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Flashcards in Anti-HTN Drugs Deck (15):
1

Diuretics
-MOA
-Types
-SE

MOA: inhibit Na reabsorption -->natriuresis and diuresis. May also have direct vasodilatory effect

Types: thiazides (e.g. hydrochlorothiazide), loop diuretics (e.g. furosemide), K+ sparing (e.g. spironolactone)

SE: hypokalemia

2

3 actions of ATII

Aldosterone secretion
NaCl reabsorption
Vasoconstriction

3

RAS schematic

B1-->renin cleaves angiotensinogen-->ATI

In lung: ATI-->ATII via ACE, which also inactivates bradykinin

ATII causes:
-aldosterone secretion
-vasoconstriction
-NaCl reabs.

4

ACE inhibitors
-prototype
-actions
-use in diabetics?
-SE

Prototype: captoPRIL

Actions: inhibit vasoconstriction/aldosterone secretion/NaCl reabs, inc vasodilation via bradykinin build-up

Diabetics: may delay diabetic nephropathy in addition to lowering BP

SE: dry cough (bradykinin), hyperkalemia (dec. aldosterone), renal dysfunction (e.g. in renal artery stenosis ATII is important in maintaining GFR), angioedema (rare)

5

Angiotensin Receptor Blocker
-prototype
-actions

Prototype: LoSARTAN

Actions: same as ACEi, except no bradykinin build-up (no cough, but less vasodilation)

6

Renin Inhibitors
-prototype
-actions

Prototype: AliskiREN

Actions: same as ARBs

7

Calcium channel blockers
-general actions

Actions: targets L-type channel in cardiac myocytes and vascular smooth muscle, decreases Ca influx and therefore the force of contraction.

8

Types of CCBs
-differences
-SE

1) Dihydropyridines (e.g. nifedIPINE) acts more on the vasculature. SE include reflex tachycardia from low BP (exacerbates arrhythmias)

2) Non-dihydropyridines act on the heart more. SE include cardiodepression
-Benzothiazepines (e.g dilTIAZem)
-Phenylalkylamines (e.g. verapAMIL)

9

Beta antagonists
-subtypes

Cardioselective (B1): MetoproLOL

Non-cardioselective: propranoLOL (B1,B2), carvediLOL(B1,B2,A1)

Partial agonists: acebutoLOL (B1)

10

Beta antagonists
-actions
-SE

Actions:

Decrease HR, contractility
Decrease renin secretion
Decrease SNS activity

SE: Bronchoconstriction in non-selective (therefore contraindicated in asthma) and fatigue due to reduced CO

11

Alpha-1 antagonists
-prototype
-actions
-SE

Prototype: praZOSIN
Actions: vasodilatory and venodilatory
SE: orthostatic hypotension

12

Vasodilators
-prototype
-actions
-frequency of use

Prototype: hydralazine
Actions: decrease SVR
Use: rarely used

13

CNS (central) agents
-prototype
-mechanism
-actions

Prototype: A2 agonists (Clonidine)
Mechanism: feedback inhibition of NE release
Actions: dec. HR, SV and TPR

14

Why use combination therapy?

Because the body has compensatory mechanisms that we need to counteract

15

Aldosterone antagonists
-prototype
-AKA

Prototype: spironolactone

AKA K+ sparing diuretics