Drugs for Hypertension Flashcards
MOA prazosin
alpha 1 antagonist
effects prazosin
vasodilation of veins and arterioles leading to decrease in overall PVR and BP
clinical app prazosin
tx HTN
- late choice in JNC8 due to ALLHAT data showing increase likelihood of stroke and CHF w/ doxazosin in comparison to chlothalidone
toxicities prazosin
palpitations, edema, orthostatic hypotension, syncope
- dizziness, HA, drowsiness, depression, nervousness
- decreased energy, weakness
- nausea, diarrhea, constipation
- urinary frequency, retrograde ejaculation
- blurred vision
tamsulosin, terazosin (doxazosin) MOA
similar to prazosin but differ w/ respect to a1a, a1b, and a1d subtype selectivity
clinical app tamsulosin, terazosin (doxazosin)
help kidney stones pass
MOA clonidine
alpha 2 agonist
effects clonidine
- transient increase in BP at first
- reduce sympathetic outflow –> decrease in PVR, renal vascular resistance, HR, and BP
- pain relief
- benefits in ADHD
clinical app clonidine
- tx for hypertension
- tx of ADHD
- pain relief for CA pts
toxicities of clonidine
- drowsiness
- HA, fatigue, dizziness, behavioral changes
- xerostomia
- REBOUND HTN IF DOSE IS MISSED
MOA a-methyldopa
alpha 2 agonist
effects a-methyldopa
sympatholytic for HTN due to reduced sympathetic outflow
clinical app a-methyldopa
management of severe hypertension
- drug of choice for gestational hypertension
toxicities a-methyldopa
- angina pectoris aggravation
- bradycardia, HF, orthostatic hypotension
- bell’s palsy
- positive Coombs test
- SLE-like syndrome
why are B-blockers contraindicated in peripheral vascular dz
they cause cold extremities especially in infants
MOA atenolol
B1 selective antagonist
what beta blocker has the highest beta 1 selectivity
bisoprolol
MOA captopril
competitive ACE inhibitor
effects captopril
prevents conversion of angiotensin I to angiotensin II, blocking vasoconstriction
- decreases plasma renin and increases aldosterone
- lowers BP
clinical app captopril
HTN
- HF with reduced EF
toxicities captoptil
- cough
- angioedema
describe enalapril
an ACEI that is a prodrug with an active form available for IV
MOA losartan
nonpeptide angiotensin II receptor antagonist with selectivity for AT1
effects losartan
blocks vasoconstrictor and aldosterone-secreting effects of angiotensin II
- induces complete inhibition of RAAS compared to ACEI
clinical app losartan
- diabetic nephropathy
- HTN
toxicities of losartan
- adverse effects more common in those w/ diabetic nephropathy
- hypotension
- cough but less than ACEI
noteworthy about valsartan
not a prodrug requiring activation
noteworthy about candesartan
relatively irreversibly binds
MOA aliskiren
direct renin inhibitor
effects aliskiren
decreases formation of angiotensin II
clinical app aliskiren
tx HTN alone or in combo w/ other antihypertensive drug
toxicities aliskiren
few (~1%)
- skin rash
- diarrhea
- cough
MOA hydralazine
direct vasodilation of arterioles
effects hydralazine
decreases systemic resistance
clinical app hydralazine
hypertensive emergency in pregnancy
toxicities hydralazine
drug-induced lupus like syndrome
- toxicities in every body system
MOA nitroprusside
causes peripheral vasodilation by direct action on venous and arteriolar smooth m.
effects nitroprusside
- reduces peripheral vascular resistance
- will increase CO by decreasing afterload
clinical app nitroprusside
HTN
- acute decompensated heart failure
toxicities of nitroprusside
toxicities in every body system
MOA minoxidil
produces vasodilation by directly relaxing arteriolar smooth m
effects minoxidil
lowers arteriolar vascular resistance
clinical app minoxidil
- HTN that is symptomatic or associated w/ target organ damage
toxicities of minoxidil
toxicities in every body system
