Antihypertensive Drugs

Question 1

Pre-Hypertensive

Answer 1

120-139

80-89

Question 2

Stage 1

Answer 2

140-159

90-99

Question 3

Stage 2

Answer 3

> 160

>100

Question 4

Old people treatment initiated at?

Answer 4

150/90

Question 5

What are the first line drugs of choice for hypertension?

Answer 5

1. Diuretics
2. Calcium Channel Blockers
3. ACEI
4. Angiotensin receptor blockers

ACE DIR CALLS ANGI

Question 6

What is the drug of choice for uncomplicated hypertension?

Answer 6

Diuretics

Question 7

Thiazide Diuretics 
Drug
MOA
SE 
Drug Interactions 
Contraindications

Answer 7

Hydrochlorothiazide. Chlorthalidone

MOA
Inhibits Na/Cl cotransporter in distal convoluted tubule
-initial volume contraction
-later decreased peripheral resistance (prostaglandin)
-mild Na excretory effect

Question 8

Thiazide Diuretics
SE
Drug Interactions
Contraindications

Answer 8

SE

1. Hyponatremia
2. Hypokalemia
3. Metabolic Alkalosis
4. Hyperglycemia
5. Hyperlipidemia
6. Hyperuricemia
7. Hypercalcemia

Drug Interactions

1. NSAIDs
2. Beta Blockers-similar side effects

Contraindications
1. Hypokalemia

Question 9

Loop Diuretics
Drug
MOA

Answer 9

Furosemide

1. blocks NA/K/Cl cotransporter
2. venous dilation via prostaglandins

Question 10

Loop Diuretics
SE
Drug Interactions

Answer 10

OH DANG

1. ototoxicity
2. hypokalemia
3. Dehydration/hyponatremia
4. Allergy
5. Nephritis
6. Gout
   - Impaired Diabetes control
   - Increased LDL/HDL

Drug Interactions

1. NSAIDS
2. Aminoglycosides

Question 11

Potassium Sparing Diuretics
Drug
MOA

Answer 11

Spironolactone
Eplerenone
Triamterene
Amiloride

Aldosterone receptor blocker-combined with diuretics-NOT USED IN MONOTHERAPY of HT

Question 12

Potassium Sparing
SE
Drug Interactions
Contraindications

Answer 12

SE

1. Hyperkalemia
2. Gynecomastia (spirono)

Drug Interactions

1. NSAiDs
2. ACE inhibitors and ARB

Contraindications
1. Renin angiotensin inhibitors

Question 13

Calcium Channel Blockers

MOA

Answer 13

All reduce vascular resistance by reducing calcium influx in vascular smooth muscle

Non-dihydropyridines also reduce pacemaker potentials, AV node conduction, and contractility

Question 14

Nifedipine

SE

Answer 14

Dihydropyridine
-limited effect on pacemaker or conduction

SE

1. acute tachycardia
2. peripheral edema

Question 15

Diltiazem

Answer 15

Non-dihydropyridine
-reduces pacemaker and conduction currents

SE
1. Bradycardia

Question 16

Verapimil

Answer 16

Non-dihydropyridine
-more pronounced reduction of currents

SE

1. Bradycardia
2. Constipation

Question 17

What are non-dihydropyridines contraindicated in?

Answer 17

Contraindication

1. pts with conduction disturbances
2. with caution in patients given beta blockers

-avoid use of short acting CCBs for chronic hypertension

Question 18

What do sympatholytic drugs do?

Answer 18

Reduce sympathetic-mediated vasoconstriction, CO, and renin release

Question 19

Clonidine
MOA
SE

Answer 19

-second line for hypertension
Alpha 2 Agonist
–>decrease sympathetic outflow from CNS

SE

1. sedation
2. dry mouth
3. dermatitis

CNS depressant

Need slow withdraw to prevent rebound hypertension

Question 20

What can you give that has less chance of rebound than clonidine?

Answer 20

Guanfacine

• has longer half life
• second line for hypertension

Question 21

Methyldopa
What is it used for?
MOA
Drug interactions
SE

Answer 21

Anti-hypertensive PREGNANCY!

