Hypertension Drugs Flashcards
Phentolamine: Pharmacokinetics
- Short half life of 19 mins (blocks alpha receptor)
Phentolamine: Adverse Effects
- Acute and prolonged HYPOTENSIVE EPISODES
- ORTHOSTATIC HYPOTENSION
- TACHYCARDIA, and
- CARDIAC ARRHYTHMIAS;
- weakness, dizziness, flushing, NASAL STUFFINESS, nausea, vomiting, and DIARRHEA
Phenoxybenzamine: MOA
non-competitive antagonist (blocks alpha receptor)
Phenoxybenzamine: Adverse Effects
many adverse effects similar to phentolamine, plus MIOSIS and occasionally causes severe allergic reactions (e.g., ANGIOEDEMA)
Prazosin: MOA (non emphasized)
competitive antagonist of postsynaptic alpha1-adrenergic receptors
Prazosin: Effects (non emphasized)
vasodilationof veins and
arterioles leads to a decrease in total peripheral resistance and blood pressure
Prazosin: Clinical Applications
• Hypertension
- a late choice in JNC8 due to ALLHAT data showing > LIKELIHOOD OF STROKE AND CHF with DOXAZOSIN in comparison to CHLORTHALIDONE
• For PTSD nightmares; Raynaud syndrome
Prazosin: Toxicities
- palpitations, edema, ORTHOSTATIC HYPOTENSION, syncope
- dizziness,headache, drowsiness, depression, nervousness
- decreased energy, weakness
- nausea, diarrhea, constipation
- urinaryfrequency, “RETROGRADE” EJACULATION, priapism
- blurred vision, reddened sclera
- nasal congestion
Similar to prazosin (but differ with respect to α1a, α1b and α1d subtype selectivity)… marketed for benign prostatic
hypertrophy and also used to help kidney stones pass
- potential one drug solution for old man in wheelchair with BPH and hypertension…
tamsulosin, terazosin, (doxazosin)
Clonidine: MOA (non-emphasized)
alpha2- adrenergic
receptor agonist, crosses blood- brain barrier
Clonidine: Effects
• IV administration produces a transient increase in blood pressure
• Then get reduced sympathetic outflow from the CNS
- produces a decrease in peripheral resistance, renal vascular resistance, heart rate, and blood pressure
- Produces pain relief
- Beneficial for ADHD to reduce hyperactivity, impulsiveness, and distractibility
Clonidine: Clinical Applications (non-emphasized)
- oral Immediate release tablets or transdermal patch for management of hypertension
- extended release tablets for treatment of ADHD
- continuous epidural administration as adjunctive therapy with opioids for treatment of severe cancer pain
- off-label includes: opioid withdrawal, postherpetic neuralgia, smoking cessation, Tourette syndrome
Clonidine: Pharmacokinetics (non-emphasized)
oral, transdermal patch and epidermal solution formulations
Clonidine: Toxicities
- Drowsiness
- Xerostomia (dry mouth)
- REBOUND HYPERTENSION IF DOSE IS MISSED
α-methyldopa: MOA
selective agonist for α2-adrenergic receptors
α-methyldopa: Effects (non-emphasized)
used as sympatholytic for hypertension due to reduced sympathetic outflow
α-methyldopa: Clinical Applications
• For management of moderate to severe hypertension
- Not recommended for initial therapy of primary hypertension
- Continues to have a role in otherwise difficult to treat hypertension
• Remains a drug of choice for gestational hypertension (aka pregnancy-induced hypertension)
- (labetalol and long- acting nifedipine also used for gestational hypertension)
α-methyldopa: Pharmacokinetics
oral and IV forms
α-methyldopa: Toxicities
There is a lot • angina pectoris aggravation • Bell’s palsy • Amenorrhea • Sore or “black” tongue,
- POSITIVE COOMBS TEST
- SLE-LIKE SYNDROME
Propranolol: MOA
NONSELECTIVE beta-adrenergic blocker (class II antiarrhythmic); competitively blocks response to beta1- and beta2- adrenergic stimulation
Propranolol: Effects
- beta1 blockade decreases heart rate, myocardial contractility, blood pressure, and myocardial oxygen demand
- beta2 blockade effects include blunting of bronchodilation and vasodilation in skeletal muscle
Propranolol: Clinical Applications (non-emphasized)
• hypertension • angina pectoris • pheochromocytoma • essential tremor supraventricular arrhythmias • ventricular tachycardias • prevention of myocardial infarction • migraine headache prophylaxis • off-label: akathisia, antipsychotic-induced; performance anxiety; thyroid storm / thyrotoxicosis; tremor, lithium-induced
Propranolol: Pharmacokinetics
given orally
Propranolol: Toxicities
- bronchospasm, dyspnea
- COLD EXTREMITIES (ESPECIALLY INFANTS) – The reason B-blockers are contraindicated if peripheral vascular disease
• bradycardia, AV conduction
disturbance, congestive heart failure, cardiogenic shock, hypotension, syncope
- disrupted sleep with nightmares, drowsiness/fatigue, agitation
- hyperglycemia or hypoglycemia; hyperkalemia; hyperlipidemia
- abdominal pain, diarrhea, constipation, etc.
