Cardio: Drugs for HTN and HTN Emergency/Urgency

Question 1

What are the first line drugs used to treat HTN?

Answer 1

Thiazides
ACEi
ARBs
CCBs (both dihydropyridines/Non-dihyropyridines)

Question 2

What are the secondary drugs for HTN?

Answer 2

Loop and K+ sparing Diuretics
B-Blockers (Cardio and Non-cardio)
a-1 blockers (-osins)
Aliskiren (direct renin inhibitors)
Central a-2 blockers (a-methyl-dopa and clonidine)
Direct Vasodilators (hydralazine, minoxidil)

Question 3

MOA of Thiazides

Answer 3

Block NaCl in the DCT
-lowers Na, which lowers water and BP

Ca is reabsorbed in Proximal Tubule due to volume contraction

Question 4

Clinical application of HCTZ?

Answer 4

HTN alone or with other hypertensives

Edema

Question 5

Off label use of HCTZ

Answer 5

Calcium Nephrolithiasis prevention

Question 6

Adverse effects of Hydrochlorothiazide?

Answer 6

Hypotension,
Electrolyte and Water depletion
Hypercalcemia, Hyperglycemia, Hyperuricemia

Sulfa allergy*

Question 7

Preferred thiazide for HTN specialists?

Answer 7

Chlorthalidone

-longer halflife

Question 8

Preffered thiazide for cardiologists?

Answer 8

Metolazone

-longer acting, great for HF

Question 9

MOA of Amiloride

Answer 9

Blocks EnaC channels in collecting duct

-less H2O means lower BP

Question 10

Clinical applications of amiloride

Answer 10

Blocks K+ loss in Loop/other diuretics

Also for ascites, Pediatric HTN

Question 11

Adverse effects of amiloride?

Answer 11

Hyperkalemia

Hyponatremia, hypovolemia, metabolic acidosis

Dizziness, N/V

Question 12

What should you monitor with ACEi or ARBs?

Answer 12

Serum creatine
-will increase shortly after giving it to pts

Also watch for Hyperkalemia

Question 13

MOA of Aliskiren

Answer 13

Direct Renin inhibitor

-decreases ATII without increase in Bradykinin activity

Question 14

Why would you stop ACEis? (main reason)

Answer 14

Angioedema

-can be deadly!

Question 15

What are the a-receptor blockers and what is their MOA?

Answer 15

Phentolamine
-competitive a-receptor blocker

Phenoxybenzamine
-non-competitive a-receptor blocker

Question 16

Adverse effects of phentolamine/phenoxybenzamine?

Answer 16

Hypotension, orthostatics, tachycardia (reflex), cardiac arrythmias

Miosis is for phenoxybenzamine

Question 17

MOA of Prazosin? (and other osins)

Answer 17

competitively blocks a-1 receptors

-leads to vasodilation of veins, decreasing PVR and BP

Question 18

Clinical applications of Prazosin

Answer 18

Late choice for HTN and PTSD

Question 19

Toxicities associated with prazosin

Answer 19

Orthostatics, edema, palpitations, increase in urinary frequency, nasal congestion

and more

Question 20

When would you use tamsulosin, terazosin?

Answer 20

Marketed specifically for BPH and to help pass kidney stones

-“potential drug for old man in wheelchair”

Question 21

MOA of Clonidine?

Answer 21

Alpha-2 receptor agonsit

-results in transient increase in BP, followed by decreased sympathetic outflow so decrease in BP

Question 22

Clinical applications for clonidine?

Answer 22

Oral tablets/patch for HTN
ADHD
Given for Severe cancer pain

Question 23

Adverse effects of clonidine?

