Pharm Drugs Used In Hypertension

Front 1

Question: A 32 year-old woman with hypertension wishes to become pregnant. Her physician informs her that she will have to switch to another antihypertensive drug. What drug is absolutely contraindicated in pregnancy?

Back 1

Ace inhibitors, such as captopril.

Also, angiotension receptor blockers, such as losartan

Front 2

Question: A PT is admitted to the emergency department with severe bradycardia after a drug overdose. His family reports that he has been depressed about his hypertension. What drug slows the heart rate in a dose-dependent manner?

Back 2

Verapamil and diltiazem.

Dihydropyridine CCB may increase HR, such as nifedipine

Front 3

Question: In comparing clonidine and prazosin, what is correct?

Back 3

Prazosin causes fewer CNS adverse effects (such as sedation) than clonidine.

Prazosin is relatively free of CNS effects. Clonidine is associated with sedation.

Front 4

Question: What is a characteristic of captopril treatment in PTs with essential hypertension?

Back 4

Decreases angiotensin II concentration in the blood.

Also, increase blood K and urine Na.

Front 5

Question: A pregnant PT is admitted to the hematology service with moderately severe hemolytic anemia. After a thorough workup, the only positive finding is a history of treatment with an antihypertensive drug since 2 months after beginning the pregnancy. The most likely cause of the PT's blood disorder is?

Back 5

Methyldopa.

Note: It is used in some obstetric practices because of its history of relative safety.

Front 6

Question: Postural hypotension is a common adverse effect of which one of the following types of drugs?

Back 6

Alpha-receptor blockers (prazosin, doxazosin, terazosin)

Front 7

Question: SE of the following drugs:

Methyldopa

Minoxidil

Verapamil

Thiazide diuretics

Back 7

Positive Coomb's test

Hirsutism

Bradycardia

Hyperglycemia, hyperuricemia, and hyperlipidemia

Front 8

Question: A significant number of PTs started on ACE inhibitor therapy for hypertension are intolerant and must bet switched to a different class of drug. What is the most common cause of this intolerance?

Back 8

Incessant cough.

Note: may be relieved by aspirin.

Front 9

Comparison of doxazosin with metoprolol shows?

Back 9

Both increase sympathetic outflow from the CNS. By reducing BP, both my cause a compensatory response to increase central sympathetic outflow.


Metoprolol: may decrease heart rate.

Doxazosin: may increase cardiac output.

Front 10

Question: Diltiazem and verapamil are associated with what?

Back 10

Increased PR interval. They also cause decrease contractility of heart, decrease heart rate and atrioventricular condution; therefore, bradycardia and increased PR interval.

CCB: associated with constipation.
Dihydropyridines: do not often cause cardiac depression, probably because they evoke increased sympathetic outflow from their dominant vascular effects.

Front 11

Question: What drug is sued in severe hypertensive emergencies, is short-acting, acts on a G-protein coupled receptor, and must be given by IV fusion?

Back 11

Fenoldopam.

Note: nitroprusside is also used for IV infusion, but releases NO

Front 12

Question: What drug is very short-acting and acts by releasing NO?

Back 12

Nitroprusside

Hydralazine also releases NO, but the duration is of hours whereas nitroprusside acts for seconds to minutes.

Front 13

What is orthostatic hypotension?

Back 13

Hypotension on assuming upright posture; postural hypotension.

Front 14

What is reset in primary hypertension?

Back 14

Baroreceptor reflex and renin response; therefore, maintains higher BP.

Front 15

What are the diuretics most important for treating hypertension?

Back 15

Thiazides (hydrochlorothiazide) and loop diuretics (furosemide)

Front 16

What are two alpha2 agonist?

Back 16

Clonidine and methylodopa.

Note: Presynaptic a2 receptors inhibit the release of noradrenaline and thus serve as an important receptor in the negative feedback control of noradrenaline release. Postsynaptic a2 receptors are located on liver cells, platelets, and the smooth muscle of blood vessels. Activation of these receptors causes platelet aggregation, and blood vessel constriction.

Front 17

Both clonidine and methyldopa both work to reduce BP by?

What are their major compensatory response?

Back 17

Reducing cardiac output, vascular resistance.

Salt rentention

Front 18

Sudden discontinuation of clonidine can cause?

Back 18

Rebound hypertension

Front 19

Complication from methyldopa?

Back 19

Positive Coomb's test, induction of hemolytic ABs. Sedation.

Front 20

What are nicotinic blockers, or ganglion-blocking drugs?

Back 20

Hexamethonium and trimethaphan.

Note: Nicotonic receptor is preganglioniic for both sympathetic and parasympathetic. Muscarinic receptor is postganglionic parasympathetic. Acetycholine works on both receptors.

Front 21

What are the SE of nicotinic blockers, or ganglion-blocking drugs?

Back 21

Parasympathetic blockade: blurred vision, constipation, urinary hesitancy, sexual dysfunction.

