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Pharm 1 > Antihypertensives > Flashcards

Antihypertensives Flashcards

1
Q

Desirable blood pressure?

A

115/75 or lower

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2
Q

Hypertensive urgency values

A

220/120

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3
Q

Secondary hypertension

A

We know what causes hypertension (5-10%) cocaine and oral contraceptives (increase BP) pheochromocytoma-tumor of adrenal gland

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4
Q

Primary hypertension

A

Cause is unknown

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5
Q

Malignant HT

A

220/120 or higher

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6
Q

Why hypertension kills

A

Stroke

MI

Left ventricular hypertrophy

Aneurysm

Renal failure

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7
Q

What controls our BP when we sit up suddenly

A

Neuronal-vascular control loop

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8
Q

What does Ca influx into vessels cause?

A

Contraction

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9
Q

What does K efflux into vessels cause?

A

Relaxation

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10
Q

Increase in cGMP in vessels causes?

A

Contraction

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11
Q

What does angiotensin II on vessels cause?

A

Contraction

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12
Q

What does DA influx into vessels cause?

A

Relaxation

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13
Q

What does endothelin receptor on vessels cause?

A

Contraction

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14
Q

When BP or Na levels in the kidney drop what happens

A

Renin is secreted

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15
Q

What controls our BP long term?

A

Kidney control loop (renin-angiotensin-aldosterone system)

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16
Q

What does renin do?

A

Angiotensinogen–>A1

17
Q

What converts A1–>A2

A

Angiotensin converting enzyme (ACE)

18
Q

What does ACE do?

A

A1–>A2

Bradykinin–>inactive product

19
Q

What does bradykinin do?

A

Dilates arteries (drops BP)

Capillary leakage (edema) Activates sensory nerves-pain and itching

20
Q

What does A2 do?

A

Vasoconstriction

Na retention

Aldosterone

21
Q

One SE of all antihypertensives

A

Hypotension

22
Q

Alpha-methyl DOPA

A

Central alpha-2 agonist

Prodrug: metabolized to alpha-methyl NE

SE:

Depression

Drowsiness

Dry mouth

Impaired Ejac.

Hepatic dysfunction

23
Q

Clonidine

A

Central alpha-2 agonist

SE:

Depression

Drowsiness

Dry mouth

Impaired Ejac.

Unlabeled uses:

  • Fibromyalgia-unspecified neuronal pain
  • Insomnia
  • Tourettes
  • Opiate withdrawal
24
Q

Propranolol

A

Tx of hypertension

Nonselective Beta blocker

Central and peripheral effects

Mech:

  • Blocks B1 receptors on heart, prevents rise in HR
  • Decreases renin secretion
    • Renin converts Angiotensinogen→A1

SE:

  • Into CNS→Depression
  • Bradycardia→fatigue
  • Impotence
  • Lowers HDL, raises triglycerides
  • Exacerbates asthma
25
Q

Reserpine

A

Tx of HT

Central and peripheral effects/effector of post-ganglionic neuron

Causes depletion of post ganglionic neuron nt (NE)→ No vasoconstriction

SE: depression, drowsiness, diarrhea

26
Q

alpha-methyl tyrosine

A

Tx of pheochromocytoma

Central and peripheral effects

Inhibits tyrosine kinase–preventing synthesis NE and epi

27
Q

“Osin”s

A

Alpha 1 blockers

Blocks alpha 1 receptor on vascular smooth m

Tx of hypertension and some specifically treat BPH

Based on the drugs he gave us:

**If it ends in -azosin its for hypertension**

**If it ends in just -osin its used for BPH**

SE

  • First dose effect-rapid drop in BP→orthostatic (postural) hypotension
    • Do not confuse w/ first pass effect
28
Q

More selective B blockers

A

Metoprolol

Acebutolol

Atenolol

Betaxolol

Nebivolol

SE:

  • Fewer CNS effects
  • Bradycardia
  • Fatigue w/ exercise
29
Q

Combined alpha and beta blockers

A

Block alpha1, beta1, and beta2

Labetalol

Carvedilol

SE:

  • Postural hypotension
  • Dry mouth
30
Q

Angiotensin receptor blockers

A

“-Artan”s

SE:

  • Decrease secretion of aldosterone
  • Fetal abnormalities
    • All agents that alter angiotensin system
    • Pregnancy risk X
31
Q

Endothelin blockers

A

“-entan”s

Tx of pulmonary arterial hypertension

SE:

  • Fetal damage
  • Testicular atrophy
  • Hepatic toxicity
32
Q

Minoxidil

A

Acts directly on smooth muscle

Prodrug

Opens K channels in arterial smooth m, increased efflux→hyperpolarization

Very refractory px

SE:

  • Hypertrichosis-hair growth
    • Rogaine
    • Discontinuation→hair loss
    • Edema and pericardial effusion→cardiac tamponade
      • Fluid in sac around heart
33
Q

Hydralazine

A

Act directly on smooth muscle

Arterial vasodilator

Increase in cGMP→relaxes smooth m

SE:

  • Slow acetylators→lupus like syndrome
34
Q

Diazoxide

A

Acts directly on smooth muscle

Opens K channels→hyperpolarization

SE:

  • Decreased insulin secretion from beta cells in pancreas→hypoglycemia
35
Q

Nitroprusside

A

Acts directly on smooth muscle

Drug of choice in hypertensive emergencies

Acts w/in seconds–given IV

Dilates art and veins→drop in BP

increases cGMP→relaxation

Rapidly degrades in soln into cyanide

36
Q

Calcium channel blockers

A

“-ipine”s

Inhibit Ca influx into vascular smooth m

Prevent vasoconstriction

SE:

  • Heartburn
  • May worsen heart failure
37
Q

ACE inhibitors

A

“-pril”s

ACE responsible for A1→A2

ACE responsible for bradykinin breakdown

Leads to decreased aldosterone secretion

SE:

  • Rash
  • Dry cough that cant be treated with suppressants
  • Angioneurotic edema-swelling of nose, throat, resp tract
  • Taste alteration
  • Fetal damage
38
Q

Aliskiren

A

Renin inhibitor

SE:

  • Fetal damage
  • Diarrhea
  • Cough
  • Angioedema
39
Q

Fenoldopam

A

Activate D1 receptors

Given IV for HT emergencies

Pharm 1 (8 decks)

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