Which pharmacologic agents are used to treat essential hypertension?
Diuretics, calcium channel blockers, angiotensin-converting enzyme inhibitors, and angiotensin II receptor blocks
Which pharmacologic agents are used to treat hypertension in patients with congestive heart failure?
Diuretics, angiotensin-converting enzyme inhibitors, angiotensin II receptor blocks, blockers (in compensated congested heart failure only) and potassium-sparing diuretics
Which pharmacologic agents are used to treat hypertension in patients with diabetes mellitus?
Angiotensin-converting enzyme inhibitors/angiotensin II receptor blocks, calcium-channel blockers, diuretics, blockers, and -blockers
Why are angiotensin-converting enzyme inhibitors especially important in patients with diabetes mellitus?
They have been shown to delay progression to diabetic nephropathy
Which does hydralazine reduce: afterload or preload?
When hydralazine is administered, which vessels dilate more: veins or arterioles?
Hydralazine causes smooth muscle relaxation by increasing concentrations of which substance in endothelial cells?
Which cardiac adverse effect results from the drop in blood pressure induced by hydralazine?
Does hydralazine cause fluid excretion or retention?
Hydralazine can induce which autoimmune complication in patients?
Systemic lupus erythematosus
Why is hydralazine contraindicated in patients with angina or coronary artery disease?
Because it can cause compensatory tachycardia
What two agents are first-line therapies for hypertension in pregnancy?
Hydralazine with methyldopa
How can the reflex tachycardia that is associated with hydralazine be prevented?
By administering it with a blocker
What is the mechanism of action of minoxidil?
Minoxidil opens potassium channels on the cell membrane, which causes hyperpolarization and subsequent relaxation of vascular smooth muscle
What are the toxicities of minoxidil?
Hypertrichosis, reflex tachycardia, angina, salt retention, and pericardial effusion
A 60-year-old man with severe hypertension presents with complaints of increased hair growth and new chest pain. Toxicity of which antihypertensive drug is most likely causing these symptoms?
Which calcium channel blocker is the most selective for vascular smooth muscle?
Which calcium channel blocker is the most cardio-selective?
Which calcium channel blocker cannot be used as an anti-arrhythmic?
What are the clinical indications for the use of calcium channel blockers?
Hypertension, angina, arrhythmias (except nifedipine), Prinzmetals angina, and Raynauds disease
Name three pharmaceutical agents that are in the class of calcium channel blockers.
Nifedipine, diltiazem, and verapamil
What is the ultimate function of calcium channel blockers?
To decrease cardiac and smooth muscle contractility
A patient is started on antihypertensive therapy. One week later he returns complaining of swollen ankles and flushed skin. Which class of medication was he likely prescribed?
Calcium channel blockers
Are nitrates more effective as preload or afterload reducers?
Does isosorbide dinitrate dilate veins or arteries more?
How does nitric oxide cause smooth muscle relaxation?
By increasing cGMP concentration
Vasodilation using nitroglycerin is caused by the release of what chemical in smooth muscle?
What are two indications for the use of nitroglycerin?
Angina and pulmonary edema
Name four adverse effects of nitroglycerin.
Reflex tachycardia, hypotension, flushing, and headache
Name three medications indicated to treat malignant hypertension.
Nitroprusside, fenoldopam, and diazoxide