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Flashcards in Antihypertensive Agents Deck (32):
1

preferred drug classes for antihypertensive action

diuretics
ACE inhibitors
calcium blockers
beta blockers

2

thiazides: hydrochlorothiazide, metolazone

frontline diuretics for chronic HT.
acts on distal tubule, inhibits water/sodium reabsorption, decrease BP and blood volume.
effective, cheap, no tolerance, and combine well with other drugs.

3

thiazide adverse effects

hypokalemia, hypercalcemia
increased uric acid - gout.
hyperglycemia/glucose intolerance (diabetic caution).
photosensitivity

4

potassium sparing diuretic

spironolactone - aldosterone antagonist
act on distal tubule and collecting duct - inhibit sodium reabsorption and potassium secretion.
for chronic HT

5

ACE inhibitor actions

decrease angiotensin II production
decrease sympathetic activity
decrease TPR (no change in CO, HR)
decrease aldosterone production (decrease sodium/water retention)
increase bradykinin (dry cough)
less effective in elderly/blacks

6

ACE inhibitors adverse effects

hypotension in hypovolemic patients.
angioedema (mainly around eyes/lips), hyperkalemia.
dry cough (increase bradykinin).
glossitis, oral ulcerations.
birth defects.
bad combination with potassium sparing diuretics.

7

angiotensin II type I receptor blockers

losartan (-sartan)
competitive antagonists.
actions similar to ACE inhibitors, less adverse effects and no cough.

8

angiotensin II receptors

type I - increase aldosterone, ADH, TPR, sympathetic activity.
type II - vasodilation (decrease TPR), increase NO.

9

renin inhibitor

aliskiren
renin inhibition - decrease angiotensin I.
similar action to ACEI (no cough).
used if poor ACEI/ARB tolerance.
less angioedema, glossitis, but similar adverse effects.

10

calcium channel blockers

bind L-type calcium channels in cardiac and vascular smooth muscle.
inhibit calcium influx.
dilate areterioles - decrease TPR, BP

11

verapamil

significant cardiac depression
decrease HR
constipation
edema
bad combo with beta blockers, HF

12

nifedipine

arteriole vasodilation
adverse:
constipation
gingival hyperplasia
hypotension, reflex tachycardia, headache, edema

13

diltiazem

similar to verapamil/nifedipine
more cardiac action than vasodilation

14

beta blockers

delayed hypotensive action
more useful than alpha blockers
rebound HT, fatigue
beta 2 blockers bad for asthma, diabetes.
actions:
1. decrease sympathetic tone
2. decrease renin secretion
3. block cardiac beta 1 receptors (decrease HR, CO, BP)

15

propranolol

non-selective beta blocker
HT, asthma, diabetes

16

metoprolol

beta 1 selective, LA action
HT, HF, arrhythmia

17

atenolol

beta 1 selective, no LA action
HT, HF, angina

18

sotalol

beta blocker, blocks potassium channels
arrhythmia only
not on exam 2

19

labetalol, carvedilol

beta/alpha blocker
HT, HF, hypertensive crisis

20

loop diuretics

furosemide
HF, acute HT
acts on loop of henle, decrease plasma calcium

21

phenoxybenzamine

irreversible alpha 1 blocker
reflex tachycardia, PHT
pheochromocytoma, HT crisis

22

prazosin

selective alpha 1 blocker
benign prostate hypertrophy, HT
no reflex tachycardia, PHT

23

phentolamine

non-selective alpha blocker
pheochromocytoma, not HT
reflex tachycardia, PHT

24

hydralazine

direct muscle relaxant, dilate arterioles not veins.
reflex tachycardia, palpation, flushing, lupus reaction.

25

minoxidil

rogaine
open potassium channels in smooth muscle.
dilate arterioles, chronic HT
hair growth, reflex tachycardia

26

nitroprusside

acute HT, HF
short term, emergency use only
increase NO, cGMP
dilates arteries and veins
reflex tachycardia, cyanide toxicity, methemoglobinemia

27

diazoxide

open potassium channels
acute HT crisis
inhibit insulin release

28

clonidine

alpha 2 agonist in CNS
HT
rebound HT, xerostomia

29

alpha methyl dopa

alpha 2 agonist
HT in pregnancy
rebound HT, xerostomia

30

guanethidine

last resort HT drug
decrease release of NE at terminals, decrease effects of TCA, cocaine.
PHT

31

reserpine

last resort HT drug
inhibit NE uptake in vesicles

32

lisinopril

ACEI
decrease angiotensin II, aldosterone
increase bradykinin
cough, hyperkalemia, glossitis