HTN 5

Question 1

Sympathoplegic drugs interfere with sympathetic (SANS) control of cardiovascular function. The result is a reduction of one or more of what 5 things?

Answer 1

1. venous tone
2. heart rate
3. contractile force of the heart
4. cardiac output
5. total peripheral resistance

Question 2

MOA of which group of meds:

• Negative chronotropic and inotropic-results in decreased CO
• Inhibit release of renin

Answer 2

Beta Blockers (“-olol”)

Question 3

The following are the main side effects of which group of meds?

–***Bradycardia, AV conduction abnormalities, development of acute heart failure

–***Acute exacerbations of asthma or COPD (bronchospasms)

Answer 3

Beta Blockers (“-olols”)

Question 4

the following are some side effects of what group of meds?

1. Aggrevate intermittant claudication and Raynaud’s phenomenon (decreased peripheral blood flow)
2. Increased sympathetic tone with Hypoglycema with increase in BP from unopposed alpha stimulation
3. Transient increase in blood glucose and serum cholesterol
4. Increase in TG and decrease in HDL

Answer 4

Beta Blockers

Question 5

How should you discontine use of Beta Blockers?

Answer 5

Avoid abrupt cessation—increase in BP, risk of unstable angina, MI

taper dose over 1-2 weeks

Question 6

Efficacy/monitoring of what group of meds?

–**Differentiated based on cardioselectivity, ISA, and membrane-stabilizing effect.

• Cardiolselective: atenolol, metoprolol*
  
  • ​dose dependent
• ISA: acebutolol, pindolol
  
  • Maintains resting HR, CO and peripheral blood flow
  • Increase risk post MI- rarely used
• Membrane stabilizing effect: all beta blockers
  
  • Important w/ the BB antiarrhythmics

Answer 6

Beta blockers

Question 7

The following should be monitored in which group of meds?

1. HR, BP prior to first dose (possibly EKG)
2. **Assess for CHF: edema, new cough, dyspnea, weight gain or unresolved fatigue
3. **Monitor BS in DM

Answer 7

Beta Blockers

Question 8

What are 4 drug interactions of Beta Blockers?

Answer 8

1. NSAIDs
2. Other SNS and PNS agents
3. CCB
4. Digoxin

Question 9

Which 2 Beta Blockers undergo extensive first pass effect?

Answer 9

Propanolol and metoprolol

Question 10

Atenolol has a relatively long half life and is ____ excreted

Answer 10

renally

Question 11

________beta blockers include propranolol causing more dizziness and drowsiness, but adding indications of migraine HA prevention, essential tremor, thyrotoxicosis, anger/rage management

Answer 11

Lipophillic

Question 12

Which Beta Blockers are Beta 1 blocker and Alpha 1 blockers?

Answer 12

Labetolol and Carvedilol

Question 13

Which beta blocker preferentially blocks Beta 1 (at doses <10) and also produces endothelium-derived nitric oxide-dependent vasodilation

Answer 13

Nebivolol

Question 14

In which patient should a nonselective Beta blocker be avoided?

Answer 14

pulmonary- Asthma, COPD

Question 15

Mechanism of which meds?

–**Selective alpha 1 blockers in the peripheral vasculature and inhibit the uptake of catecholamines in smooth muscle cells resulting in vasodilation

–**Cross blood brain barrier

Answer 15

Alpha 1 Blockers (prazosin, terazosin, doxazosin–> “-zosins”)

Question 16

Which group of meds has the following side effects?

1. **First dose phenomenon and an increase in dose: 1-3 hrs within first dose of dizziness or faintness, palpitations, and possibly syncope
   
   • Use cautiously in the elderly
2. Take dose at bedtime
3. Lassitude, vivid dreams and depression
4. Priapism
5. Sodium and water retention with higher doses
   
   • Give in combination with diuretic

Answer 16

Alpha 1 Blockers ( “-zosins”)

Question 17

What is the first dose phenomenon and which group of meds is this seen in?

Answer 17

–First dose phenomenon and an increase in dose: 1-3 hrs w/in first dose of dizziness or faintness, palpitations, and possibly syncope (so take at bedtime)

Alpha 1 blockers (“-zosins”)

Question 18

Efficacy of which group of meds?

