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Winter Exam #1 - Antihypertensive Drugs
n/a
31
Pharmacology
Graduate
12/09/2009

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Term
Diseases that contribute to atherosclerosis
Definition
hypertension, hyperlipidemia, type II diabetes
Term
factors that contribute to atherosclerosis
Definition
diet, genetics, obesity, gender, age, tobacco
Term
conditions that result from atherosclerosis
Definition
angina pectoris & myocardial infarction; transient ischemic attack & ischemic forms of stroke; cardiac arrhythmias & congestive heart failure
Term
Thiazides & thiazide-like drugs - hydrochlorothiazide (Microzide), chlorthalidone (Thalitone), indapamide
Definition
most popular drugs for chronic primary HTN; recommended for initial therapy; initially induces a natriuresis, decreasing blood volume --> decreasing cardiac output --> activates RAAS which limits degree of volume depletion & degree of decrease in BP; continued use --> decrease in peripheral vascular resistance; achieves 10 mmHg fall in diastolic BP; use low-intermediate doses; used in "volume dependent" HPN (includes African Americans, elderly HPN pts); widely used in combo with other antihypertensives
Term
Side Effects of thiazides & thiazide-like drugs - hydrochlorothiazide (Microzide), chlorthalidone (Thalitone), indapamide
Definition
hypokalemia (K wasters): muscular weakness, leg cramps, increase in ventricular ectopic activity --> sudden cardiac death; Hypercholesterolemia: 10-20 mg/dl increase in LDLs; Glucose Intolerance with hyperglycemia: use with caution in diabetics
Term
Loop diuretics - furosemide (Lasix)
Definition
most powerful diuretics; exert natriuretic effect near 20% of filtered Na load by blocking NaCl reabsorption in thick ascending limb of loop of Henle; Indications: pts w/ reduced renal Na excretion that don't respond to thiazides; short-acting --> give 2-3 times per day; SEs: hypokalemia --> weakness, cramps, cardiac arrhythmias; hypercholesterolemia; glucose intolerance w/ hyperglycemia
Term
K-sparing diuretics - spiranolactone (Aldactone), eplerenone (Inspra), triamterene (Dyrenium)
Definition
aldosterone antagonists that protect from K wastage by inhibiting renal output of K; all have limited natriuretic & BP lowering effects on their own; competitively block aldosterone receptors, indirectly antagonizing its actions such as reducing K loss; Major Use: tx of primary & secondary hyperaldosteronism, resistant forms of HTN; SEs: hyperkalemia, inhibition of sex steroid hormone receptors/biosynthesis
Term
reserpine
Definition
adrenergic peripheral neuronal inhibitor; depletes storage of peripheral NE --> reducing NE released during nerve impulse --> decreases cardiac output & peripheral resistance --> decreases BP; action is irreversible (takes time for BP activity to fall off after stopping drug); SEs: sedation, mental depression, precipitates migraines, nasal congestion, postural hypotension, bradycardia, systemic fluid retention, diarrhea, peptic ulcers
Term
methyldopa
Definition
adrenergic central neuronal inhibitors; prodrug converted to methylNE which accumulates in NE storage vesicles & acts as alpha2-adrenergic agonist in vasomotor centers, dampening neural outflow; rarely used; Major Use: tx of HTN during pregnancy; SEs: peripheral fluid retention, sedation, dry mouth, "autoimmune" disorders, parkinsonian symptoms
Term
clonidine (Catapres)
Definition
adrenergic central neuronal inhibitor; accumulates in NE storage vesicles & when released is an alpha2-adrenergic agonist; only requires a small qty to exert pharmacological actions --> transdermal patch form; Uses: tx primary HTN that provides smoother BP control with fewer SEs; ADRs & SEs: local skin rxns, dry mouth, rebound HTN if stopped quickly
Term
alpha1-receptor blockers - doxazosin (Cardura), prazosin (Minipress), terazosin (Hytrin)
Definition
adrenergic alpha1-receptor blockers; used for treatment of primary HTN; blocks arterial vascular alpha1-receptors inhibiting binding of NE --> decreases vasoconstriction --> decreases TPR --> decreases BP; similar effect in veins as well; slowly increase dose; give P 3x daily, give D & T 1x daily; Note: initial dose may cause SEVERE postural hypotension especially in pple already on diuretic; SEs: postural dizziness, stress-induced urinary incontinence, reflex tachycardia & systemic fluid retention; Beneficial effects: may improve glucose tolerance, may lower T-cholesterol & triglycerides & raises HDL
Term
selective beta1-blockers - atenolol (Tenormin), metoprolol (Lopressor, Toprol-XL)
Definition
lowers arterial BP by decreasing contractility & heart rate reducing BP;
Term
nonselective beta1 & -2 blockers W/O ISA - propanolol (Inderal-LA), nadolol (Corgard), timolol
Definition
lower arterial BP by decreasing contractility & heart rate reducing cardiac output, also inhibits renin release; Unfortunately, removes normal physiological level of beta-2-mediated vasodilation --> offsets decrease in TPR, limiting overall antihypertensive effect
Term
nonselective beta-blockers WITH ISA - pindolol
Definition
