Hypertension and pharmacotherapy

Question 1

Spironolocatone

Answer 1

aldosterone receptor blocker

Question 2

Eplerenone

Answer 2

aldosterone receptor blocker

Question 3

“zosin” drugs: prazosin, terazosin, doxazosin

Answer 3

alpha-1 adrenergic blockers

Question 4

alpha-methyldopa

Answer 4

alpha-2 agonists

Question 5

Clonidine

Answer 5

alpha-2 agonists

Question 6

Guanfacine

Answer 6

alpha-2 agonists

Question 7

acebutolol, betaxolol, esmolol, atenolol, metorpolol

Answer 7

beta-1 selective blockers

Question 8

carvedilol, labetalol

Answer 8

B1B2a1 blockers

Question 9

diltiazem

Answer 9

benzothiazepines - Calcium channel blocker

Question 10

Amlodipine, felodipine, nicardipine, nifedipine

Answer 10

dihydropyridines: Calcium channel blocker

Question 11

Verapamil

Answer 11

phenylalkylamines: Calcium channel blocker

Question 12

Furosemide

Answer 12

loop diuretic

Question 13

Ethyacrynic acid

Answer 13

loop diuretic for sulfa allergies

Question 14

hydrochlorothiazide

Answer 14

thiazide diuretics

Question 15

indapamide, chlorthalidone

Answer 15

thiazide like agents

Question 16

amiloride, triameterene

Answer 16

K-sparing diuretics

Question 17

Captopril, enalapril, lisinopril, benazepril, quinapril, meoxipril, perindopril, foesnopril

Answer 17

ACE inhibitors

Question 18

Losartan, valsartan, irbesartan, candesartan, telmisartan

Answer 18

Angiotensin receptor blockers (ARBs)

Question 19

medoxomil

Answer 19

angiotensin receptor blocker

Question 20

Hydralazine, nitroprusside

Answer 20

vasodilator drugs -open K+ channels in vascular smooth muscle (similar to Ca channel blockers)

Question 21

Aliskiren

Answer 21

Blocks renin (renin converts angiotensinogen to AI)

Question 22

List the 6 classes of anti-hypertensive drugs

Answer 22

1. Beta/alpha blockers
2. Calcium channel blockers
3. ARBs
4. ACE inhibitors
5. Diuretics
6. Unique drugs

Question 23

action of blocking B1, B2, a1, and a2 receptors. Which are helpful to block in hypertension?

Answer 23

• B1- blocking will decrease HR and contractility, and will lower BP = helpful!
• B2- blocking will vasocontrict blood vessels = not helpful! and may worsen asthma symptoms
• a1- blocking this will vasodilate blood vessels = helpful
• a2-by stimulating alpha 2 receptor you decrease NE release in the CNS, and helpful in lowering BP, so blocking thsi will cause more NE release and will increase BP

Question 24

Beta blocker side effects (3)

Answer 24

fatigue, erectile dysfunction, hyperlipidemia

Question 25

propranolol

Answer 25

B1B2 nonselective blockers

Question 26

timolol

Answer 26

B1B2 nonselective blockers

Question 27

nadolol

Answer 27

B1B2 nonselective blockers

Question 28

this drug causes postural hypotension

Answer 28

alpha blockers - when you stand up, your venous return drops, so body responds by triggering alpha receptors to vasoconstrict - if blocked, you can get dizzy

Question 29

Nifedipine, dilitazem, verapamil explain dominant effect

Answer 29

_Calcium channel blockers_ vasodilator vascular smooth muscle effects: nifedpine \> diltiazem \> verapamil Negative inotropes, HR/contractility effects: verapamil \> diltiazem \> nifedipine

Question 30

Side effects of calcium channel blockers

Answer 30

- nifedipine: edema (vasculature becomes more permeable, fluids leak out into interstitial space, diuretics cant get rid of this edema) - verapamil, dilitiazem: can precipitate heart failure, constipation, flushing

Question 31

5 effects of RAAS system and net results (4)

Answer 31

1. SNS 2. Arterioral vasoconstriction 3. Renal Na/Cl resoprtion 4. Adrenal aldosterone secretion 5. Pituitary ADH secretion Net results: 1. increase salt/water retention 2. increase BP 3. increase preload 4. increase afterload

Question 32

ACE inhibitor side effects (4)

Answer 32

1. Hyperkalemia (less Na resorption so K stays in) 2. Angioedema - swelling of face and tongue 3. renal failure 4. cough

Question 33

Mechanism for why ACE inhibitors cause cough

Answer 33

ACE usually breaks bradykinin down into inactive metabolites. Bradykinin causes cough and angioedema

Question 34

bumetanide

Answer 34

Loop diuretic

Question 35

torsemide

Answer 35

loop diuretic

Question 36

loop diuretic effects on: - calcium levels - K levels

Answer 36

- hypocalcemia - hypokalemia (the pump is Na, K, 2Cl pump) need positive drive to bring in Ca

Question 37

Side effects of Thiazide diuretics:

Answer 37

hyperGLUC elevated levels of: - glucose - lipids - uric acid - calcium (because calcium and Na compete to get inside)

Question 38

hydralazine - action - side efect - combinations of drugs - alarm

Answer 38

* direct vasodilator (smooth muscle hyperpolarization), generates NO, increases cGMP in smooth muscle * causes reflex tachycardia, co-administered with B-blocker * combined with nitrates for CHF * dont use for angina-exacerbates problem

Question 39

three drugs that causes drug-induced lupus

Answer 39

1. hydralazine 2. isoniazid 3. Procainamide (anti-arrythmic, Class IA Na blocker, increases QRS, QT, AP)

Question 40

Clonidine - action - use - side effect

Answer 40

agonists to CNS a2 receptor (tricks nervous system into thinking theres too much NE, so drops NE levels) decreases sympathetic tone - used for HTN in renal patients, believed to have less decrease in renal blood flow - rebound hypertension

Question 41

methyldopa - action - use - side effect

Answer 41

- agonist to CNS alpha-2 receptor - drug of choice in pregnancy - hemolytic anemia

Question 42

Which regulatory ssytems are the major target of antihypertensive drugs?

Answer 42

1. SNS (seconds to minutes) 2. RAAS (minutes to hours) 3. kidney salt and water balance (hours to days)

Question 43

What receptors are in the kidneys and what are their actions?

Answer 43

B1- renin release B2- vasodilation a1-vasoconstriction

Question 44

Renin is released by the juxtaglomerular cells of the kidney in response to these 4 cases:

Answer 44

1. increased SNS activity (B1 activity) 2. decreased renal perfusion pressure 3. reduced urinary [Na] 4. increased urinary [K]