–Not a first line agent

–Give in combination with diuretics to improve efficacy

–Useful when male patient has BPH

–Hypertension, PTSD related nightmares and sleep disruption, Raynaud’s, BPH

–No adverse effect on lipids-may increase HDL ??significance

Answer 18

Alpha 1 Blockers (-Zosins)

Question 19

If you have a patient suffering from HTN and BPH, what antihypertensive would be indicated?

Answer 19

Alpha 1 Blockers (ex: prazosin)

Question 20

What is important to monitor with Alpha 1 Blockers?

Answer 20

–First dose and increased dose effect-BP standing, sitting/supine

Question 21

Drug interactions of what group of meds?

–Decrease levels of dabigatran, linagliptin, vincristine

–Methylphenidate may diminish the antihypertensive effect of _______ (as well as other agents)

Answer 21

alpha-1 blockers

Question 22

Mechanism of which group of meds?

–Stimulate alpha 2 receptors in the brain which reduces sympathetic outflow from the vasomotor center in the brain and increased vagal tone.

–Reduces sympathetic activity,

–Together with enhanced parasympathetic activity can: decrease heart rate, cardiac output, total peripheral resistance, plasma renin activity and baroreceptor reflexes.

Answer 22

Central Alpha 2 Agonists (Clinidine, methyldopa)

Question 23

Which two meds are central alpha 2 agonists?

Answer 23

Clonidine

Methyldopa

Question 24

Side effects of which group of meds?

1. Sodium and water retention (most prominent with methyldopa thus give with diuretic (except in pregnancy)
2. Sedation, dry mouth, depression,
3. Orthostatic hypotension, dizziness—caution in elderly
4. Rebound hypertension with abrupt cessation—compensatory increase in NE

Answer 24

Central Alpha 2 Agonists

Question 25

Side effect of which central alpha 2 agonist? ## Footnote **high incidence of anticholinergic side effects such as sedation, dry mouth, constipation, urinary retention and blurred vision**

Answer 25

Clonidine

Question 26

Side effects of which Central Alpha 2 agonist? Can cause hepatitis or hemolytic anemia although rare—transient rise in LFTs can be noted

Answer 26

Methyldopa ## Footnote * Stop if persistent increases or alkaline phosphatase increases * May cause + direct Coombs test

Question 27

Efficacy of which group of meds? ## Footnote –Effective as single agent but are **second or third line** agent because of side effects –Dosage adjustment need in renal impairment—extend dosing interval

Answer 27

Central alpha 2 agonists (Clonidine, methyldopa)

Question 28

what med is first line in **pregnancy HTN?**

Answer 28

**Methyldop**a (Central alpha 2 agonist)

Question 29

T/F: Central alpha 2 agonists are contraindicated in pediatrics?

Answer 29

False. Central Alpha 2 agonists can be used in pediatrics

Question 30

Monitoring for which group of meds? ## Footnote –Hepatic and renal status –Hypotension, bradycardia or CNS changes on regular basis

Answer 30

Central alpha 2 agonists (Clonidine, methyldopa)

Question 31

–Consider converting patients desiring pregnancy well in advance to _______ or \_\_\_\_\_\_\_\_\_

Answer 31

Methyldopa or Labetolol

Question 32

why is there a need to add a thiazide diuretic to the central alpha 2 agonists?

Answer 32

–These agents can cause sodium and water retention because of vasodilation resulting in decreased blood flow through the kidneys which then activates the RAAS system

Question 33

Mechanism of which medication? ## Footnote **--\>depletes NE from sympathetic nerve endings and blocking transport of NE into its storage granules.** **---\>Leads to decreased PVR**

Answer 33

**Reserpine** (Peripheral Adrenergic Antagonist) 5th line (occasionally used for resistant HTN)

Question 34

Which medication **causes significant sodium and water retention** so it should be given with a thiazide diuretic This is also an inexpensive treatment regimen

Answer 34

Reserpine (peripheral adrenergic antagonist) 5th line

Question 35

Which med? **Leads to reflex parasympathetic activity:** 1. **nasal stuffiness** 2. **increased gastric acid secretion** 3. **diarrhea** 4. **bradycardia**

Answer 35

Reserpine (a peripheral adrenergic antagonist) 5th line med

Question 36

Which 2 group of meds are vasodilators?

Answer 36

1. Calcium channel blockers 2. Direct arteriole vasodilators

Question 37

What are 2 types of calcium channel blockers?

Answer 37

1. Non-dihydropyridines (Verapamil, Diltiazem) 2. Dihydropyridines ("-dipines")