Pharm of Hypertension

Question 1

Primary vs Secondary Hypertension

Answer 1

Primary:
- causes unknown but risk factors include genetics, smoking, stress, environment, diet
Secondary:
- high BP is secondary to an abnormality or drug -> renal disease, aorta constriction, Aldosteronism, Cushings, Drugs like ket, coke, nicotine, etc

Question 2

Commonly used Antihypertensive Drugs

Answer 2

A - ACE inhibitors & Angiotensin antagonists
B -Beta blockers
C - Calcium channel blockers
D -Diuretics (Thiazides, Loop, K+ sparing)

Question 3

What is Resistant HTN?

Answer 3

= Difficult to lower BP with 3 or more drug types

Question 4

Bad Drug combinations

Answer 4

Tripple whammy to avoid:
- RAS inhibitors
- NSAID
- Diuretic

Question 5

How do NSAIDs and ACE inhibitors affect autoregulation?

Answer 5

both impair autoregulation
NSAIDs:
- inhibit prostoglandin production
ACE inhibs:
- stop production of Ang II

Question 6

What are Renin Inhibitors? Example? Action?

Answer 6

• type of RAS inhibitor
  Action:
• inhibits upstream of other RAS components
  Example:
• Aliskiren (comp inhibitor of human renin

Question 7

What is Endothelin-1? What are Endothelin Receptor Antagonists? what do they do? examples?

Answer 7

Endothelin-1:
- Stim ETa adn ETb receptors (in pulm arteries)
- ETa mediates vasoconstriction
- ETb mediates vasodilation
- Overriding effect is Vasoconstriction -> increases BP -> want to stop this w drugs
Endothelin Antagonist Examples:
- Bosentan (both receptor antagonist)
- Ambrisentan (selective ETa antagonist)

Question 8

What would you use for Pulm HTN?

Answer 8

Endothelin blockers

Question 9

What are a1-blockers? examples? AEs?

Answer 9

= they block post-synaptic a1 adrenoceptors in smooth muscle
Examples:
- Non-selective = Phentolamine
- Selective = Prazosin, Tamsulosin
AEs:
- Hypotension
- Tachycardia
- Urinary urgency`

Question 10

What are CNS-mediated sympathetic inhibitors? Examples? AEs?

Answer 10

Brain a2 receptors reduce CNS sympathetic outflow causing vasodilation
Examples:
- Methyl-dopa -> forms false neurotransmitter
- Clonidine
AEs:
- sedation, depression, fatigue, HTN on withdrawal