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pharmacology > hypertensive agent > Flashcards

hypertensive agent Flashcards

1
Q

a1 blockers indications are

A

hypertension + benign prostatic hypertrophy

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2
Q

a1 blockers adverse effects are

A
  • First dose phenomenon Severe orthostatic hypotension
  • Tolerance to the hypertensive response
  • Sodium -water retention (should be used with diuretic)
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3
Q

Calcium channel blockers divided into

A
  • Non-dihydropyridines
    Verapamil (block on the heart ) and Diltiazem (intermediate and its actions)
  • dihydropyridines
    (Block on the Vascular smooth muscle)
    Ends with -dipine
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4
Q

Calcium channel blockers, dihydropyridine , adverse effects are

A

Constipation, flushing, dizziness, headache, hypotension

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5
Q

Calcium channel blockers, verapamil and diltiazem ,adverse effects are

A

Cardiac depression, bradycardia, and AV block

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6
Q

Vasodilators are

A

Hydralazine, minoxidil, sodium nitroprusside, diazoxide

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7
Q

Which one of the vasodilators cause lupus erythematosus if a pregnant woman used it?

A

Hydralazine

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8
Q

Which vasodilator used to treat severe to malignant hypertension

A

Minoxidil

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9
Q

Which vasodilator is available only for intravenous use and it used for hypertension emergencies

A

Diazoxide , sodium nitroprusside

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10
Q

Vasodilators’ adverse effects

A

1- Reflex tachycardia,
2- nausea, vomiting, headache,
3- possible fluids retention
4- hypertrichosis (excessive hair growth minoxidil)
5- hyperglycemia (diazoxide)

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11
Q

the classification of diuretic drugs

A

1- carbonic anhydrase inhibitor
2- loop diuretic
3- thiazide diuretic
4- potassium sparing
5- osmotic diuretic

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12
Q

thiazide ex.

A

hydrochlorothiazide and metolazone

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13
Q

which diuretic drug act as frontline
and most commonly used to treat hypertensive.

A

thiazide

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14
Q

the prototypical thiazide is

A

hydrochlorothiazide

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15
Q

thiazide mechanism

A

1- works on distal convoluted tubule by inhibiting the Na - Cl cotransporter resulting excretion of Na and H2O
2- loss of Ka + Mg
3- high Ca in blood

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16
Q

what drug can be used to treat calcium oxalate stones

A

thiazide

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17
Q

therapeutic use of thiazide

A

antihypertensive and for hypercalciuria

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18
Q

why the thiazide considered to be a frontline for hypertensive

A

inexpensive , effective -even with elderly-, convenient administer, well tolerance

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19
Q

what is the adverse effects of the thiazide

A

hypokalemia
hypotension
hyponatremia

hyperuricemia (70%)
hypercalcemia

erectile dysfunction (less common in the low dose + reversible)

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20
Q

which diuretic drug has most effecacy

A

the loop diuretic drug

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21
Q

the mechanism of action of loop of diuretic drug

A

inhibit the cotransporter Na\K\2Cl in the Luminal membrane in the ascending limb of loop of Henle

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22
Q

ex. of loop diuretic drug

A

bumetanide , furosemide

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23
Q

excretion of the loop diuretic drug

A

Na , K , Ca , H2O

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24
Q

adverse effect of loop diuretic drug

A

ototoxicity (ethacrynic acid >furosemide > bumetanide )

hypokalemia
hypomagnesemia
hypocalcemia
acute hypovolemia

hyperuricemia
hyperglycemia
metabolic alkalosis (high HCO3)

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25
Q

therapeutic use of the diuretic drug

A
  • not mainly used to treat hypertensive
  • used for edema
    (( DRUG OF CHOICE acute pulmonary edema of heart failure ))
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26
Q

where does the potassium sparing diuretic works and how

A

collecting tubule to inhibit the reabsorption of the Na and the excretion of K

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27
Q

the potassium sparing diuretic drug is divided into

A

aldosterone antagonist
and
epithelial sodium channel blocker

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28
Q

aldosterone antagonist (potassium sparing) ex.

A

spironolactone and eplerenone

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29
Q

epithelial sodium channel blocker ex.

A

amiloride and triamterene

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30
Q

the potassium sparing diuretic drug used as

A

adjunct therepy with (loop and thiazide ) least potent

31
Q

the potassium sparing diuretic drug used for

A

heart failure

32
Q

what is the adverse effects of the potassium sparing diuretic drug

A

gynecomastia
menstrual irregularities
hyperkalemia
nausea
hyponatremia

33
Q

ex. of the carbonic anhydrase inhibitor

A

acetazolamide

34
Q

mechanism of action for carbonic anhydrase inhibitor

A

inhibit the carbonic anhydrase enzyme
in the proximal tubular epithelial cells

35
Q

carbonic anhydrase inhibitor are more often used for their other pharmacologic action why?

