Antihypertensives

Question 0

furosemide, bumetimide, torsemide

Answer 0

loop diuretics
act at TAL of loop of henle, block Na K 2Cl contraporter
tx most effective edema treatment
AE Hypokalemia, decrease uric acid excretion, rare deafness, hypersensitivity reaction (sulfonamide cross reaction)

Question 1

Chlorfothiazide, hydrochlorothiazide

Answer 1

thiazide diuretics
first choice for HTN
act at DCT, block Na Cl symporter
AE efficacy reduced by NSAIDs, Hypokalemia, decreased uric acid and Ca excretion, cross reactivity/hypersensitivity with sulfonomides

Question 2

spirolactone, eplerenone

Answer 2

aldosterone receptor blockers
act at collecting duct, block Na reabsorption
K sparing
mild diuresis
tx resistant HTN, CHF with HTN
AE Hyperkalemia

Question 3

Tramterene, amiloride

Answer 3

K sparing diuretics
act on Late DCT and collecting ducts, block Na channels
Mild diuresis
weak antihypertensive (used with thiazides)
AE hyperkalemia

Question 4

captopril, enalapril, lisinopril, fosinopril

Answer 4

ACEI
increase bradykinin levels
decrease aldosterone levels-> increase Na excretion and decrease PVR
reverse CV remodeling
Tx mild to moderate HTN and HF
AE increased Renin levels and activity (renin escape)
dry cough and altered taste
hyperkalemia, angioedema, hypotension, rash, teratogen

Question 5

losartan valsartan, candesartan, irbesartan

Answer 5

Angiotensin receptor antagonist (ARBs), AT1 receptor antagonist
tx HTN and heart failure
act by Increasing Na secretion, decrease plasma volume and hypertrophy
increase renin levels and activity (renin escape)
as effective as ACEI for HTN but less with CV events
AE
hypotension
dry cough (less than ACEI)
rare angioedema
hyperkalemia (decreased aldosterone)
fetal renal toxicity

Question 6

aliskiren

Answer 6

Renin inhibitor, direct competitive inhibitor
increase plasma renin BUT NOT renin activity
tx HTN (not first line due to unclear effect on CV events)
AE DM or renal issues when used with ACEI or ARBs
hypotension
dry cough, rare angioedema, hyperkalemia (decreased aldosterone)

Question 7

Verapamil, diltiazem

Answer 7

Ca channel blocker, L type channels
cardioselective
negative chronotrope
tx HTN (especially African Americans and older patients)
contraindicated in heart failure (edema)
AE decreased A-V conduction and contractility
HA, gingival inflammation/hyperplasia

Question 8

nifedipine, nicardipine, amlodopine

Answer 8

Ca Channel bocker, L type channels
VSM selective
decrease PVR (smooth muscle relaxation)
Tx HTN (African Americans and elderly especially)
contraindicated in Heart failure (edema)
AE decrease A-V conduction and contractility, HA

Question 9

resperine

Answer 9

inhibits NE reuptake leading to NE depletion
decreases PVR and CO
tx mild to moderate HTN (low dose with thiazide)
AE
postural hypotension
sedation, dry mouth, nightmares
Na/H20 retention

Question 10

Clonidie

Answer 10

Central alpha2 agonist
decreases sympathetic outflow and increased vagal activity
causes decreased PVR and CO
tx resistant HTN
AE
rebound HTN
sedation, dry mouth, depression, drowsiness 
postural hypotension (elderly
Na/H2O retention

Question 11

alpah-methyldopa

Answer 11

Central acting apha2 agonist
decrease sympathetic outflow and increased vagal activity
decrease PVR and CO
tx pregnancy induced HTN
AE rebound HTN
sedation, dry mouth, depression and drowsiness
postural hypotension
Na/H2O retention

Question 12

Hydralazine

Answer 12

vasal dilator, unclear mechanism
preferentially effects arterioles -> decreased PVR-> decreased MAP
tx mild to moderate HTN (with beta blocker)
AE reflex sympathetic increase in HR, contractility and CO
HA, anorexia, Nausea, dizziness, sweating
angina, ischemic arrythmias (reflex tachycardia)
increased renin levels and activity-> fluid retention
Lupus like immune response

Question 13

mixoxidil

Answer 13

Vasodilator
preferentially effects arterioles 
activates K channels-> VSM relaxation-> decreased PVR
tx resistant HTN (with beta blocker)
tx tropical for alopecia (rogain)
contraindicated for HF (fluid retention)
AE reflex sympathetic increase (tachycardia) and renin increase
pericardial effusion w/ tamponade
abnormal hair growth

Question 14

nitroprusside

Answer 14

vasodilator
acts on veins and arteries (decrease pre and after-load)
generates NO->guanylyl cyclase-> increase cGMP
tx used to induce hypotension in surgery
tx hypertensive emergency
AE rapid drop in MAP, rare cyanide accumulation-> renal issues

Question 15

nitroglycerin

Answer 15

vasodilator
preferentially effects veins-> decreases preload
increases NO
tx used to induce hypotension in surgery
tx hypertension emergency
Pharm: short acting, tolerance
AE HA

Question 16

epoprostenol

Answer 16

Vasodilator
synthetic PGI2-> increases cAMP and inhibits thromboxane A2
tx potent antihypertensive (continuous infusion)
tx primary pulmonary HTN

Question 17

bosentam

Answer 17

Endothelin receptor blocker
non-selective ETr blocker
tx pulmonary htn
AE edema, Ha
decreased spermatogenesis 
respiratory tract infections
decreased hematocrit
hepatic effects
birth defects

Question 18

ambrisentan

Answer 18

Endothelin receptor blocker
selective ETa blocker
tx pulmonary htn
AE edema, Ha
decreased spermatogenesis 
respiratory tract infections
decreased hematocrit
hepatic effects
birth defects

Question 19

riociguat

Answer 19

vasodilator
activated guanylyl cyclase-> increases cGmP-> VSM relaxation
tx primary pulmonary htn, thromboembolic pulmonary htn
used with ETr blockers
AE HA, dizziness, nausea, diarrhea
hypotension
teratogen