V - Drugs for Hypertension

Question 1

What is the blood pressure goal in hypertensive patients with no comorbidities? Diabetes mellitus? Chronic kidney disease?

Answer 1

no comorbidities: <130/80

Question 2

Hydrochlorothiazide is a Thizide diuretic. MOA: Inhibit Na/Cl transporter in distal convuluted tubule. Cause moderate diuresis and reduced excretion of calcium

Answer 2

Uses: Hyepertension (first line), Heart failure, Hypercalciuria, Npehrogenic diabetes insipidus. SE: Hypokalemic metabolic acidosis, Hyperglycemia, Hyperlipidemia, Hyperuricemia, Sulfa allergy

Question 3

Furosemide is a Loop diuretic. MOA: Inhibit Na/K/Cl transporter in thick ascending limb of Loop of Henle. Cause powerful diuresis and increased Ca excretion.

Answer 3

Uses: Heart failure, Pulmonary edema, Hypertension, Hypercalcemia, Acute renal failure, Anion overdose SE: Hypokalemic metabolic alkalosis, Potassium wasting, Dehydration, Ototoxicity.

Question 4

Clonidine is a Sympathetic outflow blocker. MOA: Activates Alpha 2 adrenergic receptors. A2: Decreases central sympathetic outflow

Answer 4

Uses: Hypertension, Cancer pain, Opiod withdrawal. SE: Sedation, Rebound hypertension, Dry mouth. Notes: Taper use prior to discontinuation to avoid Rebound hypertension. Treat with Phentolamine.

Question 5

Methyldopa is a Sympathetic outflow blocker. MOA: Activates Alpha 2 adrenergic receptors. A2: decreases central sympathetic outflow.

Answer 5

Uses: Pre-eclampsia. SE: Hemolytic anemia (positive Coomb’s test)

Question 6

Hexamethonium is a Ganglion blocker. MOA: Completely blocks Nn nicotinic Ach receptors.

Answer 6

Uses: Hypertension (obsolete), Hypertensive emergencies. SE: Postural hypertension, Dry mouth, Blurred vision, Constipation, Sexual Dysfunction

Question 7

Reserpine is a Nerve terminal blocker. MOA: Irreversibly blocks the vesicular monoamine transporter (VMAT).

Answer 7

Uses: Hypertension (obsolete) SE: Sedation, Severe psychiatric depression, Suicidal ideation.

Question 8

Prazosin is an Adrenergic antagonist (alpha 1-selective). MOA: Selectively blocks Alpha 1 adrenergic receptors.

Answer 8

Uses: Benign Prostatic Hyperplasia, Hypertension. SE: First dose orthostatic hypotension, Reflex tachycardia (less chance)

Question 9

Propanolol is an Adrenergic antagonist (beta-nonselective). MOA: Blocks B1 and B2 receptors, Blocks sympathetic effects on heart and BP. Reduces renin release.

Answer 9

Uses: Angina prophylaxis, Hypertension, Migraine, Arrhythmias. SE: Bronchospasm, AV block, Heart failure, CNS sedation, Erectile dysfxn. Notes: Masks symptoms of hypoglycemia in diabetics. Labetalol has combined Alpha anf beta blockade = Pheochromocytoma

Question 10

Hydralazine is an oral Vasodilator. MOA: Alters intracellular Ca++ metabolism. Relaxes arteriolar smooth muscle, causing vasodilation. Decreases afterload.

Answer 10

Uses: Hypertension, Heart failure, Pre-eclampsia. SE: Edema, Reflex Tachycardia, Myocardial ischemia, Drug-induced lupus

Question 11

What medications may cause drug-induced lupus?

Answer 11

It’s HIPP to have LUPUS. Hydralazine, Isoniazid, Procainamide, Penicillamine

Question 12

Minoxidil is a vasodilator. MOA: Opens K+ channels in vascular smooth muscle, causing hyperpolarization, muscle relaxation and vasodilation. Specific for arterioles = decreased afterload.

Answer 12

Uses: Hypertension, Alopecia. SE: Edema, Reflex tachycardia, Angina, Pericarditis, Hypertrichosis, Pulmonary hypertension

Question 13

How does Minoxidil caus excessive hair growth?

Answer 13

Minoxidil stimulate hair follicles (telogen phase) to differentiate into growth follicles(anagen phase).

Question 14

Verapamil is a Non-dihydropyridine Calcium channel blocker. MOA: Non-selective block voltage-gated L-type calcium channels. Cardiac depressant

Answer 14

Uses: Angina, Hypertension, Supraventicular tachycardia, Migraine. SE: Pretibial edema, Gingival hyperplasia, Heart failure, AV block, Sinus node depression

Question 15

Nifedipine is a Dihydropyridine Calcium channel blocker. MOA: Non-selective block voltage-gated L-type calcium channels. More Vascular depressant.

Answer 15

Uses: Angina, Hypertension. SE: Constipation, Pre-tibial edema, Nausea, Flushing, Dizziness.

Question 16

Nitroprusside is an oral vasodilator. MOA: Relaxes venous and arteriolar smooth muscle. Decreases both preload and afterload.

Answer 16

Uses: Hypertensive emergency, Acute heart failure, Cardiogenic shock, Controlled hypotension. SE: Cyanide toxicity, Hypotension, Headache.

Question 17

Fenoldopam is a Dopamine agonist. MOA: Cause arteriolar vasodilation of the afferent and efferent arterioles. Increases renal blood flow.

Answer 17

Uses: Hypertensive emergency. SE: Hypotension, Hypokalemia.

Question 18

Captopril is an Angiotensis Converting Enzyme inhibitor. MOA: Inhibits ACE and formation of Angiotensin II. Decreases aldosterone secretion.

Answer 18

Uses: Hypertension, Heart failure, Post Myocardial infarction, Diabetic nephropathy. SE: Cough, Taste disturbance, Angioedema, Hypotension, Hyperkalemia, Teratogen

Question 19

Why are patients with diabetic nephropathy treated with ACE inhibitors?

Answer 19

ACE inhibitors decrease albumin excretion and slow progression from micro to macroalbuminuria (renoprotective effect).

Question 20

Losartan is an Angiotensin receptor blocker (ARB). MOA: Blocks Angiotensin in vascular smooth muscle and adrenal cortex. Decreases aldosterone secretion.

Answer 20

Uses: Hypertension, Heart failure, Diabetic nephropathy. SE: Hypotension, Teratogen, Hyperkalemia. Notes: Slows ventricular remodeling and increases survival in heart failure. Delays progression of Diabetic nephropathy.

Question 21

Why do patients taking angiotensin antagonists (ACE-Is/ARBs) develop hyperkalemia?

Answer 21

ACE inhibitors/ARBs reduce aldosterone levels and cause potassium retention.

Question 22

Aliskiren is a Rensis antagonist. MOA: Inhibits renin. Prevents conversion of angiotensinogen to angiotensin I.

Answer 22

Uses: Hypertension SE: Headache, Diarrhea, Angioedema, Renal impairement.