lower BP with less reduction in cardiac contractility & renin release but with more decrease in TPR;
Term
Clinical Effectiveness of Beta-blockers as Antihypertensives
Definition
less effective in elderly & African Americans; Chines ppl are more sensitive; Useful in: HTN with tachycardia & high cardiac output, HTN accompanied by angina, arrhythmias
Term
Side Effects of Beta-blockers
Definition
Cardiovascular: bradycardia, reduced exercise ability, fatigue, slow A-V conduction, decreased ventricular contractility, rebound HTN; Pulmonary: bronchoconstriction; Metabolic: masks tachycardia in hypoglycemic events, insulin resistance, hypertriglyceridemia & decreased HDL; CNS: bad dreams, hallucinations
Term
combined alpha-1 & beta-receptor blocker - labetalol (Trandate)
Definition
adrenergic alpha-1- & nonselective beta-blocker; causes decrease in peripheral resistance --> decreased BP; Uses: oral --> tx of more severe primary HTN, IV --> hypertensive emergency; SEs: postural dizziness, bradycardia, A-V block at high doses
Term
NO-releasing beta-1 blocker - nebivolol (Bystolic)
Definition
selective competitive beta-1 blocker that increase production & release of NO; decreasess renin release, HR, contractility, & increases NO to dilate vascular smooth muscle; Uses: HTN with impaired endothelial cell fcn, mild-moderate HTN; SEs: headache, fatigue, similar to beta-1 blockers
Term
arteriolar vasodilators - hydralazine
Definition
decreases arterial BP by decreasing TPR by directly dilating arterioles (not veins); releases NO from arteriolar endothelium; acetylated into inactive metabolites ("slow" & "rapid" acetylators); dilate resistance arterioles --> increase capillary hydrostatic pressure --> increased filtration of fluid + renal retention of Na & H2O --> arterial BP --> activates SNA & renal compensatory rxns --> stimulates heart & retention of Na & H2O; SEs: tachycardia, edema, loss of HTNsive efficacy; use with beta blocker & diuretic; "third drug option" for those not responding to diuretic & adrenergic inhibitor or other "second" choice drug; SEs: lupus-like rxn
Term
arteriolar vasodilator - minoxidil
Definition
decreases arterial BP by decreasing TPR thru direct dilation of arterioles; acts via active sulfate metabolite --> opens ATP-sensitive K channels in arteriolar smooth muscle cells; SEs: tachycardia, edema, loss of antiHTNsive effect, HAIR GROWTH; Uses: tx of most severe HTN when renal insufficiency is present
Term
dihydropyridine Calcium Channel Blockers (CCBs)
Definition
amlodipine (Norvasc), felodipine (Plendil), nifedipine (Procardia XL)
Term
dihydropyridine CCBs - amlodipine (Norvasc), nifedipine (Procardia XL), felodipine (Plendil)
Definition
lower BP by reducing Ca entry into arterial vascular smooth muscle cells through arterial L-type Ca channels --> reduces arterial vascular tone --> decrease in TPR --> decrease in BP; Uses: effective in all HTNs, especially elderly & African-Americans; SEs: slight postural dizziness, ankle edema, tachycardia; avoid rapid, fast-acting preps --> too many MIs
Term
other CCBs - verapamil (Calan), diltiazem (Cardizem)
Definition
act in heart --> decrease Ca entry in ventricular L-type Ca channels --> decrease ventricular contractility --> decreased cardiac output; Uses: treat all types of HTN, especially in elderly & African-Americans; SEs: directly suppresses HR & AV conduction, nausea, HA, constipation, V --> seroius myocardial depression (excessive bradycardia)
Term
Angiotensin Converting Enzyme Inhibitors (ACEIs)
Definition
captopril (Capoten), enalapril (Vasotec), lisinopril (Prinivil, Zestril), fosinopril (Monopril), quinapril (Accupril), ramipril (Altace)
Term
Angiotensin II Receptor Blockers (ARBs)
Definition
losartan (Cozaar), valsartan (Diovan), candesartan (Atacand)
Term
Renin Inhibitors
Definition
aliskiren (Tekturna)
Term
ACEIs MoA
Definition
inhibits angiotensin converting enzyme; decreases TPR & BP; inhibits synthesis of aldosterone --> decrease in Na & fluid retention; increases availability of bradykinin & related PG vasodilators --> further decrease BP & peripheral vascular resistance; inhibits angiotensin-II-facilitated release of NE --> prevent reflex tachycardia
Term
Clinical Uses of ACEIs, ARBs, & Renin Inhibitors
Definition
"normal renin" & "high renin" primary HTN, HTN 2ndary to diabetic nephropathy; DO NOT USE in pts with established bilateral renovascular HTN;
Term
ARBs - losartan (Cozaar), valsartan (Diovan), candesartan (Atacand)
Definition
competitive angiotensin-II receptor antagonists; causes decrease in TPR & BP, inhibits aldosterone synthesis --> reduces Na & H2O retention; inhibit angiotensin-II-facilitated release of NE --> prevent reflex tachycardia
Term
Side Effects with ACEIs, ARBs, & Renin Inhibitors
Definition
hyperkalemia, hypotension; nonproductive cough (increased bradykinin, ACEIs); angioedema of face, mouth; harm fetal development --> avoid during pregnancy
Term
Drug Interactions with ACEIs, ARBs, & Renin Inhibitors
Definition
K-sparing diuretics or K supplements --> hyperkalemia worsens; NSAIDs --> impair ACEIs by blocking bradykinin-mediated vasodilation
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