Vasodilators and Sympatholytics DSA I

Question 1

vasodilators

Answer 1

relax smooth m of arterioles

• decreased TPR
• symapthetic reflex prevents orthostatic hypotension and sex dysfunction
• vasodilators work best with other anti-hypertensives

Question 2

DHPs

Answer 2

block vascular L-type Ca channels > cardiac

CCB

Question 3

non-DHPs

Answer 3

non-selective block of vascular and cardiac L-type Ca channels

CCB

Question 4

CCBs

Answer 4

smooth m. - vasodilation arterioles > veins
-decreased TPR, afterload, O2 heart demand

cardiac muscle - reduced contractility, slowed SA node pacemaker and AV node conduction velocity**

Question 5

CCB pharmacy

Answer 5

oral admin

• high first pass
• often used IV

Question 6

amlodipine

Answer 6

long half life CCB

Question 7

adverse effects for DHP CCBs

Answer 7

excessive hypotension, dizzy, HA, periphera edema, flushing, tachycardia, rash, gingival hyperplasia

Question 8

adverse effects for non-DHP CCBs

Answer 8

dizzy, HA, peripheral edema, constipation, AV block, bradycardia, heart failure, rash with diltiazem, pulmonary edema, coughing, wheezing

Question 9

short acting nifedipine

Answer 9

studies indicate - increasead risk of MI, stroke, death
-not for chronic HTN

instead use slow-release and long-acting DHPs

Question 10

non-DHP contraindication

Answer 10

beta-blocker use

Question 11

AV conduction

Answer 11

nifedipine does not decrease AV conduction

-therefore, use more safe in AV conduction abnormalities

Question 12

verapamil

Answer 12

may increase digoxin levels

Question 13

clinical use of CCBs

Answer 13

long term therapy for HTN, HTN emergency, angina

Question 14

K channel openers

Answer 14

open K channels in smooth m.

• hyperpolarizes smooth m. membrane
• reducing probability of contraction
• arteriolar dilator - reduced systemic vascular resistance and MAP

Question 15

diazoxide

Answer 15

potassium channel opener

• long acting
• high protein binding
• administered 3-4 injectsions 5-15 min apart

Question 16

potassium channel opener adverse effects

Answer 16

hypotension - stroke and MI

• hypotension greater with renal failure patients, patients with beta-blockers (give small doses)
• hyperglycemia
• avoid ischemic heart disease (likely angina)

Question 17

potassium channel opener use

Answer 17

hypertensive emergency

Question 18

minoxidil

Answer 18

potassium channel opener in smooth m.

-dilation of arterioles, not veins

Question 19

adverse effects of minoxidil

Answer 19

HA, sweating, hypertrichosis (hair growth)

must be used in combo with beta blocker and loop diuretic
-bc of reflex sympathetic stimulation and sodium/fluid retention (angina, edema, palpitations, tachycardia)

Question 20

clinical use of minoxidil

Answer 20

long term outpatient for severe HTN

Question 21

stimulate hair growth

Answer 21

minoxidil - rogaine

Question 22

fenoldopam

Answer 22

dopamine D1 agonist

• peripheral arteriolar dilator and natriuretic
• administered IV (short half life and rapid metabolism)
• avoid in glaucoma patients

Question 23

post-operative HTN

Answer 23

fenoldopam

Question 24

hydralazine

Answer 24

stimulates NO release from endothelium

• increased cGMP
• dilation of arterioles
• high first pass - low bioavailabilty

Question 25

adverse with hydralazine

Answer 25

HA, nausea, anorexia, palpitations, sweating, flushing | -angina or arrhythmia in ischemic heart disease

Question 26

hydralazine clinical use

Answer 26

long term outpatient HTN | -combo with nitrates - heart failure and HTN in blacks

Question 27

HTN in pregnancy Tx

Answer 27

methyldopa and hydralazine

Question 28

sodium nitroprusside

Answer 28

releases NO > increased cGMP -dilation of arterial and venous vessels -BP decrease and CO same IV admin

Question 29

cyanide poisoning

Answer 29

released during metabolism of sodium nitroprusside

Question 30

nitroglycerin

Answer 30

release NO - relax smooth m of veins > arteries - no effect on cardiac/skeletal m - decreased platelet aggregation high first past - administer sublingual reached minutes, last 15-30 minutes -longer duration patches available

Question 31

adverse effects of nitroglycerin

Answer 31

orthostatic hypotension, syncope, throbbing HA contraindicated - increased intracranial pressure

Question 32

drug-drug nitroglycerin interactions

Answer 32

synergistic hypotension | -wth sildenafil, tadalafil, or vardenafil