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What is the MOA for Hydralazine?
Inhibits Ca channels, creates NO causing relaxation of vascular smooth muscle
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Is Hydralazine used as a first line monotherapy?
No, not used as either
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Hydralazine is usually used in combination with what?
A diuretic
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When Hydralazine is used for CHF, what group is it most effective in?
African Americans
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What situations is Hydralazine used for?
Refractory hypertension and hypertension with CHF
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Describe the bioavailability of Hydralazine.
Dependent on genetics (slow/fast acetylators)
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What are the adverse effects of Hydralazine?
Fluid retention, hypotension, Lupus-like symptoms, dry mouth, headache, nausea and edema
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How long is the duration of Lupus –like side effects associated with Hydralazine?
Reversible upon discontinuation
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Lupus like side effects may occur with Hydralazine under what conditions?
Chronic use
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What is the MOA of Minoxidil?
K channel opener, causing hyperpolarization and relaxation in vascular smooth muscle
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What is the clinical effect of Minoxidil?
Directly decreases peripheral vascular resistance and lowers BP
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What is Minoxidil used for?
Refractory Hypertension only
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What is the DOA for Minoxidil?
24 hours (long)
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Is Minoxidil very efficacious?
Yes, highly efficacious
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What are the adverse effects of Minoxidil?
Fluid retention, edema, tachycardia and palpitations, hypertrichosis
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What is Minoxidil usually used in combination with?
B-blockers and a diuretic
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Minoxidil is an ingredient in what non-antihypertensive?
Rogaine
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What patients are likely to suffer from hypertrichosis when using Minoxidil?
Those on long term therapy
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What are the alpha 2-adrenergic receptor antagonists used to treat hypertension?
Clonidine, Guanfacine, Methyldopa
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What is the MOA for alpha 2-adrenergic receptor antagonists in the treatment of hypertension?
Inhibits neurons in Brainstem, causing centrally mediated vasodilation and reduction in HR
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Rank the alpha 2-adrenergic receptor antagonists in terms of efficacy?
All about equivalent
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What are alpha 2-adrenergic receptor antagonists used for?
Mild to moderate hypertension
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Are alpha 2-adrenergic receptor antagonists used for monotherapy?
No
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What are the adverse effects of alpha 2-adrenergic receptor antagonists?
Hypotension, Sedation, Withdrawal, Dry mouth and Vivid dreams
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What percent of patients on alpha 2-adrenergic receptor antagonists experience Sedation?
40%
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What percent of patients on alpha 2-adrenergic receptor antagonists experience Dry mouth?
20%
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What are the withdrawal symptoms of alpha 2-adrenergic receptor antagonists?
Hypertension, tachycardia, nervousness and excitement
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How are Direct Vasodilators used?
IV to treat hypertensive emergencies
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What are the Direct Vasodilators?
Nitroprusside, Diazoxide, Fenoldopam
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What is the MOA for Nitroprusside?
NO producer
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What is the MOA for Diazoxide?
K channel opener
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What is the MOA for Fenoldopam?
Dopamine receptor agonist
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What is the MOA of Respirine?
Depletes NOR and EPI from sympathetic nerve terminals and adrenal medulla (can also do the same in brain)
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What are the adverse effects of Reserpine?
Postural Hypotension, fluid retention, Nightmares, impaired ejaculation, sedation and suicidal thoughts
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Is Reserpine commonly used?
No, rarely, Drug of last resort
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What groups of Antihypertensives can be used to Treat Hypertension in patients with Heart Failure?
Diuretics, B-blockers, ACE inhibitors, ARBs
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What groups of Antihypertensives can NOT be used to Treat Hypertension in patients with heart Failure?
CCBs
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What groups of Antihypertensives can be used to Treat Hypertension in patients post MI?
B-blockers, ACE inhibitors, ARBs
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What groups of Antihypertensives can NOT be used to Treat Hypertension in patients post MI?
Diuretics and CCBs
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What groups of Antihypertensives can NOT be used to Treat Hypertension in patients with coronary Disease?
All can be used
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What groups of Antihypertensives can be used to Treat Hypertension in patients with coronary Disease?
All: Diuretics, B-blockers, ACE inhibitors, ARBs and CCBs
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What groups of Antihypertensives can be used to Treat Hypertension in patients with Diabetes?
ACE inhibitors, ARBs and CCBs
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What groups of Antihypertensives can NOT be used to Treat Hypertension in patients with Diabetes?
Diuretics and B-blockers
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What groups of Antihypertensives can be used to Treat Hypertension in patients trying to prevent stroke?
Diuretics, ACE inhibitors, ARBs
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What groups of Antihypertensives can NOT be used to Treat Hypertension in patients trying to prevent stroke?
B-blockers and CCBs
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What groups of Antihypertensives can be used to Treat Hypertension in patients with kidney disease?
ACE inhibitors and ARBs
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What groups of Antihypertensives can NOT be used to Treat Hypertension in patients with kidney disease?
Diuretics, B-blockers and CCBs
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