Ch. 22: Antihypertensive drugs
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| beta blockers have what ending? | "olol"
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| MOA of beta blockers? | decrease activation of beta one receptors on teh heart, resulting in decreased cardiac output, resulting in decreased blood presssure. heart does less work, so its a good maintenance therapy for CHF.
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| beta blockers help to reduce symptoms of what thyroid disease? | hyperthyroidism.
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| what is another antihypertensive effect of beta blockers? | reduce renin production (via blcokade of the juxtaglomerular cells of thekidney, the cells that normally produce renin). decreased renin results in decreased angiotensin II, resulting in decreased total peripheral resistance (VD), decreased BP
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| AEs of beta blockers? | fatigue, insomnia, impotence, decreased HDL, increased TGs.
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| non selective beta blockers are contraindicated in which type of patients? | COPD, asthma (but selective beta 1 blockers can be used with careful monitoring)
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| what are the non selective beta blockers that also block the alpha 1 receptor? | labetalol, carvedilol. they also block the alpha one receptor.
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| which non selective beta blocker, in addition to its beta 2 blockade, also hase some beta 2 agonist action as well? | lebatolol.
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| what are the rest of the non selective beta blockers? | propranolol, timolol, pindolol, nadolol
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| MOA of thiazide diuretics? | block sodium reuptake in the DCT, resulting in increased sodium (and therefore water) excretion. results in decreased blood volume, and thus a decreased cardiac output
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| ADRs of thiazides? | hypokalemia, hypercalcemia, hyperuricemia. there is some possibility of hypersensitivity reactions in sulfa allergic patients.
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| what is the most commonly used thiazide diuretic? | hydrochlorothiazide.
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| dildiazam, nifedipine, and verapimil are what class of drugs? | calcium channel blockers.
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| which CCb affects both the vasculature and the heart, with more effect on the vasculature? | diltiazem
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| which CCB affects the vasculature only? | nifedipine
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| which CCb affects both the heart and the vasculature? | verapamil
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| ultimate results of CCB? | vasodilation, decreased cardiac output with resulting decrease in blood pressure.
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| ADRs of CCBs? | constipation, vertigo, headache, fatigue, hypotension
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| captopril, lisiniopril, enalapril, are what class of drugs? | ACE inhibitors
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| MOA of ace inhibitors? | prevent the conversion of Angiotensin I to Angiotensin II. resulting in increased vasodilation. there is also increased bradykinin activity, augmenting decrease in blood pressure, bc it is a natural vasodilator.
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| ADRs of Ace inhibitors? | dry cough, rash, fever, altered taste, hypotension, hyperkalemia, angioedema, first dose syncope, fetotoxic.
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| prozasin, terazosin...what drug class? | alpha blockrs.
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| AEs of alpha blockers? | reflex tachycardia, first dose syncope
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| losartan, candesartan, valsartan..what drug class? | Angiotensin II receptor blockers. they have no effect on angiotensin II production and do not block the ACE directed degradation of bradykinin
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| clonidine belongs to what drug class? | central alpha 2 agonist, depresses sympathetic outflow and thus works to decrease blood pressure by decreasing CNS sympathetic effects on CV system
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| this is a smooth muscle relaxant, producing vasodilation | hydralazine
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| this is another central alpha 2 agonist | alpha methyldopa
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| this is a vasodilator of veins and arteries | notroprusside
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| mionoxidil is what class of drugs? | vasodilator
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| what is the first line therapy for all patients to prevent hypertension and the required component to all hypertension treatment? | lifestyle modification, includin gmaintenance of optimal weight and a healthy diet (DASH), cessation of smoking, exercise, restriction of sodium, and moderation in consumption of alcohol.
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| what is the target blood pressure for all patients (except those with coronary artery disease risk, a history of stable angina, unstable angina, or MI or those with left heart failure?) | <140/90
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| what are the drugs of choice for treatment of blood pressures greater than 140/90? | ACE inhibitors, ARB, bet ablockers, CCB, thiazides. thiazides are considered first line, so should be tried first in these patients.
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| if a patient has stage 2 hypertension, what two drugs should be used? | two drugs, and one must be a thiazide
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| define stage 2 hypertension | greater than 160/100
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| what is the target blood pressure for those with a high risk o fcoronary artery disease? | <130/80
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| what patients are considered to be at high risk for coronary artery disease? | patients with DM, chronic renal disease, known (but asymptomatic) coronary artery diseaes, known coronary artery disease, coronary artery disease equivalent
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| what is the target blood pressure for those with a high risk of coronary artery disease? | <130/80.
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| what is the first line drug for patients with chronic renal disease or with diabetes mellitus | ACE or ARB
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| for all other patients in the coronary artery disease high risk cateogry, what is the first line drug? | thiazide diuretic.
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| what is the target blood pressure for patients with a history of stable angina, unstable angina, or MI? what is the drug of choice for these patients? | <130/80, DOC is bet ablocker plus with er an ACEI or ARB. if BP is not successful with these two, a CCB or thiazide should be added. if beta blocker is not tolerated or other contraindicated, should be replaced with verapamil or diltiazam
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| what is the target BP of patients with CHF? | <120/80.
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| drug of choice for CHF patients? | when they are stable: BB plue wither ACEI or ARB plus loop or thiazide diuretic (plus, if with severe CHF, an aldosterone antagonist).
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| in CHF patients, which drugs are contraindicated? | verapamil, diltiazem, clonidine, and alpha blockers is contraindicated. African americans with severe CHF should also consider addition of hydralazine or isosorbide dinitrate.
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| during acute exacerbation of CHF (decompensated CHF, shortness of breath, pleural effusion, pulmonary edema), which drug must be discontinued until patient's cardiac output has been restored with adequate dosing of digoxin? | bet ablockers
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| what is the DOC for heart failure itself? | digoxin
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| define hypertensive emergency | BP greater than 210/150. the diastolic criterion is dropped to 130 if the patient has pre-existing conditions such as cerebral hemorrhage or CHF. treatment may include sodium notroprusside or labetalol.
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| this drug is administered IV in a hypertensive emergency ,and causes vasodilation of both arteries and veins, causing decreased cardiac preload. | nitroprusside
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| nitroprusside is metabolized to what? | cyanide, but its usually not a problem if given IV. if it is a problem, sodium thiosulfate is given.
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| this drug is both a beta blocker and an alpha blocker. because of its beta blocker action, it prevents the reflex tachycardia that other alpha blocking or vasodilatory agents may cause | labetaolol
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| this is a direct arterial vasodilator no longer used. its effects are similar to hydralazine | diazoxide
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| what drug has replaced diazoxide as an alternative agent for hypertensive emergency treatment, and is a complete dopamine 1 receptor agonist? | fenoldopam
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