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83 Cards in this Set
- Front
- Back
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how many HTN has identifiable cause?
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10%
aka secondary |
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different classes of antihypertensive drugs?
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diuretics
sympathetic modifiers vasodilators calcium channel blockers ACE inhibitors angiotensin II receptor blockers renin inhibitor |
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antihypertensives with principal CNS effect?
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clonidine
methyldopa |
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clonidine mechanism?
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stimulation of α2 receptors resulting in decreased sympathetic outflow from cns
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adverse effects of clonidine?
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sedation, depression
dry mouth orthostatic hypotension hypertensive crisis on sudden withdrawal |
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administration of clonidine?
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oral
transdermal available iv (initial pressor response) |
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methyldopa?
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prodrug - stimulate central α receptors resulting in decreased sympathetic outflow
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administration of methyldopa?
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oral
iv (NO initial increase in BP) |
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adverse effects of methyldopa?
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sedation
decreased mental concentration depression and EP dry mouth orthostatic hypotension hepatotixicity positive Coombs, hemolytic anemia |
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drugs acting at sympathetic nerve endings?
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reserpine
guanethidine |
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mechanism of reserpine?
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decreased release of neurotransmitter
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mechanism of guanethidine?
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decreased release of neurotransmitter
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adverse effects of reserpine?
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sedation
depression |
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adverse effects of guanethidine?
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orthostatic hypotension
block uptake of some drugs (TCA) |
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adrenergic receptor blockers used for treatment of hypertension?
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prazosin
propranolol |
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prazosin?
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selective α1 blocker
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terazosin?
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selective α1 blocker
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doxazosin?
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selective α1 blocker
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adverse effects of selective α1 blockers?
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first dose phenomenon
dizziness headache |
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how is first dose phenomenon minimized?
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start with low dose at bedtime to prevent symptomatic orthostatic hypotension
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β blockers mechanism in lowering BP?
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decrease HR
decrease contractility decreased renal renin release |
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other properties of some β blockers?
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cardioselectivity
intrinsic sympathomimetic activity (partial agonist) membrane stabilizing activity (local anesthetic) differences in lipid solubility |
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elimination of β blockers?
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liver, kidney, or combination
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adverse effects of β blockers?
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may worsen heart failure
bradyarrhythmias bronchospasm prolong hypoglycemia in those taking insulin increased triglycerides, decreased HDL CNS effects (sedation, dreams) withdrawal |
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why experience β blocker withdrawal symptoms and what is recommended?
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increased receptor density
recommend gradual tapering |
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elimination of α blockers?
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mainly by liver
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α + β blockers?
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labetalol
carvedilol |
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labetalol?
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α + β blocker
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carvedilol?
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α + β blocker
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actions of α + β blockers?
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α1 selective; β nonselective
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side effect of labetalol?
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hepatotixicity
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therapeutic indication for carvedilol?
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heart failure in certain patients
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nebivolol?
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new β blocker
produces vasodilation |
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side effects of α + β blockers?
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α + β blockade
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vasodilators?
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hydralazine
minoxidil fenoldopam diazoxide |
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hydralazine?
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relax of arteriolar smooth muscle via NO release
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what drugs is hydralazine used with to minimize compensatory responses?
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β blockers
diuretic |
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hydralazine administration?
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oral
parenteral |
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therapeutic uses of hydralazine?
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antihypertensive
combination with organic nitrate in heart failure |
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hydralazine elimination?
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acetylation
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adverse effects of hydralazine?
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palpitations
angina headache drug-induced lupus fluid retention |
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hydralazine and slow acetylators?
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greater risk of developing drug-induced lupus
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minoxidil?
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highly efficacious arteriolar dilator (prodrug)c
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minoxidil mechanism?
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K channel opening activity resulting in hyperpolarization of smooth muscle cells (stabilizes membrane at resting potential and makes contraction less likely) --> relaxation
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minoxidil administration?
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oral
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adverse effects of minoxidil?
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palpitations
angina headache hypertrichosis pericardial effusion ECG changes (T wave flattening) |
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serious adverse effect of minoxidil?
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pericardial effusion
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hypertrichosis?
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increased hair growth
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fenoldopam?
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parenteral vasodilator for hypertensive emergencies
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fenoldopam mechanism?
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stimulation of D1 receptors causing vasodilation
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fenoldopam administration?
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continous IV as it is rapidly metabolized
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adverse effects of fenoldopam?
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headache
flushing increased HR increased intraocular pressure |
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contraindications for fenoldopam?
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glaucoma: may cause increased intraocular pressure
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diazoxide?
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parenteral arteriolar dilator for hypertensive emergencies
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diazoxide mechanism?
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opening of K channels
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diazoxide administration and duration?
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IV
4-12 hour duration |
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diazoxide elimination?
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hepatic metabolism and urinary excretion of unchanged drug
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adverse effects of diazoxide?
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excessive lowering of BP
reflex SNS stimulation fluid retention hyperglycemia |
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contraindications for diazoxide?
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ischemic heart disease: can provoke angina, electrocardiographic evidence of ischemia, and cardiac failure due to reflex SNS stimulation
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sodium nitroprusside?
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highly efficacious arterial and venous smooth muscle relaxation
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sodium nitroprusside mechanism?
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stimulation of guanylyl cyclase
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sodium nitroprusside pharmacokinetics?
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continuous IV infusion;
rapid onset and offset of action; photosensitive; breakdown to cyanide and thiocyanate |
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why can rapid onset and offset of sodium nitroprusside be beneficial?
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can be titrated to get to correct dosing
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adverse effects of sodium nitroprusside?
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hypotension
cyanide toxicity thiocyanate toxicity |
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captopril?
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ACEI
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lisinopril?
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ACEI
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ramipril?
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ACEI
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enalapril?
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ACEI
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enalaprilat?
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ACEI
active metabolite of enalapril |
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ACEI available for IV use?
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enalaprilat
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ACEI therapeutic mechanism?
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decreased AII resulting in vasoconstriction and reduced aldosterone;
decreased breakdown of vasodilator bradykinin |
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why is renin activity increased with ACEI?
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reflex to decreased BP
loss of feedback inhibition from angiotensin II |
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contraindications for ACEI?
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bilateral renal artery stenosis - may reduce GFR
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ACEI effect in chronic renal disease?
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decrease albuminuria
stabilize renal function (due to decreasing pathologically elevated capillary pressure) |
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adverse effects of ACEIs?
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hypotension
dry nonproductive cough angioedema hyperkalemia decreased renal function fetal toxicity, birth defects skin rash alteration in taste neutropenia |
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which diuretic most likely to see dry, nonproductive cough as a side effect?
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ACEI
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ending of ACEIs?
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-pril
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ending of ARBs?
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-sartan
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ARB mechanism?
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inhibits type 1 angiotensin II receptors
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adverse effects of ARBs?
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hypotension
hyperkalemia angioedema cough decreased kidney function fetal toxicity, birth defects |
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aliskiren?
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renin inhibitor
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aliskiren mechanism?
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inhibits renin resultingin decreased renin activity and angiotensin I and II levels
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adverse effects of aliskiren?
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diarrhea
angioedema cough hyperkalemia no use in pregnancy |
