Antihypertensives 2 Flashcards by Gopu Premrajan

What are the β blocker drugs?

propranolol
atenolol
metoprolol
pindolol

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When would you give someone a beta blocker as a first line of treatment for HTN?

when patients have comorbidities of: coronary artery disease, HF or post MI

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What comoboridies must be associated with HTN for you to prescribe the patient ________ blockers as first line treatment?

Beta blockers;

post MI
coronary artery disease
Heart failure

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Metoprolol and atenolol are _____ β blockers

Selective: beta 1 blockers (most widely used)

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What beta blocker is given during pregnancy?

Pindolol

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What are the selective β-1 blockers?

metoprolol

- atenolol

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Which β blocker drug is a partial agonist?

Pindolol (given for HTN in pregnant women)

Non selective β1 and β2 partial agonist with intrinsic sympathomimetic activity

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________ receptor is important in the release of renin for the RAAS.

β1

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β blockers inhibits the release of _____ and______

NE and renin

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How long does it take to see the effects of beta blockers?

Several weeks

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A patient with coronary syndrome and HTN is prescribed metoprolol, what is one of the major adverse effects of this drug class?

↓ libido and impotence
bradycardia
CNS effects: fatigue, lethargy, insomnia and hallucinations

Metorprolol = β blocker

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↓ libido and impotence is an AE of taking _________ drugs

Beta blockers

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_____ HDL and ______ TAGs levels is an AE of β blockers

↓ HDL and ↑ TAG

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When giving a β blocker to a patient with HTN, what should you advise them?

Closely monitor glucose levels because β blockers can mask the tachycardia that is associated with a hypoglycemic episode

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Propranolol is contraindicated in ______

Asthmatics and COPD patients

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What kind of drug is prazosin?

It is an α1 BLOCKER

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Name the α1 blockers:

Prazosin and doxazosin

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-zosin is the suffix for what drugs

For α1 BLOCKERS

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Minimal changes are seen in ______, _____ and _____ when using prazosin

Prazosin = α1 blocker

CO, renal blood flow, GFR

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Would you expect to see reflex tachycardia when administering doxazosin?

Doxazosin = α1 blocker

This is counterintuitive and so this is where you WOULD NOT see any reflex tachycardia when giving an α1 blocker

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Reflex tachycardia is seen when you use a ___________ α blocker such as ___________ BUT NOT with a _____________ α blocker

NON SELECTIVE: phenoxybenzamine/ phentolamine (will see reflex tachycardia)

SELECTIVE = NO REFLEX TACHYCARDIA

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In treating HTN, when you give _______ blockers you DO NOT get Na/water retention but with ______ blockers you do.

β blockers = no Na/water retention because blocks β1 receptor for the RAAS

α blockers - WILL SEE Na/water retention

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What drug would be best to prescribe to an holder male patient with benign prostatic hyperplasia for HTN?

α1 blocker

Important to note that α1 blockers are rarely used to treat HTN except for unique situations like this

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What is a specific adverse effect of doxazosin?

It is a α1 blocker and is show tin ↑ rate of CHF

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What kind of drug is labetalol?

Mixed α and β blocker (α1 and β)

What drug is useful to treat patient in hypertensive emergencies?

Give labetalol IV because it causes rapid reduction in BP (mixed α1 and β blocker)

What is the effect of α2 agonist and name a drug that is an α2 agonist

- central α2 agonists cause ↓ sympathetic outflow by acting on presynaptica α2 receptors → ↓ resistance and CO → ↓ BP CLONIDINE = α2 agonist

What is the effect of clonidine on renal blood flow?

Clonidine = α2 agonist DOES NOT ↓ renal blood flow OR GFR (would expect to ↑ but does NOT)

What are the two central α2 agonists?

- clonidine | - methyldopa

What is the drug of choice for pregnancy induced HTN? What kind of drug is it?

METHYLDOPA is a central α2 agonist

What is the difference in the effects of the two central α2 agonists?

A2 agonists: clonidine and methyldopa Both ↓ resistance and BP and both DO NOT ↓ renal blood flow or GFR Clonidine: ↓ CO Methyldopa: does NOT ↓ CO

A positive Coombs test is an AE seen in long term treatment with ____________ (antihypertensive)

Methyldopa

A positive Coombs test can result in ________, _______., and _______ in someone taking __________

- hemolytic anemia - hepatitis - drug fever = methyldopa

What kind of drug is hydralazine?

Direct vasodilator (NOT used as 1st line of treatment for HTN but usually 3rd line and given with drugs that manage their AE’s)

What kind of drug is minoxidil?

Direct vasodilator

What are the two direct vasodilator and what kinds of drugs are they usually given with?

- hydralazine and minoxidil - given with: diuretic (vasodilation and ↓ in BP will cause ↑ water and sodium retention) AND β blocker (counteract the reflex tachycardia)

Hydralazine acts mainly on _______

Arterioles

What drug would you give for a patient who is pregnant and is in a hypertensive crisis?

Direct vasodilator: hydralazine

Reversible lupus like syndrome is an adverse effect of what drug?

Hydralazine (direct vasodilator)

What re some common adverse effects of hydralazine?

