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Flashcards in Anti-hypertensives Deck (116)
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1

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)

4

DOC to treat anti hypertension in pregnancy

Clonidine; also doesn't cause a change in lipids

5

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

6

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

7

Reserpine Toxicities

Toxicities: sedation & depression
Disadvantages/Contraindicated: depression

8

Guanethidine toxicities & disadvantages/contraindications

Toxicities:
1. Orthostatic Hypotention
2. Fluid retention
Disadvantages/Contraindicated: CHF

9

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

10

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

11

Alpha 1 blockers used to treat HTN

1. prazosin
2. terazosin
3. doxazosin

12

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

13

Beta Blockers used to treat Hypertension

1. metoprolol
2. atenolol
3. carvedilol (blocks B1 & alpha receptors)

14

Drugs used to treat HTN that work by decreasing CO

1. beta blockers
2. calcium-channel blockers (work by decreasing HR & FOC)

15

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)

16

Antihypertensives that work at the vasomotor center

1. methyldopa
2. clonidine
3. guanabenz
4. guanfacine

17

Antihypertensives that work at sympathetic ganglia

Trimethaphan

18

Antihypertensives that work at sympathetic nerve terminals

1. guanethidine
2. guanadrel
3. reserpine (not used bc it depletes MO-->depression)

19

Antihypertensives that work at beta receptors of heart

beta blockers ie propranolol

20

Antihypertensives that work at angiotensin receptors of vessels

1. losartan
2. other angiotensin receptor blockers

21

Antihypertensives that work at alpha receptors of vessels

1. prazosin
2. and other alpha 1 blockers

22

Antihypertensives that work at vascular smooth muscle

1. hydralazine
2. minoxidil
3. nitroprusside
4. diazoxide
5. verapamil & other CCB
6. Fenoldopam

23

Antihypertensives that work at kidney tubules

1. thiazides, etc

24

Antihypertensives that work at beta receptors of juxtaglomerular cells that release RENIN

Propranolol & other beta blockers

25

Angiotensinogen is converted to angiotensin 1 by _____ which is inhibited by _______

1. renin
2. alskiren

26

angiotensin 1 is converted to angiotensin II by _________ which is inhibited by ___________

1. Angiotensin-converting enzyme (ACE)
2. Captopril & other ACE inhibitors

27

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!

28

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

29

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

30

MOA for beta blockers as anti-HTN drugs

1. decrease in CO by blocking cardiac Beta 1 receptors
2. inhibition of renin release by blocking beta 1 receptors on JG cells