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Anti-HTN Anti-Anginal

1
Q

Effects of reserpine: (4)

A

decreased TPR
decreased CO
decreased renin
decreased BP

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2
Q

Side effects of reserpine:

A

sedation
depression
increased incidence of ulcers

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3
Q

Effects of
prazosin (minipress)
terazosin (hytrin)

A 
(alpha-1 blocker, so:)
decrease TPR
decreased BP
increase HDL
decrease LDL
beneficial effect on insulin resistance
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4
Q

Used in older men with HTN and BPH:

A

terazosin (hytrin)

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5
Q

Effects of BB: (5)

A 
decrease HR + contractility (thus CO)
decrease renin/ATII
   *no Na/H2O retention
with chronic use: decrease TPR
decreased production of aq. humor
   *glaucoma
treats stage fright
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6
Q

Pindolol does NOT affect levels of ___ like other BB

A

renin/ATII

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7
Q

BB are useful in patients with HTN and:

A

CHF
MI or ischemic heart disease
hyperthyroidism
migraines

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8
Q

Beta-1 cardioselective drugs

A

metoprolol

atenolol

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9
Q

Partial beta-agonists; less effective than other BB:

A

pindolol

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10
Q

Side effects of BB: (7)

A 
cold extremities (due to alpha action)
bradycardia 
bronchospasm
CNS (bad dreams, depression)
drug withdrawal syndrome
block glycogenolysis
increase LDL/decrease HDL
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11
Q

Should not be given with verapamil or diltiazem (non-DHP)

A

beta blockers

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12
Q

Nonselective beta and alpha 1 antagonists

A

labetalol

carvedilol (coreg)

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13
Q

Effects of nebivolol (bystolic)

A 
promotes NO vasodilation
very beta-1 selective = 
   decreases BP
   decreases HR
   decreases TPR
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14
Q

Effects of ACEI:

A

decrease BP
decrease TPR
vasodilation

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15
Q

What patients have a greater response to ACEI?

A

those with elevated renin or Na depletion

greater decrease in BP

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16
Q

Renoprotective: delays renal disease in type I diabetics

A

captopril

lisinopril

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17
Q

increases synthesis of prostaglandins (vasodilation) in vascular and renal endothelium

A

captopril

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18
Q

ACEI activated by deesterification

A

ramipril

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19
Q

Side effects of ACEI’s:

A
  1. angioedema
  2. fetal toxicity (not for 2nd/3rd trimester)
  3. dry cough
  4. hyperkalemia
  5. hypotension (if hypovolemic +/or Na depleted), possibly 1st dose
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20
Q

ATII receptor antagonists end in the suffix…

A

-sartan

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21
Q

Effects of ARBs

A

vasodilation
increased Na/water excretion
decrease TPR
decrease BP/CO

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22
Q

What do you do if one anti-HTN med causes a dry cough?

A

switch patient to ARBs

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23
Q

ARBs block the action of ATII on _____ receptors

A

AT type 1

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24
Q

What beta blocker is likely to have drug-drug interactions?

A

carvedilol

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25
Q

Competitive TXA2 receptor antagonist

A

losartan

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26
Q

Attenuates platelet aggregation

A

losartan

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27
Q

increases uric acid excretion

A

losartan

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28
Q

ARB that inhibits CYP

A

losartan

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29
Q

Side effects of ARBs

A
  1. hyperkalemia
  2. fetal toxicity
  3. hypotension (hypovolemic +/or Na depleted patients)
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30
Q

ARB that causes hepatic dysfunction

A

losartan

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31
Q

Effect of renin inhibitors

aliskiren

A

decrease BP **dose-dependent

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32
Q

(CCBs)
phenylalkylamines are ~selective for:
dihydropyridines selectively block:

A

L-type Ca channels in myocardium

L-type Ca channels in blood vessels

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33
Q

Effects of dihydropyridines:

A

decrease systemic vascular resistance
decrease arterial pressure
NO/MILD changes in HR (except short acting dihy’s)

34
Q

CCBs most effectively control BP in what type of patient?

A

patients with low renin HTN

this is more common in AA and elderly

35
Q

Side effects of dihydropyridines:

A

peripheral edema
hypotension
constipation

36
Q

Reflex tachy occurs in patients taking what dihydropyridine?

A

nifedipine (procardia), short acting

37
Q

Side effects of hydralazine?

A

palpitations (tachy, may lead to angina)
Autoimmune reactions

(not a s/e, but causes water retention)

38
Q

What drugs are direct vasodilators?

A

minoxidil

nitroprusside

39
Q

Side effects of minoxidil:

A

increases renin

hirsutism

40
Q

How does minoxidil affect BP?

