Antihypertensives II

Question 1

drug of choice for pregnancy induced hypertension

Answer 1

methyldopa

Question 2

adverse effects of alpha 2 agonists

Answer 2

rebound hypertension with abrupt cessation
sodium and water retention
hemolytic anemia
hepatitis 
orthostatic hypotension

5 H’s

Question 3

drugs for pulmonary hypertension (increase in BP in pulmonary artery, vein, or capillaries)

Answer 3

bosentan and epoprostenol

Question 4

how does bosentan work

Answer 4

antagonist at the endothelial receptors of vascular endothelium and SM

usually activation of these receptor is associated with vasoconstriction

Question 5

bosentan is an inducer and metabolized by

Answer 5

CYP 2C9 and CYP 3A4

Question 6

adverse effects of bosentan

Answer 6

HERS

Headache, Edema, Respiratory tract infection Spermatogenesis inhibition

Question 7

contraindication of bosentan

Answer 7

pregnancy - it is a FDA category X drug so it is teratogenic

Question 8

mechanism of epoprostenol

Answer 8

synthetic form of prostacyclin so it is a vasodilator

given IV

Question 9

adverse effects of epoprostenol

Answer 9

CV: tachycardia, flushing, hypotension
CNS: headache, anxiety
GI: nausea and vomiting
neuromuscular and skeletal: arthralgia, jaw pain

Question 10

contraindication for epoprostenol

Answer 10

hypersensitivity
chronic use in pts with heart failure
pts who develop edema after first dose

Question 11

drugs used to treat hypertensive emergencies

Answer 11

parenteral vasodilator: sodium nitroprusside, nitroglycerine, hydralazine
beta blockers: labetolol and esmolol
dopamine receptor agonist: fenoldopam
calcium channel blockers: nicardipine
alpha blockers: phentolamine
potassium channel openers: diazoxide

Question 12

drug of choice for hypertensive emergencies

Answer 12

sodium nitroprusside because it reduces BP in less than two mins

Question 13

uses of nitroprusside

Answer 13

management of hypertensive emergencies, heart failure, controlled hypotension (to reduce bleeding during surgery)

Question 14

what is the mechanism of nitroprusside

Answer 14

activation of guanylyl cyclase from release of NO or direct stimulation by enzyme –> increase in cGMP –> dilation of arterial and venous vessels –> relaxation of smooth muscle

Question 15

adverse effects of nitroprusside

Answer 15

hypotension (toxicity)
reflex tachycardia
cyanide toxicity (if liver or kidney problem and can’t get rid of metabolite of nitroprusside)
goose bumps, abdominal cramping, nausea, vomiting, headache, muscle twitching, sweating

Question 16

clinical application of nitroglycerine

Answer 16

same as sodium nitroprusside
management of hypertensive crisis
heart failure
controlled hypotension

Question 17

mechanism of action for nitroglycerine

Answer 17

NO activates guanylyl cyclase –> increased cGMP –> smooth muscle relaxation

Question 18

adverse effects of nitroglycerine

Answer 18

hypotension (toxicity)
methemoglobinemia
headache, allergic reactions, flushing

Question 19

in what type of hypertensive crisis is esmolol usually used for

Answer 19

aortic dissection and postoperative hypertension

Question 20

adverse effects of esmolol

Answer 20

hypotension

nausea, thrombophlebitis, and painful extravasation

Question 21

type of hypertensive crisis is fenoldopam used for

Answer 21

patients with renal failure

Question 22

contraindication to fenoldopam

Answer 22

glaucoma

Question 23

mechanism of antihypertensive emergency drug, nicardipine

Answer 23

calcium channel blocker

Question 24

hypertensive emergency that requires phentolamine

Answer 24

pheochromocytoma, cocaine and amphetamine toxicity, clonidine withdrawal, MAO inhibitor drugs

Question 25

clinical use of diazoxide

Answer 25

management of hypertensive emergency

treatment of hyperglycemia secondary to insulinoma

Question 26

mechanism of diazoxide

Answer 26

open K+ channels and stabilizes membrane potential at resting levels prevent vascular SM contraction

Question 27

adverse effects of diazoxide

Answer 27

hypotension
reflex tachycardia
sodium and water retention
inhibition of insulin release

Question 28

what is a renin inhibitor that is used to treat hypertension

Answer 28

aliskiren

Question 29

adverse effects of aliskiren

Answer 29

hypotension, hyperkalemia, angioedema, acute renal failure (due to lack of vasoconstrictive effect of angiotensin II)

Question 30

contraindications for aliskiren

Answer 30

pregnancy
bilateral renal artery stenosis
hyperkalemia