Flashcards in More drugs Deck (80):
Effects of reserpine: (4)
Side effects of reserpine:
increased incidence of ulcers
(alpha-1 blocker, so:)
beneficial effect on insulin resistance
Used in older men with HTN and BPH:
Effects of BB: (5)
decrease HR + contractility (thus CO)
*no Na/H2O retention
with chronic use: decrease TPR
decreased production of aq. humor
treats stage fright
Pindolol does NOT affect levels of ___ like other BB
BB are useful in patients with HTN and:
MI or ischemic heart disease
Beta-1 cardioselective drugs
Partial beta-agonists; less effective than other BB:
Side effects of BB: (7)
cold extremities (due to alpha action)
CNS (bad dreams, depression)
drug withdrawal syndrome
increase LDL/decrease HDL
Should not be given with verapamil or diltiazem (non-DHP)
Nonselective beta and alpha 1 antagonists
Effects of nebivolol (bystolic)
promotes NO vasodilation
very beta-1 selective =
Effects of ACEI:
What patients have a greater response to ACEI?
those with elevated renin or Na depletion
(greater decrease in BP)
Renoprotective: delays renal disease in type I diabetics
increases synthesis of prostaglandins (vasodilation) in vascular and renal endothelium
ACEI activated by deesterification
Side effects of ACEI's:
2. fetal toxicity (not for 2nd/3rd trimester)
3. dry cough
5. hypotension (if hypovolemic +/or Na depleted), possibly 1st dose
ATII receptor antagonists end in the suffix...
Effects of ARBs
increased Na/water excretion
What do you do if one anti-HTN med causes a dry cough?
switch patient to ARBs
ARBs block the action of ATII on _____ receptors
AT type 1
What beta blocker is likely to have drug-drug interactions?
Competitive TXA2 receptor antagonist
Attenuates platelet aggregation
increases uric acid excretion
ARB that inhibits CYP
Side effects of ARBs
2. fetal toxicity
3. hypotension (hypovolemic +/or Na depleted patients)
ARB that causes hepatic dysfunction
Effect of renin inhibitors
decrease BP **dose-dependent
phenylalkylamines are ~selective for:
dihydropyridines selectively block:
L-type Ca channels in myocardium
L-type Ca channels in blood vessels
Effects of dihydropyridines:
decrease systemic vascular resistance
decrease arterial pressure
NO/MILD changes in HR (except short acting dihy's)
CCBs most effectively control BP in what type of patient?
patients with low renin HTN
(this is more common in AA and elderly)
Side effects of dihydropyridines:
Reflex tachy occurs in patients taking what dihydropyridine?
nifedipine (procardia), short acting
Side effects of hydralazine?
palpitations (tachy, may lead to angina)
(not a s/e, but causes water retention)
What drugs are direct vasodilators?
Side effects of minoxidil:
How does minoxidil affect BP?
opens K-ATP channels, which causes relaxation of arteriolar smooth muscle
**dilates arterioles NOT veins
Effects of nitroprusside:
forms NO, causing vasodil (arteries/veins)
Decreases CO in normal
Side effects of nitroprusside:
1. excessive hypotension
3. metabolized to cyanide (cyanate/thiocyanate toxicity: give small dose for small period)
Nitroprusside is used to treat:
HTN emergencies in patients with ventricular failure
**why does this seem to contradict??
clonidine acts on what receptors?
postsynaptic alpha-2A adrenoreceptors in the rostral ventrolateral medulla
(decreases symp impulses from RVLM to heart and vessels)
Effects of clonidine
decrease peripheral vasc resistance
Because it releases endogenous opiates, this drug is used as an analgesic in neuropathic pain
Side effects of clonidine
contact dermatitis, if patch form
clonidine withdrawal (HTN)
Effects of bosentan:
What is this indicated for?
vasodilation (by blocking endothelin 1 and 2 receptors)
_____ (alone or with beta-blockers) decrease mortality in patients with HTN
Which drug class has the advantage of decreasing HTN wile improving lipid profile and insulin resistance?
alpha 1 blockers
Offers secondary protection in CAD (plus anti-HTN)
_____ should not be stopped abruptly--taper down doses
ACEI are the 1st choice drug for patients with:
Angina is treated by: (approaches)
1. increase blood blow
2. decrease oxygen consumption
3. prevent platelet aggregation (**Aspirin)
(Nitrates) Venodilation causes reduced preload, which results in:
1. decreased ventricular pressure in diastole
2. decreased oxygen demand
3. increased subendocardial blood flow
(Nitrates) Coronary vasodilation results in:
1. blood flow to ischemic areas
2. selective dilation of epicardial/collateral coronary vessels
3. prevention/reversal of vasospasm
(Nitrates) Overall effects on hemodynamics:
decreased pulmonary vascular resistance
slightly reduced CO
Adverse effects of nitrates:
hypotension (due to arterial vasodil)
Orthostatic hypotension (reduced preload)
headache (dilation of meningeal arteries)
Drug reactions with nitrates
viagra and other type V PDE inhibitors
(causes hypotension and MI)
Nitrates are abosorbed (quickly/slowly) and metabolized (quickly/slowly)
quickly (via 1st pass**)
Side effect of abrupt discontinuation of nitrates
What type of CCBs target smooth muscle cells? Cardiac cells?
How do non-dihydropyridine CCB's treat angina?
decrease oxygen demands by decreasing HR, contractility and afterload
~coronary vasodilation prevents or reverses vasospasm
How do dihydropyridine CCB's treat angina?
reduces oxygen demand by reducing afterload
***coronary vasodilation (causes reflex cardiac stimulation)
Side effects of DHP CCB's?
exacerbation of angina (coronary steal)
Side effects of non-DHP CCB's?
DO NOT USE IN CHF
How do beta blockers treat angina?
1. decrease HR and contractility in response to exercise
2. decreases afterload
Why combine nitrates or DHP CCB's with beta blockers treat angina?
BB prevent reflex tachycardia and contractility
4 drugs used in combo for unstable angina
BB are useless in what type of angina?
When would you use CCB's instead of BB in angina?
valvular insuff (reduce afterload)
sinus brady/AV block
DM with variable glu levels
Expensive, late Na-current inhibitor that increases oxygen utilization in heart
Drugs that reduce CHD event
Reduces CHD, reinfarction and stroke after MI or unstable angina
Improves survival post MI in patients with LV dysfunction
Indirectly reduces afterload (via decr renin)