Vasodilating Drugs Flashcards by nancy Gillcrist

sodium nitroprusside

vasodilator –> spontaneous nonenzymatic NO release
nonspecific - dilates arteries AND veins (decrease afterload and preload)
HTN emergencies –> fast acting but toxicity limits use
**can cause cyanide accumulation –> NOT for patients with renal issues

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what is the toxicity associated with sodium nitroprusside?

cyanide accumulation (–>cyanide–>thiocyanate –> kidneys)
can cause acid/base issues, arrhythmias, death
DO NOT USE WITH RENAL ISSUES

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minoxidil

vasodilator, K+ channel opener
hyperpolarization causes arteriolar smooth m relaxation
doesnt affect veins
coadminister with B blocker to avoid reflex
BUT can evoke sympathetic reflex (increase HR, renin, contractility)

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Rogaine

topical minoxidil
minoxidil, a K+ channel opener, increases hair growth
can have CV effects

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what drug opens K+ channels?

minoxidil

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hydralazine

oral
directly vasodilates smooth m arterioles
decreases TPR (afterload) and BP
can cause sympathetic relfex(HR increase, renin retention)
Use with pregnancy HTN

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drug for HTN associated with pregnancy?

hydralazine

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clonidine

CNS central acting vasodilator (sympathoLYTIC)
stimulates alpha2A receptor in brainstem to decrease sympathetic outflow!
BUT high doses reverse the effect –> activate alpha 2B on vascular smooth m and cause vasoconstriction

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what happens with high doses of clonidine?

lose dilation effect

activates alpha 2B receptor in smooth m which causes vasoconstriction

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alpha 2A vs alpha 2B receptors

2A is in CNS and causes vasodilation(decrease sympathetic)

2B is in vascular smooth m and vasoconstricts

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guanadrel

false neurotransmitter that is inactive at postganglionic adrenergic receptors
taken up by NE transporter and replaces NE in vesicles
BUT there is potential for NE release so DONT USE WITH pheochromocytoma

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risk of guanadrel?

since it is a false neurotransmitter there is a chance NE could be released

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reserpine

binds to storage vesicles in CNS and PNS and inhibits transport and storage of NE/dopa

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categories of ca channel blockers

dihydropyridine

non-dihydropyridine

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vasodilating dihydropyridine? and nondihydropyridine?

di- nifedipine

non-verapamil

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ca ch blockers (dihydro/nondihydro) effects

both act on smooth m (artery>venous) AND myocardium
inhibit L-type Ca channels
decreases contractility and Sa rate/av conductivity
dont affect skeletal muscle

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verapamil

nondihydropyridine
L type ca ch blocker , affects vessels and heart
vasodilates vessels
decreases SA rate and AV conduction velocity
use: HTN and arrythmias
BUT can cause ecessive vasodilation, ,AV node block, and decreased CO

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T/F: verapamil only affects smooth m?

FALSE

it affects vessels AND myocardium (SA rate and AV conduction v)

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nifedipine

dihydropyridine
L type ca ch blocker, smooth m and myocardium
keeps intracellular Ca LOW
reflex causes increase in HR and contractility
use with heart failure

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which to use with heart failure: nifedipine or verapamil

nifedipine due to reflex

verapamil can cause excess dilation and AV node block/decreased CO

PDE inhibitors

phosphodiesterase inhibitors
prevent hydrolysis of cAMP or cGMP to their inactive form –>increased cAMP = + inotropism of heart
vasodilation! = ‘inodilators’
2 drugs = theophylline and sildenafil
can cause thrombocytopenia/ increase in mortality?

what category can cause thrombocytopenia?

PDE inhibitors

sildenafil

PDE inhibitor, prevents breakdown of cGMP –> dilation and decrease preload/afterload = +inotropism
selective for PDE5(cGMP) which is in penile, retina, and vasculature
treat: erectile dysfunction

what drug treats erectile disfunction?

sildenafil

nitroglycerin

``` organic nitrate used to vasodilate (release NO) treat: angina, HTN, ischemia, after coronary bypass venous dilation(>artery) ```

after a coronary bypass, give the patient...

nitroglycerin

phentolamine

nonselective alpha blocker, vasodilates | use for patients with catecholamine emergencies

esmolol

B blocker, vasodilates | use: aortic dissection and postop HTN

vasodilator to treat after aortic dissection?

esmolol

vasodilator for postop HTN?

esmolol

labetolol

alpha and B blocker, vasodilates | Use for active coronary disease patients

fenoldopam

dopamine receptor 1 agonist activates D1 and vasodilates increases renal perfusion Use for patients with renal disfunction

drug to vasodilate in renal disfunction patients?

fenoldopam

drugs to use for quick/emergency acute HTN?

sodium nitroprusside is fastest (seconds) | minutes: clevidipine, fenoldopam, labetolol, phentolamine

Long term chronic HTN drugs

prazosin, doxasin, clonidine, guanabenz/reserpine, hydralazine, minoxidil

amlodipine

ca ch blocker, dihydropyridine vasodilates and decreases BP Use with patients with COPD, CHF, CAD

prazosin

alpha1 antagonist, vasodilator

atenolol

nonselective B antagonist, blocks B1 and B2 | vasodilator

what vasodilator blocks B1 and B2?

atenolol and propanolol

propanolol and sotalol

B1 and B2 nonselective antagonist | vasodilator

carvedilol

alpha1, B1 and B2 blocker/antagonist | vasodilates

what drug blocks B1, B2 AND alpha1 but not alpha 2

carvedilol

captopril

ACE(angiotensin converting enzyme) inhibitor, vasodilates using RAAS system inhibits renal function and vasodilates

spironolactone and eplerenone

aldosterone receptor antagonist, vasodilator

losartan

ARB (angiotensin 2 receptor antagonist) decrease in TPR, vasodilates use with patients who cant tolerate ACE inhibitors

what drugs use RAAS system to vasodilate?

``` captopril spironolactone eplerenone losartan aliskiren ```

aliskiren

renin inhibitor, vasodilates

direct vasodilating drugs?

hydralazine, minoxidil, sodium nitroprusside

clevidipine

PDE inhibitor