Answer 23

Drosiness, headache, fatigue
Xerostomia
Rebound HTN if dose missed**

Question 24

MOA of a-methyldopa

Answer 24

a-2 agonist

-great for HTN due to reducing sympathetic flow

Question 25

Clinical applications of a-methyldopa

Answer 25

Moderate to severe HTN | Drug of choice for gestational HTN**

Question 26

Adverse effects of a-methyldopa

Answer 26

``` Bells Palsy Angina aggrevation Orthosatitcs Positive direct Coombs teset** SLE like syndrome** ```

Question 27

MOA of propranolol

Answer 27

Nonselective B blocker | -decreases HR and contractility=decrease BP

Question 28

Clinical applications of propranolol

Answer 28

``` HTN Angina Pectoris Essential tremor V-tach Prevention of MI Migraine ```

Question 29

Adverse effects of Propranolol?

Answer 29

Bronchospasm, dyspnea, cold extremities bradycardia, AV block, heart failure

Question 30

Is propranolol indicated for PVD?

Answer 30

No, can worsen the cold extremities

Question 31

MOA for atenolol

Answer 31

Cardioselective B-1 antagonist | -slows HR and contractility to decrease O2 demand

Question 32

Clinical applications ofr Atenolol

Answer 32

HTN Angina Pectoris Secondary MI prevention A-fib

Question 33

Toxicities with atenolol

Answer 33

bradycardia, AV block, heart failure, chest pain, cold extremities

Question 34

What makes metoprolol and bisprolol different in the category of B-1 antagonists?

Answer 34

Metoprolol is more lipid soluable, so has more CNS adverse effects Bisoprolol is the most selective for B-1

Question 35

What happens if an a-2 agonist or B-blockers is stopped abruptly?

Answer 35

Rebound sympathetic activity and death

Question 36

Why has B-blocker use declined in recent years?

Answer 36

Does not prevent MI, HF or death as well as other therapies Highest risk of stroke**

Question 37

MOA of hydralazine

Answer 37

Vasodilator of Arterioles! | -reduced afterload, lower BP

Question 38

When would you use hydralazine?

Answer 38

HTN emergency in pregnancy | HF that doesnt respond to ACEi/ARBs

Question 39

Adverse effects of Hydralazine? (big 2)

Answer 39

Drug induced lupus* Worsens angina pectoris or CAD Many others

Question 40

MOA of Nitroprusside?

Answer 40

Vasodilator of Veins and Arterioles | -decrease Afterload, increase CO

Question 41

Clinical use of nitroprusside

Answer 41

HTN emergency ADHF HTN during surgery

Question 42

Adverse effects of nitroprusside?

Answer 42

Flushing, HTN, orthostatics, tachycardia (reflex) Cyanide toxicity** -tinnitis, seizures, lactic acidosis

Question 43

MOA of Minoxidil

Answer 43

Relaxes arterioles | -lowers vascular resistance=lower BP

Question 44

Clinical applications of minoxidil

Answer 44

HTN emergency

Question 45

Adverse effects of minoxidil

Answer 45

ECG changes (t-wave), pericardial effusion Hypertrichosis (hair growth)

Question 46

What do you use to treat HTN in stable ischemic heart disease?

Answer 46

B-blockers -slide 83 Can add CCBs and diuretics if goal not met

Question 47

How do you treat HTN in CKD?

Answer 47

ACEi or ARBs

Question 48

Are non-dihydropyridine CCBs recommended for HTN in those w HFrEF?

Answer 48

No, contraindicated

Question 49

How do you treat HTN in those with HFpEF

Answer 49

Diuretics for symptoms, and if HTN persists then add ACEi or ARBs+B-blocker

Question 50

How do you treat HTN after renal transplantation?

Answer 50

Calcium antagonist | -CCB?

Question 51

How do you treat HTN in those with a-fib?

Answer 51

ARBs are first line choice

Question 52

How do you manage HTN in those with aortic disease?

Answer 52

B-blockers

Question 53

What drugs are used in HTN emergencies?

Answer 53

``` CCBs (nicardipine, cleviidipine) Nitrates Hydralazine (pregnancy) Esmolol Labetalol Phentolamine Fendolapam (great for kidney damage) Enalaprilat (ACEi) ```