Hypertension Drugs 1

Question 1

How is blood pressure related to risk of stroke and CV disease?

Answer 1

Risk rises exponentially with increasing blood pressure

Question 2

What is the distribution of hypertension within the general population?

Answer 2

hypertension exhibits normal distribution

Question 3

Who gets hypertension the most?

Answer 3

older women

Question 4

What percentage of US adults has hypertension?

Answer 4

30.4% about 67 million people

Question 5

What percentage of US adults with hypertension are under good control?

Answer 5

46.5% about 31 million people which means that 53.5% are uncontrolled

Question 6

What percentage of US adults with uncontrolled hypertension are unaware they have it?

Answer 6

about 40%

Question 7

What adverse CV events can be associated with hypertension?

Answer 7

heart failure
myocardial ischemia & infarction
stroke
aortic aneurysm & dissection
retinopathy
nephrosclerosis
renal failure

Question 8

According to JNC8, what is the target BP for people >60 years?

Answer 8

<90

Question 9

According to JNC8, what is the target BP for people 18 years with CKD, and >18 years with diabetes?

Answer 9

<90

Question 10

What are the 4 major classes of anti-hypertensive drugs?

Answer 10

• vasodilators
• adrenergic affecting agents
• RAS affecting agents
• diuretics

Question 11

How do vasodilators in general decrease BP?

Answer 11

• decrease vascular tone which decreases peripheral resistance
• causes degrees of increased SNS output usually increasing heart rate

Question 12

What are some direct arterial vasodilators?

Answer 12

• Hydralazine
• Minoxidil
• Diazoxide
• Nitroprusside
• Fenoldopam

Question 13

Arterial vasodilators cause direct smooth muscle relaxation reducing perfusion pressure which activates what reflexes?

Answer 13

– baroreceptor activation: compensatory increase in sympathetic outflow; tachyphylaxis can cause loss of antihypertensive effect
– Reflex release of renin (which can be blocked by beta-blockers)

Question 14

What is hypertensive crisis?

Answer 14

BP> 180/120

needs to be brought down gradually

Question 15

What is hypertensive urgency?

Answer 15

elevated BP with no acute or progressing target-organ injury

Question 16

What is hypertensive emergency?

Answer 16

high BP with acute or progressing target-organ damage

Question 17

Hypertensive emergency can result in what?

Answer 17

encephalopathy, intracranial hemorrhage, acute left ventricular failure with pulmonary edema, dissecting aortic aneurysm, unstable angina, eclampsia

Question 18

What is the MOA of nitric oxide donors?

Answer 18

NO binds receptor and causes increase in cGMP/protein kinase G

Question 19

Do nitric oxide donors only work on arteries?

Answer 19

No, some venous component

Question 20

Which nitric oxide donor can cause cyanide toxicity?

Answer 20

nitroprusside

Question 21

General adverse effects of direct arterial vasodilators?

Answer 21

– sodium / water retention

– tachycardia / angina

Question 22

Adverse effect of hydralazine?

Answer 22

Hydralazine can cause lupus-like syndrome

Question 23

Adverse effect of minoxidil?

Answer 23

Minoxidil can cause hair growth

Question 24

How could you counteract the fluid retention and reflex tachycardia?

Answer 24

Use with diuretic (preferably thiazide) & β-blocker

Question 25

In general, how do Ca channel blockers affect hypertension?

Answer 25

- decrease vascular tone which decrease peripheral resistance - there is a small increase in heart rate due to SNS

Question 26

What are some Ca channel blockers?

Answer 26

* Nifedipine * Diltiazem * Verapamil * Amlolodipine

Question 27

What are some non-dihyrdopyridines?

Answer 27

diltiazem & verapamil

Question 28

What are some dihyrdopyridines?

Answer 28

amlodipine, felodipine & nifedipine

Question 29

Adverse effects of all Ca channel blockers?

Answer 29

flushing & headaches

Question 30

Ca channel blockers that cause negative inotropic effect?

Answer 30

verapamil > diltiazem > nifedipine

Question 31

Ca channel blockers that cause constipation?

Answer 31

verapamil > diltiazem or nifedipine

Question 32

Ca channel blockers that cause decreased AV conduction?

