L 33-35

Question 1

4 Main categories of drugs used for hypertension

Answer 1

1) Diuretics
2) Drugs affecting SNS (sympatholytics): alpha-2 agonists, alpha-1 blockers, beta blockers
3) Vasodilators: NO, K+ channel, D-1 receptor, Ca channel
4) RAAS inhibitors: ACEI, ARB’s (ang receptor blockers), Renin inhibitor

Question 2

Anti-hypertension drugs in diuretics category

Answer 2

Hydrochlorothiazide (prototype)

Furosamide

Question 3

Anti-hypertension drugs in sympatholytic category that are alpha-2 agonists

Answer 3

Clonidine

Methyldopa

Question 4

Anti-hypertension drugs in sympatholytic category that are alpha-1 blockers

Answer 4

Prazosin
Doxazosin
Terazosin

Question 5

Anti-hypertension drugs in in sympatholytic category that er beta-blockers

Answer 5

Propranolol, Timolol, Nadolol (non-specific)
Metoprolol, Atenolol, Nebivolol (beta-1 specific)
Acebutolol (beta-1, with ISA)
Pindolol (with ISA)
Carvedilol (alpha and beta blocker)

Question 6

Anti-hypertension drugs in vasodilator category that act through NO

Answer 6

Hydralazine

Sodium nitroprusside

Question 7

Anti-hypertension drugs in vasodilator category that open K+ channels

Answer 7

Minoxidil

Diazoxide

Question 8

Anti-hypertension drugs in vasodilator category that stimulate D-1 receptors

Answer 8

Fenoldopam

Question 9

Anti-hypertension drugs in vasodilator category that are Ca channel blockers

Answer 9

Verapamil
Diltiazem
Nifedipine

Question 10

Anti-hypertension drugs in RAAS inhibitor category

Answer 10

Captopril (-pril’s)–ACE inhibitors
Losartan (-sartan’s)–ARB’s=angiotensin receptor blockers
Aliskiren–Renin inhibitor

Question 11

Specific causes of Hypertension

Answer 11

Renal artery constriction
Coarctation of aorta
Pheochromocytoma
Cushing's disease
Primary aldosteronism

Question 12

Common complications of hypertension

Answer 12

CAD
Stroke
Renal failure

Question 13

Sympathetic receptor that stimulates renin secretion

Answer 13

beta-1

Question 14

4 ways SNS affects blood pressure

Answer 14

1) Resistance arterioles
2) Capacitance venules
3) Heart output
4) Renin secretion

All increase BP, this is why sympatholytics are used for HT

Question 15

Explain Baroreceptor reflex

Answer 15

1) Baroreceptor in carotid sinus senses MAP
2) Signal sent to nucleus of tractus solitarius onto inhibitory neurons that fire into the vasomotor center
3) Vasomotor center sends signal down spine to autonomic ganglia
4) Autonomic Ganglia send motor fibers out to sympathetic nerve endings that act on alpha/beta receptors

Increased baroreceptor firing => inhibition of vasomotor center=> decreases SNS tone=> decreased BP

All happens within 3-4 beats

Question 16

What should be done before initiating drug therapy for HT?

Answer 16

Life-style modification before drugs:
Exercise
Lose weight
Limit dietary salt, fat, alcohol
Stop smoking

Question 17

Why must BP be dropped slowly, especially in elderly?

Answer 17

To prevent damage to vital organs.

In elderly, coronary perfusion may become inadequate=>morbidity and mortality

Question 18

In patients over 50, which part of BP is more significant in terms of cardiac risk factor?

Answer 18

Systolic matters more than diastolic in persons over 50

Question 19

What is initial drug treatment for all HT patients, and what is the most significant contraindication?

Answer 19

Thiazides are first line for most patients
Except for those with a sulfa allergy
Or those with high-risk conditions like: DM, kidney disease, ischemic heart dis., HF, cerebrovascular disease.

Question 20

Thiazide mech of action to lower BP

Answer 20

Thiazides act in distal convoluted tubule to block Na/Cl co-transport.
Dec Na reabsorption=>decrease in blood volume and decrease in CO=>dec BP
Over time, dec Na in smooth muscle cells=>dec muscle sensitivity to vasopressors. Also with time cause K channel opening=>vasodilation

Question 21

Indapamide

Answer 21

Thiazide type diuretic that also is a direct vasodilator

Question 22

Common side-effects of thiazide diuretics used to reduce BP

Answer 22

Impotence
Gout–competes for transporter in kidney
Hypokalemia
Muscle cramps
Dec insulin production=> increased plasma lipids, reduced glucose tolerance

Question 23

In what populations are Thiazides more effective?

Answer 23

African-American

Elderly

Question 24

Name 2 main centrally acting Sympatholytics

Answer 24

Clonidine

Methyldopa

Question 25

Mech of action for centrally acting Sympatholytic agents

Answer 25

Alpha-2 agonists in Medulla that reduce peripheral sympathetic activity=>vasodilation and reduced renin secretion

Question 26

Differences in action between Clonidine and Methyldopa

Answer 26

Clonidine lowers HR and CO more than Methyldopa

Methyldopa is a prodrug that is converted to methylnorepinephrine

Question 27

Mech for xerostomia with sympatholytics

Answer 27

Activation of alpha-2 receptors blocks function of most preganglionic nerves throughout the body, high doses will inhibit cholinergic activation of PSNS to salivary glands

Question 28

Sudden withdrawal of Clonidine will cause:

Answer 28

Hypertensive crisis because of down regulation of alpha-2 receptors

Question 29

Side effects of Methyldopa

Answer 29

Hemolytic anemia with pos Coombs test

Gynecomastia and lactation

Question 30

Most common side-effects of sympatholytics

Answer 30

Sedation

Nausea, dizziness, nightmares, depression