A

because they are much more less efficacious than loop and thiazide

36
Q

carbonic anhydrase inhibitor is used for

A

glaucoma and mountain sickness

37
Q

what is the adverse effects of carbonic anhydrase inhibitor

A

metabolic acidosis
hypokalemia
renal stones

38
Q

ex. of the osmatic diuretic drugs

A

mannitol

39
Q

the therapeutic use of the mannitol

A

increased intracranial pressure or acute renal failure

40
Q

the adverse effect of mannitol

A

dehydration and hyponatremia

41
Q

what is the action of osmatic diuretic drug

A

increased fluid loss by osmotically active molecules in the proximal tubule
+ increase the renal flow after administration

42
Q

what drug used for intracranial pressure

A

osmatic diuretic drug mannitol

43
Q

what is the drug of choice for acute pulmonary edema of heart failure

A

loop diuretic drug

44
Q

what is the identifiable causes of HT

A

sleep apnea
drug induced
chronic kidney disease
chronic steroid therapy

45
Q

non drug treatment of HT

A

LOW :
-salt intake
-calories
-smoking
-alcohol
-stress factors
-caffeine
HIGH: activity !!!!

46
Q

what is the three general mechanism that drugs take to lower the BP

A
  • alter synthetic activity
  • alert sodium / water balance
    -relax vascular smooth muscle
47
Q

what is the three possible mechanism for beta blockers

A
  • CNS effect (decrease the sympathetic NS tone)
  • inhibit the renin secretion (beta 1 receptor mediated renin release )
  • block cardiac beta 1 receptor ( lower the cardiac output)
48
Q

the beta blocker and ACE inhibitors work best with patient whom

A

white and young

49
Q

what is the drug used for hypertensive patient with angina pectoris

A

beta blockers

50
Q

what is the drug used for hypertensive patient with myocardial infraction

A

beta blockers

51
Q

what is the drug used for hypertensive patient with CHF

A

beta blockers

52
Q

sides effects for beta blockers

A

bronchospasm
hypotension
fatigue
bradycardia
decrease libido

53
Q

drug withdrawal for beta blockers

A

must be tapered over 2-3 weeks

54
Q

alpha blockers are selective to

A

alpha 1

55
Q

alpha blockers ex.

A

prazosin
terazosin
doxazosin

56
Q

vasodilators are best been co administrated with

A

-b blockers ( decrease heart rate )
-diuretic (treat edema )

57
Q

ACE inhibitors ex.

A

captopril
lisinopril
fosinopril
enalapril

58
Q

what is the drug used for hypertensive patient with diabetes

A

ACE inhibitors

59
Q

three mechanism for ACE inhibitors to work

A
  • reduce aldosterone -> low Na/H2O retention
  • reduce angiotensin -> low vasocontraction
  • increase bradykinin -> vasodilation
60
Q

adverse effects for ACE inhibitors

A
  • DRY COUGH
  • ALERTED TASTE
  • ANGIOEDEMA
  • hypotensive
  • rash
  • hyperkalemia
  • reversible renal impairment
61
Q

ACE inhibitors are under what category for pregnant woman

A

category D ( teratogenic )

62
Q

angiotensin II antagonist ex.

A

losartan , valsartan

63
Q

how many time should be the angiotensin II antagonist taken

A

once daily

64
Q

which drug from angiotensin II antagonist undergo extensive first pass metabolism

A

losartan

65
Q

aliskiren is an example for

A

renin inhibitor drugs

66
Q

what is the adverse effect of aliskiren

A

diarrhea

67
Q

ex. of centrally acting adrenergic drugs

A

clonidine , alpha methyldopa

68
Q

mechanism of action for clonidine

A

act directly at a2 receptors

69
Q

what the therapeutic uses of clonidine

A

mild to moderate hypertensive
suitable for renal failure patient

70
Q

the adverse effect of clonidine

A

sedation
a dangerous effect is rebound hypertensive (follows a abrupt withdrawal)

71
Q

a methyldopa mechanism of action

A

first converted to a methylnorepinephrine
which activate CNS a2 whose function is to decrease sympathetic outflow

72
Q

other drugs for hypertensive include

A

fenoldapam

guanethidine and reserpine which are rarely used

73
Q

fenoldapam mechanism of action
safe for who
contraindicated for

A

a dopamine 1 agonist
safe for all emergency patients
contraindicated for glaucoma

74
Q

hypertensive emergency

A

1- SODIUM NITROPRUSSIDE (emergency , malignant hypertensive )
2- LABETALOL (a b blocker )
3- DIAZOXIDE
ALL administrated IV

pharmacology (5 decks)

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