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20 Cards in this Set

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HTN drugs that prolong survival
beta blockers
thiazide diuretics
ACE inhibitors
Methyldopa
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
Clonidine
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
Reserpine
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)
Guanethidine
Adrenergic Neuron Blocker
Binds to storage granules to inhibit NE release
SE: Diarrhea, fluid retention(use w/ diuretics), orthostatic hypotension, sexual dysfunction
Prazosin
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)
Doxazosin
Tarazosin
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)
Propanolol
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
Hydralazine
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)
Nitroprusside
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
Minoxidil
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)
Directly acting Arteriolar vasodilator vs. Arteriolar/Venular vasodilator
Selective Arteriolar:
Minoxidil, Hydralazine and Diazoxide

Non-selective (Arterioles/Venules):
Nitroprusside
Diazoxide
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)
Calcium Channel Blockers
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)
Verapamil
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
Diltiazem
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
Nifedipine
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
Nimodipine
Dihydropyridine Calcium Channel Blockers

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

Used: Subarachnoid hemorrhage--prevents vasospasm

SE: gingival overgrowth ,proteiuria
Venular Vasodilators
Nitrates
Losartan
AT-1 Receptor Antagonist (ARB's)

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