Drugs for HTN

Question 1

Prazosin

Answer 1

competitive a1-antagonist

• a late choice
• increased likelihood of stroke and CHF with doxazosin in comparison to chlorthalidone
• toxicities: orthostatic hypotension, “retrograde” ejeculation

Question 2

Clonidine

Answer 2

a2-agonist (crosses BBB)

• causes transient increase in blood pressure, reduced sympathetic outflow
• toxicities: drowsiness, xerostomia, rebound hypertension if dose if missed

Question 3

a-Methyldopa

Answer 3

selective a2-agonist

• drug of choice for gestational hypertension**
• toxicities: positive Coombs test, SLE-like syndrome

Question 4

Propranolol

Answer 4

nonselective beta-blocker

• decreases HR, myocardial contractility, BP and myocardial oxygen demand
• toxicities: cold extremities** (reason they are contraindicated in peripheral vascular disease)

Question 5

Atenolol

Answer 5

competitive b1-selective adrenergic antagonist

• decreases HR, myocardial contractility, BP and myocardial oxygen demand
• toxicities: persistent bradycardia, cardiac failure, chest pain, Raynaud’s, complete AV block

Question 6

Captopril

• half life?
• toxicities?

Answer 6

competitive ACE inhibitor

• lowers Ang II, increasing renin, decreasing aldosterone
• half life = 1.7 hours
• toxicities: cough, angioedema** (is main reason to stop, can be deadly)

Question 7

Losartan

Answer 7

nonpeptide Angiotensin II antagonist

• blocks vasoconstriction, tx of diabetic nephropathy
• toxicities: adverse effects more common in those with diabetic nephropathy (orthostatic hypotension, hypogycemia, hyperkalemia)

Question 8

Aliskiren

Answer 8

direct renin inhibitor

• new, expensive, no obious benefits, some evidence of increased risk of adverse effects
• decreases formation of Ang II
• few toxicities: skin rash (1%), diarrhea, cough

Question 9

Nifedipine

Answer 9

dihydropyridine CCB

• frequency-dependent (not cardioactive)
• used in hypertensive emergency in pregnancy (off-label), pulmonary hypertension
• toxicities: flushing, peripheral edema, headache, palpations, gingival hyperplasia

Question 10

Verapamil

Answer 10

non-dihydropyridine CCB

• frequency-dependent (cardioactive)
• used in supraventricular tachyarrhythmia
• toxicities: headache, gingival hyperplasia, constipation

Question 11

Diltiazem

Answer 11

non-dihydropyridine CCB

• frequency-dependent (cardioactive)
• control of rapid ventricular rate in pt with A-fib/flutter
• toxicities: edema, headache

Question 12

Hydralazine

Answer 12

direct vasodilation of arterioles

• decreases systemic resistance
• used in hypertensive emergency in pregnancy**
• toxicities: drug-induced lupus-like syndrome (lots of other multi-system SA’s)

Question 13

Nitroprusside

Answer 13

direct vasodilator (venous and arteriolar)

• reduced peripheral resistance, increases CO
• multisystem SA’s

Question 14

Minoxidil

Answer 14

direct vasodilator (directly relaxes arteriolar smooth muscle)

• tx of HTN that is symptomatic or associated with target organ damage
• multi-system SA’s