Flashcards in Intro to Antihypertensive Agents IV Deck (51):
1
amlodipine
calcium channel blocker
2
clevidipine
calcium channel blocker
-DHP
3
felodipine
calcium channel blocker
-DHP
4
isradipidine
calcium channel blocker
-DHP
5
nicardipine
calcium channel blocker
-DHP
6
nifedipine
calcium channel blocker
-DHP
7
nisoldipine
calcium channel blocker
-DHP
8
diltiazem
calcium channel blocker
-non-DHP
9
verapamil
calcium channel blocker
-non-DHP
10
diazoxide
K channel opener
11
minoxidil
K channel opener
12
fenoldopam
dopamine agonist
13
hydralaine
NO donor
14
nitroprusside
NO donor
-nitropress
15
nitroglycerin
NO donor
-organic nitrate
16
isosorbide dinitrate
NO donor
-organic nitrate
17
calcium channel blocker mechanism
block L-type Ca channels
-cardiac myocyte and SA and AV nodal cells
decreased vascular smooth m contraction
18
dihydropyridine mechanism
-bind L-type Ca channels
-arteriolar vasodilation predominant
**more vascular effect
19
non-dihydropyridine mechanism
-bind L-type Ca channels
-predominant cardiac effects, but also act at vascular tissues
verapamil > diltiazem
20
hemodynamics of CCBs
-reduced TPR
-reduced afterload
-reduced O2 demand
-non-DHPs reduce CO
-decreased coronary vascular resistance and increased coronary blood flow
21
CCBs and cardiac muscle
negative inotropic effect
-Na fast channel primary depolarization, but Ca slow channels is additional
-Ca entry - induce Ca release from SR
-Ca binds troponin - allows contraction
verapamil > diltiazem > DHPs (inotropic effects)
22
DHPs
relax vascular smooth m at lower concentration than required for direct action on heart
23
DHPs and cardiac muscle
greater vasodilatory effect
-reflex increased sympathetic tone that overcomes negative inotropic effect
24
CCB effect on cardiac nodal cells
SA and AV node - depolarization L-type Ca channels
DHPs block channel - but don't effect recovery of channel and ARE NOT frequency dependent
25
verapamil and diltiazem
non-DHP CCB
-block channel, delay recovery of channel, and ARE frequency dependent
-decreased rate of SA node depolarization and slow AV nodal conduction
-useful for Tx of supraventricular tachyarrhythmias but dangerous for patients with slow nodal conduction
26
non-DHPs
more cardiac effect
-decreased contractility, suppress SA automaticity, and AV conduction
27
CCB pharmacokinetics
high 1st pass effect
28
long half life CCBs
amlodipine, felodipine, isradipine
29
DHP with long plasma half lives **
preferred to minimize reflex cardiac effects
-**decreased reflex tachycardia
-release preparations are available
30
CCBs sometimes used IV
nifedipine, clevidipine, verapamil, diltiazem
31
CCB adverse effects
generally very well tolerated
-excessive vasodilation - dizzy, hypotension, HA, nausea
-constipation** (verapamil), peripheral edema, coughing, wheezing, pulmonary edema
32
non-DHP with beta blocker**
contraindicated
-risk for potential AV block
33
non-DHP contraindications
-ventricular dysfunction
-SA or AV nodal conduction defects
-systolic BP < 90
34
CCB clinical uses
HTN (with other agent to counteract reflex CV response), hypertensive emergency, angina (reduced O2 demand)
35
potassium channel opener mechanism
increased K permeability
> hyperpolarizes smooth m. membrane
> reduce probability of contraction
36
diazoxide adverse effects
-excessive hypotension can cause stroke/MI
-hyperglycemia
37
minoxidil adverse effects
-HA, sweating, hypertrichosis, reflex tachycardia, edema
38
with minoxidil
use beta-blocker and diuretic
39
topical minoxidil
baldness
40
potassium channel openers
arteriolar vasodilation
-diazoxide and minoxidil
41
fenoldopam
D1 dopamine receptor agonist
-renal afferent arteries contain dopamine receptors
>increased blood flow to kidney
42
clinical use fenoldopam
HTN emergency and post op HTN
43
adverse effects of fenoldopam
tachycardia, headache, flushing
44
avoid in patients with glaucoma
fenoldopam
-increased IOP
45
hydralazine mechanism
released NO from endothelium
>dilates arterioles (not veins)
46
clinical for hydralazine
first line for HTN in pregnancy (with methyldopa)
combine with nitrates -heart failure pts
47
adverse effects of hydralazine
fluid and Na retention
-HA, nausea, anorexia, sweating, flushing, palpitations
-reflex tachycardia - provoke angina
-lupus like syndrome (reversible on drug withdrawal)
48
effect of organic nitrates
dilate arterial and venous vessels
>decreased TPR and venous return
>decreased preload and afterload
>main relaxation of large veins (decreased venous return/preload)
>also decreased O2 demand
>smaller decreased afterload
49
adverse effects of nitroprusside
excessive hypotension, CN poisoning
50
adverse effects of nitrates
orthostatic hypotension, syncope, throbbing HA
51