Kaplan Section 3 Chapter 3 AntiHypertensive Drugs
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| 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
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| 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
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| 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)
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| 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
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| 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
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| Name the direct-acting vasodilators used in anti-HTN therapy. | Hydralazine, Nitroprusside, Minoxidil, Diazoxide
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| Hydralazine | activate NO/EDRF pathway --> arteriolar dilation --> dec TPR (esp cerebral, coronary, renal); used in mod to severe HTN.
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| Side effects of hydralazine | headache, flushing, sweating, fluid retention (use diuretic), reflex tachy (use B blocker), if slow acetylator --> SLE-like syndrome
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| Nitroprusside | pro-drug --> sulfonation --> opens K+ channels --> membrane hyperpolarization --> arteriolar vasodilation; inc renin --> renal vasodilator. Used in mod to severe HTN.
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| 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).
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| 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.
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| Side effects of diazoxide | fluid retention (use diuretic, but not thiazide), tachy (use B blocker), dec insulin release --> hyperglycemia
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| 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.
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| 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.
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| 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.
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| What population should avoid ACEi's and AT-1 antagonists? | pregnant women. Teratogen --> fetal hypotensio, renal failure, skull and renal malformations.
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| What is recommended for the initial drug treatment fo mild to moderate HTN? | B blocker or thiazide diuretic as DOC's.
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| If angina and HTN, use what? | B blockers, CaCB's
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| If Diabetes and HTN, use what? | ACEi's, AT-1 antagonists
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| If Heart failure and HTN, use what? | ACEi's, AT-1 antagonists
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| If post-MI and HTN, use what? | B blockers
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| If BPH and HTN, use what? | a blockers
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| If dyslipidemias and HTN, use what? | a blockers, CaCB's
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