Online activity 6

1-You have a 46 y/o African American female with diagnosis of myocardial infarction, hyperlipidemia and hypertension. She was started on simvastatin 40 mg for her hyperlipidemia and metropolol tartrate 25 mg twice daily for cardiac and hypertension. She remains hypertensive at 152/88. Which medication class would you consider for her hypertension?

2-Answer the following questions for each of the 6 Antihypertensive drug classes (ACE inhibitor, Calcium Channel Blocker, Beta Blocker, Diuretics, Angiotensin receptor blockers, etc.)
- Drug Classification
- Name of one drug in the classification
- Mechanism of Action
- Side effects
- Contraindications
- Drug Interaction

SUMMARY OF ANTIHYPERTENSIVE AGENTS

DRUG	MECHANISM OF ACTION	ADVERSE EFFECTS	CAUTION
DIURETICS Thiazides (HCTZ) Loop diuretics (Lasix) useful if Cr. > 1.7 K+ Sparing diuretics Aldosterone blocker (Spironolactone)	Block Na, Cl reabsorption in the early convoluting tubule. Volume reduction leads to ( PVR Block Na reabsorption at the ascending limb of Henle’s loop. By blocking solute reabsorption, passive reabsorption of water is prevented producing profound diuresis Block the action of aldosterone in the distal nephron. K+ is retained while Na is excreted producing very mild diuresis	Hypotension, hypokalemia, hypochloremia, dehydration, ( LDL, ( glucose, ( uric acid Hypotension, hypokalemia, hypochloremia, dehydration, ototoxicity,( LDL, ( HDL, ( glucose, ( uric acid Hyperkalemia, endocrine effects	Pregnancy, gout, sulfa allergy, diabetes Pregnancy, gout, diabetes. Caution with digoxin Don’t combine with ACEI or in patients with renal insufficiency.
BETA ANDRENERGIC ANTAGONISTS (BETA BLOCKERS) Propran *olol*	Block the beta1 receptors in the heart which slows the heart rate, ( CO, ( AV conduction. ( renin production in the kidneys, ( PVR. Decreases mortality in patients with MI. Used to treat heart failure (Carvedilol-metoprolol), angina, dysrhythmias	Bradycardia, heart block, ( CO, bronchoconstriction, fatigue, insomnia, depression, sexual dysfunction, masks the s/s of hypoglycemia, inhibits glycogenolysis. Cardioselective have less AE (Metoprolol)	Caution in patients with heart block, bradycardia, heart failure, diabetes, asthma, depression, peripheral vascular disease, severe allergy. Abrupt withdrawal can lead to rebound tachycardia. Used with CCB(cardio suppression
ACE INHIBITORS (ACEI) Enala *pril*	Inhibits ACE which converts angiotensin I into angiotensin II. ( Production of angiotensin II (a potent vasoconstrictor) & aldosterone is reduced. Blood volume is decreased and arterioles and veins dilate to decrease BP. Used for heart failure. Dilates efferent arteriole in kidneys to decrease nephropathy. Prevents MI, stroke and death.	Hypotension, cough, angioedema, hyperkalemia, fetal injury, renal failure	Contraindicated in pregnancy or and in patients with renal artery stenosis or in patients with history of angioedema. Don’t use with K+ sparing diuretics. Use first line in diabetics for renal protection
ANGIOTENSIN RECEPTOR BLOCKERS (ARBs) Cande *sartan*	Blocks the action of angiotensin II. Overall affect same as with ACEI. Nephropathy is reduced. Prevents MI, stroke and death similar to ACEI	Hypotension, angioedema, hyperkalemia, fetal injury, renal failure. (no cough)	Contraindicated in pregnancy or in patients with renal artery stenosis or in patients with history of angioedema
CALCIUM CHANNEL BLOCKERS (CCBs) Amlo *dipine*	*Non dihydropyridines- verapamil & diltiazem:* Blocks calcium channels in the heart and blood vessels. Peripheral dilation of arterioles decreases BP. Blockage of calcium channels in heart ( coronary perfusion. Blockage at the and SA and AV node ( heart rate. Blockage in the myocardium ( force of contraction. Used for HTN and angina, dysrhythmias *Dyhydopyridines (Norvasc):* Blocks calcium channels in arterioles which leads to vasodilation and ( BP. Blocks calcium channels mainly on vascular smooth muscle with minimal blockade of calcium channels in the heart.	Constipation, bradycardia, heart block, worsening of heart failure Peripheral edema, hypotension, headache. Reflex tachycardia with nifedipine Does not alter heart rate	Caution in heart failure, bradycardia, or if patient is on BB or digoxin
ALPHA 2 AGONISTS (Clonidine )	Selective stimulation of alpha2 receptors in the CNS. Central activation of alpha2 receptors decreases sympathetic outflow to blood vessel and heart. Vasodilation and ( CO decreases blood pressure	Hypotension, bradycardia, ( CO, sedation, dry mouth, fetal harm, impotence, gynecomastia, depression, fetal harm.	Clonidine not used in pregnancy Abrupt withdrawal of clonidine can lead to rebound hypertension. (Methyldopa is drug of choice in pregnancy)
ALPHA1 BLOCKERS Pra *zosin*	Blocks alpha1 receptors in the arterioles and veins preventing vasoconstriction. Relaxes smooth muscle in the bladder neck and prostatic capsule to benefit men with BPH	Orthostatic hypotension, reflex tachycardia, nasal congestion, inhibition of ejaculation	May increase cardiovascular events and heart failure. Not used first line to treat HTN
VASODILATORS	Hydralazine dilates arterioles. Used for eclampsia. Nipride dilates veins and arterioles. Organic nitrates dilate veins	Postural hypotension, reflex tachycardia, expansion of blood volume. Thiocyanate toxicity
ADRENERGIC NEURON-BLOCKING AGENTS	Reserpine causes depletion of NE from postganglionic sympathetic neurons to decrease stimulation of adrenergic receptors. ( activation of beta receptors slows heart rate and reduces cardiac output. ( alpha activation promotes vasodilation	Depression, bradycardia, orthostatic hypotension, nasal congestion