Antihypertensive Drugs

Front 1

HTN drugs that prolong survival

Back 1

beta blockers
thiazide diuretics
ACE inhibitors

Front 2

Methyldopa

Back 2

activates alpha 2 adrenoceptors in the medulla to decrease vasomotor outflow and decrease PVR. Safe in pregnancy and renal dysfunction
SE: sedation, dizziness, decreased libido, edema, + coombs

Front 3

Clonidine

Back 3

activates presynaptic alpha 2 receptors in the medulla--decreased vasomotor outflow
Used: mild to moderate HTN, opioid and nicotine dependency
SE: dry mouth, sedation/insomnia, edema, bradycardia, rebound HTN on abrupt withdrawal

Front 4

Reserpine

Back 4

Adrenergic Neuron Blocker
causes destruction of storage granules in peripheral and central nerve endings--decreased NE in sympathetic neurons, decreased CO and PVR. In CNS, decreased NE, DA and 5HT
SE: edema, sedation, depression, + GI secretions, mild orthostatic hypotension (venules dilate)

Front 5

Guanethidine

Back 5

Adrenergic Neuron Blocker
Binds to storage granules to inhibit NE release
SE: Diarrhea, fluid retention(use w/ diuretics), orthostatic hypotension, sexual dysfunction

Front 6

Prazosin

Back 6

Alpha Blocker (non-selective)
decreased arteriolar resistance, increased venous capacitance. Initial reflex tachy f/b vasodilation w/ decreased PVR. No change in renal blood flow. W/ BPH--decreases urine flow by decreasing sphincter tone
SE: first dose syncope, orthostatic hypotension, urinary incontinence (more common in women)

Front 7

Doxazosin
Tarazosin

Back 7

Alpha 1 Selective Blocker
less reflex tachy

decreased arteriolar resistance, increased venous capacitance. No change in renal blood flow. W/ BPH--increases urine flow by decreasing sphincter tone
SE: first dose syncope, orthostatic hypotension, urinary incontinence (more common in women)

Front 8

Propanolol

Back 8

Beta Blocker (B1=B2)Nonselective
decreased blood pressure
whites & young pt's respond better than old or black/hispanic pt's.
SE: CV depression, fatigue,sexual dysfunction, LDL & TG's increase with chronic use. Don't use nonselectives with Diabetics (increased insulin resistance), asthmatics or pt's w/ PVD. Rebound HTN w/ abrupt w/drawal

Front 9

Hydralazine

Back 9

Direct Acting Vasodilator (NO/EDRF pathway)
Decreased PVR via arteriolar dilation (also coronary, renal and cerebral beds--less skin and muscle).
Used in moderate/severe HTN. Orally active, metabolized by N-Acetyltransferase (genotypic variation)
SE: Drug induced SLE (in slow acetylators), headache, flushing, sweating, fluid retention(use w/ diuretic), reflex tachy (use w/ beta blocker)

Front 10

Nitroprusside

Back 10

Direct Acting Vasodilator
Decreased PVR via arteriolar and venule dilation via guanylyl cyclase-cGMP-NO pathway
USE: Via IV in hypertensive emergencies
SE: forms thiocyanate and cyanide ions which can cause toxicity (>12 hr), can increase renin release, rebound HTN

Front 11

Minoxidil

Back 11

Direct Acting Vasodilator
Pro-drug that on sulfation opens K+ channels--causing membrane hyperpolarization leading to arteriolar vasodilation. Potent renal vasodilator--increases renin
SE: Headache, flushing, sweating, fluid retention (use w/ diuretic), reflex tachy (use w/ beta blocker), pulmonary htn (volume shifts), hypertrichosis (clinical use-topically)

Front 12

Directly acting Arteriolar vasodilator vs. Arteriolar/Venular vasodilator

Back 12

Selective Arteriolar:
Minoxidil, Hydralazine and Diazoxide

Non-selective (Arterioles/Venules):
Nitroprusside

Front 13

Diazoxide

Back 13

Direct Acting Vasodilator
Arteriolar vasodilator--opens K+ channels--causing membrane hyperpolarization leading to arteriolar vasodilation.

increases CO and renin
Use: IV in HTN emergencies and insulinomas (decreases insulin release), relaxes uterine smooth muscle

SE: hyperglycemia, fluid retention (use w/ diuretic but not a thiazide), reflex tachy (use w/ beta blocker)

Front 14

Calcium Channel Blockers

Back 14

Block L-type Ca2+ channels in cardiac muscle and vascular tissues
Decreased intracellular Ca2+--decreased contractility. Vasodilation of arterioles and coronary vessels. Natriuretic-renal
Blacks/hispanics and elderly respond well
SE: Constipation, headache, gingival overgrowth (DP's),proteiuria (DP's)

Front 15

Verapamil

Back 15

Calcium Channel Blockers

Block L-type Ca2+ channels in cardiac muscle (less in vascular tissues)
Decreased intracellular Ca2+--decreased contractility.

SE: Possible AV block, Constipation, headache, P-glycoprotein drug transporter inhibition

Front 16

Diltiazem

Back 16

Calcium Channel Blockers
(similar to Verapamil)
Block L-type Ca2+ channels in cardiac muscle (less in vascular tissues)
Decreased intracellular Ca2+--decreased contractility.

SE: Possible AV block

Front 17

Nifedipine

Back 17

Dihydropyridine Calcium Channel Blockers

Block L-type Ca2+ channels in vascular tissues (less cardiac effects)
SE: Reflex tachy--arrhytmias-MI, SE: Constipation, headache, gingival overgrowth ,proteiuria

Front 18

Nimodipine

Back 18

Dihydropyridine Calcium Channel Blockers

Block L-type Ca2+ channels in vascular tissues (less cardiac effects)

Used: Subarachnoid hemorrhage--prevents vasospasm

SE: gingival overgrowth ,proteiuria

Front 19

Venular Vasodilators

Back 19

Nitrates

Front 20

Losartan

Back 20

AT-1 Receptor Antagonist (ARB's)

Blocks the effects of angiotensin II but do not affect Bradykinin levels of enhance its effects