Hypertension Drugs Flashcards
1
Q
Candesartan
Irbesartan
Losartan
Valsartan
A
AT1 antagonists (ARBs)
- Non-peptide competitive agonists of AT1 receptors (inhibits vasoconstriction, Na retention, and renin feedback), reduce plasma volume, decrease cellular hypertrophy, residual AT2 stimulation (promote vasodilation and natriuresis), increase Ang-(1-7)
- Fewer side effects than ACEIs – hypotension, hyperkalemia, acute renal failure, not for pregnancy or nursing moms
- Hypertension, heart failure, diabetes, chronic kidney disease, prevent secondary MI
2
Q
Catopril Enalapril Lisinopril Fosinopril Quinapril
A
ACE Inhibitors
- More potent arterial than venous dilators (reduce afterload and increase SV and CO)
- Block conversion of AI to AII and AIII (classical RAS pathway), elevate bradykinin levels, decrease peripheral resistance, decrease aldosterone, increase plasma renin, increase Ang-(1-7)
- DRY COUGH, angioedema, hypotension, hyperkalemia, acute renal failure, rash, not for pregnancy or nursing moms
3
Q
Conivaptan
A
Vasopressin Receptor Antagonists
- V1/V2 receptor antagonist
- Hyponatremia caused by SIADH (IV to hospitalized patients
4
Q
Tolvaptan
A
Vasopressin Receptor Antagonists
- Selective V2 receptor antagonist - oral
- Hypervolemic and euvolemic hyponatremia resistant to fluid restriction (heart failure, cirrhosis, SIADH)
5
Q
Aliskiren
A
Renin Inhibitor
- Direct, competitive inhibitor of renin – increase plasma renin but not renin activity
- GI/allergic symptoms, hypotension, hyperkalemia, acute renal failure, not for pregnancy or nursing moms
- Essential Hypertension
6
Q
Atenolol (oral/IV) Metoprolol (oral/IV) Acebutolol Esmolol (IV only) Bisoprolol
A
Sympatholytics
- B1 Receptor Antagonists
- Decrease CO, renin secretion, central sympathetic outflow, resetting of baroreceptors, decrease HR and contractility, improve LV structure and function, improved abnormal Ca handling
- Nausea, vomiting, confusion, fatigue, sleep disorders, avoid in asthmatics or PVD, increase in type 2 diabetes, hypoglycemia, hyperlipidemia, bradycardia, impotence, hypotension
- Alone or in combo for hypertension, coronary heart disease w/o signs of acute heart failure (combo with nitrates), heart failure due to LVEF, atrial arrhythmias, slow AV node conduction, prevent sudden cardiac death post MI
7
Q
Propranolol (oral/IV) Nadolol Pindolol Timolol Carvedilol (also a1
A
Sympatholytics
- Nonselective beta antagonists
- Decrease CO, renin secretion, central sympathetic outflow, resetting of baroreceptors, decrease HR and contractility, vasoconstriction, bronchoconstriction, impaired glycogenolysis, improve LV structure and function, improved abnormal Ca handling
- Nausea, vomiting, confusion, fatigue, sleep disorders, avoid in asthmatics or PVD, increase type 2 diabetes, hypoglycemia, hyperlipidemia, bradycardia, impotence, hypotention
- Alone or in combo for hypertension, coronary heart disease w/o signs of acute heart failure (combination with nitrates), heart failure due to LVEF, atrial arrhythmias, slow AV node conduction
8
Q
Doxazosin
Prazosin
Terazosin
A
Sympatholytics
- A receptor antagonists. Blockade of a1 receptors on VSM – dilation of arterioles and capacitance veins
- Reflex tachycardia, orthostatic hypotension, fluid retention, GI upset, palpitation, tinnitus, headache, dizziness, urinary incontinence
- Alone or in combination of hypertension, pheochromocytoma
9
Q
Carvedilol
A
Sympatholytics
- Mixed a/b antagonists
- Non-selective B and a1 receptor antagonist
- Antioxidant and antiprolifeartive – hypertension and heart failure
10
Q
Labetalol
A
Sympatholytics
- Mixed a/b antagonists
- Non-selective B and a1 receptor antagonist
- Chronic hypertension and hypertensive emergencies
11
Q
Reserpine
A
Inhibitor of Peripheral Transmission
- Deplete NE from adrenergic nerve endings, inhibits reuptake of NE into storage terminal, decrease peripheral resistance and CO
- Postural hypotension, sedation, dry mouth, nightmares, sodium and water retention
- Mild to moderate hypertension - can use low dose in combination with thiazide diuretic
12
Q
a-methyldopa
Clonidine
Guanabenz
A
Central-Mediated Agents
- Stimulate brainstem a2 adrenergic receptors (decrease sympathetic outflow), vagal activity to heart increased, decreased PVR and CO
- Withdrawal/rebound, sedation, dry mouth, depression, drowsiness, sodium and water retention, postural hypotension
- Resistant hypertension (clonidine), pregnancy induced hypertension (methyldopa)
13
Q
Epoprostenol
A
Vasodilators
- Prostacyclin – direct vasodilator via cAMP, counteracts thromboxane A2
- Potent antihypertensive (continuously administered), primary pulmonary hypertension
14
Q
Hydralazine
A
Vasodilators
- Arterial vasodilator. Mechanism unclear – reduced intracellular Ca, preferential effect on arterioles, decrease PVR/MAP, reflex increase in HR, contractility, CO, increase renal blood flow.
- Headache, anorexia, nausea, dizziness, sweating, angina or ischemic arrhythmias, incrased renin and fluid retention, Lupus
- Mild to moderate hypertension in combination with diuretic and B-blocker, advanced heart failure
15
Q
Minoxidil
A
Vasodilators
- Preferential effect on arterioles, decrease PVR, activates K channels and VSM relaxation, reflex increase in HR, contractility, CO, renin secretion, fluid retetntion
- Fluid retention, decreased PVR, activates K channels/VSM relaxation, reflex increase in HR
- Resistant hypertension in combination with diuretic and B-blocker
