Antihypertesnive therapy

Question 1

Primary (essential) HTN:

Answer 1

Diuretics, ACE inhibitors, ARBs, CCBs

Question 2

HTN with CHF

Answer 2

Diuretics, ACE inhibitors/ARBs, B-blockers (compensated CHF), aldosterone antagonists

Question 3

HTN with diabetes mellitus

Answer 3

ACE inhibitors/ARBs. Calcium channel blockers, diuretics, B-blockers, a-blockers

Question 4

Calcium channel blockers:

Answer 4

Amlodipine, nimodipine, nifedipine (dihydropyridine); diltiazem, verapamil (non-dihydropyridine)

Question 5

CCB mech:

Answer 5

Block voltage-dependent L-type Ca channels of cardiac and smooth muscle, thereby reduce muscle contractility.
Vascular SM - amlodipine = nifedipine > diltiazem > verapamil
Heart - verapamil > diltiazem > amlodipine = nifedipine (verapamil = ventricle)

Question 6

CCB use:

Answer 6

Dihydropyridine (except nimodipine): HTN, angina (including Prinzmetal), Raynaud phenomenon

Question 7

CCB tox:

Answer 7

Cardiac depression, AV block, peripheral edema, flushing, dizziness, hyperprolactinemia, and constipation, gingival hyperplasia

Question 8

Hydralazine: mech

Answer 8

Increases cGMP –> smooth muscle relaxation. Vasodilates arterioles > veins; afterload reduction

Question 9

Hydralazine: use

Answer 9

Severe HTN, CHF. First-line therapy for HTN in pregnancy, with methyldopa. Frequently coadministered with a B-blocker to prevent reflex tachycardia.

Question 10

Hydralazine: tox

Answer 10

Compensatory tachycardia (contraindicated in angina/CAD), fluid retention, nausea, HA, angina. Lupus-like syndrome

Question 11

Hypertensive emergency:

Answer 11

Nitroprusside, Nicardipine, Clevidipine, Labetalol, and Fenoldopam

Question 12

Nitroprusside: mech/tox

Answer 12

Short acting; Increases cGMP via direct release of NO. Can cause cyanide toxicity (releases cyanide)

Question 13

Fenoldopam: mech/tox

Answer 13

Dopamine D1 receptor agonist - coronary, peripheral, renal, and splanchnic vasodilation. Decreases BP and Increases natriuresis

Question 14

Nitroglycerin, isosorbide dinitrate: mech

Answer 14

Vasodilate by increasing NO in vascular SM –> increase cGMP and SM relaxation. Dilate veins&raquo_space;arteries. Decrease preload

Question 15

Nitroglycerin, isosorbide dinitrate: use

Answer 15

Angina, acute coronary syndrome, pulmonary edema

Question 16

Nitroglycerin, isosorbide dinitrate: tox

Answer 16

Reflex tachycardia (treat with B-blocker), hypotension, flushing, HA, “Monday disease” in industrial exposure: development of tolerance for vasodilating action during the work week and loss of tolerance over the weekend results in tachycardia, dizziness, and HA upon reexposure

Question 17

Antianginal therapy: Goal

Answer 17

Reduction of myocardial O2 consumption (MVO2) by decreasing 1 or more of the determinants of MVO2: end diastolic volume, BP, HR, contractility.