Drugs for HTN Flashcards
Primary (essential) HTN is most common. What are the 3 subtypes?
Low renin - 25% most commonly in AAs and elderly
Normal renin - 60%
High renin - 15%
What are the a-receptor blockers used first in HTN?
What is the problem with them?
Phentolamine and Phenoxybenzamine
Short half-lives and hypotension (ortho also), tachy and arrhythmias.
Nasal stiffness.
N/V/D.
MOA of Prazosin
S/E
Antagonize a1-Rs
Orthostatic hypotension
Retrograde ejaculation
Clonidine MOA
S/E
Binds a1 R and reduce SNS outflow which lowers BP
Rebound HTN (if dose missed), drowsiness, xerostomia
a-methyldopa MOA
Drug of choice for:
S/E
Selectively agonize a2-Rs
Gestational HTN
Pos. Coombs test
SLE-like syndrome
Propanolol MOA
S/E
Non-selective beta blocker (b1 and b2 Rs)
Bronchospasm, cold extremities, bradycardia, hyperglycemia, etc.
Why aren’t BBs given in vascular disease?
Because they cause cold extremities in peripheral vascular disease
Atenolol MOA
Selective b1 blocker
Which BB has the highest selectivity for b1?
Bisoprolol
Metoprolol MOA
Half-life is less than:
Toxicities where?
b1 selective blocker
Less than atenolol
CNS
What happens if a2-agonists or BB is stopped abruptly?
Excessive carciac stimulation (loss of BB), which leads to tachy, HTN, angina, arrhythmias.
Released CNS brakes (a2 agonist).
Both lead to REBOUND HTN and death.
BB used to be _____, but now are _____.
First choice tx, but now are given much less for HTN use
In RAS inhibition, what happens to GFR in the kidney and creatinine levels?
Is it concerning?
Protective action for patients with:
GFR falls due to ACE inhibition which causes an increase in creatinine.
Can be alarming to docs, but not a concern unless there is hyperkalemia.
DM
Captopril MOA
Toxicities:
ACE-inhibitor
Cough and *angioedema
What ACE-I is a prodrug?
What is the route of administration?
Enalapril
IV
Benazepril and Lisinopril are ACE-Is with what kind of half-life?
Longer half-lives which permit 1x daily use
Losartan MOA
Non-peptide AT II receptor anatgonist
Which AT II is not a prodrug?
Which one binds irreversibly?
Valsartan
Candesartan
Aliskiren MOA
Why is it not given much?
Direct inhibitor of renin
New, expensive, no obvious benefits, adverse effects, etc.
Majot toxicity of ACE-I is seen in:
Pregnant women
Hydralazine MOA
When is it given?
Major well-known toxicity?
Direct VD of arterioles
HTN emergency in pregnancy
Drug-induced lupus-like syndrome
Nitroprusside MOA
Half-life?
When is it given?
Direct VD of vv. and aa.
Very short
HTN crisis
Minoxidil MOA
It is considered the…
VD of arteriole SM
Best VD for arterioles
When are BBs indicated for HTN?
In pts. with HTN and stable IHD
Drug of choice in pts. with HTN and CKD?
ACE-inhibitor (class IIa)
