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hypertensive agent Flashcards

1
Q

a1 blockers indications are

A

hypertension + benign prostatic hypertrophy

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2
Q

a1 blockers adverse effects are

A
  • First dose phenomenon Severe orthostatic hypotension
  • Tolerance to the hypertensive response
  • Sodium -water retention (should be used with diuretic)
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3
Q

Calcium channel blockers divided into

A
  • Non-dihydropyridines
    Verapamil (block on the heart ) and Diltiazem (intermediate and its actions)
  • dihydropyridines
    (Block on the Vascular smooth muscle)
    Ends with -dipine
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4
Q

Calcium channel blockers, dihydropyridine , adverse effects are

A

Constipation, flushing, dizziness, headache, hypotension

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5
Q

Calcium channel blockers, verapamil and diltiazem ,adverse effects are

A

Cardiac depression, bradycardia, and AV block

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6
Q

Vasodilators are

A

Hydralazine, minoxidil, sodium nitroprusside, diazoxide

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7
Q

Which one of the vasodilators cause lupus erythematosus if a pregnant woman used it?

A

Hydralazine

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8
Q

Which vasodilator used to treat severe to malignant hypertension

A

Minoxidil

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9
Q

Which vasodilator is available only for intravenous use and it used for hypertension emergencies

A

Diazoxide , sodium nitroprusside

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10
Q

Vasodilators’ adverse effects

A

1- Reflex tachycardia,
2- nausea, vomiting, headache,
3- possible fluids retention
4- hypertrichosis (excessive hair growth minoxidil)
5- hyperglycemia (diazoxide)

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11
Q

the classification of diuretic drugs

A

1- carbonic anhydrase inhibitor
2- loop diuretic
3- thiazide diuretic
4- potassium sparing
5- osmotic diuretic

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12
Q

thiazide ex.

A

hydrochlorothiazide and metolazone

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13
Q

which diuretic drug act as frontline
and most commonly used to treat hypertensive.

A

thiazide

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14
Q

the prototypical thiazide is

A

hydrochlorothiazide

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15
Q

thiazide mechanism

A

1- works on distal convoluted tubule by inhibiting the Na - Cl cotransporter resulting excretion of Na and H2O
2- loss of Ka + Mg
3- high Ca in blood

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16
Q

what drug can be used to treat calcium oxalate stones

A

thiazide

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17
Q

therapeutic use of thiazide

A

antihypertensive and for hypercalciuria

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18
Q

why the thiazide considered to be a frontline for hypertensive

A

inexpensive , effective -even with elderly-, convenient administer, well tolerance

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19
Q

what is the adverse effects of the thiazide

A

hypokalemia
hypotension
hyponatremia

hyperuricemia (70%)
hypercalcemia

erectile dysfunction (less common in the low dose + reversible)

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20
Q

which diuretic drug has most effecacy

A

the loop diuretic drug

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21
Q

the mechanism of action of loop of diuretic drug

A

inhibit the cotransporter Na\K\2Cl in the Luminal membrane in the ascending limb of loop of Henle

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22
Q

ex. of loop diuretic drug

A

bumetanide , furosemide

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23
Q

excretion of the loop diuretic drug

A

Na , K , Ca , H2O

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24
Q

adverse effect of loop diuretic drug

A

ototoxicity (ethacrynic acid >furosemide > bumetanide )

hypokalemia
hypomagnesemia
hypocalcemia
acute hypovolemia

hyperuricemia
hyperglycemia
metabolic alkalosis (high HCO3)

