Antihypertensives 🤯 Flashcards
Once you’re on HTN meds, when can you stop taking them
Never
What are the 2 effects of diuretics on BP?
Decrease CO by decreasing blood volume
Decrease peripheral vascular resistance
(Probably FYI: by decreasing Na content in smooth muslce cells and activating K+ channels, the muscles are less sensitive to vasopressors)
What kind of drugs are clonidine and Methyldopa
Centrally acting sympatholytics
Where do clonidine and methyldopa act
On the brain
Will we see reflex tachycardia with clonidine or methyldopa?
NO! They act on the CV center in the brain!
When do we use methyldopa most
Pregancy
What are the adverse effects of clonidine and methyldopa
DRY MOUTH
Sedation (and other CNS effects)
Methyldopa can cause hemolytic anemia if they have a positive Coombs test and you give it to them
What is the MOA of clonidine and methyldopa?
They stimulate a2 receptors in the brain, which decreases NE release!
If a patient has a positive ________test, you should NOT give Methyldopa
Coombs
Will cause hemolytic anemia
Which drugs are the a1 blockers
Prazosin
Terazosin
Doxazosin
Who is the ideal patient for a1 blockers
Old man with BPH and HTN
Can help with urine flow
Do we see reflex tachycardia with a1 blockers
Yes
What class of drug has the first dose phenomonon
a1 blockers
Make sure patient takes first dose before bed since postural hypotension will be intense at first
Do a1 blockers affect lipids or glucose?
No
Can you use B blockers for vasodilation
NO NO NO NONONO a thousand times NOOOOOOOOOOOOOOO
They are NOT direct vasodilators!!!!!!!!!!!!!!
Do you need to know everything about b blockers
Yes
What are the HIP drugs and what do they do?
Hydralazine**
Isoniazid
Procainamide
They cause drug-induced SLE in slow acetylators
What is the MOA of Fenoldopam
Is stimulates D1 receptors to relax arteriolar smooth muscle
When do we use fenoldopam
Emergency hypertensive situations
IV only
What is the MOA of Minoxidil?
It opens K+ channels to stabilize membranes and dilate ARTERIOLES
Minoxidil dilates (arterioles/veins)
Arterioles
What is an interesting adverse effect of minoxidil
Hair growth!
Topical minoxidil= Rogaine
Why do vasodilators threaten coronary perfusion?
They TANK your diastolic BP, PLUS your HR goes up so there’s less time between beats =less blood flow and less time between beats for heart to get perfused
Do ACE inhibitors cause reflex tachycardia?
NO!!!!!!! They lower BP but they ALSO reset the baroreceptors so there is no reflex tachycardia
Will ACEs and ARBs cause water and sodium retention?
No! Becasue they inhibit the angiotensin II activation of aldosterone synthesis
Which drug classes should NOT be combined with digoxin due to the risk of causing arrhytmias? Why not?
Thiazides and loops.
Cause hypokalemia
Can B-blockers cause atherosclerosis?
Yes, becasue they increase LDL and reduce glucose tolerance
What is the DOC for HTN in type II diabetics
ACEs and ARBs
Are thiazides good for diabetics
NO!!! They have an inhibitory effect on insulin release
What is the least preferred drug for people with:
High physical activity
African heritage
Diabetes
Peripheral vascular disease
Beta blockers!
When do we use Hydralazine?
Severe hypertension (last resort drug)
Hypertensive emergencies in pregnancy
When do we use sodium nitroprusside?
Emergencies ONLY - IV only**
Why is sodium nitroprusside only used in emergencies?
Rapid onset
Effect disappears in minutes
Metabolized by liver to thiocyanate (cyanide!)**
What is a side effect of the dihydropyridine CCBs
Gingival hyperplasia 🦷
What is the most common side effect of verapamil
Constipation
What is the DOC for HTN in diabetics
ACE/ARB- prevents nephropathy
What is the drug of choice for CKD even when they don’t have HTN?
ACE/ARB
If your patient is showing even the slightest sign of diabetic nephropathy, what drug do you need to give them
ACE/ARB
What drug class is not ok for patients with bilateral renal artery stenosis?
ACE/ARBs
Their GFR is already too low, they need Angiotensin and aldosterone to keep it up.
Which drugs can cause hemolytic anemia if the pt has a positve Coombs test
Methyldopa
What do sympatholytics (other than clonidine and methyldopa) do to Na+ and H2O retention
They increase it! Due to activating the baroreflex.
These drugs are best combined with a diuretic
