(THER) Antihypertensives I and II

Question 1

Hydralazine MOA and Indication

Answer 1

Arteriole vasodilator

Ind: Resistant hypertension; pregnancy induced hypertension

Question 2

Spironolactone should not be used in combination with which drugs?

Answer 2

Drugs that inhibit the RAA system (ACE Inhibitors, ARBs, or BBs)

Question 3

Thiazides are not as useful in patients with…

Answer 3

Renal insufficiency

Question 4

What is the effect of Calcium Channel Blockers?

Answer 4

Relax peripheral arterial vascular smooth muscle and decrease total peripheral resistance.

Question 5

What effect do calcium channel blockers have on cardiac output/contractility?

Answer 5

Decrease calcium-induced calcium release from myocyte SR and can reduce CO

Question 6

Nifedipine MOA and Side effects

Answer 6

Relatively selective vasodilator

AEs: Acute tachycardia; peripheral edema

Question 7

Diltiazem Effects and Adverse Effects

Answer 7

Effects: Reduces both CO and peripheral resistance

AEs: bradycardia

Question 8

Patients taking short-acting nifedipine, diltiazem or verapamil were 1.6 times more likely to… as compared to patients on other hypertensives.

Answer 8

Have an MI than patients on other antihypertensives.

Question 9

MOA and Effect for Sympatholytic Drugs

What does it mean that they are centrallyy acting agents?

Answer 9

Reduce sympathetic drive to heart/blood vessels

They reduce this sympathetic output from vasopressor centers in the brainstem.

Question 10

Clonidine MOA and AEs (3)

Drug interaction?

Answer 10

Alpha-2 agonist: decreases sympathetic outflow from CNS

AE: sedation, dry mouth, contact dermatitis

May interact with other CNS depressants, potentiating their action

Question 11

In what way should you withdraw patients off of Clonidine and why?

Answer 11

Withdraw slowly to prevent rebound hypertension

Question 12

How does Guanfacine differ from Clonidine?

Answer 12

It has similar effects but a longer half-life

Question 13

Methyldopa MOA (2)

Answer 13

1. Agonist at a-2 adrenergic receptor (decreases sympathetic tone, dropping BP)
2. Competes for DOPA decarboxylase preventing production of dopamine and subsequent NE/Epi

Question 14

Methyldopa AEs and key interaction

Answer 14

AE: sedation

Interaction: reduces L-dopa therapeutic effects

Question 15

Which drug is probably the most extensively used hypotensive agent in management of hypertension in pregnant women?

Answer 15

Methyldopa

Question 16

Reserpine MOA

Answer 16

Disrupts NE vesicular storage, leading to the eventual digestion of NE by MAO. Overall drop in sympathetic stimulation.

Question 17

Function of Alpha Adrenergic Antagonists

Answer 17

Block arterial and venous constriction

Question 18

Indication for phenoxybenzamine

Answer 18

Used in patients with hypertension due to pheochromocytoma

Question 19

Prazosin is similar to which 2 drugs which are more commonly prescribed?

Answer 19

Terazosin and Doxazosin

Question 20

Prazosin function (2)

Answer 20

1. Alpha Adrenergic Antagonist
2. Also causes beneficial decease in LDL/HDL ration

Question 21

Prazosin AEs

Answer 21

1. First dose produces precipitous fall in BP
2. Fluid retention
3. Can promote postural hypotension

Question 22

How do B-blockers lead to vasodilation?

Answer 22

By increasing NO release or blocking a-adrenergic receptors

Question 23

Nadolol selectivity? Half-life?

Answer 23

Non-selective B-blocker; longer half-life

Question 24

Labetolol MOA

Is it more lipophilic or lipophobic?

Answer 24

Mixed beta/alpha receptor antagonist (beta/alpha blocker)

Lipophilic

Question 25

Carvedilol MOA/effect

Answer 25

1. Non-selective B-blocker 2. Some alpha receptor antagonist properties 3. Vasodilatory

Question 26

B-blocker AEs and Drug interactions

Answer 26

1. Bradycardia 2. Increased serum triglycerides/decreased HDL levels 3. Insomnia 4. Hyperglycemia _Drug Interactions_: CCB’s increased risk of conduction disturbances

Question 27

Drug interactions for B-blockers

Answer 27

Calcium Channel Blockers (CCBs) increase risk of conduction disturbances when combined with B-blockers

Question 28

Hydralazine Side Effects (3)

Answer 28

Tachy; aggravation of angina; fluid retention

Question 29

Hydralazine Contraindication

Answer 29

CAD

Question 30

Minoxidil Indication and AEs

Answer 30

Indication: Resistant hypertension AE: tachycardia; aggravation of angina; fluid retention

Question 31

Nitroprusside Indication/ AEs

Answer 31

Indication: Hypertensive emergencies AE: cyanide poisoning

Question 32

Lisonopril falls under what umbrella of drugs?

Answer 32

ACE Inhibitors

Question 33

Side Effects/ Drug Interactions for ACE Inihibitors

Answer 33

AEs: hyperkalemia; dry cough; angioedema Interactions: can exacerbate hyperkalemia when given with potassium sparing diuretics

Question 34

ACE Inhibitor COntraindication

Answer 34

Should not be given to _pregnant women_, as Ang II is important in fetal renal development, particularly in the 2nd and 3rd trimesters

Question 35

Key point about ACE Inhibitors and Diabetic Patients

Answer 35

ACE-I's preserve renal function in patients with diabetes

Question 36

Losartan MOA and AEs

Answer 36

Selective Angiotensin I receptor Blocker (ARB)

Question 37

Losartan Drug interactions and contraindications are the same as what other drug?

Answer 37

ACE inhibitors

Question 38

Why are ACE-I and K+ sparing diuretics a poor drug combination?

Answer 38

They both promote hyperkalemia

Question 39

For Black patients, what are the best first line options for hypertension? In what context should the other drugs be used for the best effect?

Answer 39

**Diuretics or Calcium Channel Blockers (CCBs)** should be used as first line treatment in uncomplicated hypertension for AA patients. Other drugs (BBs, ACEIs or ARBs) should be used in combination w/ diuretics for best effect.

Question 40

Which drugs are best for patients with Diabetes mellitis who are hypertensive? (3)

Answer 40

ACEI, alpha antagonists and CCBs