Antihypertinsives

Question 1

Verapamil

Answer 1

◦ Verapamil uses :( angina , SVT +a fib , migraine + cluster headaches prophylaxis )
-Side effects (1’ AV block , constipation , periphral edema , headache …) ,
Don’t use it in HF

Question 2

Alpha+beta blockers

Answer 2

• Carvedilol, although an effective antihypertensive, is mainly used in the treatment of heart failure.
• Carvedilol, as well as metoprolol succinate, and bisoprolol have been shown to reduce morbidity and mor- tality associated with heart failure.
• Labetalol is used in the management of gestational hypertension and hypertensive emergencies.

Question 3

Alpha1 blockers (prazozin,…)

Answer 3

• causing relaxation of both arterial and venous smooth muscle
• long-term tachycardia does not occur, but salt and water retention does. -Reflex tachycardia and postural hypoten-sion often occur at the onset of treatment and with dose increases, requiring slow titration of the drug in divided doses.
• Due to weaker outcome data and their side effect profile, α-blockers are no longer recommended as initial treatment for hypertension, but may be used for refractory cases + BPH

Question 4

Clonidine

Answer 4

• a2 central agonist
• Clonidine is used primarily for the treatment of hypertension that has not responded adequately to treatment with two or more drugs. (Kaplan:mild-moderate HTN)
• Clonidine does not decrease renal blood flow or glomerular filtration and, therefore, is useful in the treatment of hypertension complicated by renal disease
• opiate withdrawal
• Rebound hypertension occurs following abrupt withdrawal of clonidine. The drug should, therefore, be withdrawn slowly if discontinuation is required.
• Adverse effects include sedation, dry mouth, and constipation

Question 5

Methyl dopa

Answer 5

# cetral a2 agonist
# Adverse effects include sedation, dry mouth, and constipation , +ve coombs test ,(cns depression, edema{give diuretics}, TCA interaction  >>both)
# Its use is limited due to adverse effects and the need for multiple daily doses. It is mainly used for management of hypertension in pregnancy, (Kaplan:mild-moderate HTN , pregnancy HTN)

Question 6

CCBs

Answer 6

Uses:HTN ,angina (esp. Prinzmetal angina) , anti arrythmics (only verapamil , ditiazem)
,

-side effects : reflex tach + gingival hyperplasia (-dipines)
-First-degree atrioventricular block and constipation are common dose- dependent side effects of verapamil. Verapamil and diltiazem should be avoided in patients with heart failure or with atrioventricular block due to their negative inotropic
, periphral edema , hypotesion Sx&raquo_space;Dizziness, headache, fatigue (esp. Dipines )

Question 7

β-blockers

Answer 7

# decreasing cardiac output +inhibit the release of renin from the kidneys
# Nebivolol is a selective blocker of β 1 receptors, which also increases the production of nitric oxide, leading to vasodilation
# main use:in hypertensive patients with concomitant heart disease, such as supraventricular tachyarrhythmia (for example, atrial fibrillation), previous myocardial infarction, angina pectoris, and chronic heart failure.
# S.E.:cardiac depression (hypotension +bradycardia) ,cns depression (insomnia+fatigue+..) , decrease lipids+erectile dysfunction ,rebound , lipid disturbance )
# !!: asthma , PVD, 2'+3' AV block

Question 8

Vasodilator (direct acting smooth muscle relaxants )

Answer 8

such as hydralazine , minoxidil ,primarily in arteries and arterioles(selective)

• not used as primary drugs to treat hypertension.
• but Cx reflex stimulation of the heart ,may prompt angina pectoris, myocardial infarction, or cardiac failure + increase plasma renin concentration so (hydralazine is almost always administered in combination with a β-blocker, such as propranolol, meto- prolol, or atenolol (to balance the reflex tachycardia) and a diuretic (to decrease sodium retention)
• hydralazine is accepted medication for controlling blood pressure in pregnancy- induced hypertension
• S.E. Hydralazine :lupus-like syndrome can occur with high dosages, (but it is reversible upon discontinuation) ,headache, tachycardia, nausea, sweating, arrhythmia, and precipitation of angina

-Minoxidil treatment causes hypertri- chosis (the growth of body hair). This drug is used topically to treat male pattern baldness.

Question 9

Anti hypertensives for pregnancy

Answer 9

1- hydralazine
2- methyl dopa
3- labetalol
4- nephidipine