A

opens K-ATP channels, which causes relaxation of arteriolar smooth muscle
**dilates arterioles NOT veins

41
Q

Effects of nitroprusside:

A

forms NO, causing vasodil (arteries/veins)
Decreases TPR
Decreases CO in normal

42
Q

Side effects of nitroprusside:

A
  1. excessive hypotension
  2. palpitations/tachycardia
  3. metabolized to cyanide (cyanate/thiocyanate toxicity: give small dose for small period)
43
Q

Nitroprusside is used to treat:

A

HTN emergencies in patients with ventricular failure

**why does this seem to contradict??

44
Q

clonidine acts on what receptors?

A

postsynaptic alpha-2A adrenoreceptors in the rostral ventrolateral medulla

(decreases symp impulses from RVLM to heart and vessels)

45
Q

Effects of clonidine

A

decrease peripheral vasc resistance

decrease HR

46
Q

Because it releases endogenous opiates, this drug is used as an analgesic in neuropathic pain

47
Q

Treats ADHD

48
Q

Side effects of clonidine

A

sedation
contact dermatitis, if patch form
clonidine withdrawal (HTN)

49
Q

Effects of bosentan:

What is this indicated for?

A

vasodilation (by blocking endothelin 1 and 2 receptors)

pulmonary HTN

50
Q

_____ (alone or with beta-blockers) decrease mortality in patients with HTN

51
Q

Which drug class has the advantage of decreasing HTN wile improving lipid profile and insulin resistance?

A

alpha 1 blockers

52
Q

Offers secondary protection in CAD (plus anti-HTN)

A

beta blockers

53
Q

_____ should not be stopped abruptly–taper down doses

A

beta blockers

54
Q

ACEI are the 1st choice drug for patients with:

A

high renin
diabetes
nephropathy
CHF-propensity

55
Q

Angina is treated by: (approaches)

A
  1. increase blood blow
  2. decrease oxygen consumption
  3. prevent platelet aggregation (**Aspirin)
56
Q

(Nitrates) Venodilation causes reduced preload, which results in:

A
  1. decreased ventricular pressure in diastole
  2. decreased oxygen demand
  3. increased subendocardial blood flow
57
Q

(Nitrates) Coronary vasodilation results in:

A
  1. blood flow to ischemic areas
  2. selective dilation of epicardial/collateral coronary vessels
  3. prevention/reversal of vasospasm
58
Q

(Nitrates) Overall effects on hemodynamics:

A

decreased pulmonary vascular resistance

slightly reduced CO

59
Q

Adverse effects of nitrates:

A

hypotension (due to arterial vasodil)
Orthostatic hypotension (reduced preload)
headache (dilation of meningeal arteries)

60
Q

Drug reactions with nitrates

A

viagra and other type V PDE inhibitors

causes hypotension and MI

61
Q

Nitrates are abosorbed (quickly/slowly) and metabolized (quickly/slowly)

A 
quickly
quickly (via 1st pass**)
62
Q

Side effect of abrupt discontinuation of nitrates

63
Q

What type of CCBs target smooth muscle cells? Cardiac cells?

A

DHPs

non-DHPs

64
Q

How do non-dihydropyridine CCB’s treat angina?

A

decrease oxygen demands by decreasing HR, contractility and afterload

~coronary vasodilation prevents or reverses vasospasm

65
Q

How do dihydropyridine CCB’s treat angina?

A

reduces oxygen demand by reducing afterload

***coronary vasodilation (causes reflex cardiac stimulation)

66
Q

Side effects of DHP CCB’s?

A

GI irritation
peripheral edema
exacerbation of angina (coronary steal)

67
Q

Side effects of non-DHP CCB’s?

A

bradycardia
asystole
AV block
constipation

DO NOT USE IN CHF

68
Q

How do beta blockers treat angina?

A
  1. decrease HR and contractility in response to exercise

2. decreases afterload

69
Q

Why combine nitrates or DHP CCB’s with beta blockers treat angina?

A

BB prevent reflex tachycardia and contractility

70
Q

4 drugs used in combo for unstable angina

A

BB
nitrates
ASA
heparin

71
Q

BB are useless in what type of angina?

A

vasospastic

72
Q

When would you use CCB’s instead of BB in angina?

A

DHP:
valvular insuff (reduce afterload)
sinus brady/AV block

non-DHP:
depression
asthma
DM with variable glu levels

73
Q

Expensive, late Na-current inhibitor that increases oxygen utilization in heart

A

ranolazone/renexa

74
Q

Drugs that reduce CHD event

A

beta blockers

75
Q

Reduces CHD, reinfarction and stroke after MI or unstable angina

76
Q

Improves survival post MI in patients with LV dysfunction

77
Q

Reduces HR
Reduces contractiliy
Indirectly reduces afterload (via decr renin)

A

beta blockers

78
Q

coronary vasodilation
reduced preload
reduced afterload

79
Q

coronary vasodilation

reduced afterload

A

nifedipine

80
Q

coronary vasodilation
reduced HR
reduced contractility
reduced afterload

A

verapamil

diltiazem

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