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Pharmacology 2 > Exam 2: Hypertensive Drugs > Flashcards

Exam 2: Hypertensive Drugs Flashcards

1
Q

Blood pressure is directly proportional to what two things?

A

CO and vascular resistance

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2
Q

What is the most common cause of failure of HTN drug therapy?

A

Non-compliance

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3
Q

In regards fo HTN, what do thiazide diuretics do?

A

Used in mild-moderate HTN to lower BP by 10-15.

-Increase sodium and H20 excretion will ultimately lower BP

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4
Q

What are the common side effects of diuretics?

A
  • Reduced glucose tolerance
  • Increased plasma lipid concentration
  • impotence
  • Gout
  • Hypokalemia
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5
Q

How do Sympatholytic drugs work?

A

-Decrease BP by reducing sympathetic vasomotor tone

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6
Q

Why are sympatholytics commmonly combined with diuretics?

A

Sympatholytics activate baroreflexes and generally cause Na and H2O retention

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7
Q

What two drugs are the centrally acting sympatholytics?

A

Clonidine and methyldopa

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8
Q

What is the MOA of clonidine and Methyldopa?

A

Stimulate medullary Alpha2 adrenergic receptors, leading to decreased peripheral sympathetic nerve activity

***remember alpha2 is inhibitory!

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9
Q

What are the adverse effects of centrally acting sympatholytics?

A
  • sedation
  • xerostomia
  • ED
  • Methyldopa may also produce hemolytic anemia with positive Coombs test, hepatotoxicity, and increased prolactin secretion (gynecomastia)
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10
Q

What are the contraindications for centrally acting sympatholytics?

A
  • Not recommended for Monotherapy because of CNS effects
  • sudden withdrawal of clonidine can lead to Hypertensive crisis
  • TCAs and yohimbine inhibit clonidine therapeutic action
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11
Q

What kind of drug is Prazosin?

A

A1 adrenergic antagonist

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12
Q

What are the indications for Prazosin?

A
  • Reduces NE vasoconstriction
  • decreased peripheral vascular resistance (Decrease BP)
  • Beneficial for BPH and does not affect plasma lipids
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13
Q

What are the adverse effects of Prazosin?

A
  • Postural hypotension (first dose phenomenon)
  • Na and water retention
  • reflex tachycardia
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14
Q

How do B-Blockers work to decrease BP?

A

Blocks B receptors in the heart to reduce CO, kidneys to reduce renin secretion, and CNS to reduce sympathetic vasomotor tone

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15
Q

Why are b blockers commonly combined with other drugs?

A

To counteract reflex tachycardia and increase renin secretion

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16
Q

B-blockers are preferred for patients with what conditions?

A

Angina, post MI, migraines, and HF

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17
Q

Who are B-blockers least preferential in?

A

Patients with high physical activity, African heritage, asthma, DM, hypercholesterolemia, and peripheral vascular disease

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18
Q

How do Nebivolol decrease ED?

A

Nebivolol increases NO, which increases Vasodilation, which decreases ED

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19
Q

What are the contraindications to B blockers?

A
  • DM
  • End stage HF
  • Bradycardia
  • Heart block
  • Asthma
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20
Q

What two drugs are combined A1 and B blockers? What is their general indication?

A

Labetalol and Carvedilol

-Used for vasodilation without reflex tachycardia

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21
Q

What are the indications for labetalol?

A
  • Decrease BP in hypertensive emergencies

- Pregnancy (stronger than Methyldopa)

22
Q

What are the indications for Carvedilol?

A

Hypertension and HF, especially post MI

23
Q

What are the adverse effects of Carvedilol and Labetalol?

A
  • Orthostatic hypotension
  • Bronchoconstriction
  • Labetalol is hepatotoxicity, emergency use only
24
Q

What drug dilates both veins and arteries?

A

Sodium nitroprusside

25
Q

What two vasodilators are used for chronic oral treatment?

A

Hydralazine and CCBs

26
Q

Hypotension caused By a vasodilator can be accompanied by what other symptoms?

A
  • Reflex tachycardia and increased myocardial contraction
  • increased renin secretion
  • fluid retention
  • Headaches
  • palpitations
27
Q

What are the indications for Hydralazine?

