Pharmacology of Antihypertensive Drugs

Question 1

Beta blocker generations

Answer 1

1st - non selective
2nd - beta 1 receptor
Third - with additional action

1 - proponalol/nadalol

2 - atenolol/metoprolol

3 - carvedilol, labetalol, nebivolol

Question 2

Cardvedilol

Labetalol

Nebivolol

additional actions

Answer 2

Carv - blocks alpha, antioxdant, reduce cardiac hypertrophy

Blocks alpha

Vasodilator

Question 3

Consequences of beta blockade

Answer 3

Dec in contractile force
Dec in HR
Dec renin release and AT2

Therefore dec force, rate and renin secretion

Question 4

HTN and beta blockers

Answer 4

Due to beta 1 blockade and dec in CO, HR, and renin

Question 5

Beta blockade in SVT and ischemic HD

Answer 5

Blocks SA and AV nodal beta receptors

Dec force and ratre of contraction so dec myocardial oxygen consumption

Question 6

Beta blockade in post MI, HF

Answer 6

MI - prevent reinfarction…dec in oxygen consumption, work of the heart, and blocks arrhtyhmias

HF - blockade elevated symp, hypertrophic growth and free rad formation

Question 7

Side effects of beta blockrs

Answer 7

Bradycardia and AV nodal blockade

Dec in contractility

Hypotension

Sedation, fatigue, lassitude

Question 8

Beta2 blockade side effects

Answer 8

Specific to 1st gen

Airway dz and peripheral vascular dz

Question 9

Calcium channel blockers

Answer 9

Amlodipine/nifedipine

First line for HTN…arterial vasodilators that dec PVR

Question 10

CCBs MOA

Answer 10

1) slow HR and lower BP
2) only verapamil and diltizaem act at SA node to slow down
3) ALL CCBs vasodilate

Question 11

Hydralazine

Answer 11

Second line HTN tat is vasodilator

Reserved for mod to severe

Question 12

Hydralazine SE

Answer 12

Genetic based - inactivated by N-acetylation and can produce a lupus like syndrome

Likelihood of lupus-like syndrome increeased in the slow acetylator population

Vasodilator SE - typical effects are hypotension, headache, tachycardia

Question 13

Minoxidil

Answer 13

Arterial vasodilator that stimulates an outward K+ channel resulting in hyperpolarizaiton of vascular smooth muscle cell

Question 14

Minoxidil use and SE

Answer 14

Mod to severe HTN

Hypotension, headache, tachy and hair grwoth

Question 15

ACEI and ARBs uses and cautions

Answer 15

1st line for HTN and HF

Lisinopril and losartan

Stronger with ACEI

Caution in pregnant

Question 16

ACEI side effect

Answer 16

Bradykinin induced cough

Question 17

ACEI and ARB side effect

Answer 17

Hyperkalemia due to aldosterone inhibion

Angioedema, loss of taste, hypotension

Question 18

Alikerin

Answer 18

Binds to reinin and blocks catalytic activity…AT 2 will be decreased

Can be used alone or with others

Do not use in diabetics

Question 19

Thiazide diuretics use

Answer 19

1st line for HTN

HCTZ and chlorthalidone

Intiially reduce plasma volume…LT use with dec in PVR

Question 20

SE and toxocity of thiazeise

Answer 20

hypotension and volume depletion

Impotence

Hypokalemia - increase likelihood of vent arrhythmias and potentiate arrhythmogenic action of toher drugs…can produce muscle weakness and drowsiness

Some HS

Question 21

Drug interactions of thiazises

Answer 21

NSAIDs and lithium

Question 22

K+ sparing

Answer 22

Amiloride and triamteren - direct Na channel inhibs

Aldosterone antagonists - spironolactone and eplernone

Question 23

K+ sparing uses

Answer 23

Not usually used alone to tx HTN

USed to minimize K+ loss cuased by other diuretics

Aldosterone antag for HF

Question 24

K+ sparing toxicity

Answer 24

Hyperkalemia

Spirnolactone - hynecomastia, dec libido and impotence in men and menstural probs in women

Question 25

Clonidine

Answer 25

Alpha 2 receptor agonist that dec sympathetic outflow and therefore dec BP