(THER) Antihypertensives I and II Flashcards
Hydralazine MOA and Indication
Arteriole vasodilator
Ind: Resistant hypertension; pregnancy induced hypertension
Spironolactone should not be used in combination with which drugs?
Drugs that inhibit the RAA system (ACE Inhibitors, ARBs, or BBs)
Thiazides are not as useful in patients with…
Renal insufficiency
What is the effect of Calcium Channel Blockers?
Relax peripheral arterial vascular smooth muscle and decrease total peripheral resistance.
What effect do calcium channel blockers have on cardiac output/contractility?
Decrease calcium-induced calcium release from myocyte SR and can reduce CO
Nifedipine MOA and Side effects
Relatively selective vasodilator
AEs: Acute tachycardia; peripheral edema
Diltiazem Effects and Adverse Effects
Effects: Reduces both CO and peripheral resistance
AEs: bradycardia
Patients taking short-acting nifedipine, diltiazem or verapamil were 1.6 times more likely to… as compared to patients on other hypertensives.
Have an MI than patients on other antihypertensives.
MOA and Effect for Sympatholytic Drugs
What does it mean that they are centrallyy acting agents?
Reduce sympathetic drive to heart/blood vessels
They reduce this sympathetic output from vasopressor centers in the brainstem.
Clonidine MOA and AEs (3)
Drug interaction?
Alpha-2 agonist: decreases sympathetic outflow from CNS
AE: sedation, dry mouth, contact dermatitis
May interact with other CNS depressants, potentiating their action
In what way should you withdraw patients off of Clonidine and why?
Withdraw slowly to prevent rebound hypertension
How does Guanfacine differ from Clonidine?
It has similar effects but a longer half-life
Methyldopa MOA (2)
- Agonist at a-2 adrenergic receptor (decreases sympathetic tone, dropping BP)
- Competes for DOPA decarboxylase preventing production of dopamine and subsequent NE/Epi
Methyldopa AEs and key interaction
AE: sedation
Interaction: reduces L-dopa therapeutic effects
Which drug is probably the most extensively used hypotensive agent in management of hypertension in pregnant women?
Methyldopa
Reserpine MOA
Disrupts NE vesicular storage, leading to the eventual digestion of NE by MAO. Overall drop in sympathetic stimulation.
Function of Alpha Adrenergic Antagonists
Block arterial and venous constriction
Indication for phenoxybenzamine
Used in patients with hypertension due to pheochromocytoma
Prazosin is similar to which 2 drugs which are more commonly prescribed?
Terazosin and Doxazosin
Prazosin function (2)
- Alpha Adrenergic Antagonist
- Also causes beneficial decease in LDL/HDL ration
Prazosin AEs
- First dose produces precipitous fall in BP
- Fluid retention
- Can promote postural hypotension
How do B-blockers lead to vasodilation?
By increasing NO release or blocking a-adrenergic receptors
Nadolol selectivity? Half-life?
Non-selective B-blocker; longer half-life
Labetolol MOA
Is it more lipophilic or lipophobic?
Mixed beta/alpha receptor antagonist (beta/alpha blocker)
Lipophilic
Carvedilol MOA/effect
- Non-selective B-blocker
- Some alpha receptor antagonist properties
- Vasodilatory
B-blocker AEs and Drug interactions
- Bradycardia
- Increased serum triglycerides/decreased HDL levels
- Insomnia
- Hyperglycemia
Drug Interactions: CCB’s increased risk of conduction disturbances
Drug interactions for B-blockers
Calcium Channel Blockers (CCBs) increase risk of conduction disturbances when combined with B-blockers
Hydralazine Side Effects (3)
Tachy; aggravation of angina; fluid retention
Hydralazine Contraindication
CAD
Minoxidil Indication and AEs
Indication: Resistant hypertension
AE: tachycardia; aggravation of angina; fluid retention
Nitroprusside Indication/ AEs
Indication: Hypertensive emergencies
AE: cyanide poisoning
Lisonopril falls under what umbrella of drugs?
ACE Inhibitors
Side Effects/ Drug Interactions for ACE Inihibitors
AEs: hyperkalemia; dry cough; angioedema
Interactions: can exacerbate hyperkalemia when given with potassium sparing diuretics
ACE Inhibitor COntraindication
Should not be given to pregnant women, as Ang II is important in fetal renal development, particularly in the 2nd and 3rd trimesters
Key point about ACE Inhibitors and Diabetic Patients
ACE-I’s preserve renal function in patients with diabetes
Losartan MOA and AEs
Selective Angiotensin I receptor Blocker (ARB)
Losartan Drug interactions and contraindications are the same as what other drug?
ACE inhibitors
Why are ACE-I and K+ sparing diuretics a poor drug combination?
They both promote hyperkalemia
For Black patients, what are the best first line options for hypertension? In what context should the other drugs be used for the best effect?
Diuretics or Calcium Channel Blockers (CCBs) should be used as first line treatment in uncomplicated hypertension for AA patients.
Other drugs (BBs, ACEIs or ARBs) should be used in combination w/ diuretics for best effect.
Which drugs are best for patients with Diabetes mellitis who are hypertensive? (3)
ACEI, alpha antagonists and CCBs
