Antihypertensives II Flashcards
drug of choice for pregnancy induced hypertension
methyldopa
adverse effects of alpha 2 agonists
rebound hypertension with abrupt cessation sodium and water retention hemolytic anemia hepatitis orthostatic hypotension
5 H’s
drugs for pulmonary hypertension (increase in BP in pulmonary artery, vein, or capillaries)
bosentan and epoprostenol
how does bosentan work
antagonist at the endothelial receptors of vascular endothelium and SM
usually activation of these receptor is associated with vasoconstriction
bosentan is an inducer and metabolized by
CYP 2C9 and CYP 3A4
adverse effects of bosentan
HERS
Headache, Edema, Respiratory tract infection Spermatogenesis inhibition
contraindication of bosentan
pregnancy - it is a FDA category X drug so it is teratogenic
mechanism of epoprostenol
synthetic form of prostacyclin so it is a vasodilator
given IV
adverse effects of epoprostenol
CV: tachycardia, flushing, hypotension
CNS: headache, anxiety
GI: nausea and vomiting
neuromuscular and skeletal: arthralgia, jaw pain
contraindication for epoprostenol
hypersensitivity
chronic use in pts with heart failure
pts who develop edema after first dose
drugs used to treat hypertensive emergencies
parenteral vasodilator: sodium nitroprusside, nitroglycerine, hydralazine beta blockers: labetolol and esmolol dopamine receptor agonist: fenoldopam calcium channel blockers: nicardipine alpha blockers: phentolamine potassium channel openers: diazoxide
drug of choice for hypertensive emergencies
sodium nitroprusside because it reduces BP in less than two mins
uses of nitroprusside
management of hypertensive emergencies, heart failure, controlled hypotension (to reduce bleeding during surgery)
what is the mechanism of nitroprusside
activation of guanylyl cyclase from release of NO or direct stimulation by enzyme –> increase in cGMP –> dilation of arterial and venous vessels –> relaxation of smooth muscle
adverse effects of nitroprusside
hypotension (toxicity)
reflex tachycardia
cyanide toxicity (if liver or kidney problem and can’t get rid of metabolite of nitroprusside)
goose bumps, abdominal cramping, nausea, vomiting, headache, muscle twitching, sweating
clinical application of nitroglycerine
same as sodium nitroprusside
management of hypertensive crisis
heart failure
controlled hypotension
mechanism of action for nitroglycerine
NO activates guanylyl cyclase –> increased cGMP –> smooth muscle relaxation
adverse effects of nitroglycerine
hypotension (toxicity)
methemoglobinemia
headache, allergic reactions, flushing
in what type of hypertensive crisis is esmolol usually used for
aortic dissection and postoperative hypertension
adverse effects of esmolol
hypotension
nausea, thrombophlebitis, and painful extravasation
type of hypertensive crisis is fenoldopam used for
patients with renal failure
contraindication to fenoldopam
glaucoma
mechanism of antihypertensive emergency drug, nicardipine
calcium channel blocker
hypertensive emergency that requires phentolamine
pheochromocytoma, cocaine and amphetamine toxicity, clonidine withdrawal, MAO inhibitor drugs
clinical use of diazoxide
management of hypertensive emergency
treatment of hyperglycemia secondary to insulinoma
mechanism of diazoxide
open K+ channels and stabilizes membrane potential at resting levels prevent vascular SM contraction
adverse effects of diazoxide
hypotension
reflex tachycardia
sodium and water retention
inhibition of insulin release
what is a renin inhibitor that is used to treat hypertension
aliskiren
adverse effects of aliskiren
hypotension, hyperkalemia, angioedema, acute renal failure (due to lack of vasoconstrictive effect of angiotensin II)
contraindications for aliskiren
pregnancy
bilateral renal artery stenosis
hyperkalemia
