Cardiovascular Drugs: Antihypertensives

Question 1

LIst drug classes that can be used to decrease preload

Answer 1

diuretics
nitroglycerin
RAAS drugs
sodium nitroprusside
PDE inhibitor

Question 2

List drug classes that can be used to decrease afterload

Answer 2

hydralazine
RAAS drugs
dihydropyridines
minoxidil
sodium nitroprusside

Question 3

list drug classes that can be used to decrease contractility

Answer 3

B1 antagonists
calcium channel blockers

Question 4

list drug classes that can be used to increase contractility

Answer 4

digoxin
B1 agonists (dobutamine)
dopamine
PDE inhibitor

Question 5

list drug classes that can be used to regulate (decrease) heart rate

Answer 5

B1 antagonists
calcium channel blockers

Question 6

Are diuretics used for hypertension?

Answer 6

yes

Question 7

Explain the RAAS

Answer 7

angiotensinogen produced in liver

renin produced in kidneys

renin catalyzes angiotensinogen –> ang2

ACE (high concentration in lungs) catalyzes ang1 –> ang2

ang2 = ADH secretion, vasoconstriction, aldosterone increase (Na+/water retention)

Question 8

Mechanism of action of ACE inhibitors

Answer 8

inhibit ACE, thus inhibit ang2 formation.

–> vasodilation, decreased aldosterone, decreased CV remodeling

Question 9

aldosterone results in:

Answer 9

Na+/H2O retention
CV remodeling

Question 10

list some ACE inhibitors

Answer 10

lisinopril
enalopril
captopril
benazepril

Question 11

route of administration of ACE inhibitors

Answer 11

PO except enalopril (IV)

Question 12

Major adverse effects of ACE inhibitors

Answer 12

**dry cough
**angioedema (rare)
first dose hypotension
hyperkalemia

Question 13

are ACE inhibitors approved for use during pregnancy

Answer 13

no

Question 14

How do ARBs (angiotensin II receptor blockers) work?

Answer 14

block the effects of ang2 at the receptor

Question 15

What are the major differences between ACE inhibitors and ARBs?

Answer 15

ARBs don’t result in as much cough/angioedema risk
ARBs don’t result in as much aldosterone suppression (lower hyperK+ risk)
ARBs may not prevent cardiovascular remodeling as well

Question 16

How do direct renin inhibitors work?

Answer 16

inhibit the release of renin and thus block the entire RAAS

Question 17

What is the first line RAAS drug in prevention of cardiac morbidity and mortality?

Answer 17

ACE inhibitors

Question 18

List a direct renin inhibitor

Answer 18

aliskiren

Question 19

List some ARBs

Answer 19

losartan
valsartan
cadesartan

Question 20

How do the aldosterone antagonists work?

Answer 20

block the effects of aldosterone = K+ retention, Na+/H2O excretion

Question 21

List some aldosterone antagonists

Answer 21

spironolactone
eplerenone

Question 22

Adverse effects of aldosterone antagonists?

Answer 22

hyperK+
endocrine effects with spironolactone

Question 23

What are the cardiac outcomes of beta 1 antagonism

Answer 23

decreased HR
decreased contractility
decreased AV node conduction

Question 24

What does B1 agonism do in the kidney

Answer 24

stimulate renin release (RAAS activation)

Question 25

What do calcium channel blockers do in the heart?

Answer 25

same as B1 blockers decreased HR decreased AV node conduction decreased contractility

Question 26

What do calcium channel blockers do in the vasculature?

Answer 26

vasodilation

Question 27

Which class of calcium channel blockers work only in the vasculature?

Answer 27

Dihydropyridines

Question 28

What is the difference between dihydropyridines and nondihydropyridines?

Answer 28

Nondihydropyridines block calcium channels in the heart and vasculature; dihydropyridines block calcium channels in the vasculature only

Question 29

What do you expect to HR & BP after dihydropyridine administration?

Answer 29

decrease BP reflex tachycardia

Question 30

what do you expect to happen to HR & BP after nondihydropyridine administration?

Answer 30

decrease BP decrease HR

Question 31

list some dihydropyridines

Answer 31

nifedepine amlodipine nicardipine nimodipine

Question 32

list some nondihydropyridines

Answer 32

verapamil diltiazem

Question 33

What is the effect of arteriole vasodilation

Answer 33

decreased afterload = increased cardiac output, increased tissue perfusion

Question 34

what is the effect of venous vasodilation?

Answer 34

decreased preload = decreased ventricular filling & contractility = decreased cardiac output & decreased tissue perfusion

Question 35

Does venous or arteriole vasodilation result in more orthostatic hypotension?

Answer 35

venous (more pooling in the very large capacitance vessels)

Question 36

Does venous or arteriole vasodilation result in more reflex tachycardia?

Answer 36

Arteriole (baroreceptors are located in the arteries)

Question 37

What does hydralazine result in?

Answer 37

Direct arteriole vasodilation reflex tachycardia long term use = fluid retention

Question 38

What vasodilator works the FASTEST?

Answer 38

sodium nitroprusside

Question 39

Does sodium nitroprusside dilate the veins or the arteries?

Answer 39

both

Question 40

What is the maximum length of time recommended for sodium nitroprusside infusion?

Answer 40

3 days

Question 41

Do the organic nitrates result in more venous or more arteriole vasodilation?

Answer 41

venous

Question 42

List some organic nitrates

Answer 42

nitroglycerin isosorbide mononitrate isosorbide dinitrate

Question 43

What is the active substance of the organic nitrates?

Answer 43

nitric oxide (NO)

Question 44

What is the route of administration of nitroglycerin?

Answer 44

IV (continuous infusion d/t short half life) sublingual buccal transdermal PO

Question 45

What is the route of administration of isosorbides?

Answer 45

PO

Question 46

What is the route of administration of sodium nitroprusside?

Answer 46

IV (continuous infusion d/t short half life)

Question 47

Points of patient education when administering nitroglycerin transdermal?

Answer 47

Show how to measure out the dose Ensure 8+hrs/day "drug free" (to avoid tolerance development) - usually at night when angina isn't provoked