activity while they were blocked.
What are some drug interactions that need to be remembered for alpha 2 agonists?
TCAs which dec. the antihypertensive effects of alpha 2 agonists
the antihypertensive effects oppose each other
What are the direct acting vasodilators that can be used as antihypertensives that directly act through NO?
hydralazine
nitroprusside
What are the direct acting drugs that open potassium channels that act as vasodilators and can be used as antihypertensives?
minoxidil and diazoxide
Chronic (preexisting) HTN in pregnancy is often treated with what drugs?
methyldopa or labetalol
New-onset HTN in pregnancy or preeclampsia is treated with what drugs?
labetalol or hydralazine
Which drugs are recommended for treating cyanide poisoning? Explain the MOA
hydroxocobalamin and sodium thiosulfate
the cobalt molecule in hydroxocobalamin binds cyanide-forming cyanocobalamin, which is readily excreted in the urine.
Difference between hydralazine and nitroprusside?
hydralazine decreases TPR via arteriolar dilation while nitroprusside dec. TPR via dilation of both arterioles and venules?
Use for hydralazine?
moderate to severe HTN
preeclampsia
S/E of hydralazine?
SLE-like syndrome in slow acetylators (would see (+)ANA and (+) antihistones (this histones means drug induced)
edema
reflex tachycardia
Use of nitroprusside?
hypertensive emergencies via IV
S/E nitroprusside?
cyanide toxicity
MOA of minoxidil and diazoxide?
opens K+ channels causing hyper polarization of vascular smooth muscle results in arteriolar vasodilation
What are the uses for minoxidil and diazoxide?
insulinoma (diazoxide)
severe hypertension ( minoxidil)
baldness (topical minoxidil)
What are the S/E for minoxidil and diazoxide?
- hypertrichosis (excessive hair growth any part of the body for males and females)
- hyperglycemia (dec. insulin release (diazoxside))
- edema
- reflex tachycardia
What drugs should be avoided when you have dyslipidemias?
avoid beta blockers and thiazides
Can fenoldopam cause reflex tachycardia?
yes
What are the strategies for the treatment of pulmonary HTN? Name the drugs indicated for treatment
drugs with vasodilator effects
Bosentan
Prostacyclin (PGI2) analogs: Epoprostenol
Sildenafil
MOA of Bosentan?
an ET -A receptor antagonist
ET1 endothelin 1 is a powerful vasoconstrictor through ET-A and B receptors
S/E of Bosentan?
those associated with vasodilation (headache, flushing, hypotension)
What is Bosentan contraindicated in?
pregnancy
Prostacyclin PGI2 analogue used for primary pulmonary HTN?
Epoprostenol
MOA of sildenafil for pulmonary HTN treatment?
- inhibits type V PDE
- increases cGMP
- Causes pulmonary artery relaxation
- decreases pulmonary HTN
Most suitable antihypertensive drugs for treatment of angina?
beta blockers, CCBs
Most suitable antihypertensive drugs for treatment of diabetes?
ACEIs, ARBs
Most suitable antihypertensive drugs for treatment of heart failure?
ACEIs, ARBs, beta blockers
Most suitable antihypertensive drugs for treatment of post-MIs?
beta blockers
Most suitable antihypertensive drugs for treatment of BPH?
alpha blockers
Most suitable antihypertensive drugs for treatment of dyslipidemias?
alpha blockers, CCBs, ACEIs/ARBs
Most suitable antihypertensive drugs for treatment of chronic kidney disease?
ACEIs, ARBs
