Antihypertensives

Question 1

MOA of antihypertensives

Answer 1

Decrease BP by decreasing CO and TPR or decreasing preload by decreasing blood volume

Question 2

Chronic hypertensive treatment can cause

Answer 2

Reflex tachycardia and increase renin with edema formation

-Give a beta blocker and a diuretic also

Question 3

First approach to treatment of HTN

Answer 3

DASH diet, weight reduction, Na restriction, aerobic activity

Question 4

Recommended treatment for post MI or high CAD risk

Answer 4

Beta blocker: cardioprotective

ACE inhibitor: decreases incidence of HF, stroke and MI

Question 5

Recommended treatment for diabetes and htn

Answer 5

ACE inhibitor
ARB blocker
Delays progression of nephropathy

Question 6

Recommended treatment for CHF and htn

Answer 6

ACE inhibitor

Usually in conjunction with beta blocker and diuretic

Question 7

Recommended treatment for BPH and htn

Answer 7

a1 blocker

Only time this is used as a first line agent

Question 8

Recommended treatment for not black and <55

Answer 8

ACEI, ARB

Question 9

Recommended treatment for not black and >55

Answer 9

Calcium channel blocker or diuretics

Question 10

Recommended treatment for black any age

Answer 10

Calcium channel blocker or diuretic

Question 11

First line drug used in hypertensive emergency

Answer 11

Clevidipine

L type calcium channel blocker

Question 12

Diuretics

Answer 12

Most consistent effect htn drug

Initially decrease volume and chronically decrease TPR by vasodilation

Question 13

VMAT

Answer 13

puts NE back into vesicles in presynpatic terminal

Question 14

NET

Answer 14

Reuptakes NE from synapse

Question 15

Decreasing NE causes

Answer 15

Decreased TPR (a1 blockade), decreased HR (b1 blockade), postural hypotension (a1 blockade), rebound hypertension if withdrawal occurs

Question 16

alpha methyldopa

Answer 16

a2 agonist–blocks outflow of NE

Drug of choice in pregnancy

Question 17

Clonidine

Answer 17

a2 agonist

Useful in opiate withdrawal

Question 18

Guanethidine

Answer 18

Gets reuptaken into presynaptic nerve terminal and displaces NE in vesicles causing a decrease in NE release

Question 19

a1 blockers

Answer 19

decrease BP by relaxing vascular smooth muscle and decreasing TPR
Not commonly used as primary agents due to orthostatic hypotension

Question 20

Beta blockers

Answer 20

Decrease HR, decrease contractility, decrease CO, decrease renin, decrease TPR
Can cause bradycardia and AV block

Question 21

Examples of nonselective Beta blockers

Answer 21

Propranolol, Nadolol, Timolol

Question 22

Examples of Cardioselective B1 blockers

Answer 22

Atenolol, Betaxolol, Bisoprolol, Metoprolol

Safer to use in people with asthma, PVD, and diabetes

Question 23

Third generation Beta blockers

Answer 23

Vasodilators
B1, B2, a1 blockade
Carvedilol and labetalol

Question 24

Direct vasodilators

Answer 24

No ANS pharmacology

Cause reflex tachycardia and edema–use a beta blocker and diuretic also

Question 25

Hydralazine

Answer 25

Prodrug of NO Selective arteriolar dilation Safe in pregnancy Combine with beta blockers to decrease reflex tachycardia Hydralazine + nitrates = life saving in HF

Question 26

Minoxidil

Answer 26

Potent direct arteriolar vasodilator Orally Suppresses insulin release so is only used short term

Question 27

Calcium channel blockers

Answer 27

2 classes: dihydropyridines and non-dihydropyridines

Question 28

Dihydropyridines

Answer 28

"-dipine" Block L type Ca channels in vascular smooth muscle causing vasodilation and decreased TPR no effect on HR or contractility

Question 29

Non-dihydropyridines

Answer 29

Verapamil and Diltiazem Decrease Ca channels in heart tissue causing decreased HR and contractility Used in patients with angina who can not tolerate beta blockers

Question 30

ACE inhibitors

Answer 30

"-pril" Block angiotensin I-->angiotensin II and therefore block sodium and water retention Increase bradykinin activity by blocking metabolism of it--causes increased vasodilating effects Decrease aldosterone--may cause hyperkalemia Long term benefits May result in dry cough or angioedema

Question 31

ARB

Answer 31

"-sartan" Directly antagonizes angiotensin II receptor Does not affect bradykinin metabolism No long term benefits as ACEI

Question 32

Adverse effects of ACE inhibitors and ARB's

Answer 32

Cause hypotension and hyperkalemia Both contraindicated in bilateral RAS Contraindicated in pregnancy due to risk of potter syndrome

Question 33

Ca channel blockers make what worse

Answer 33

HF

Question 34

Nifidepine and pregnancy

Answer 34

Can be used

Question 35

SE of calcium channel blockers

Answer 35

GI blockage, gingival hyperplasia, lightheadedness, peripheral edema, reflex tachycardia

Question 36

1st line agents for treating hypertension

Answer 36

thiazides, ACEI, ARBs, and CCB (dihydropyridines)

Question 37

ACEI are especially good for patients who have

Answer 37

HF, MI, Diabetes

Question 38

Hypertension emergency

Answer 38

iV beta blockers, IV labetalol, Hydralazine, Nitroprusside, Fenoladpine

Question 39

Nitroprusside

Answer 39

Increase NO causing arterial and venous dilation | Can convert to cyanide--poisoning

Question 40

Fenoldapine

Answer 40

Arterial vasodilation, natriuresis, increased renal perfusion

Question 41

ACEI contraindicated in

Answer 41

Pregnancy and bilateral renal stenosis

Question 42

ACEI can help decrease

Answer 42

Diabetic nephropathy

Question 43

ACEI and GFR

Answer 43

Decreases GFR--do not take with NSAIDs

Question 44

Aliskiren

Answer 44

Direct renin inhibitor