Sympathetic blockade: sexual dysfunction, orthostatic hypotension.

Front 22

What are two postganglionic sympathetic nerve terminal blockers?

Back 22

Reserpine and guanethidine.

Reserpine depletes the adrenergic nerve terminal of NOR

Guanethidine deplete and block release of the stores of NOR

Front 23

How often are reserpine and guanethidine used? SE?

Back 23

Reserpine: occasionally
SE: behavioral depression.

Guanethidine: withdrawn
SE: orthostatic hypotension

Front 24

What drug use to be prescribed for hypertension due it its ability to form a false-transmitter (octopamine) in sympathetic postganglionic neuron terminals and lower BP?

Why was it stopped?

Back 24

MAOIs (tranylcypromine, phenelzine, isocarboxazid).

Indirect-acting sympathomimetics (tyramine in fermented foods) can cause release of large amounts of NOR (with octopamine) and result in hypertensive crisis.

Front 25

What are three alpha1 blocks? And it SE.

Back 25

Prazosin, doxazosin, terazosin. Suffix: -azosin.

First-dose syncope: orthostatic hypotension on first dose with possible syncope.

Note: responsible for contraction and are situated on vascular and on non-vascular smooth muscle.

Front 26

What drug is used heavily for hypertension? And its SE

Back 26

Beta blockers: propranolol, atenolol, metoprolol, and carvedilol.

Bronchospasm in asthmatics; excessive cardiac depression

Front 27

Just good to know

Back 27

In insulin-dependent diabetics, beta-blockers can prolong, enhance, or alter the symptoms of hypoglycemia, while hyperglycemia appears to be the major risk in noninsulin-dependent diabetics.

Front 28

What are the four MOA that vasodilators can use?

Back 28

Release of NO, opening of K channels (hyperpolarization), blockade of Ca channels; activation of D1 receptors.

Front 29

What are two vasodilators that have an effect on arterioles and not veins?

Back 29

Hydralazine and minoxidil.

Front 30

What is hydralazine MOA and its SE?

Back 30

Release NO from endothelial cells.

Reflex tachycardia, drug-induced lupus, fluid retention

Front 31

What is minoxidil MOA and its SE?

Back 31

It opens K channels and relaxes smooth muscle cells. It is used for severe hypertension.

Marked tachycardia, and hirsutism.

Note: hirsutism is so prevalent, that minoxidil's trade name is Rogaine!!!

Front 32

What two CCB that are used for hypertension are class IV antiarrhythmic?

SE?

Back 32

Verapamil and diltiazem.

In addition to be used for hypertension, these vasodilators can also reduce cardiac output.

Excessive cardiac depression; constipation

Front 33

What are some other CCB?

Back 33

Dihydropyridine analogs: nifedipine, amlodipine.

Suffix: -dipine

Front 34

What are three parenteral vasodilators used in hypertensive emergencies?

Back 34

Nitroprusside, Diazoxide, and fenoldopam

Front 35

What is nitroprusside MOA? SE?

Back 35

Release of NO.

It then stimulates guanylyl cyclase and increase cGMP concentration in smooth muscles.

Excessive hypotension, thiocyanate and cyanide toxicity.

Front 36

What is diazoxide MOA? SE?

Back 36

Opens K channels thus hyperpolarizing and relaxing smooth muscles.

Hypotension and hyperglycemia (reduces insulin release)

Front 37

What is fenoldopam MOA and SE?

Back 37

Dopamine D1 receptor activation that causes prompt, marked arteriolar vasodilation.

Excessive hypotension.

Front 38

What is the MOA of ACE inhibitors? Its use and SE.

Back 38

Captopril, enalapril. Suffix: -opril.

Reduction in angiotension II and an increase in the vasodilators of the kinin family (bradykinin).

Used for CHF and hypertension.

Cough, hyperkalemia, teratogen.

Front 39

What are some angiotensin receptor blockers? SE

Back 39

Losartan. Also, valsartan, irbesartan, candesartan. Suffix: -sartan.

Although they are less likely to to cause cough as compared to ACE inhibitors, they do cause hyperkalemia and are a teratogen like ACE inhibitors.

Front 40

What is a renin antagonist? SE?

Back 40

Aliskiren.

Angioedema, renal impairment.

Front 41

What is the MOA of ACE inhibitors? Its use and SE.

Back 41

Captopril, enalapril. Suffix: -opril.

Reduction in angiotension II and an increase in the vasodilators of the kinin family (bradykinin).

Used for CHF and hypertension.

Cough, hyperkalemia, teratogen.

Front 42

What are some angiotensin receptor blockers? SE

Back 42

Losartan. Also, valsartan, irbesartan, candesartan. Suffix: -sartan.

Although they are less likely to to cause cough as compared to ACE inhibitors, they do cause hyperkalemia and are a teratogen like ACE inhibitors.

Front 43

What is a renin antagonist? SE?

Back 43

Aliskiren.

Angioedema, renal impairment.