Pharm: HTN

Question 1

HTN in pregnancy

Answer 1

Hydralazine
Labetalol
Methyldopa
Nifedipine

Question 2

Dihydropyridine Ca channel blockers

Answer 2

-dipine (amlodipine, clevidipine, nicardipine, nimodipine
Block voltage-gated L-type Ca channels, particularly in smooth muscle –> v muscle contractility
Use: HTN, angina (including Prinzmetal), Raynauds
Nimodipine - subarachnoid hemorrhage
Clevidipine - HTN emergency
Side effects: peripheral edema, flushing, dizziness, gingival hyperplasia

Question 3

Non-dihydropyridine Ca channel blockers

Answer 3

Verapamil, diltiazem
Block voltage-gated L-type Ca channels on cardiac muscle (diltiazem also some smooth muscle) –> v muscle contractility
Use: HTN, angina, a-fib/flutter
Side effects: cardiac depression, AV block, hyperprolactinemia, constipation

Question 4

HydrAlAzine

Answer 4

^cGMP –> smooth muscle relaxation
Vasodilates Arterioles>veins –> Afterload v
Use: severe HTN, HF (with organic nitrate), safe during pregnancy
Often w beta blocker to prevent reflex tachycardia
Side effects: compensatory tachycardia (contraindicated in angina/CAD), fluid retention, headache, angina, Lupus-like syndrome

Question 5

HTN emergency

Answer 5

clevidipine
fenoldopam
labetalol
nicardipine
nitroprusside

Question 6

Nitroprusside

Answer 6

short acting for HTN emergency
^cGMP via direct release of NO
can cause cyanide toxicity

Question 7

Fenoldopam

Answer 7

HTN emergency
Dopamine D1 receptor agonist
coronary, peripheral renal, and splanchnic vasodilation
vBP
^natriuresis
use postoperatively as antihypertensive
can cause hypotension and tachycardia

Question 8

Minoxidil

Answer 8

K channel opener in arteriolar smooth muscle –> hyperpolarization and relaxation
Little effect on venous or capacitance vessels
Side effect: reflex tachycardia and ^ contractility –> cardiac ischemia… coadminister w beta blocker
Also used for hair growth

Question 9

Phosphodiesterase inhibitors

Answer 9

Theophylline (non-selective)
Amrinone, milrinone (PDE3 inhibitors)

prevents hydrolysis of cAMP, cGMP –> ^cAMP –> positive isotropism in heart and dilation of resistance and capacitance in peripheral vasculature
v afterload and preload

Sildenafil (Viagra) - selective PDE5 inhibitor - erectile dysfunction and pulmonary HTN