Antihypertensive Agents

Question 1

preferred drug classes for antihypertensive action

Answer 1

diuretics
ACE inhibitors
calcium blockers
beta blockers

Question 2

thiazides: hydrochlorothiazide, metolazone

Answer 2

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.

Question 3

thiazide adverse effects

Answer 3

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

Question 4

potassium sparing diuretic

Answer 4

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

Question 5

ACE inhibitor actions

Answer 5

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

Question 6

ACE inhibitors adverse effects

Answer 6

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.

Question 7

angiotensin II type I receptor blockers

Answer 7

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

Question 8

angiotensin II receptors

Answer 8

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

Question 9

renin inhibitor

Answer 9

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.

Question 10

calcium channel blockers

Answer 10

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

Question 11

verapamil

Answer 11

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

Question 12

nifedipine

Answer 12

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

Question 13

diltiazem

Answer 13

similar to verapamil/nifedipine

more cardiac action than vasodilation

Question 14

beta blockers

Answer 14

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)

Question 15

propranolol

Answer 15

non-selective beta blocker

HT, asthma, diabetes

Question 16

metoprolol

Answer 16

beta 1 selective, LA action

HT, HF, arrhythmia

Question 17

atenolol

Answer 17

beta 1 selective, no LA action

HT, HF, angina

Question 18

sotalol

Answer 18

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

Question 19

labetalol, carvedilol

Answer 19

beta/alpha blocker

HT, HF, hypertensive crisis

Question 20

loop diuretics

Answer 20

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

Question 21

phenoxybenzamine

Answer 21

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

Question 22

prazosin

Answer 22

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

Question 23

phentolamine

Answer 23

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

Question 24

hydralazine

Answer 24

direct muscle relaxant, dilate arterioles not veins.

reflex tachycardia, palpation, flushing, lupus reaction.

Question 25

minoxidil

Answer 25

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

Question 26

nitroprusside

Answer 26

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

Question 27

diazoxide

Answer 27

open potassium channels acute HT crisis inhibit insulin release

Question 28

clonidine

Answer 28

alpha 2 agonist in CNS HT rebound HT, xerostomia

Question 29

alpha methyl dopa

Answer 29

alpha 2 agonist HT in pregnancy rebound HT, xerostomia

Question 30

guanethidine

Answer 30

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

Question 31

reserpine

Answer 31

last resort HT drug | inhibit NE uptake in vesicles

Question 32

lisinopril

Answer 32

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