Hypertension and Ischemia And arrythmia drugs

Question 1

Dopamine

Answer 1

Vasoconstrictor
Useful in patient who is hypotensive and in acute heart failure.
Dose Dependent:
Low dose acts on D1 to dilate renal and splanchnic vessels
Mild Dose acts on B1 to produce tachycardia and increase contractility
High Dose acts on A1 receptors to promote increased peripheral vascular resistance

Question 2

Clonidine

Answer 2

Presynaptic A2 agonist(A2 inhibits NE release)
Reduces catecholamine activity and reduces renin release. It lowers HR and CO moreso than a-methyldopa does
Use in HTN
Caution: in Severe Coronary Insufficiency, Recent MI, Cerebrovascular Disease, and Chronic Renal Failure
Adverse: Dry mouth, dizziness, drowsiness, constipation, REBOUND TENDERNESS ON ABRUPT WITHDRAWAL. To treat it, give clonidine again or use alpha or beta blockingn agents

Question 3

alpha-methyldopa

Answer 3

Presynaptic A2 agonist that acts at a different site than clonidine. Reduces catecholamines/sympathetic outflow
Uses: HTN IN PREGNANCY (PRE-ECLAMPSIA)
Contraindicated: Liver Disease
Adverse: Positive Coombs Test, Lactation in both sexes, sedation, fever, jaundice.

Question 4

Phentolamine

Answer 4

Competitive non-selective a1/a2 antagonist. Arterial and Venous dilation resulting in reduced peripheral vascular resistance and venous return. Should be used with a diuretic and B blocker to prevent the retention of salt and water and reflex tachycardia(due to lowered BP).
Used for pheochromocytoma
Contraindicated in CAD
Adverse: Hypotension and accompanying tachycardia and arrhythmias.

Question 5

Prazosin

Answer 5

Selective A1 antagonist. No reflex tachycardia due to unopposed a2 actions. Also can retain salt and water if not given with a diuretic
Used for HTN and BPH
Adverse: Hypotension,dizziness, and syncope on first dose
Nasal Congestion

Question 6

Propanolol

Answer 6

Competitive non-selective B1, B2 antagonist. Reduces catecholamine release and renin release.
Use in HTN, angina, arrhythmias, MI, in pheo if using a1 blocker prasozin
Adverse: bradycardia, vertigo, fatigue, sexual dystfunction, withdrawal

Question 7

Metoprolol

Answer 7

Competitive B1 selective antagonist, resulting in decreased Renin release, HR, and contractility.
Used: HTN, Heart Failure, Angina.
Contraindicated: 2 or 3 degree Heart block
Adverse Effecgts: Cardiac depression, Heart block, and sexual dysfunction.

Question 8

Carvedilol

Answer 8

Non-selective B1/B2 antagonist and A1 antagonist. Also anti-oxidant activity.
Uses in HTN and Heart Failure
Contraindicated in 2 or 3 degree heart block and asthma
Adverse effects: sexual dysfunction rarely, masks signs of diabetes and thyrotoxicosis, combines propanolol and prazosin side effects

Question 9

Labetolol

Answer 9

B1/B2 antagonist non selective and A1 antagonist
Uses: HTN including pregnancy induced. oral for normal HTN, IV for severe. NOT FOR HEART FAILURE
Contraindicated in HF, ashtma, and 2 or 3 degree heart block
Adverese: Masks signs, cardiac depression, rare sexual side effects, hepatic injury, combines propanolo and prazosin.

Question 10

Nifedipine

Answer 10

The most coronary Vasodilation, no AV node suppression
Uses: HTN, angina, vasospasm, not in atrial arrhythmias
Contraindicated: Pregnancy, ischemia
Side Effects: Peripheral dependent edema, reflex tachycardia, dizziness, nausea, limb bud defects, headache and flushing
Can be used with B blockers, ACE, Diuretics

Question 11

Diltiazem

Answer 11

Lots of SA and AV node Suppression
Uses: HTN, angina, atrial arrhtymias
Side Effects: Myocardial Depression, headache and flushing, bradycardia
Can be Used with B blockers

Question 12

Verapamil

Answer 12

Lots of SA and AV node Suppression
Uses: HTN, angina, atrial arrhtymias
Side Effects: Increases digoxin toxicity, constipation, myocardial depression, headache, flushing
Do NOT use with B blockers

Question 13

Hydralazine

Answer 13

Use for HTN, and for pregnancy HTN MOA unknown,
Dilates arterioles
Combo therapy for AA in Heart Failure
Side Effects: present with lupus like if caucasian woman taking it, reflex tachycardia, , edema
Contraindicated in CAD and rheumatic heart disease

Question 14

Minoxidil

Answer 14

Use: Severe Refractory HTN or hair loss
It is a prodrug orally and it dilates arterioles
MOA: Activates vascular ATP- sensitive K channels to hyperpolarize cells
Side effects: Hypertrichosis, reflex tach, salt and water retention, left ventricular hypertrophy and pericardial effusion, gynecomastia
Contraindicated in : Pheochromo, ischemic heart disease

Question 15

Diazoxide

Answer 15

Use in hypertensive emergencies and pregnancy HTN
Given IV
MOA: Activates vascular ATP- sensitive K channels to hyperpolarize cells
Side Effects: Hyperglycemia, subendocardial necrosis, reflex tach, salt and water retnetion, hypotension, edema.
Contraindicated in : Pheochromo, ischemic heart disease

Question 16

Ranolazine

Answer 16

Use for Chronic Angina, for patients symptomaitc on other anginal therpay
MOA: Prevents sodium overload that leads to calcium overload
Side Effects: QT prolongation
Interacts with Verapamil and Digoxin and drugs that inhibit CYP3a/P450
Contraindicated in: Hepatic impairment, QT prolongation, or drugs that affect P450 or QT

Question 17

Nitroglycerin

Answer 17

increases NO production without endothelial cells. Dilates veins at lower concentration and arteries at higher concentration
USE: Angina prophylaxis, acute angina.