Drugs to Treat HTN and HTN Urgency/Emergency Flashcards
What is the difference between primary HTN and secondary HTN in terms of treatment?
Drugs lower BP but do not treat underlying cause for primary HTN while people can be cured of secondary HTN
What are causes of secondary HTN?
1) Renal parenchymal disease
2) Renovascular disease
3) Primary aldosteronism
4) Obstructive sleep apnea
5) Drug or alcohol induced
6) Pheochromocytoma
Where do thiazide diuretics act on?
What transporter is blocked?
1) Distal convoluted tubule
2) Na-Cl cotransporter
What drug is used to manage HTN by inhibiting sodium reabsorption in the distal tubules via blockade of Na+-Cl cotransporter?
When is it not effective in patients?
1) Hydrochlorothiazide
2) In patients with low GFR
Unlike thiazides what can work in patients with low GFR in the treatment of HTN?
Furosemide (loop diuretic)
What blocks epithelial sodium channels in the collecting ducts?
What is its clinical application in terms of HTN?
1) Amiloride
2) Counteract K+ loss induced by other diuretics in the Tx of HTN
What is a competitive antagonist of aldosterone receptors?
What is its clinical application in terms of HTN?
1) Spironolactone
2) Counteract K+ loss induced by other diuretics in the Tx of HTN
What is the difference between amiloride and spironolactone?
The steroid effects of spironolactone are slow on and slow off
What is a competitive inhibitor of angiotensin converting enzyme that is used to treat HTN by preventing the conversion of angiotensin I to angiotensin II?
Captopril
What is the most common reason to stop ACE inhibitor?
What deadly reason to stop it?
1) Coughing
2) Angioedema (Pt can be choked by their swollen tongue)
What is a competitive non peptide angiotensin II receptor antagonist that is used to treat HTN by blocking the effects of angiotensin II?
Losartan
The decrease in angiotensin II has what effect on efferent tone?
What can this precipitate in patients with bilateral renal stenosis?
What can this precipitate in diabetic patients?
1) Decreases it
2) Renal failure
3) Preserve renal function
At what trimesters of pregnancy is ACE inhibitors contraindicated?
All of them
What CCBs is the most widely used CCB in the treatment of HTN in part due to a very long half life?
Amlodipine
Which category of CCBs have the most pronounced effect in vasodilation?
Dihydropyridines (nifedipine and amlodipine)
What is a competitive antagonist of postsynaptic α1-adrenergic receptors used to treat HTN but not used anymore because they increase chance of stroke and CHF?
Prazosin
What is an alpha-2 adrenergic receptor agonist that crosses the BBB and used for the treatment of HTN?
What can happen if a dose is missed?
1) Clonidine
2) Rebound HTN
What is a selective agonist for α2-adrenergic receptors that remains a drug of choice for gestational HTN?
α-methyldopa
What nonselective beta-adrenergic blocker competitively blocks response to beta1- and beta2- adrenergic stimulation and can be used in the Tx of HTN?
Propranolol
What competitive β1-selective adrenergic receptor antagonist can be used in the Tx of HTN?
Atenolol and metoprolol
The sudden abrupt stopping of α2-agonist leads to?
This ultimately results in?
1) Excessive SNS tone
2) Rebound HTN and death
What causes direct vasodilation of arterioles and is used in hypertensive emergencies such as pregnancy?
Hydralazine
What causes peripheral vasodilation by direct action on venous and arteriolar smooth muscle and can be used in the management of hypertensive crises?
Nitroprusside
What is the choice of therapy for renal vascular HTN?
Drugs that block RAS and statin therapy
If a patient has angina along with HTN what class of drugs are given?
Beta blockers
In the treatment of HTN in patients with CKD, what is the first line therapy used if they are displaying albuminuria?
ACE inhibitor
In the treatment of HTN in patients with aortic disease what class of drugs are given?
Beta blockers
In black adults with HTN but without HF or CKD, including those with DM, initial antihypertensive treatment should include?
Thiazide-type diuretic or CCB
Women with HTN who become pregnant, or are planning to become pregnant, should be transitioned to what drugs during pregnancy?
Methyldopa, nifedipine, and/or labetalol
What dihydropyridine CCBs can be given as an IV antihypertensive drug for hypertensive emergencies?
Nicardipine and Clevidipine
What NO dependent vasodilators can be given as an IV antihypertensive drug for hypertensive emergencies?
Sodium nitroprusside and Nitroglycerin
What direct vasodilator can be given as an IV antihypertensive drug for hypertensive emergencies?
Hydralazine
What beta-1 selective adrenergic blocker can be given as an IV antihypertensive drug for hypertensive emergencies?
Esmolol
What combined alpha-1 selective and nonselective beta adrenergic blocker can be given as an IV antihypertensive drug for hypertensive emergencies?
Labetalol
What nonselective alpha adrenergic blocker can be given as an IV antihypertensive drug for hypertensive emergencies induced by catecholamine excess?
Phentolamine
