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USMLE - Pharm

Kaplan Section 3 Chapter 3 AntiHypertensive Drugs

Name the 4 strategies to combat HTN with drugs 1. reduce blood volume 2. reduce SANS tone 3. reduce vagal tone 4. relaxation of vascular smooth muscle
What are the 4 determinants of BP? 1. CO - heart rate (not enough vagal tone --> HR too fast), 2. CO - contractility (too much SANS tone, B1), 3. peripheral resistance (too much SANS tone, a1), 4. body fluid volume (edema, too much renin, or too much ANGII --> too much Na and H2O retention
What are the drugs that combat the 4 determinants of BP? 1. CO - heart rate (B blockers, CaCB's), 2. CO - contractility (B blockers), 3. peripheral resistance (anti-adrenergics, CaCB's, direct vasodilators, diuretics), 4. body fluid volume (diuretics, ACEi, ANGII antagonists)
What are the three anti-hypertensives that actually prolong survival? Live longer by ACEing THe Bank. 1. ACEi's, 2. thiazide diuretics, 3. B blockers
Name the sympathoplegics used in antiHTN therapy a2 agonists: a-methyldopa, clonidine; dec NE release: reserpine, guanethidine; a1 blockers: prazosin, doxazosin, terazosin; B blockers - propranolol
Name the direct-acting vasodilators used in anti-HTN therapy. Hydralazine, Nitroprusside, Minoxidil, Diazoxide
Hydralazine activate NO/EDRF pathway --> arteriolar dilation --> dec TPR (esp cerebral, coronary, renal); used in mod to severe HTN.
Side effects of hydralazine headache, flushing, sweating, fluid retention (use diuretic), reflex tachy (use B blocker), if slow acetylator --> SLE-like syndrome
Nitroprusside pro-drug --> sulfonation --> opens K+ channels --> membrane hyperpolarization --> arteriolar vasodilation; inc renin --> renal vasodilator. Used in mod to severe HTN.
Side effects of nitroprusside headache, flushing, sweating, fluid retention (use diuretic), reflex tachy (use B blocker), pulm HTN due to volume shifts, hypertrichosis (excessive hair growth).
Diazoxide K+ channel opening --> arteriolar vasodilation --> reflex tachy, inc CO, inc renin. Used IV for HTN emergencies, used to treat insulinoma (dec insulin secretion), relaxes uterine sm musc.
Side effects of diazoxide fluid retention (use diuretic, but not thiazide), tachy (use B blocker), dec insulin release --> hyperglycemia
What is the difference between captopril and losartan? Captopril = ACEi. Losartan = AT-1 receptor antagonist. Losartan blocks downstream from Captopril so that it avoids affecting bradykinin.
Why should you use ACEi or AT-1 antagonists for diabetics? Both dec vasoconstriction and BP --> dec glomerular efferent resistance --> slow development and progression of nephropathy.
What are the adverse effects of ACEi and AT-1 antagonists? hypotension, hypovolemia, dry cough (with ACEi's), hyperkalemia, acute renal failure (if have renal artery stenosis), angioedema.
What population should avoid ACEi's and AT-1 antagonists? pregnant women. Teratogen --> fetal hypotensio, renal failure, skull and renal malformations.
What is recommended for the initial drug treatment fo mild to moderate HTN? B blocker or thiazide diuretic as DOC's.
If angina and HTN, use what? B blockers, CaCB's
If Diabetes and HTN, use what? ACEi's, AT-1 antagonists
If Heart failure and HTN, use what? ACEi's, AT-1 antagonists
If post-MI and HTN, use what? B blockers
If BPH and HTN, use what? a blockers
If dyslipidemias and HTN, use what? a blockers, CaCB's
Created by: Christina Pham Christina Pham on 2008-02-05

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