A
  • Dilates arterioles but not veins
  • used in chronic therapy of severe HTN
  • Used in severe HTN or HTN emergencies in pregnancy
28
Q

What are the adverse effects of hydralazine?

A
  • HA, nausea, anorexia, angina, ischemic arrhythmias

- SLE in slow acetylators

29
Q

What are the two vasodilators that specifically act through NO?

A

Hydralazine and sodium nitroprusside

30
Q

What are the indications for sodium nitroprusside?

A
  • Rapidly lowers blood pressure and the effect disappears in minutes after discontinuation
  • Used for emergency HTN situations
31
Q

What are the adverse effects of Sodium nitroprusside?

A
  • Cyanide accumulation

- Metabolic acidosis, arrhythmias, excessive hypotension (deficiency in cyanide metabolism)

32
Q

What the is MOA of Fenoldopam?

A

-Specific agonist D1 receptors and postsynaptic receptor stimulation relaxes arteriolar smooth muscle

33
Q

What is the indications of Fenolopam?

A

Emergency hypertensive situations

34
Q

What are the specific pharmacokinetics of Sodium nitroprusside?

A

Metabolized rapidly in the liver to thiocyanate

35
Q

What are the adverse effects of Fenoldopam?

A

-Reflex tachycardia, Headache, and flushing

36
Q

What kind of drugs are Nifedipine and amlodipine?

A

Dihydropyridines

37
Q

What is the MOA of CCBs?

A
  • Orally active, bind to L type channels in the myocardium to decrease contractility and conduction.
  • Vasodilation
38
Q

What kind of muscle muscle do CCBs relax?

A

-Relaxes all muscle that depend on Calcium for normal resting tone and contraction

39
Q

What are the major cardiac effects of CCBs?

A
  • Decrease contractility (inotropic)
  • Decrease impulse generation in the SA node (Chronotropic)
  • Decrease AV node conduction (Dromotropic)
40
Q

Which CCBs has most of its effects in the cardiac muscle?
Which in vascular muscle?
Which has equal effects?

A

Cardiac muscle: Verapamil
Vascular smooth muscle: Nifedipine
Equal: Diltiazem

41
Q

Which CCB is the most likely to produce reflex tachycardia?

A

Nifedipine

**highest vasodilation, marked hypotension, and reflex tachycardia

42
Q

What are the adverse effects of CCBs?

A
  • Dihydropyridines cause most vascular side effects like reflex tachycardia
  • Gingival hyperplasia
  • constipation
43
Q

What are the contraindications of Verpamil and diltiazem?

A
  • SA or AV node abnormalities, B blockers

- HF

44
Q

How do ACE inhibitors prevent hypertension?

A
  • Reduce direct vasoconstriction by ATII

- Reduce the release of aldosterone

45
Q

Do ACE inhibitors cause reflex sympathetic activation?

A

NO, because there are AT receptors presynaptically and baroreceptors, so these drugs reset the set point on baroreceptors

46
Q

ACE inhibitors are the DOC for HTN with what conditions?

A

DM, CKD, and HFrEF

47
Q

Why are ACE inhibitors commonly given with diuretics?

A
  • Enhance the antihypertensive efficacy of diuretic drugs

- Balance the adverse effects of diuretics

48
Q

What is the DOC for CKD even without HTN?

A

ACE inhibitors, they decrease proteinuria and stabilize renal function
-Particularly indicated in diabetic nephropathy

49
Q

What are the adverse effects of ACE inhibitors?

A
  • Orthostatic Hypotension and dizziness
  • Dry hacking cough
  • Angioedema and anaphylaxis
  • Acute renal failure in patients with bilateral renal artery stenosis
50
Q

What are the contraindications to ACE inhibitors?

A
  • Pregnancy
  • Potassium sparing diuretics
  • Combination with NSAIDS will cause vasodilation (bradykinin leads to PG synthesis)
51
Q

What kind of drugs are Losartan and Valsartan?

A

ARBs

52
Q

What are the main differences between ACE inhibitors and ARBs?

A

-ACE inhibitors have decreased AT2 receptors activity and little CV effects as well as increased bradykinin levels

Pharmacology 2 (12 decks)

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