Answer 32

verapamil = diltiazem > nifedipine

Question 33

Ca channel blockers that cause edema?

Answer 33

nifedipine > verapamil or diltiazem

Question 34

Which adrenergic receptors on the heart increase contractility and HR?

Answer 34

beta-1

Question 35

Which adrenergic receptors on arterioles causes vasoconstriciton?

Answer 35

alpha-1

Question 36

Which adrenergic receptors on arterioles cause vasodilation?

Answer 36

beta-2

Question 37

Which adrenergic receptors on the lungs cause bronchodilation?

Answer 37

beta-2

Question 38

Which adrenergic receptors on the kidneys cause increased renin?

Answer 38

alpha-1 and beta-1

Question 39

In general, how to mixed alpha blockers lower blood pressure?

Answer 39

- block alpha-1 decreasing vascular tone which decreases peripheral resistance - block alpha-2 decreasing venous tone decreases venous return which decrease CO - large increase in HR due to SNS

Question 40

What are alpha-1/alpha-2 blocker drugs?

Answer 40

Phenoxybenzamine & Phentolamine

Question 41

MOA of alpha-1/alpha-2 blocker drugs?

Answer 41

inhibit smooth muscle catecholamine uptake in peripheral vasculature: vasodilation & BP lowering

Question 42

In general, how to alpha-1 specific blockers lower blood pressure?

Answer 42

- block alpha-1 decreasing vascular tone which decreases peripheral resistance - smaller increase in HR due to SNS

Question 43

What are some alpha-1 specific blockers?

Answer 43

* Prazozin * Terazosin * Doxazosin

Question 44

Benefits of being alpha-1 specific?

Answer 44

* Smaller increase in heart rate * Do not stimulate renin release * Does not block α2 – thus NE can inhibit its own release

Question 45

Alpha-1 blockers have a first dose effect, what's that?

Answer 45

– orthostatic hypotension – transient dizziness, faintness, palpitations, syncope within 1 to 3 hours of 1st dose – reflex tachycardia – first dose at bedtime to minimize effect

Question 46

A mixed α1 /β Blocker can help minimize first dose effect, what's up with that?

Answer 46

– α1 competitive inhibitor – β1& β2 competitive inhibitor – Mild orthostatic hypotension & headaches

Question 47

In general, how do beta-blockers lower blood pressure?

Answer 47

- inhibit beta-1 on kidneys decreases renin decreasing ATII decreases vascular tone decreasing peripheral resistance - inhibit beta-1 on heart decreasing rate which decreases CO

Question 48

Stimulating beta-1 receptors does what?

Answer 48

– heart, kidney | – stimulation increases HR, contractility, renin release

Question 49

Stimulating beta-2 receptors dose what?

Answer 49

– lungs, liver, pancreas, arteriolar smooth muscle – stimulation causes bronchodilation & vasodilation – mediate insulin secretion & glycogenolysis

Question 50

What are some beta-blocker drugs?

Answer 50

* Propranolol - β1 / β2 * Metropolol – β1 * Atenolol – β1 * Labetalol – β1 / β2 / α1

Question 51

Beta-blockers work best in young adults and work well in older adults in combo with what?

Answer 51

diuretics

Question 52

Which beta-blockers are cardio selective?

Answer 52

Metropolol & Atenolol have greater affinity for β1 than β2 receptors – inhibit β1 receptors at low to moderate dose – higher doses block β2 receptors

Question 53

Cardio selective beta-blockers are safer for who?

Answer 53

Safer in patients with bronchospastic disease, peripheral arterial disease, diabetes – may exacerbate bronchospastic disease when selectivity lost at high doses

Question 54

Generally preferred β-blockers for hypertension?

Answer 54

Metropolol & Atenolol

Question 55

Potential adverse effects of beta blockers?

Answer 55

– Glucose intolerance, masked hypoglycemia – Bradycardia, dizziness – Bronchospasm – Increased triglycerides and decreased HDL – CNS: Depression, fatigue, sleep disturbances – Reduced C.O., exacerbation of heart failure – Impotence – Exercise intolerance