Pharm 2 - Exam 6 Anti-Hypertensives

What declines as sodium is depleted from the body after diuretics?

Peripheral vascular resistance

What is the MOA of Indapamide?

Diuretic and vasodilation properties (acts directly on smooth muscles of blood vessels)

What are the adverse effects of Hydrochlorothiazide? (HCTZ)

hypokalemia, hyperglycemia, hyperuricemia, hyperlipidemia

What is Metolazone used for?

Most commonly used to supplement a loop diuretic two or three times per week

What class is Methyldopa?

Central acting on vasomotor center (Brain)

When would we not use Methyldopa?

Pt with liver disease

What class is Clonidine?

Alpha 2 receptor agonist

What are adverse effects of Clonidine?

rebound hypertension, dry mouth, sedation, depression

What class is Metoprolol?

Cardioselective beta blocker

What do we use Metoprolol for?

BP, angina, and improve survival after a heart attack

What class is Carvedilol?

blocks beta 1, beta 2 and alpha 1 receptors

What is the MOA of Propranolol?

reduces BP primarily as a result of decreased cardiac output

What do we use Propranolol for?

HTN, performance anxiety

What is an adverse effect of Propranolol?

Bronchospasm

What is the MOA of Pindolol?

intrinsic sympathomimetic activity (partial beta-agonist activity)

What drug is antagonized by NSAIDs?

Pindolol

What drug is the DOC for BP control and pre-eclampsia during pregnancy?

Labetalol

What class is Nebivolol?

β1-selective blocker with vasodilating properties that are not mediated by alpha blockade

What do we use Prazosin for?

BPH

What drug is used to treat nightmares?

Prazosin

What is an adverse effect of Prazosin?

First dose syncope

What are adverse effects of Minoxidil?

reflex tachycardia, fluid retention

Chronotropic Definition

substance or condition that affects the heart rate (chronotropy)

Inotropic Definition

substance or condition that affects the force of the heart's contractions (inotropy)

What do we use Minoxidil for?

Baldness (applied topically), hair growth is a side effect po

What do we use Nitroprusside for?

short term rapid reduction of BP, hypertensive emergencies

What MOA is sodium Nitroprusside?

Powerful parenterally administered vasodilator

What are side effects of Nitroprusside?

Accumulation of cyanide with prolonged use

What is important to know when using Hydralazine?

Tachyphylaxis develops rapidly when used as monotherapy

When using 400mg/day or more of Hydralazine, what can occur?

there is a 10-20% incidence of a syndrome that resembles SLE

What is the MOA of Lisinopril?

decr angio II

When is Lisinopril contraindicated?

ACEI induced angioedema, pregnancy

What is an adverse effect of Lisinopril?

Cough (due to increased bradykinin)

What is a drug interaction of Lisinopril?

Hyperkalemia (K-sparing diuretics or K supplements)

What are the adverse effects of Losartan

Hyperkalemia

What class is Aliskiren?

Direct renin inhibitor

What lifestyle modifications are to be used before pharmacotherapy?

Healthy diet, reduce stress, exercise

What first line agents are not for patients older than 60 years of age?

Beta blockers

What class of drugs can also treat osteoporosis?

Thiazide diuretics

What is the most common cause of angina?

atherosclerosis of the large coronary vessels

Info for Angina Pectoris

- Coronary blood flow is directly related to the perfusion pressure (aortic diastolic pressure) and the duration of diastole.

- Coronary blood flow ceases during systole.

- The duration of diastole becomes a limiting factor for myocardial perfusion during tachycardia.

- Myocardial oxygen demand is determined by ventricular wall stress (intraventricular pressure, ventricular radius, wall thickness), heart rate, and contractility

How do beta blockers work with Angina Pectoris?

beta blockers have their effect by reducing myocardial oxygen demand through reduction of heart rate

Info for Nitrates

• Nitroglycerin is the prototype of this group.

• NTG is volatile and must be stored in a tightly sealed glass bottle.

• Oral bioavailability is only 10 - 20% due to first pass metabolism

What is the MOA of Nitric Acid?

causes activation of guanylyl cyclase and an increase in cyclic GMP

What's important to know when taking Nitrates?

A nitrate-free period of 8 hours should be observed between doses

What is the primary direct result of NTG?

increased venous capacitance

What are adverse effects of Nitrates?

Orthostatic hypotension, tachycardia

What class of drugs have more cardiac depression, decrease contractility and heart rate?

Non-dihydropyridines (Verapamil, Diltiazem)

When do we not use calcium channel blockers?

Pts with heart failure who have pulmonary congestion

What are the DOC for the prophylaxis of variant angina (Prinzmetals)?

Calcium Channel Blockers

Why are beta blockers beneficial in treating angina?

their hemodynamic effects (decreased HR, BP and contractility

In patients with unstable angina with recurrent ischemic episodes at rest, what is the principal mechanism?

recurrent platelet-rich nonocclusive thrombus formation

What 2 drugs are used to treat peripheral artery disease?

Cilostazol and Pentoxifylline