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CV Antihypertensive Drugs
CV Antihypertensive Drugs
51
Medical
Professional
11/15/2010

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Term
Non-pharm therapy for HTN
Definition
Lose weight even w/o changing salt intake
Salt intake works best for blacks
Less alcohol
More exercise
Term
First-line antiHTNs
Definition
Thiazides
Term
Thiazide: MOA, effects
Definition
Saluresis causing dec. EABV = dec. TPR = dec. BP -20/-10 (2-4 wks)
Activated RAAS but HR NC or slightly inc.
Reverses LVH
CO returns to pretreatment value
Term
The antiHTN effect of thiazides occurs at ___. Inc. the dose above this value ___
Definition
Small doses
Doesn't cause a greater fall in BP but inc. incidence of metabolic issues
Term
How does salt restriction work with HCTZ?
Definition
Modest salt restriction prevents the need for larger doses of HCTZ and limits the loss of K
Term
Thiazides have no effect on BP in patients w/ ___
Definition
GFR <30 ml/min
Term
Thiazides are routinely used to prevent/reverse ___
Definition
Salt and water retention caused by other antiHTNs like arterial VD, a/B blockers, centrally-acting sympatholytics
Term
Thiazides: S/E
Definition
Hypokalemia (from activated RAAS) = watch it w/ digoxin
(hypokalemia causing) Inhibit insulin secretion causing hyperglycemia = don't give to diabetics!
Hyperuricemia = may cause gout
Term
Thiazide-induced hypokalemia can be lessened/prevented by:
Definition
Low doses of HCTZ + Na restriction
Cotx w/ K-sparing diuretic like amiloride, triamterene, spironolactone
Cotx w/ ACEI/ARB
Cotx w/ B-blocker
Cotx w/ K supplement
Term
ACEI end in...
Definition
-pril
Term
ACEI/ARBs: general MOA
Definition
Balanced VD!
Term
ACEI: MOA, effects
Definition
Prevents conversion of AngI to AngII as well as breakdown of bradykinin (aldosterone maintained by ACTH and plasma K)
Reversal of AngII effects on collagen synthesis = inc. compliance of large arteries = dec. SBP
Balanced VD = dec. TPR = dec. MAP (CO little changed)
NC GFr + inc. RBF = dec. FF = no salt/water retention
NC HR and baroreflex still in tact
Term
ACEI: DOC for...
Definition
HTN patients w/ HF/LVH/DM
Patients w/ systolic dysfxn post MI
Term
ACEI: S/E
Definition
Prego category X!!!
Angioedema
*Dry cough (give ARB or aspirin)
*Skin rash (dose-related)
*Ageusia, dysgeusia
First-dose hypotension esp. if already taking thiazide
*Dec. glomerular pressure = renal insufficiency in pt w/ bilateral renal artery stenosis or stenosis of single kidney
Hyperkalemia in pt on K-sparing diuretic or oral supplement
*Fatigue, weakness, sexual dysfxn rare
No hypokalemia, hyperglycemia, hyperuricemia
Term
ARBs end in...
Definition
-sartan
Term
ARBs: MOA
Definition
Block AT1-R = no AngII effects
Term
If an additional fall in BP is desired on ARBs, add ___
Definition
Small dose of HCTZ rather than inc. dose of ARB
Term
ARB: indications
Definition
HTN
HF
Term
DHPs: indications
Definition
Mild-moderate HTN
Systolic HTN
HTN in pt w/ asthma, DM, renal dysfxn, gout, hyperlipidemia
Proteinuria in NIDDM (but ACEI/ARB better)
Term
DHPs: MOA, effects
Definition
L-type Ca channel is found in vascular smooth muscle
Depolarization causes them to open, allowing Ca to flow down its gradient
This Ca activates calmodulin and triggers the release of stored Ca from the SR
CCAs block L-type Ca channels in arterioles (don't block the SR channels!)
VD = dec. TPR/DBP = dec. afterload
Large arteries: inc. compliance = dec. SBP
Baroreflex inc. in sympathetic activity
CO maybe slightly inc.
No salt/water retention b/c direct natriuretic effect at renal tubules
NC RAAS
Term
DHPs: S/E
Definition
Pedal edema from dilation of precap. sphincters
Paradoxical angina from dilating healthy arteries more than atherosclerotic ones thus causing ischemia in the latter areas
Hypotension
GERD
Term
B-blockers are a cheap/effective way to manage HTN, but...
