Antihypertensives Day II

Question 1

dose of beta blockers

Answer 1

depends on which beta blocker

Question 2

are beta blockers 1st line

Answer 2

no

Question 3

when are beta blockers used

Answer 3

reserved for significant cardiac history

• heart failure
• post MI
• high coronary artery dz
• CKD

Question 4

MOA of beta blockers

Answer 4

1. beta 1 receptors located in heart and beta 2 receptors are located in the lungs
2. beta blockers block beta 1 receptors thus decreasing the effects of epinephrine and nor-epinephrine which therefore decrease BP and HR

Question 5

cardio selective beta blockers

Answer 5

AMEBBA: 
atenolol
metoprolol
esmolol
bisoprolol
betaxaolol
acebutolol

Question 6

mixed alpha and beta blockers

Answer 6

carvedilol and labetalol

Question 7

ISA beta blockers

Answer 7

intrinsic sympathomimetic activity

CAPP - carteolol, aceutolol, penbutolol, pindolol

Question 8

nonspecific beta blockers

Answer 8

nadolol, propanolol, timolol

Question 9

common ADE of beta blockers

Answer 9

1. beta blocker blues - tired fatigued depressed - chest might feel different due to change in heart beat
2. sexual dysfunction (permanent), rebound HTN if suddenly discontinued

Question 10

what can propanolol be used for other than HTN

Answer 10

stage fright

and migraines

Question 11

Contraindications for beta blockers

Answer 11

1. asthma and COPD
2. diabetes - masks hypoglycemia
3. severe peripheral vascular dz (can worsen symptoms)
4. heart block
5. severe acute heart failure
6. pregnancy category C

Question 12

what is sotalol used for?

Answer 12

class III anti-arrhythmic agent NOT HTN

Question 13

examples of alpha 1 blockers

Answer 13

prazosin
terazosin
doxazosin

Question 14

MOA of alpha 1 blockers

Answer 14

competitvely inhibits alpha 1 receptors in the periphery which causes vasodilation

Question 15

alpha 1 blockers place in therapy

Answer 15

only as an add on especially in males not to be used often

Question 16

uses of alpha 1 blockers

Answer 16

HTN - not monotherapy

BPH - Tamsulosin & Alfuzosin

Question 17

alpha 1 blockers ADE

Answer 17

1. first dose effect - significant orthostatic hypotension with first dose and any subsequent dose titrations
2. orthostatic hypotension, dizziness, vertigo
3. reflex tachycardia, especially early in therapy (not seen if also on beta blocker, but may worsen orthostatic effects)
4. need to slowly titrate dose upward
5. fatigue, vivid dreams, depression, dry mouth

Question 18

dose of following alpha 1 blockers

1. doxazosin
2. terazosin
3. prazosin

Answer 18

Dox - 1/day
Tera - 2/day
Praz - 2-3/day

Question 19

examples of centrally acting alpha 2 agonists

Answer 19

1. methylodpa

2. clonidine

Question 20

MOA of alpha 2 agonists centrally acting

Answer 20

stimulates alpha 2 receptors in brain, reduces outflow of sympathetic system from brain, which produces a decrease in BP and peripheral vascular resistance

(tricks brain to think theres enough in the body)

Question 21

place in therapy for centrally acting alpha 2 agonists

Answer 21

methylodopa - limited use, good for pregnancy!

clonidine - often used for resistant hypertension

other: substance abuse treatment - opiate withdrawal and avoidance & adjunct in pain management

Question 22

centrally acting alpha 2 agonists ADE

• general
• methylodopa vs clonidine

Answer 22

1. orthostatic hypotension, dizziness
2. fatigue, depression, sedation
3. sodium and water retention
4. rebound tachycardia and HTN if stopped abruptly
   Methylodopa - liver toxicities, hemolytic anemia
   Clonidine - rash with patch, anticholinergic like side effects (dry mouth, sedation, constipation, urinary retention

Question 23

which alpha 2 agonist is available as a patch

Answer 23

clonidine - applied every 7 days

effects begin within 12-24 hours and last up to 3 days after patch removal (start oral dose first to make sure it agrees with patient then can use the patch)

Question 24

examples of vasodilators

Answer 24

hydralazine

minoxidil

Question 25

MOA of vasodilators

Answer 25

direct vasodilator, especially in arteries and arterioles, leading to decreased systemic vascular resistance
causes peripheral vasodilation

Question 26

common ADE of vasodilators

Answer 26

1. reflex tachycardia, consider co administration of beta blocker
2. increase in renin as response to vasodilation, consider co administration with diuretic
3. H/A is common
4. Hydralazine - lupus-like syndrome (butterfly rash), dermatitis, drug fever, peripheral neuropathy, hepatitis
5. minoxidil - hirsutism - not used for HTN anymore - main ingredient in rogaine

Question 27

common preferred combos for HTN

Answer 27

1. ACE-I/ARB + thiazide

2. ACE-I/ARB + dihydropyridine CCB

Question 28

not preferred but acceptable combos for HTN

Answer 28

1. CCB + Thiazide
2. Thiazide + K sparing diuretic
3. beta blocker + diuretic or dihydropyridine CCB

Question 29

OTC drug induced HTN

Answer 29

NSAIDS
Appetite suppressants
Caffeine
Pseudoephedrine

Question 30

non OTC drugs that can induce HTN

Answer 30

corticosteroids
alcohol - excessive
ACTH
amphetamines
cyclosprine
estrogen
excess thyroid hormones
duloxetine
erythropeitin

Question 31

3 most common beta blocker & doses

Answer 31

1. atenolol - once/day
2. metoprolol succinate - once/day
3. metoprolol tartrate - 2/day

Question 32

beta blockers approved for CHF

Answer 32

bisoprolol
metoprolol succinate
cardevidiolol