04 hypertension

Question 1

what drug is a front line agent for both hypertension and benign prostate hypertrophy?

Answer 1

Prazosin

Question 2

Prazosin (Terazosin, Doxazosin, Tamsulosin, [-osin]

Answer 2

• selective alpha 1-receptor blocker
• does not produce reflex tachy cardia
• also for benign prostate hypertrophy
• postural hypotension

Question 3

phenoxybenzamine:

Answer 3

• irreversible alpha 1 receptor blocker, long acting
• reflex tachycardia effect, postural hypotension
• therapeutic value in pheochromocytoma, HT crisis
• postural hypotension

Question 4

Phentolamine

Answer 4

(non-selective alpha-receptor blocker)

• reflex tachycardia, not used for HT
• postural hypotension

Question 5

what are the alpha-adrenoceptor antagonists that can be used for hypertension and what is the main side effect

Answer 5

• Phenoxybenzamine (main use pheochromocytoma, HT crisis)
• Prazosin (also for benign prostate hypertrophy
• Phentolamine (Not really used for HT)
• Adverse effect: postural hypotension (all)

Question 6

which drug is a direct vasodilator?

Answer 6

hydralazine

Question 7

hydralazine:

Answer 7

Use: HT, HF,

• direct vasodilator, mainly arterioles, decr TPR can cause reflex tachycardia,
• SE: reflex increase SNS, flushing, palpitations, lupus

Question 8

if a patient has a lupus-type reaction

Answer 8

hydralazine, prokinemide(?)

Question 9

minoxidil

Answer 9

• ‘rogaine”
• opens K+ channels in smooth muscle
• stabilizing of membrane at it resting potential, contractionless likely
• dialtes arterioles but not veins, thus anti HT
• SE: reflex sympathetic stimulation (used with beta blocker)
• SE: fluid retention, hypertrichosis

Question 10

sodium nitroprusside

Answer 10

-vasodilator
-used for acute emergency (short time)hypertension and CHF
-used IV (cyanide toxicity via oral admin)
-activation of guanylyl cyclase (direct and/or via release of NO–> incr in cGMP–>dephosphor of myosin light chain
-dialtes both arterial and venous vessels
-decr venous return to the heart, reflex tachycardica
SE: reflex incr HR, sever HT, cyanide liberation–>cyanide toxicity

Question 11

cyanide toxicity is an adverse effect of what drug?

Answer 11

sodium nitroprusside

Question 12

Fenoldopam

Answer 12

• Dopamine agonist (D1A)
• acute HTN (emergency), renal failure
• one of the DOC for HT crisis

Question 13

what is/are the adverse effects of fenoldopam?

Answer 13

-increased HR, increase ocular pressure and decrease K+

Question 14

what drugs could be used for an acute hypertensive emergency?

Answer 14

Nitroprusside or Fenoldopam or diazoxide

Question 15

what drug opens K+ channels -stabilizing membrane potential?

Answer 15

Diazoxide and minoxidil (Rogaine)

Question 16

• used for acute hypertensive crisis
• opens K+-channels - stabilizes membrane potential
• dilates arteriolar vessels
  decrease TPR –> reflex incre HR –> incre CO
• inhibits insulin release (via opening K+-channels on beta cell membrane)
• similar structure as thiazides but no diuretic effect

Answer 16

Diazoxide

Question 17

vasodilators cause a decrease in TPR, this activates the reflex causing an increase in fluid retention negative the effect of the drug. Thus, vasodilators are often combined with_____ to decrease the sympathetic activity

Answer 17

beta blockers, or thiazides

Question 18

what drugs/classes are vasodilators?

Answer 18

Calcium channel blockers, hydralazine, minoxidil

Question 19

Clonidine

Answer 19

• centrally acting sympatholytic agent
• alpha 2 selective agonist
• hypertension, opioid withdrawal
• not frontline
• it decreases sympathetic outflow

Question 20

what is the preferred agent for HT in pregnancy?

Answer 20

alpha-methyldopa

-it decreases sympathetic outflow

Question 21

what are the adverse effects of clonidine and alpha-Methyldopa?

Answer 21

• dry mouth, drowsiness, lightheadedness, dizziness, impotence
• abrupt withdrawl effect (rebound HT, esp. clonidine)

Question 22

what two drugs are ganlionic blocking agents?

Answer 22

Trimethaphan and Mecamylamine

• they block ganglionic nicotinic receptors (SNS, PNS)
• first effective antihypertensive class
• currently not used for chronic HT
• DRUGS OF LAST RESORT

Question 23

Trimethaphan

Answer 23

• ganglionic-blocking agent
• i.v. injection, rapid, short half life
• hypertensive crisis (CNS mediated), controlled hypotension during surgery

Question 24

which ganglionic blocking agent is effective orally and which one is given by i.v.?

Answer 24

mecamylamine-oral

trimethaphan-i.v.

Question 25

which drug can be used during surgery for controlled hypotensive (which will reduce bleeding)?

Answer 25

timethaphan

Question 26

which drug inhibits uptake of NE into storage vesicles and leads to depletion of transmitter stores in the nerve terminal? Adverse effects?

Answer 26

Reserpine (antihyptensive agent) - agent of last resort - SE: severe sedation, metal depression, parkinsonism, increases gastric acid secretion

Question 27

which drug decreases the release of NE from nerve terminals causing a gradual depletion of NE stores? and what are its side effects?

Answer 27

Guanethidine (antihyptensive agent) - agent of last resort - adverse effects: marked postural hypotension, diarrhea, impaired ejaculation

Question 28

if a patient is diabetic, what drug for HT?

Answer 28

use an ACEI/ARBs/Aliskiren improve renal function

Question 29

what effect does smoking have on effectiveness of HT agents?

Answer 29

beta blockers are less effective with chain smokers

Question 30

what agents are less effective in blacks than whites?

Answer 30

beta-blockers and ACEI/ARBs

Question 31

what effect does age have on efficacy of agents?

Answer 31

beta-blockers and ACEI/ARB efficacy may decrease with age (>70 yrs)

Question 32

if someone is taking NSAIDS chronically, what effect can it have on what HT agents?

Answer 32

decrease the response to diuretics, ACEI, and beta-blockers

Question 33

which drugs are contraindicated in pregnancy?

Answer 33

ACEI/ARBs/Aliskerin | -also atenolol

Question 34

HT agents recommended during pregnancy:

Answer 34

main one: alpha-methyl dopa | -others include beta-blockers (not atenolol), prazosin, nifedipine, labetalol, hydralazine

Question 35

what class of agents typically have the adverse effect of postural hypotension (HT)?

Answer 35

alpha agonists

Question 36

to counter the reflex cardiac stimulation by vasodilators, what is typically taken in combination?

Answer 36

beta-blockers

Question 37

sympatholytics and vasodilators cause fluid retention, what can be taken in combination to counter this?

Answer 37

thiazides

Question 38

thiazides cause hypokalemia, what agents are used in combination to counter this?

Answer 38

ACEIs/ARBs/K-sparing agents

Question 39

which two drug classes should NOT be used in combination therapy?

Answer 39

Beta-blockers and ACE inhibitors

Question 40

if someone has HT and has had previous heart failure, what drug would you give them?

Answer 40

beta blocker

Question 41

if someone has HT and diabetes...give them

Answer 41

an ACE inhibitor or an ARB

Question 42

if someone has HT and has had a previous heart failure, what drug class should they avoid?

Answer 42

Calcium channel blockers

Question 43

which class of drugs can cause angioedema and glossitis

Answer 43

-ACEI