Antihypertensives

Question 1

Categories of Cardiovascular Medications

Answer 1

Antiarrhythmics
Antihypertensives
Inotropes
Vasodilators
Diuretics
Antihyperlipidemics
Anti-plateletes
Thrombolytics

Question 2

Hypertension with concomitant diseases
Essential Hypertension

Answer 2

Diuretics; high doses can lead to orthostatic hypotension, hyponatremia and hypokalemia with increased urine Na+ and K+ concentrations

ACE inhibitors/ARBs
Calcium channel blockers; peripheral edema is a common side effect

Direct renin inhibitors

Question 3

Hypertension with Concomitant Diseases
CHF

Answer 3

Diuretics; K+-sparing diuretics (eg. spironolactone)

ACE inhibitors/ARBs; may use ARB if patient fails ACE-I therapy

Contraindicated; do not use β-blockers in uncompensated patients

Question 4

Hypertension with Concomitant Diseases
DM

Answer 4

Diuretics

ACE inhibitors/ARBs; added benefit of ↓ risk of diabetic nephropathy

Calcium channel blockers

β-blockers; mechanism of action includes block of catecholamine-induced renin release by the kidney, use cardioselective (β1 selective) drugs to avoid bronchoconstrictive effects (e.g. metoprolol)

α-blockers (-zosin’s)

Question 5

Hypertension with Concomitant Diseases
Pregnancy

Answer 5

Methyldopa
Hydralazine
Labetolol

Contraindicated; do not use ACEIs/ARBs due to teratogenicity

Question 6

Hypertension with Concomitant Diseases
COPD and Asthma

Answer 6

Calcium channel blockers

Contraindicated; do not use β-blockers due to potential bronchoconstriction

Question 7

Hypertension with Concomitant Diseases
BPH

Answer 7

α-blockers
can treat both BPH and hypertension at same time

Question 8

Hypertension with Concomitant Diseases
Post MI

Answer 8

Spironolactone
Calcium channel blockers
β-blockers

Question 9

Treatment of Malignant hypertension
Nitroprusside

Answer 9

↑ cGMP via direct release of NO
results in ↓ TPR in venules and arterioles

Cyanide toxicity; treated with nitrites + sodium thiosulfate

Question 10

Treatment of Malignant hypertension
Fenoldopam

Answer 10

Dopamine D1 receptor agonist;

Preferentially ↑ flow in renal vasculature

Preserves blood supply of kidney
o note: fenolDOPAm

Question 11

Treatment of Malignant hypertension
Diazoxide

Answer 11

K+ channel opener, results in hyperpolarization of arteriolar smooth muscle
↓ TPR

↓ insulin secretion resulting in hyperglycemia