- conjunctival hyperemia, decreased visual acuity, mydriasis
Atenolol: MOA
• competitive β1-selective adrenergic receptor antagonist
• little or no effect on
β2- receptors except at high doses
Atenolol: Effects
beta1 blockade decreases heart rate, myocardial contractility, blood pressure, and myocardial oxygen demand
Atenolol: Clinical Applications
- treatment of hypertension, alone or in combination with other agents
- management of angina pectoris
• secondary prevention
postmyocardial infarction
• off-label: atrial fibrillation (rate control); cardiac risk reduction during surgery; pediatric hypertension; acute ethanol withdrawal (in combination with a benzodiazepine); supraventricular arrhythmias; unstable angina; ventricular arrhythmias
Atenolol: Pharmacokinetics
- PO: rapid but incomplete absorption
* not lipophilic, does not cross BBB
Atenolol: Toxicities (non-emphasized)
- bradycardia (persistent), cardiac failure, chest pain, cold extremities, complete atrioventricular block, edema, hypotension, Raynaud’s phenomenon, second degree atrioventricular block
- confusion, fatigue, headache, insomnia, lethargy, nightmares
- constipation, diarrhea, nausea
- impotence
another widely used beta1-selective blocker, shorter half-life than atenolol but available in extended release form; more lipid soluble so more likely to produce adverse CNS effects (e.g., lethargy/confusion, nightmares)
metoprolol
notable for having highest beta1-selectivity
bisoprolol
Captopril: MOA
competitive inhibitor of
angiotensin- converting enzyme (ACE)
Captopril: Effects
- prevents conversion of angiotensin I to angiotensin II, a potent vasoconstrictor and mitogen for cardiovascular remodeling
- lowers levels of angiotensin II –> Increased plasma renin activity and decreased aldosterone secretion
- Lowers BP
Captopril: Clinical Applications (non-emphasized)
- hypertension, add thiazide or loop diuretic if additional lowering is needed at max recommended dose
- acute hypertension (urgency/emergency)
- heart failure with reduced ejection fraction
- LV dysfunction following MI
- diabetic nephropathy
- off-label: aldosteronism (diagnosis), delay the progression of nephropathy and reduce risks of cardiovascular events HT + DM
Captopril: Pharmacokinetics
- Rapidly absorbed, ~60% bioavailability
- Substrate of CYP2D6 (major)
- excreted primarily in urine, 40-50% as unchanged drug
- t1/2: ~1.7 hrs, longer in renal impairment
Captopril: Toxicities
• COUGH
- hypotension
- headache
- drowsiness
- dizziness, orthostatic dizziness
• ANGIOEDEMA, anaphyllactoid reactions
- loss of/altered taste (especially captopril among class)
- rare cholestatic jaundice
- rare agranulocytosis, neutropenia, anemia, pancytopenia, thrombocytopenia
- myalgia, weakness
- polyuria, renal failure, renal insufficiency