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Anti HTN Drugs


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hydraulic equation for BP?

drugs should reduce either CO or TPR
Major classes of anti-HTN?

ACE inhibitor
Calcium Channel Blocker
Targets of anti-hypertensives?
Vasomotor Center
Sympathetic nerve terminals
Beta receptors of heart
Sympathetic ganglia
Angiotensin receptors of vessels
alpha-receptors of vessels
Vascular smooth muscle
Kidney tubules
beta-receptors of JGA that release renin
Angiotensin converting enzyme
acts on vasomotor center: stimulates presynaptic a2-receptors to inhibit NE release

lower TPR and some CO

indication: moderate HTN and often combined with thiazide diuretic
methyldopa toxicities?
- drug-induced positive Coombs' test associated with hemolytic anemia
- lactation and prolactin release
- edema
- sedation
- impotence
- dry mouth
- hepatitis
stimulates central a2-adrenergic receptors

lower TPR and some CO decrease

for mild to moderate HTN
clonidine toxicities?
- sedation
- dizziness
- dry mouth
- rebound HTN after sudden withdrawal from high doses
clonidine should not be combined with which drugs?
tricyclics; they inhibit clonidine's actions
centrally acting anti-HTN with mxn of action and side effect similar to clonidine
what drug do you give to old men with HTN and BPH?
a1 blockers:
- prazosin
- terazosin
- doxazosin
prazosin, terazosin and doxazosin
a1 blockers to treat moderate HTN
toxicities of prazosin, terazosin and doxazosin?
- dizziness
- orthostatic hypotension (after 1st dose)
- headache
what do you risk when giving beta-blockers to pts with essential HTN over age of 60yrs?
in what part of the body do a1 blockers work?
decrease peripheral vascular resistance; minimal decrease in CO
what anti HTN drugs reduce renin release?
beta blockers
bronchoconstriction and reduced HDL and increased plasma tracylglycerol is a side effect in what anti-HTN drugs?
beta blockers
reserpine and guanethedine mxn?
block the release of stored NE
what effect do diuretics have on plasma lipid conc.?
- dilate arteriolar smooth muscle to decrease PVR
- in moderate HTN and CHF
hydralazine better for african americans or whites?
african americans; use ACE-inhibitors for whites
what is flomax (tamsulosin)?
alpha 1 blocker - acts on BPH withouth the anti HTN effects
what kind of alpha1 receptors are in the prostate?
75% are alpha1A (tamsulosin)
arteriolar vasodilator used for severe HTN; blocks K+ channels, resulting in hyperpolarization and relaxation of smooth muscle cells
sodium nitroprusside
release NO -> stimulate guanylyl cyclase -->
increase production of cGMP --> decrease Ca++ ions
--> relaxation of smooth muscle in both arteries and veins
sodium nitroprusside side effects?
- cyanide toxicity (cyanide ions made during metabolism of sodium nitroprusside)
how do you treat cyanide toxicity?
infusion of rhodanese
where is ACE located?
lungs; convert ATI to ATII
what does ATII do?
potent vasoconstrictor and stimulates release of aldosterone
what does aldosterone do?
increase Na and water retention
what do ACE inhibitors do?
block conversion of ATI to ATII and boosts bradykinin levels (potent vasodilator)
what are 4 ACE inhibitors?
what drug interaxn should you watch for in ACE inhibitors?
NSAIDs can reduce vasodilatory effects; NSAIDs block bradykinin
how is bradykinin formed?
kininogen is converted to bradykinin by kallikrein
what effect does bradykinin have on prostaglandin synthesis?
increases prostaglanding synthesis
name two ARBs (angiotensin receptor blockers)
losartan and valsartan
what are 3 adverse effects of losartan and valsartan?
1. headache
2. hyperkalemia - especially in pts taking potassium-sparing diuretics
3. hypotension
what 2 anti-HTN meds are contraindicated in pregnancy?
ACE inhibitors and ARBs

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