HTN Day 2

Question 1

Name the Non-dihydropyridines (CCB)

Answer 1

Verapamil

Diltiazem

Question 2

Name the Dihydropyridines (CCB)

Answer 2

Amlodipine
Felodipine
Isradipine
Nifedipine

Question 3

What is the role of calcium in relation to contraction?

Answer 3

When channels are opened: causes calcium influx into smooth muscle: specifically cardiac & vascular. Results in activation of intracellular calcium with ultimately leads to muscle contraction (activates myosin & actin).

Question 4

What is the general MOA of CCBs

Answer 4

Inhibits Ca++ influx into cells to prevent muscle contraction.

Question 5

What is the MOA of Dihydropyridines?

Answer 5

Inhibits Ca++ influx into vascular smooth muscle specifically, resulting peripheral vasodilation (decrease in BP)

Question 6

What is the MOA of Non-dihydropyridines?

Answer 6

Inhibits Ca++ influx into cardiac smooth muscle specifically, resulting in a decrease of rate and force of contraction (chronotropy & inotropy).

Question 7

What is the place in therapy of the CCBs?

Answer 7

First Line for HTN

Question 8

What are the other uses of the Non-dihydropyridines?

Answer 8

Supraventricular tachycardia

a fib

Question 9

What is another use of Verapamil specifically?

Answer 9

Migraine prophylaxis

Question 10

What is the general adverse effect of all CCBs?

Answer 10

Hypotension

Question 11

Name the ARDs of the Non-dihydropyridines?

Answer 11

Constipation (Verapamil)
Bradycardia
worsening of CHF
Heart block
Gingival hyperplasia

Question 12

Name the ARDs of the Dihydropyridines?

Answer 12

Peripheral edema (worst with Nifedipine)
Reflex tachycardia
Flushing
HA

Question 13

What are the issues with sublingual Nifedipine?

Answer 13

Risk for severe hypotension and there is a reported increased risk for MI and death.

Question 14

What population are dihydropyridines especially good for?

Answer 14

Elderly bc they tend to have isolated systolic HTN

Question 15

What is special about Clevidipine?

Answer 15

It is IV only and is contraindicated in soy and/or egg allergic patients

Question 16

What are the drug interactions associated with Verapamil?

Answer 16

It is metabolized by CYP3A4 and also an inhibitor of this enzyme.

Question 17

Name the Alpha 1 Blockers FDA approved for HTN?

Answer 17

Prazosin
Terazosin
Doxazosin

Question 18

Name the Alpha 1 Blockers FDA approved for BPH?

Answer 18

Tamsulosin

Alfuzosin

Question 19

What is the MOA of Alpha 1 Blockers?

Answer 19

Competitively inhibits alpha-1 receptors in the periphery which causes vasodilation.

Question 20

What is the Place in Therapy of Alpha 1 Blockers?

Answer 20

Only as an add on especially in males. Not to be used often, not as monotherapy.

Question 21

What are the uses of Alpha 1 Blockers?

Answer 21

HTN

BPH

Question 22

What are the ARDs of Alpha 1 Blockers?

Answer 22

"First dose effect" - significant orthostatic hypotension w first dose & any subsequent dose titrations. SLOWLY titrate.
Orthostatic hypotension
Dizziness
Vertigo
Reflex tachycardia (esp. early in therapy - not seen if on BB too)
Fatigue
vivid dreams
depression
dry mouth

Question 23

What are the doses of Alpha 1 Blockers?

Answer 23

Take at night!!
Doxazosin 1x/day
Terazosin 1 to2x/day
Prazosin 2-3x/day

Question 24

Name the Centrally acting agents - Alpha 2 agonists.

Answer 24

Methyldopa

Clonidine

Question 25

What is the MOA of Centrally acting agents - Alpha 2 agonists?

Answer 25

Stimulates alpha 2 receptors in brain, reduces sympathetic outflow from brain, which produces a decrease in BP and peripheral vascular resistance.

Question 26

What is the place in therapy of Methyldopa?

Answer 26

Good for use during pregnancy (Category B)

Question 27

What is the place in therapy of Clonidine?

Answer 27

Often used for resistant HTN. Other uses are substance abuse tx (opiate withdrawal & avoidance) and adjunct in pain mgmt.

Question 28

What are the general ARDs of Centrally acting agents - Alpha 2 agonists?

Answer 28

``` Orthostatic hypotension dizziness fatigue depression sedation Na+ & H2O retention Rebound tachycardia & HTN if stopped abruptly ```

Question 29

What are the ARDs of methyldopa specifically?

Answer 29

Liver toxicity | Hemolytic anemia

Question 30

What are the ARDs of clonidine?

Answer 30

Rash w patch | "anticholinergic-like side effects" dry mouth, sedation, constipation, urinary retention

Question 31

What is another route of admin for clonidine?

Answer 31

Available as a patch applied every 7days, effects begin within 12-24 hours & last up to 3 days after patch removal

Question 32

What are the vasodilators of HTN?

Answer 32

Hydralazine | Minoxidil

Question 33

What is the MOA of the vasodilators?

Answer 33

Direct vasodilator, especially in arteries & arterioles, leading to decreased systemic vascular resistance. Causes peripheral vasodilation

Question 34

What is the are the common ARDs of vasodilators?

Answer 34

Reflex tachycardia (consider co-admin of BB) Increase in renin as response to vasodilation, (consider co-admin w diuretic). HA

Question 35

What the ARDs of hydrazine specifically?

Answer 35

``` Lupus-like syndrome (butterfly like rash) Dermatitis Drug fever Peripheral neuropathy Hepatitis ```

Question 36

What the ARDs of minoxidil?

Answer 36

Hirsutism

Question 37

What are the preferred combos?

Answer 37

ACE/ARB and Thiazide | ACE/ARB and Dihydropyridine CCB

Question 38

What are the acceptable combos?

Answer 38

CCB and thiazide Thiazide and K sparing diuretic BB and diuretic or dihydropyridine CCB

Question 39

Name some drugs that can induce HTN?

Answer 39

* Corticosteroids * Excessive alcohol * NSAIDs * ACTH * Amphetamines * Appetite suppressants * Caffeine * Cyclosporine * Estrogen * Pseudoephedrine * Thyroid hormone (in excess) * Duloxetine * Venlafaxine * Bevacizumab * Sorafenib * Erythropoietin