Drugs for Hypertension

Question 1

MOA prazosin

Answer 1

alpha 1 antagonist

Question 2

effects prazosin

Answer 2

vasodilation of veins and arterioles leading to decrease in overall PVR and BP

Question 3

clinical app prazosin

Answer 3

tx HTN
- late choice in JNC8 due to ALLHAT data showing increase likelihood of stroke and CHF w/ doxazosin in comparison to chlothalidone

Question 4

toxicities prazosin

Answer 4

palpitations, edema, orthostatic hypotension, syncope

• dizziness, HA, drowsiness, depression, nervousness
• decreased energy, weakness
• nausea, diarrhea, constipation
• urinary frequency, retrograde ejaculation
• blurred vision

Question 5

tamsulosin, terazosin (doxazosin) MOA

Answer 5

similar to prazosin but differ w/ respect to a1a, a1b, and a1d subtype selectivity

Question 6

clinical app tamsulosin, terazosin (doxazosin)

Answer 6

help kidney stones pass

Question 7

MOA clonidine

Answer 7

alpha 2 agonist

Question 8

effects clonidine

Answer 8

• transient increase in BP at first
• reduce sympathetic outflow –> decrease in PVR, renal vascular resistance, HR, and BP
• pain relief
• benefits in ADHD

Question 9

clinical app clonidine

Answer 9

• tx for hypertension
• tx of ADHD
• pain relief for CA pts

Question 10

toxicities of clonidine

Answer 10

• drowsiness
• HA, fatigue, dizziness, behavioral changes
• xerostomia
• REBOUND HTN IF DOSE IS MISSED

Question 11

MOA a-methyldopa

Answer 11

alpha 2 agonist

Question 12

effects a-methyldopa

Answer 12

sympatholytic for HTN due to reduced sympathetic outflow

Question 13

clinical app a-methyldopa

Answer 13

management of severe hypertension

- drug of choice for gestational hypertension

Question 14

toxicities a-methyldopa

Answer 14

• angina pectoris aggravation
• bradycardia, HF, orthostatic hypotension
• bell’s palsy
• positive Coombs test
• SLE-like syndrome

Question 15

why are B-blockers contraindicated in peripheral vascular dz

Answer 15

they cause cold extremities especially in infants

Question 16

MOA atenolol

Answer 16

B1 selective antagonist

Question 17

what beta blocker has the highest beta 1 selectivity

Answer 17

bisoprolol

Question 18

MOA captopril

Answer 18

competitive ACE inhibitor

Question 19

effects captopril

Answer 19

prevents conversion of angiotensin I to angiotensin II, blocking vasoconstriction

• decreases plasma renin and increases aldosterone
• lowers BP

Question 20

clinical app captopril

Answer 20

HTN

- HF with reduced EF

Question 21

toxicities captoptil

Answer 21

• cough

- angioedema

Question 22

describe enalapril

Answer 22

an ACEI that is a prodrug with an active form available for IV

Question 23

MOA losartan

Answer 23

nonpeptide angiotensin II receptor antagonist with selectivity for AT1

Question 24

effects losartan

Answer 24

blocks vasoconstrictor and aldosterone-secreting effects of angiotensin II
- induces complete inhibition of RAAS compared to ACEI

Question 25

clinical app losartan

Answer 25

- diabetic nephropathy | - HTN

Question 26

toxicities of losartan

Answer 26

- adverse effects more common in those w/ diabetic nephropathy - hypotension - cough but less than ACEI

Question 27

noteworthy about valsartan

Answer 27

not a prodrug requiring activation

Question 28

noteworthy about candesartan

Answer 28

relatively irreversibly binds

Question 29

MOA aliskiren

Answer 29

direct renin inhibitor

Question 30

effects aliskiren

Answer 30

decreases formation of angiotensin II

Question 31

clinical app aliskiren

Answer 31

tx HTN alone or in combo w/ other antihypertensive drug

Question 32

toxicities aliskiren

Answer 32

few (~1%) - skin rash - diarrhea - cough

Question 33

MOA hydralazine

Answer 33

direct vasodilation of arterioles

Question 34

effects hydralazine

Answer 34

decreases systemic resistance

Question 35

clinical app hydralazine

Answer 35

hypertensive emergency in pregnancy

Question 36

toxicities hydralazine

Answer 36

drug-induced lupus like syndrome | - toxicities in every body system

Question 37

MOA nitroprusside

Answer 37

causes peripheral vasodilation by direct action on venous and arteriolar smooth m.

Question 38

effects nitroprusside

Answer 38

- reduces peripheral vascular resistance | - will increase CO by decreasing afterload

Question 39

clinical app nitroprusside

Answer 39

HTN | - acute decompensated heart failure

Question 40

toxicities of nitroprusside

Answer 40

toxicities in every body system

Question 41

MOA minoxidil

Answer 41

produces vasodilation by directly relaxing arteriolar smooth m

Question 42

effects minoxidil

Answer 42

lowers arteriolar vascular resistance

Question 43

clinical app minoxidil

Answer 43

- HTN that is symptomatic or associated w/ target organ damage

Question 44

toxicities of minoxidil

Answer 44

toxicities in every body system