Antihypertensives

Question 1

Metoprolol MOA

Answer 1

B1 blocker

Question 2

Labetalol MOA

Answer 2

A1, B1, B2 blocker

Question 3

Esmolol MOA

Answer 3

B1 blocker

Question 4

Nicardipine MOA

Answer 4

Dihydropyridine CBB

Question 5

Hydralazine MOA

Answer 5

Arteriolar Dilator

Question 6

Fendolopam MOA

Answer 6

Dopamine type 1 agonist

Question 7

Nitroprusside MOA

Answer 7

NO donor

Question 8

Nitroglycerine MOA

Answer 8

NO donor

Question 9

Metoprolol Dose

Answer 9

1-5mg

Question 10

Labetalol Dose

Answer 10

5-20 mg bolus

0.5-2 mg/min infusion

Question 11

Esmolol Dose

Answer 11

50-300 mcg/kg/min infusion

Question 12

Nicardipine Dose

Answer 12

100 mcg bolus

5-15 mg/hr infusion

Question 13

Hydralazine Dose

Answer 13

2.5-20 mg IV bolus

onset: 10-20 min
duration: 3-6 hrs

Question 14

Fendolopam Dose

Answer 14

0.05-1.6 mcg/kg/min infusion

Question 15

Nitroprusside Dose

Answer 15

0. 25-10 mcg/kg/min infusion
   - metabolism involves interaction with oxyHgb to form methemoglobin which is an unstable radical which breaks down releasing cyanide. high doses (>2mcg/kg/min) may result in cyanide accumulation

Question 16

Nitroglycerine Dose

Answer 16

5-300 mcg/kg/min

Question 17

A patient known to be taking verapamil was given dantrolene in the OR for suspected MH. Complications associated with these medications administered in tandem include?

Answer 17

Cardiovascular collapse & increased potassium levels

Question 18

Sympathomimetics with the greatest affinity for the alpha receptors?

Answer 18

phenylephrine

norepinepherine

Question 19

HTN meds that should be used with caution in coronary artery disease?

Answer 19

hydralazine
nitroprusside

-reflex tach can worsen the metabolic demand on the heart

Question 20

Sodium nitroprusside vasodilates with the help of which active mediator?

Answer 20

NO

Question 21

Deflourination and renal toxicity is a complication associated with which antihypertensive:

Answer 21

Hydralazine

Question 22

labetalol –> IV and Oral beta/alpha ratios

Answer 22

IV: 3-1
Oral: 7-1

Question 23

Which of the following is NOT mainly an adrenergic receptor ANTAGONIST? (esmolol, prazosin, labetalol, clonidine, propranolol)

Answer 23

clonidine

Question 24

Anti-hypertensive drug classes

Answer 24

Diuretics
Sympatholytics (alpha & beta blockers)
Vasodilators
CCBs
ACE-Is / ARBs

Question 25

Thaizide Diuretics for HTN

Answer 25

``` Hydrochlorothiazide (HydroDIURIL) Chlorthalidone (Hygroton) Chlorothiazide (Diuril) Indapamide (Lozol) Metolazone (Zaroxolyn) ```

Question 26

K+ Sparing Diuretics for HTN

Answer 26

Amiloride (Midamor) Spironolactone (Aldactone) Triamterene (Dyrenium)

Question 27

Loops Diuretics for HTN

Answer 27

Furosemide (Lasix), Bumetanide (Bumex), Ethacrynic acid (Edecrin) Torsemide (Demadex)

Question 28

Methods to manage hypertension (4)

Answer 28

- central & peripheral control of SNS - RAAS - tone of vascular sm. muscle - fluid balance (Na+ & H2o)

Question 29

ACE-Is for HTN

Answer 29

"PRIL" | captopril, enalapril, benazepril, fosinopril, lisinopril, quinapril, r spirapril, moexipril, perindopril, trandolapril

Question 30

ARBs for HTN

Answer 30

"SARTAN" | losartan, valsartan, candesartan, eprosartan, irbesartan, telmisartan

Question 31

CCBs for HTN

Answer 31

verapamil, diltiazem, nifedipine, nicardipine, isradipine, amlodipine, felodipine

Question 32

Vasodilators for HTN

Answer 32

hydralazine minoxidil sodium nitroprusside nitroglycerine

Question 33

ACE-I MOA

Answer 33

-block the conversion of ATI to ATII, since ATII is a potent vasoconstrictoror

Question 34

ACE-I Side effects

Answer 34

cough, angioedema, rash, ARF, hyperkalemia, taste disturbances, teratrogenic, NSAIDS antagonize effects

Question 35

ARB MOA

Answer 35

-competitive inhibition, block ATII from binding at its receptor sites

Question 36

CCB MOA

Answer 36

- interfere with Ca++ influx across myocardial and vascular sm. muscle cell membranes - interfere by binding to alpha1 subunit (verapamil), modulating the shape of the channel (amlodipine), act on alpha1 subunit - mechanism unknown (diltizem)

Question 37

CV effects of CCBs

Answer 37

- decreased myocardial contractility - decreased HR - decreased activity/rate of AV node conduction - vascular sm. muscle relaxation, vasodilation, and decrease BP - decrease coronary resistance and increase CBF

Question 38

Vasodilators work at the vascular wall to promote vasodilation by "donating" what endogenous mediator?

Answer 38

Nitric oxide (NO) Donated NO diffuses through the vascular endothelium to smooth muscle where it (2 nd messenger) activates soluble guanylate cyclase --> GTP --> cGMP Ex: Hydralazine, sodium nitroprusside, nitroglycerine

Question 39

Sodium nitroprusside (SNP) has 3 toxicities:

Answer 39

1) cyanide toxicity (risk at >2mcg/kg/min) 2) Methemoglobinemia (risk at > 10 mg/kin/min) 3) Effects of high thiocyanate concentrations

Question 40

SNP cyanide toxicity diagnosis

Answer 40

Should be suspected when tachyphylaxis occurs, despite maximal infusion rates – Metabolic acidosis – Mixed venous PO2 increases reflecting the inability of tissues to utilize O2 – CNS dysfunction: seizures

Question 41

SNP cyanide toxicity treatment

Answer 41

Treatment – Immediately discontinue SNP – Administer 100% O2 – NaHCO 3 for metabolic acidosis – Sodium thiosulfate 150 mg/kg over 15 min • Converts cyanide to thiocyanate (nontoxic) – If severe, sodium nitrite 5 mg/kg • Converts hemoglobin to methemoglobin allowing the conversion of cyanide to cyanomethemoglobin – Hydroxocobalamin (Vit B12a) 25 mg/hr • Binds cyanide to form cyanocobalamin (B12)

Question 42

SNP methemoglobinemia toxicity treatment

Answer 42

- unlikely unless doses exceed 10mg/kg/min to produce 10% methemoglobin - screen patients receiving high doses of SNP when evidence of impaired oxygenation despite adequate arterial oxygenation and CO

Question 43

Anesthetic implications of CCBs - drug interactions

Answer 43

- potentiate effects of NMBs, impair reversal - may increase risk of local anesthetic toxic reactions during regional anesthesia - administration of dantrolnene in the presence of CCBs may result in hyperkalemia and CV collapse

Question 44

vasodilators effects on arteries vs veins

Answer 44

SNP - A=V | NTG - A>V