- fluid retention and reflex tachycardia - REVERSIBLE LUPUS LIKE SYNDROME - headache, nausea, sweating, flushing

What is a unique adverse effect of minoxidil that is not seen in the other drug that acts similarly (________)

(Hydralazine; both are direct vasodilators) - hypertrichosis: regrowth of hair

_______ can be given topically to treat male pattern baldness

Minoxidil (direct vasodilator) has a AE of hypertrichosis so using this AE to regrow hair

What are the 3 different types of treatments for pulmonary HTN?

- prostaglandins (epoprostenol) - inhibitors of endothelin synthesis and action (bosentan) - vasodilators (sildenafil)

What kind of drug is epoprostenol, route of administration and effect

It is a synthetic PGI2 given via continuous infusion ↓ peripheral, pulmonary and coronary resistance (used to treat pulmonary HTN)

What are some adverse effects of epoprostenol?

Epoprostenol is a synthetic PGI2 given to treat pulmonary HTN - flushing, headache, jaw pain, diarrhea and arthralgias

Bosentan is used to treat _______________ and its MOA is ________

Pulmonary HTN; Blocks the initial transient depressor (ETA) and prolonged pressor responses to endothelin

Which drug should NEVER be given to treat pulmonary HTN in pregnant patients or someone who wants to become pregnant

Bosentan (nonselective endothelin receptor blocker)

_________ is a drug for pulmonary HTN that is contraindicated with the use of nitrates

Sildenafil; will result in extreme hypotension

What is the MOA of sildenafil and what is it used to treat?

- inhibits phosphodiesterase 5 → ↑ cGMP → SM relaxation

What are the first line treatment in treating HTN in someone with a previous MI?

β blocker and then add ACEI/ARB

What is the first line treatment for HTN in patients with heart failure?

- ACEI/ARB + thiazide (or loop) diuretic + β blocker

What is the difference between a hypertensive emergency and a hypertensive urgency:

Emergency: severe HTN with signs of damage to target organs (brain, CV, kidneys) Urgency: very high BP WITHOUT target organ damage

How is the treatment different for hypertensive emergency vs. hypertensive urgency

Emergency must be treated with IV drugs for immediate action but urgency can be given an oral drug combination

What specific BP’s categorizes a patient having a hypertensive emergency?

- in a healthy pt: DBP > 150 w/ SBP > 210 | - in a patient with pre existing complications such as cerebral hemorrhage or aortic stenosis : DBP > 120

BP in managing hypertensive emergency should be progressively reduced in order to avoid:

MI, stroke or visual changes Monitor via arterial line and give a short acting titratable IV drug

What it is the first step in managing a hypterneisve crisis?

- first lower BP by no more than 25% within minutes to an hour (want to get near 100-110 DBP)

In managing a hypertensive emergency, after the first lowering, you want to reduce the BP to a goal (______/_______) within __-__ hours and then gradual reduction to normal over the next _____ hours

160/100; 2-6 hours; 8-24 hours

If a patient is in a hypertensive crisis due to preeclampsia, what drug would you give to ↓ HTN?

Hydralazine

What a clinical use of sodium nitropusside

Used to ↓ BP in hypertensive emergency and must be given via IV and requires a continuous infusion and given with β blocker to counteract the reflex tachycardia

Sodium nitroprusside causes vasodilation by acting on _________

Arterial and venous smooth muscle

Cyanide poisoning is an adverse effect of ______________

Sodium nitroprusside; Metabolism of nitroprusside → cyanide ion

What would you give to a patient suffering from cyanide poisoning?

- sodium thiosulfate

Which mixed α and β blocker can be used to manage hypertensive emergency?

Labetalol

What kind of drug is fenoldopam and what does it act on?

- it is a peripheral Dopamine 1 receptor agonist | - ARTERIOLAR dilation

In a patient who is in a hypertensive emergency and has history of renal insuffiency, what is the best drug to give?

Fenoldopam; it maintains or increases renal perfusion and lowers BP

Contraindications of fenoldopam

Don’t give to patients with glaucoma

Which calcium channel blocker can be used to treat hypertensive emergencies?

- Nicardipine (causes reflex tachycardia so give a β blocker with it)

what is the drug of choice in hypertensive emergencies in patients with cardiac ischemia or angina or after a cardiac bypass surgery?

NITROGLYCERIN

What is the MOA of nitroglycerin and when would you give it?

- vasodilator that acts more on the veins than arteries | - DOC for patients with MI/angina or after cardiac bypass surgery and are in hypertensive emergency

MOA of diazoxide

- artierolar dilator that prevents SM contraction by opening K channels

Which drug causes arteriolar dilation by opening K+ channels?

Diazoxide

What is a unique adverse effect of diazoxide?

- inhibits insulin release → treat hypoglycemia due to insulinoma

__________ or ________ would be chosen over ARB’s or ACEI to treat HTN in black patients with no other comorbidities

Thiazides or calcium channel blockers

What drugs are used for HTN emergency treatment? (9)

- sodium nitroprusside - labetalol - fenoldopam - nicardipine - nitroglycerin - diazoxide - phentolamine - esmolol - hydralazine