Pharm 1 - Anti-Hypertensive Drugs (Sympatholytics - Nierenberg)

Front 1

Clonidine

Back 1

AntiHTN and adjuct to rx of opioid withdrawal.
Proph. of migraine.

Stimulates alpha2 in brainstem to down-reg NE output

Front 2

Clonidine
Pharmacokinetics

Back 2

F=85%
Also avail as cutaneous patch

Front 3

Clonidine
Toxicity

Back 3

Gradually withdraw.
Bradycardia, lethargy, depression, allergy to sulfa antibiotics, K, Mg, Na, Cl depletion, metabolic alkalosis, volume depletion, worsens hyperuricemia.

Front 4

Clonidine
Special consid

Back 4

Avoid in pregnany and pts with renal insuff.

Front 5

Trimethaphan

Back 5

Brief use as IV infusion.
Ganglionic blocker (nicotinic) - parasymp and symp blockade to produce vaso and venodilation.

Front 6

Trimethaphan
Pharmacokinetics

Back 6

Partly metab and partly excreted by kidneys.
Only IV available.

Front 7

Trimethaphan
Toxicity

Back 7

Sudden drop in BP and any other symp and parasymp response.

Front 8

Trimethaphan
Special considerations

Back 8

NSAIDs make it less effective, hyperkalemia with KCl

Helps to tilt pt to control BP (body can't compensate to increase preload with standing or tilted)

Used during general anes.

Front 9

Reserpine

Back 9

Prevents uptake of NE or serotonin to deplete the neuron of these two.

Front 10

Reserpine
Pharmacokinetics

Back 10

Good oral bioavail - effects take 2-3 weeks to develop.

Front 11

Reserpine
Special consid

Back 11

Dizziness, orthostatic hypotension, depression.

Front 12

Atenolol - better than other beta blockers because...

Back 12

Long half life (take it once a day), cheap, relatively selective to beta1.

Front 13

Atenolol

Back 13

Beta1 blocker
AntiHTN, antiarrythmic, antianginal, primary and secondary prev of MI, mild/moderate CHF (BUT NOT SEVERE CHF!!!).

Results in less contractility, HR, renin release from JGA.

Front 14

Atenolol
pharmacokinetics

Back 14

po or iv
renally excreted.

Front 15

Atenolol
toxicity

Back 15

heart block can worsen severe CHF, can worsen bronchospasm in asthmatics.

Front 16

Atenolol
Special consid

Back 16

V. useful in pts with HTN and exertional angina, MI, afib.

Be careful of abrupt withdrawal!

Front 17

Propanolol

Back 17

Short acting. Non-selective (beta1 and 2)

Front 18

Metoprolol

Back 18

Short acting. Somewhat beta1 selective.

Front 19

Beta blockers first line?

Back 19

Only if pt has HTN and angina/MI/arryth/risk factors for MI.

This is bc it doesn't protect against stroke all that well.

Front 20

Prazosin

Back 20

Alpha-1 blocker. Tx of HTN, BPH and Raynaud's syndrome.

Inhibits NE-mediated vaso and venoconstriction

Assists with BPH bc NE mediates contraction of the bladder sphincter.

Front 21

Prazosin
Pharmacokinetics

Back 21

F=60%
po or transdermal.
Metab in liver

Front 22

Prazosin
toxicity

Back 22

excessive hypotension with passing out (especially in pts on diuretics)

Front 23

Prazosin
special consid

Back 23

start gradually at bedtime to avoid passing out.

reflex tachycardia often occurs.

Front 24

Labetolol

Back 24

Alpha and beta receptor blocker
Lowers BP

Front 25

Labetolol
pharmacokinetics

Back 25

F=25%
iv available
metab in liver

Front 26

Labetolol
toxicity

Back 26

avoid is pts with bradycardia, asthma, shock, cardiomyopathy, pheochromocytoma, pregnancy

Front 27

Labetolol
special consid

Back 27

Reduced dose in pts with impaired liver func,
dizziness
most often used for HTN crisis (as with nitroprusside)

Front 28

Carvedilol

Back 28

Also blocks alpha1 and beta receptors

Front 29

Contraind with asthma...

Back 29

beta blockers

Front 30

Contraind with gout...

Back 30

diuretics

Front 31

Contraind in pregnancy

Back 31

Many, but especially ACEinh and ARBs

Front 32

Good with angina...

Back 32

beta (exertional) and calcium blockers (variant/prinzmetals)

Front 33

good with diabetes

Back 33

ACEinh and ARBs