Drugs for HTN

Question 1

Primary (essential) HTN is most common. What are the 3 subtypes?

Answer 1

Low renin - 25% most commonly in AAs and elderly

Normal renin - 60%

High renin - 15%

Question 2

What are the a-receptor blockers used first in HTN?

What is the problem with them?

Answer 2

Phentolamine and Phenoxybenzamine

Short half-lives and hypotension (ortho also), tachy and arrhythmias.
Nasal stiffness.
N/V/D.

Question 3

MOA of Prazosin

S/E

Answer 3

Antagonize a1-Rs

Orthostatic hypotension
Retrograde ejaculation

Question 4

Clonidine MOA

S/E

Answer 4

Binds a1 R and reduce SNS outflow which lowers BP

Rebound HTN (if dose missed), drowsiness, xerostomia

Question 5

a-methyldopa MOA

Drug of choice for:

S/E

Answer 5

Selectively agonize a2-Rs

Gestational HTN

Pos. Coombs test
SLE-like syndrome

Question 6

Propanolol MOA

S/E

Answer 6

Non-selective beta blocker (b1 and b2 Rs)

Bronchospasm, cold extremities, bradycardia, hyperglycemia, etc.

Question 7

Why aren’t BBs given in vascular disease?

Answer 7

Because they cause cold extremities in peripheral vascular disease

Question 8

Atenolol MOA

Answer 8

Selective b1 blocker

Question 9

Which BB has the highest selectivity for b1?

Answer 9

Bisoprolol

Question 10

Metoprolol MOA

Half-life is less than:

Toxicities where?

Answer 10

b1 selective blocker

Less than atenolol

CNS

Question 11

What happens if a2-agonists or BB is stopped abruptly?

Answer 11

Excessive carciac stimulation (loss of BB), which leads to tachy, HTN, angina, arrhythmias.

Released CNS brakes (a2 agonist).

Both lead to REBOUND HTN and death.

Question 12

BB used to be _____, but now are _____.

Answer 12

First choice tx, but now are given much less for HTN use

Question 13

In RAS inhibition, what happens to GFR in the kidney and creatinine levels?

Is it concerning?

Protective action for patients with:

Answer 13

GFR falls due to ACE inhibition which causes an increase in creatinine.

Can be alarming to docs, but not a concern unless there is hyperkalemia.

DM

Question 14

Captopril MOA

Toxicities:

Answer 14

ACE-inhibitor

Cough and *angioedema

Question 15

What ACE-I is a prodrug?

What is the route of administration?

Answer 15

Enalapril

IV

Question 16

Benazepril and Lisinopril are ACE-Is with what kind of half-life?

Answer 16

Longer half-lives which permit 1x daily use

Question 17

Losartan MOA

Answer 17

Non-peptide AT II receptor anatgonist

Question 18

Which AT II is not a prodrug?

Which one binds irreversibly?

Answer 18

Valsartan

Candesartan

Question 19

Aliskiren MOA

Why is it not given much?

Answer 19

Direct inhibitor of renin

New, expensive, no obvious benefits, adverse effects, etc.

Question 20

Majot toxicity of ACE-I is seen in:

Answer 20

Pregnant women

Question 21

Hydralazine MOA

When is it given?

Major well-known toxicity?

Answer 21

Direct VD of arterioles

HTN emergency in pregnancy

Drug-induced lupus-like syndrome

Question 22

Nitroprusside MOA

Half-life?

When is it given?

Answer 22

Direct VD of vv. and aa.

Very short

HTN crisis

Question 23

Minoxidil MOA

It is considered the…

Answer 23

VD of arteriole SM

Best VD for arterioles

Question 24

When are BBs indicated for HTN?

Answer 24

In pts. with HTN and stable IHD

Question 25

Drug of choice in pts. with HTN and CKD?

Answer 25

ACE-inhibitor (class IIa)