Flashcards in Anti-hypertensives Deck (116)
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Clonidine
centrally acting alpha 2 agonist
MOA: activate alpha 2 receptor-->decrease central sympathetic outflow-->decrease NE release
Effect:-->decrease TPR
Uses:
1. HTN
2. Clonidine used in withdrawal from abused drugs
Advantages of using:
1. No change in lipids
2. used in nicotine dependence
2
Clonidine Toxicities
1. dry mouth
2. sedation
3. rebound HTN
3
Methyldopa Toxicities
1. positive Coombs test (hemolytic anemia)
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DOC to treat anti hypertension in pregnancy
Clonidine; also doesn't cause a change in lipids
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Methyldopa
centrally acting alpha 2 agonist
MOA: activate alpha 2 receptor-->decrease central sympathetic outflow-->decrease NE release
Effect:-->decrease TPR
Uses:
1. HTN in pregnancy--DOC
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Reserpine
MOA; Effects & Uses
Sympathetic nerve terminal blocker
MOA: blocks vesicular uptake & depletes transmiter stores
Hemodynamic effects: Decrease TPR & CO
Uses: rarely used to treat HTN
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Reserpine Toxicities
Toxicities: sedation & depression
Disadvantages/Contraindicated: depression
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Guanethidine toxicities & disadvantages/contraindications
Toxicities:
1. Orthostatic Hypotention
2. Fluid retention
Disadvantages/Contraindicated: CHF
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Guanethidine MOA, Effects & Uses
Sympathetic nerve terminal blocker
MOA: interferes with amine release & replaces NE in vesicles
Hemodynamic effects: Decrease TPR & CO
Uses: rarely used to treat HTN
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Use of Alpha 1 blockers to treat Hypertension
MOA:
1. selectively block alpha1A receptors
2. reduce prostatic SM tone
Hemodynamic effects: Decrease TPR
Uses: 1. HTN 2. BPH
Toxicities: orthostatic hypertension
Disadvantages/contraindications: none
Advantages: Decreases VLDL & LDL
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Alpha 1 blockers used to treat HTN
1. prazosin
2. terazosin
3. doxazosin
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Use of Beta blockers to treat Hypertension
MOA:
1. Block B1 receptors
2. decrease renin secretion
Hemodynamic effects--> Decrease CO
Clinical Uses: 1. HTN 2. HF
Toxicities/interactions: Bronchoconstriction
Contraindication:
1. Bronchial asthma
2. Heart Block
Advantages: Prolong survival
***labetalol is DOC in pregnancy
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Beta Blockers used to treat Hypertension
1. metoprolol
2. atenolol
3. carvedilol (blocks B1 & alpha receptors)
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Drugs used to treat HTN that work by decreasing CO
1. beta blockers
2. calcium-channel blockers (work by decreasing HR & FOC)
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Vasodilators used to treat HTN that work by decreasing systemic vascular resistance
1. alpha blockers
2. direct-acting vasodilators
3. Angtiotensin-converting enzyme inhibitors (ACE inhibitors)
4. angiotensin receptor blockers (ARBs)
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Antihypertensives that work at the vasomotor center
1. methyldopa
2. clonidine
3. guanabenz
4. guanfacine
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Antihypertensives that work at sympathetic ganglia
Trimethaphan
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Antihypertensives that work at sympathetic nerve terminals
1. guanethidine
2. guanadrel
3. reserpine (not used bc it depletes MO-->depression)
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Antihypertensives that work at beta receptors of heart
beta blockers ie propranolol
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Antihypertensives that work at angiotensin receptors of vessels
1. losartan
2. other angiotensin receptor blockers
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Antihypertensives that work at alpha receptors of vessels
1. prazosin
2. and other alpha 1 blockers
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Antihypertensives that work at vascular smooth muscle
1. hydralazine
2. minoxidil
3. nitroprusside
4. diazoxide
5. verapamil & other CCB
6. Fenoldopam
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Antihypertensives that work at kidney tubules
1. thiazides, etc
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Antihypertensives that work at beta receptors of juxtaglomerular cells that release RENIN
Propranolol & other beta blockers
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Angiotensinogen is converted to angiotensin 1 by _____ which is inhibited by _______
1. renin
2. alskiren
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angiotensin 1 is converted to angiotensin II by _________ which is inhibited by ___________
1. Angiotensin-converting enzyme (ACE)
2. Captopril & other ACE inhibitors
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How do diuretics treat HTN?
1. they reduce venous pressure & CO by reducing blood volume
2. HOW? They act on the kidney to enhance Na & water excretion
3. Reducing blood volume not only reduces central venous pressure, but also CO!
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What group of diuretics are preferred for HTN? WHY? Ex?
Thiazides, bc maximum antihypertensive action is at LOWER doses than the diuretic dose!
Ex) hydrochlorothiazide
Added BONUS: they reduce SVR with long-term use
Loss of Na-->decreased vessel stiffness-->decreased TPR
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Toxicity of Thiazides
1. hypokalemia
2. decrease glucose tolerance and may unmask latent DM
3. increase plasma LDL, cholesterol & triglycerides (TG)
4. increase plasma uric acid & may precipitate acute gout
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