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25
therapeutic use of the diuretic drug
- not mainly used to treat hypertensive - used for edema (( DRUG OF CHOICE acute pulmonary edema of heart failure ))
26
where does the potassium sparing diuretic works and how
collecting tubule to inhibit the reabsorption of the Na and the excretion of K
27
the potassium sparing diuretic drug is divided into
aldosterone antagonist and epithelial sodium channel blocker
28
aldosterone antagonist (potassium sparing) ex.
spironolactone and eplerenone
29
epithelial sodium channel blocker ex.
amiloride and triamterene
30
the potassium sparing diuretic drug used as
adjunct therepy with (loop and thiazide ) least potent
31
the potassium sparing diuretic drug used for
heart failure
32
what is the adverse effects of the potassium sparing diuretic drug
gynecomastia menstrual irregularities hyperkalemia nausea hyponatremia
33
ex. of the carbonic anhydrase inhibitor
acetazolamide
34
mechanism of action for carbonic anhydrase inhibitor
inhibit the carbonic anhydrase enzyme in the proximal tubular epithelial cells
35
carbonic anhydrase inhibitor are more often used for their other pharmacologic action why?
because they are much more less efficacious than loop and thiazide
36
carbonic anhydrase inhibitor is used for
glaucoma and mountain sickness
37
what is the adverse effects of carbonic anhydrase inhibitor
metabolic acidosis hypokalemia renal stones
38
ex. of the osmatic diuretic drugs
mannitol
39
the therapeutic use of the mannitol
increased intracranial pressure or acute renal failure
40
the adverse effect of mannitol
dehydration and hyponatremia
41
what is the action of osmatic diuretic drug
increased fluid loss by osmotically active molecules in the proximal tubule + increase the renal flow after administration
42
what drug used for intracranial pressure
osmatic diuretic drug mannitol
43
what is the drug of choice for acute pulmonary edema of heart failure
loop diuretic drug
44
what is the identifiable causes of HT
sleep apnea drug induced chronic kidney disease chronic steroid therapy
45
non drug treatment of HT
LOW : -salt intake -calories -smoking -alcohol -stress factors -caffeine HIGH: activity !!!!
46
what is the three general mechanism that drugs take to lower the BP
- alter synthetic activity - alert sodium / water balance -relax vascular smooth muscle
47
what is the three possible mechanism for beta blockers
- CNS effect (decrease the sympathetic NS tone) - inhibit the renin secretion (beta 1 receptor mediated renin release ) - block cardiac beta 1 receptor ( lower the cardiac output)
48
the beta blocker and ACE inhibitors work best with patient whom
white and young
49
what is the drug used for hypertensive patient with angina pectoris
beta blockers
50
what is the drug used for hypertensive patient with myocardial infraction
beta blockers
51
what is the drug used for hypertensive patient with CHF
beta blockers
52
sides effects for beta blockers
bronchospasm hypotension fatigue bradycardia decrease libido
53
drug withdrawal for beta blockers
must be tapered over 2-3 weeks
54
alpha blockers are selective to
alpha 1
55
alpha blockers ex.
prazosin terazosin doxazosin
56
vasodilators are best been co administrated with
-b blockers ( decrease heart rate ) -diuretic (treat edema )
57
ACE inhibitors ex.
captopril lisinopril fosinopril enalapril
58
what is the drug used for hypertensive patient with diabetes
ACE inhibitors
59
three mechanism for ACE inhibitors to work
- reduce aldosterone -> low Na/H2O retention - reduce angiotensin -> low vasocontraction - increase bradykinin -> vasodilation
60
adverse effects for ACE inhibitors
- DRY COUGH - ALERTED TASTE - ANGIOEDEMA - hypotensive - rash - hyperkalemia - reversible renal impairment
61
ACE inhibitors are under what category for pregnant woman
category D ( teratogenic )
62
angiotensin II antagonist ex.
losartan , valsartan
63
how many time should be the angiotensin II antagonist taken
once daily
64
which drug from angiotensin II antagonist undergo extensive first pass metabolism
losartan
65
aliskiren is an example for
renin inhibitor drugs
66
what is the adverse effect of aliskiren
diarrhea
67
ex. of centrally acting adrenergic drugs
clonidine , alpha methyldopa
68
mechanism of action for clonidine
act directly at a2 receptors
69
what the therapeutic uses of clonidine
mild to moderate hypertensive suitable for renal failure patient
70
the adverse effect of clonidine
sedation a dangerous effect is rebound hypertensive (follows a abrupt withdrawal)
71
a methyldopa mechanism of action
first converted to a methylnorepinephrine which activate CNS a2 whose function is to decrease sympathetic outflow
72
other drugs for hypertensive include
fenoldapam guanethidine and reserpine which are rarely used
73
fenoldapam mechanism of action safe for who contraindicated for
a dopamine 1 agonist safe for all emergency patients contraindicated for glaucoma
74
hypertensive emergency
1- SODIUM NITROPRUSSIDE (emergency , malignant hypertensive ) 2- LABETALOL (a b blocker ) 3- DIAZOXIDE ALL administrated IV

pharmacology (5 decks)

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