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27 Cards in this Set
- Front
- Back
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Dihydropyridines (Amlodipine and Nifedipine)
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Block Ca in vascular peripheral arterioles: Decrease PVR
Do not affect nodal conduction *Good for angina |
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Verapamil Contraindication
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LV Dysfunction- can cause heart failure in patients with low cardiac reserve
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CCB Side Effects
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Hypotension
Cardiac depression Headache Flushing Constipation *Nifedipine: Tachycardia and Edema |
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CCB Drug Interactions
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Verapamil/Diltiazem and B Blocker: Marked bradycardia and conduction blockade
Verapamil/Diltiazem and Digoxin: conduction blockade Amlodipine and ACE-I reduced CV events- good combo! |
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CCB Indications
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Low renin hypertension (AA and elderly)
Isolated systolic hypertension (elderly) |
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B Blocker MOA- Heart, Vessels, Kidney
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Heart: Prevent NE from binding receptor and increasing cAMP so ultimately Ca can't come in and myosin can't form crossbridges
Vessels: cAMP has opposite effects leading to dilation so the blockade actually vasoconstricts Kidney: Blocks receptor leading to decreased renin production |
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Propranolol
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Nonselective antagonist of B1 and B2
SEs: Bronchial constriction, acute withdrawl syndrome, increased lipids, glucose intolerance *Caution in patients with diabetes or hyperlipidemia |
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B Blocker Indications
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Mild and moderate hypertension
Patients on vasodilators to prevent reflex tachycardia Patients with underlying heart disease (CHF, Ischemia, MI) |
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ACE-I
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Inhibits the formation of AngII so there is no Aldo activation and Na retention, vasodilation of vessels and blocked Bradykinin degradation
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ACE-Is
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Enalapril- renal excretion
Ramipril- Quick Lisinopril- give once daily Captopril- taste changes |
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ACE-I SEs and CIs
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SEs: Hypotension, hyperkalemia, angioedema (AA) due to bradykinin, cough, rash, taste change
CIs: K sparing diuretics, many AAs, Pregnancy (slows cell prolif.) |
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ARB: Losartan
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AT1 receptor: vasoconstriction, SNS activation, Na/H2O retention, cell proliferation
SEs: some angioedema, dizziness CI: pregnancy |
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ACE/ARB Indications
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Heart failure, renal disease, *diabetes
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A-1 Blockers: -zosins
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Peripheral A1 blockers
Bind NE released from nerve terminals Decrease vascular tone and PVR Prazosin- SEs of dizziness, HA, drowsiness, first dose phenom. of orthostatic htn Doxazosin and Terazosin- Longer T1/2 and used for BPH due to relaxing of vascular SM |
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Guanethidine
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Enters nerve terminals via NE transporter and depletes NE stores in vessicles
Acts as a false NT |
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Reserpine
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Blocks transport of dopamine into storage granules
Acts centrally and peripherally |
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SEs of Guanethidine and Reserpine
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Orthostatic hypotension, depression, congestion, bradycardia, impotence, diarrhea, salt and water retention
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Guanethidine and Reserpine Drug Interactions
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Drugs that alter the amine pump: MOAIs, Tricyclic antidepressants, Ephedrine, Amphetamines, Phenothiazines
*These agents could also cause htn after chronic use of guanethidine due to receptor hypersensitivity **Both are LAST RESORT drugs for refractory htn |
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Central A2 Agonists
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A2 acts to stimulate PNS and decrease SNS
Agonists are methyldopa and clonidine Peripheral a2 cause vasoconstriction (give high IV dose to get this effect) |
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Clonidine
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Central A2 agonist
Transdermal patch administration SEs: dry mouth, drowsiness, dizziness Useful in diagnosis of pheochromocytoma (<500pg/ml if tumor free) Tricyclic antidepressants can reverse its anti-htn effects |
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Methyldopa
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SEs: Sedation, dry mouth, dizziness, sodium retention, orthostatic htn, and hemolytic anemia (if long use)
First choice for htn of pregancy |
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Clonidine and Methyldopa Drug Interactions
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Tricyclic antidepressants prevent the anti-htn effect
Barbiturates reduce efficacy through hepatic enzyme induction MOAIs when co-administered produce htn and CNS stimulation |
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Hydralazine
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Vasodilator
Direct action on arterioles via Ca Stored in arterial wall so prolonged action SEs: Reflex tach, Na/H20 retention, headache, nausea, dizziness, Lupus syndrome |
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Minoxidil
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Vasodilator
Activates K channels: hyperpolarizes and relaxes cell Must be metabolized by liver into active form SEs: is hydralazine w/o lupus syndrome, hypertrichosis *treats severe htn and must be given with sympatholytic and diuretic |
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Sodium Nitroprusside
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For Htn Crisis
NO dilates vascular SM Given IV- effects stop when IV stops Toxic metabolite cleared by kidneys SEs: rebound htn, tolerance |
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Diazoxide
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Vasodilator of arterial muscle only, no effect on venous system
Activates K channels |
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Labetalol/Carvedilol
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Mix of A/B receptor antagonists
Labetolol 1:3 selectivity A:B Carvedilol 1:10 selectivity A:B *Decrease TPR without reflex tach Useful for pts with pheochromocytoma |
