Pharm Antihypertensives

Question 1

What are first line drugs for hypertension?

Answer 1

ACEI/ARB
Ca channel blockers
Thiazide diuretics

Question 2

Initial tx of HTN:
Gen pop:
1. Black
2. Non black

CKD
3. black and non black

Diabetes

4. Black
5. Non black

Answer 2

1. Thiazide diuretics or CCB
2. Above but also ACEI or ARB
3. ACEI or ARB
4. Thiazide diuretics or CCB
5. ACEI or ARB

Question 3

Long term effects of diuretics include ___

Answer 3

• reduces Na content of arteriolar smooth muscle cells
• decreases muscle sensitivity to vasopressors
• decreases PVR
• promotes excretion of Na and H2O

Question 4

Thiazides are initial therapy for patients with ___

Answer 4

Normal renal function

*chloryhalidone and hydrochlorothiazide

Question 5

Loop diuretics are initial therapy for patients with ___

Answer 5

Renal dysfunction or congestive HF

Question 6

Loop diuretics ex ___

K sparing ex ____

Answer 6

Furosemide

Spironolactone, eplerenone

Question 7

Thiazides and loop diuretics may increase ___

Answer 7

Lipid and glucose levels

Question 8

ACEI ex ___

ARB ex ___

Answer 8

• prils

- sartans

Question 9

ACEI and ARBs are beneficial for pts with ___

Answer 9

Diabetes
Chronic renal disease
HF

Question 10

Adverse effects of ACEI

*contraindications

Answer 10

Cough, hypotension (also with ARB) and hyperkalemia (also with ARB)
*pregnant, bilateral renal a. stenosis (both also with ARB)

Question 11

Drug-drug interactions for ACEI and ARB

Answer 11

NSAIDs

Question 12

CCB ex ___

Answer 12

-dipines

Question 13

Beta blockers MOA

Answer 13

Reduce HR and contractility

Block renin release

Question 14

1. Nonselective Beta blockers

2. Cardio selective Beta blockers

Answer 14

1. Propranolol

2. Metoprolol, atenolol

Question 15

Nebivolol is a ___ antagonist, but a ___ agonist

Answer 15

Beta 1

Beta 3

Question 16

Uses for non selective alpha receptor antagonists (e.g. _____)

Answer 16

Pheochromocytoma
Hypertensive crisis
E.g. Phentolamine, phenoxybenzamine

Question 17

Uses for selective alpha 1receptor antagonists (e.g.: _____)

Answer 17

Chronic HTN with BPH

E.g. -zosins, prazosin, terazosin

Question 18

Alpha 2 adrenergic agonists are central acting agents. What are some examples?

Answer 18

Methyldopa (prodrug, safe during pregnancy)

Clonidine

Question 19

Adverse effects of Alpha 2 adrenergic agonists

Answer 19

Both methyldopa and clonidine:
Dry mouth
Sedation 
Lethargy
Mild depression 
*only methyldopa: autoimmune rxns leading to hemolytic anemia or hepatotoxicity

Question 20

Arterial vasodilators ex ___

Uses

Answer 20

Hydralazine
Minoxidil
*moderate to severe HTN

Question 21

Arterial vasodilators

1. MOA
2. Route
3. Uses

Answer 21

1. A. Hydralazine: dilated arterioles, but not understood
   B. Minoxidil: K channel opener, hyperpolarizes membrane, indirectly inhibits Ca influx
2. A. oral or IV
   B. Oral
3. A. CHF, Mod to severe HTN, safe during pregnancy
   B. Severe refractory HTN

Question 22

Minoxidil must be combined with ___

Answer 22

A sympatholytic and a diuretic

Question 23

Arterial vasodilators adverse effects

Answer 23

Reflex tach
Fluid retention
Hypotension
*minoxidil: stimulates hair growth 
*hydralazine: lupus like syndrome in slow acetylators

Question 24

Parenteral drugs for hypertensive emergencies: 
Nitroprusside:
1. Route
2. MOA
3. Adverse effects

Answer 24

1. IV
2. Relaxes veins and arteries, reduces preload and afterload
3. Hypotension

Question 25

Other IV drugs for hypertensive emergencies

Answer 25

``` Fenoldopam Esmolol (beta) Labetalol (A1 and beta) Nicardipine and clevidipine (CCB) Phentolamine (Alpha) Enalaprilat (ACEI) ```

Question 26

Classes of drugs used to treat pulmonary HTN

Answer 26

ETa blockers Prostaglandins PDE5 inhibitors Soluble guanylate cyclase stimulant

Question 27

ETa blockers ex ___

Answer 27

Ambrisentan Bosentan Macitentan

Question 28

Prostaglandins ex ___

Answer 28

Epoprostenol Iloprost Trepostinil Selexipag

Question 29

PDE5 inhibitors ex ___

Answer 29

Tadalafil | Sildenafil

Question 30

Soluble guanylate cyclase stimulant ex ___

Answer 30

Riociguat