Pharmacology of HTN

Question 1

methyldopa - 4

Answer 1

• prodrug
• false neurotransmitter
• converted to methyl NE
• reduces sympathetic output (less NE is released)

Question 2

methyldopa use and S/E

Answer 2

• use :htn in pregnancy
• S/E: sedation and hemolytic anemia
• interactions : Parkinsosn, Geriatrics, Depression

Question 2

direct stimulation of alpha adrenergic receptors

Answer 2

clonidine - also reduces sympathetic output

• MOXONIDINE

Question 3

clonidine indications - 3

Answer 3

• mild to moderate HTN
• opoiod withdrawal
• menopausal hot flusehs

Question 3

clonidine side effects and interactions

Answer 3

S/E - DDSS
interactions : G, D ,&raquo_space; glaucoma, epilepsy, CNS depressants (alcohol incr)

Question 4

doxazosin and terazosin MOA

Answer 4

• selective a1 antagonism
• vasodilatory efffects via post synaptic receptors…
• prevents NA binding

Question 4

T and D indication and S/E, interactions

Answer 4

• hypertension and BPH, phaeochromocytoma (tumor in the adrenal gland)

S/E - hypotension at first dose, dizziness, vertigo

• palpitations, peripheral edema, tachycardia, somnolence and nervousness

interactions - gastro and esophageal obstruction

Question 4

what is terazosin/ doxazosin used with

Answer 4

other drugs, NEVER USED AS MONOTHERAPY

Question 5

4th line SM agent

Answer 5

hydralazine (only has activity in the arteries)

Question 6

hydralazine MOA, uses

Answer 6

• vasodilatory, reduces oxidation of NO, thus low BP
• uses : htn and heart failure

Question 7

how is t1/2 increased with hydralazine

Answer 7

binds to the walls of the arteries, increasing its half life

Question 8

hydralazine interactions - THALO

Answer 8

Tachycardia
HOC
Aortic stenosis
Lupus
Other hypetensives

Question 8

hydralazine S/E

Answer 8

• hypotension at first dose and reflex tachycardia, hence take it with a beta blocker

Question 9

dihydralazine

Answer 9

hypertensive emergency - still needs SAHPRA approval

Question 9

sodium nitroprusside MOA, use, S/E, interactions

Answer 9

• direct vasodilatory effects on both the veins and arteries
• used in clinical emergencies
• S/E - severe hypotention
• tachycardia and other antihypertensives

Question 10

learn the vasodilators table

Question 11

learn the CCB table

Question 14

propanolol and timolol

Answer 14

avoid in asthma and COPD

• P - increased bradycardia with verapimil and digoxin

Question 15

sotalol

Answer 15

avoid QT proloning agents

Question 16

atenolol

Answer 16

less CNS penetration than other agents so less depression risk

Question 17

bisoprolol

Answer 17

lower bronshospasm than non selective (since it is cardioselective)

Question 18

metoprolol

Answer 18

more CNS penetration (depression and vivd dreams risk)

• similar to biso in that there is less bronschospasm bc of selcetivity

Question 18

nebivolol

Answer 18

vasodilatory effects via NO release, better tolerated in respiratory consitions = bronchodilation i presume

Question 19

carvediolol

Answer 19

a1 blocking effects, better BP control but higher dizziness risk

Question 19

low ceiling diuretics

Answer 19

thiazides - hydrochlorthiazides - indapamide - chlortalidone

Question 19

uses of low ceiling thiazides

Answer 19

hypertension

Question 19

high ceiling

Answer 19

loop - furesomide -torasemide -bumetanide

Question 20

uses of loop diuretics

Answer 20

used in hypertension where hypovolaemia and oedema is present

Question 20

K+ classes

Answer 20

- amiloride - triamterene -spirinolactone

Question 21

uses of K+ sparing

Answer 21

usually second line in hypertensive treatment

Question 21

thiazides MOA and S/E and indication

Answer 21

MOA: inhibits Na/Cl reabsorption from proximal sites. loss of K, Mg, Zn, and some Ca I: hypertension and edema S/E = gout attacks, GIT, electrolye imbalances and hypovolaemia

Question 22

hydrohlorthiazide interactions

Answer 22

CB LAND - hypercalcemia

Question 22

indapamide interactions

Answer 22

same as hydro, but with hyponatremia

Question 23

furesomide MOA and I and DI

Answer 23

inhibits Na/CL reabsorption at the loop of henle I: HTN, oedema and hypercalcemia DI: taccc ngl

Question 23

spironolactone MOA, I, S/E

Answer 23

MOA: aldpsterone inhibitor I: resistant HTN, oedema and off label for hyperandrogenism S/E: GGEH G - gynacomastia

Question 24

hypovolaema

Answer 24

dehydration

Question 24

spironolactone signs an

Answer 24

NSAIDS (aspirin) Digoxin (confirm no use) ACEi

Question 25

do spironolactones cause hyper or hypokalemia

Answer 25

HYPER

Question 26

amiloride is usually combined with

Answer 26

HZT

Question 26

amiloride +HZT MOA, indi, s/e, di

Answer 26

MOA: inhibts Na reabsoprtion at the distal tubule I: resistant htn, oedema where k+ sparing is intended S/E: GIT: anorexia, flatulence electrolyte imbalance : hyperkalemia DI: NSAIDs Pottasium supplements ACEi - increase risk of hyperkalemia

Question 26

learn electrolyte table

Question 27

another loop diuretic

Answer 27

ethacrynic acid

Question 28

urinary HC03

Answer 28

metabolic alkalosis

Question 29

carbonic annhydrase inhibitors

Answer 29

acetazolomide in the PCT

Question 29

H retention causesmetabolic acidosis

Question 29

what 3 things are affected when angiotensin 2 binds AT1 receptors

Answer 29

1. vascular growth 2. vasoconstriction 3. salt retention

Question 29

captopril moa, ind, s/e, di

Answer 29

moa: prevents conversion of ang 1 to ang 2 ind: htn and hf s/e: HIPS AJ di: npd

Question 30

water soluble ACE

Answer 30

linsinopril

Question 30

what enhances captopril

Answer 30

a low salt diet

Question 31

learn the prodrugs table

Question 31

teratogenic class of drugs

Answer 31

- ACEi - ARBs

Question 32

learn ARB table

Question 32

bedides constriction what does angiotensin 2 do

Answer 32

increase heart rate