Definition
Dec. glomerular pressure = inc. FF = salt/water retention that limits antiHTN effect = pseudotolerance
Term
In tx of HTN, B-blockers are combined w/ ___
Definition
Thiazides to cause a further reduction in BP and prevent any salt/water retention that may occur in response to the fall in glomerular pressure
Term
HTN drugs that don't cause salt/water retention
Definition
Thiazides
ACEI/ARBs
DHPs
Term
HTN emergency drugs
Definition
Diazoxide
Labetalol
Na nitroprusside
Term
Labetalol: MOA
Definition
Block cardiac B1R = prevent symp stimulation = dec. HR
Block a1R in vasculature = balanced VD = dec. TPR = dec. MAP = dec. preload and afterload
Partial agonist at vascular a2R = active VD
Dec. glomerular pressure = inc. FF = salt/water retention
NC RAAS
Term
Labetalol: HTN emergency effects
Definition
IV push = smooth effect = onset 2-4 min, peak 10-15, duration 2-4 hrs
NC HR
NC CO = cerebral/coronary/renal blood flows maintained
Can use in preeclampsia
Term
Labetalol: S/E
Definition
Orthostatic hypotension
Headaches
Fatigue
Dec. sexual fxn
Term
aMeDA: indications, effects
Definition
Pediatric and prego HTN
Slow fall in BP prevents MI/CVA
Term
aMeDA: S/E
Definition
Sedation
Dry mouth
Rebound HTN
Fatigue, flu-like syndrome
Pos. Coomb's
Hepatitis
Term
aMeDA: limitations
Definition
Need a diuretic
S/E
Term
Clonidine: indications, MOA
Definition
Used w/ diuretic to tx mild/mod HTN
Lipid soluble = enters brain
Stim postsynaptic a2R in rostral ventrolateral medulla = inhibit symp outflow
Term
Clonidine: effects
Definition
Dec. glomerular pressure = inc. FF = salt/water retention = pseudotolerance
RAAS suppressed
Term
Clonidine: S/E
Definition
Sedation: can persist!
Dry mouth
Vivid dreams, restlessness, depression
Orthostatic intolerance, bradycardia, slowed AV conduction
Withdrawal syndrome
Term
Arterial VD for HTN
Definition
Diazoxide
Hydralazine
Minoxidil
Term
Arterial VD for HTN: effects
Definition
Dec. TPR = dec. DBP = dec. afterload
Baroreflex inc. in symp. activity
-Inc. HR and dp/dt
-Venoconstriction = inc. preload
-Together = inc. CO (give w/ B-blocker to temper this otherwise feels like the heart is pounding, also prevents secondary hyperaldosteronism)
-Inc. RAAS = salt/water retention
Term
Arterial VD for HTN: indications
Definition
Patients w/ severe HTN resistant to combined tx w/ first line drugs
Severe HTN: can't be used as single drugs b/c of tachycardia and inc. EABV
Diazoxide: can be used to arrest labor in eclampsia
Term
Minoxidil can also be used as...
Definition
Rogaine
Term
Hydralazine has a ___ onset whereas minoxidil has a ___ onset.
Definition
Rapid
Slow
Term
Arterial VD for HTN: S/E
Definition
Tachycardia, palpitations, angina
Edema
Hydralazine: SHIP! = fever, arthralgia, arthritis
Diazoxide: hyperglycemia
Term
Na nitroprusside: MOA
Definition
Balanced VD!
-Dec. TPR = dec. DBP = baroreflex inc. HR
-Venodilation = dec. preload
-NC CO
Not given long enough to cause salt/water retention

If given to patients w/ CHF, balanced VD = inc. CO = hemodynamic saluresis
Term
Na nitroprusside: pharmacokinetics
Definition
t1/2 = 30s = dose titration based on hemodynamic response
Can only give to supine patients
Must be in D5W covered w/ foil via slow IV
Term
Na nitroprusside: indications
Definition
HTN emergencies
Controlled hypotension during surgery
Halt acute dissecting aortic aneurysm
Inc. CO in CHF
Dec. myocardial O2 demand post MI
Term
Na nitroprusside: S/E
Definition
Tachycardia, palpitations
Thiocyanate intoxication: anorexia, nausia, delirium, hallucinations, psychosis, metabolic acidosis (counter w/ furosemide to improve renal fxn!)
Term
The goal of antiHTN therapy is...
Definition
Lower DBP below 80 mmHg
Term
If patients have an inadequate response to a single agent...
Definition
Use a different class of first-line agents
Then add second drug from another class of first-line agents
Then add a third drug from another class of first-line agents
Term
Tx systolic HTN
Definition
Systolic HTN a result of dec. arterial compliance = wide PP
Tx w/ ACEI/ARB, DHP to inc. compliance
Term
Drugs that cause salt/water retention
Definition
B-blockers
a-blockers
Clonidine
Arterial VD
Term
VD that dec. CO
Definition
NTG
Term
VD that NC CO = balanced VD
Definition
ACEI/ARBs
Labetalol
Centrally acting = aMeDA, clonidine
Na nitroprusside
DHPs not nifedipine
Term
VD that inc. CO
Definition
Arterial VD
Nifedipine
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