Vasodilators & Ace Inhibitors, Pharm Ii

Front 1

What are representative alpha-adrenergic antagonists?

Back 1

prazosin (Minipress), terazosin (Hytrin), doxazosin (Cardura)

Front 2

Selective blockade of alpha-1 receptors causes?

Back 2

reduced peripheral vascular resistance and causes venodilation

Front 3

Alpha-adrenergic antagonists are more effective when?

Back 3

used in combination with other antihypertensive agents (eg, beta-blockers, diuretics)

Front 4

What may occur if alpha-adrenergic antagonists are used without a diuretic?

Back 4

Na and water retention, because aldosterone secretion--Na reabsorption and water follows

Front 5

Adverse effects of alpha-adrenergic antagonists?2

Back 5

Headache and orthostatic hypotension

Front 6

Minoxidil or?

Back 6

Loniten

Front 7

Minoxidil

Back 7

direct relaxation of arteriolar smooth muscle causing vasodilatation; little effect on veins

Front 8

What is the active metabolite of Minoxidil and what does it do?

Back 8

minoxidil sulfate- opens potassium channels in vascular smooth muscle

Front 9

Uses of minoxidil

Back 9

Restricted to hypertension that is not manageable with maximum therapeutic doses of a diuretic in combination with two other antihypertensive drugs

Front 10

Adverse effects of minoxidil include? 2

Back 10

pericardial effusion(possibly progressing to tamponade) and exacerbation of angina pectoris

Front 11

Vasodilators are often used with?

Back 11

a beta-adrenergic antagonist and/or diuretic in the treatment of hypertension

Front 12

ACE inhibitors end in? Name 4 examples

Back 12

-pril
1. Captopril (Capoten)
2. Enalapril (Vasotec)
3. Lisinopril (Zestril)
4. Fosinopril (Monopril)

Front 13

Mechanism of action of ACE inhibitors

Back 13

inhibit angiotensin converting enzyme (ACE) a.k.a peptidyl-dipeptidase A, and thus the formation of angiotensin II from angiontensin I

Front 14

What else may contribute to the antihypertensive effect of ACE inhibitors?

Back 14

increased bradykinin activity

Front 15

ACE is also known as?

Back 15

kininase II and catalyzes bradykinin metabolism

Front 16

Cardiovascular effects of ACE inhibitors?

Back 16

1. Decreased PVR
2. HR and CO are not altered
2. No reflex sympathetic stimulation

Front 17

Uses of ACE inhibitors (4)

Back 17

1. Treatment of essential hypertension (even low-renin patients respond)
2. Treatment of diabetic nephropathy
3. CHF
4. MI - improved survival

Front 18

Why do ACE inhibitors help treat diabetic nephropathy?

Back 18

reduced proteinuria and stabilization of renal function independent of BP lowering effect

Front 19

Adverse effects of ACE inhibitors?

Back 19

1. Skin rash
2. Hyperkalemia may occur (decreased aldosterone)
3. Cough; angioedema
4. May cause acute renal failure in some patients, eg, with renal artery stenosis

Front 20

Angiotensin II receptor antagonists mechanism of action

Back 20

1. Selective antagonism of angiotensin II receptors
2. No effect on bradykinin metabolism

Front 21

Angiotensin II receptor antagonists end in? Name examples (6)

Back 21

-artan
1. Losartan (Cozaar)
2. Valsartan (Diovan)
3. Irbesartan (Avapro)
4. Candesartan (Atacand)
5. Telmisartan (Micardis)
6. Eprosartan (Teveten)

Front 22

What are other drugs used for chronic mangament of hypertension?

Back 22

1. Diuretics
2. Calcium channel blockers (particularly sustained-release formulations)
3. Beta-adrenergic antagonists

Front 23

It is important to keep in mind, if the patient is continuing their antihypertensive drug therapy they may have?

Back 23

Blunted SNS activity -- exaggerated blood pressure drop may therefore occur in response to blood loss, change in body position, or decreased venous return due to positive pressure ventilation

Front 24

Patients treated with ACE inhibitors, may have increased propensity for?

Back 24

intraoperative hypotension; moreover, the hypotension can be refractory to sympathomimetic agents such as phenylephrine and ephedrine

Front 25

Abrupt withdrawal from clonidine may?

Back 25

precipitate severe rebound hypertension

Front 26

Abrupt withdrawal of beta-adrenergic antagonists may precipitate?

Back 26

beta-receptor hyperresponisveness

Front 27

Antihypertensive agents that deplete NE may decrease the response to?

Back 27

predominantly indirect-acting sympathomimetics (eg, ephedrine)

Front 28

Antihypertensive agents that deplete the NE may increase the response to?

Back 28

direct-acting sympathomimetics (eg, phenylephrine)

Front 29

ACE inhibitors may blunt the response to?

Back 29

sympathomimetic agents

Front 30

Sedation associated with some antihypertensive agents may?

Back 30

reduce anesthetic requirements (methyldopa, clonidine, reserpine)