Alpha 2 agonist
-competes with L-DOPA for DOPA decarboxylase

Drug Interactions
Levodopa

SIde effects
1. Sedation

Question 22

Reserpine
Combined with?
SE
Drug interactions

Answer 22

-used for resistant hypertension
blocks VMAP vesicular transport

Combined with diuretics
-used for mild and moderate hypertension

SE

1. Depression
2. Nasal Congestion

Drug interactions

1. CNS depressant
2. If given with MOAi could have reversal and lead to hypertensive crisis

Question 23

Alpha antagonist

Answer 23

block vasoconstriction

Question 24

Phenoxybenzamine

Answer 24

Non-selective
Used in Pheochromocytoma

SE
Tachycardia

Question 25

Prazosin

Answer 25

Second line for chronic hypotension Selective alpha1 antagonist -less tachycardia than direct vasoconstrictors -doesnt impair exercise tolerance terazosin and doxazosin have longer half lives SE 1. Hypotension (1st dose)

Question 26

Beta Antagonists MOA

Answer 26

decreased cardiac contractility and CO, decreased renin secretion

Question 27

Propranolol Type Indication Lipophilic

Answer 27

Non selective 1. Hypertension with angina, MI, or arrhythmia 2. used as adjunct to prevent tachycardia with vasodilators Lipophilic

Question 28

``` Nadolol Type Indication HL Lipophilic ```

Answer 28

Non Selective 1. Long-term angina, hypertension Longer half life* 1/day Not Lipophilic

Question 29

Pindolol Type Indication Lipophilic

Answer 29

Non Selective Partial agonist 1. Chronic Hypertension - Less brady than other beta blockers * Slightly Lipophilic

Question 30

Metoprolol Type Indication Lipophilic

Answer 30

B1 Selective 1. Hypertension, Long term angina somewhat lipophilic

Question 31

Atenolol Type Indication Lipophilic

Answer 31

B-1 Selective 1. Chronic Hypertension Not Lipophilic

Question 32

Labetalol Type Indication Lipophilic

Answer 32

Mixed alpha/beta antagonist 1. Chronic hypertension Lipophilic

Question 33

Carvedilol Type Indication Lipophilic

Answer 33

Mixed alpha/beta receptor blocker and NO generator 1. Chronic Hypertension and CHF 2. Vasodilator-NO Somewhat lipophilic

Question 34

Which beta blockers are not lipophilic?

Answer 34

Atenolol and Nadolol

Question 35

What are SE/contraindications/drug interactions of Beta blocker?

Answer 35

1. Bradycardia 2. Increased Triglycerides 3. Decreased HDLs 4. Hyperglycemia 5. Impaired Exercise tolerance Contraindications 1. Cardiogenic shock 2. sinus brady 3. asthma 4. severe heart failure Drug interactions 1.CCB(reduced contractility and conduction) Non selective -increased airway resistance Lipophilic 1. insomnia 2. chronic fatigue

Question 36

Vasodilators | MOA

Answer 36

vasodilation of primary arterioles

Question 37

Hydralazine Indication SE

Answer 37

resistant hypertension pregnancy induced hypertension SE 1. tachy 2. angina aggravation 3. fluid retention 4. NSAIDs can reduce effectiveness

Question 38

Minoxidil | Indication

Answer 38

Resistant hypertension

Question 39

Nitroprusside

Answer 39

Emergencies Acute Hypertensive Crisis SE 1. Cyanide poisoning

Question 40

``` ACEi MOA SE Drug Interactions Contraindications ```

Answer 40

Blocks production of Angiotensin 2 * *Prolongs survival in pts with HF or LV dysfunction after MI * *Preserves renal function in diabetic patients SE 1. hyperkalemia 2. dry cough 3. angioedema Drug Interactions 1. Exacerbates hyperkalemic effect of k sparing Contraindication 1. pregnancy-bilateral renal stenosis

Question 41

Captopril

Answer 41

short HL-requires multiple doses

Question 42

Enalapril

Answer 42

converted to active metabolite | longer HL 1-2/day

Question 43

Lisinopril

Answer 43

1/day dosing

Question 44

Angiotensin 2 Receptor Blockers MOA

Answer 44

Mediate Vasoconstriction and sodium retention

Question 45

Losartan

Answer 45

Select AT1 receptor antagonist SE Hyperkalemia Contraindications Pregnancy Drug interaction K sparing diuretics

Question 46

What are three good combos?

Answer 46

1. Thiazide or Loop with K sparing 2. Thiazide with BB 3. CCB with ACEI

Question 47

If someone has diabetes what do you give them?

Answer 47

ACEI | CCBs have few effects on carb metabolism

Question 48

If someone has heart failure what do you give them?

Answer 48

ACEI + Diuretic

Question 49

If someone has MI what do you give them?

Answer 49

ACEI-reduce remodeling | BB-reduce arrhythmia and remodeling

Question 50

What should you give African American pts?

Answer 50

Monotherapy with diuretics or CCBs most efficacious