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Pharm CH39 Antihypertensives (Sympatholytics (Centrally acting alpha2…
Pharm CH39 Antihypertensives
kidneys are the regulators of bp via the renin–angiotensin system
also baroreceptors
Cultural responses to antihypertensive agents
African Americans
Asian Americans
Sympatholytics
Beta-adrenergic blockers
Nonselective beta blockers
Inhibit beta1 and beta2 receptors
Propranolol
and
carvedilol
Cardioselective beta blockers
Block beta1 receptors
Acebutolol, atenolol, betaxolol, bisoprolol,
and
metoprolol
SE: Hypotension, dizziness, fatigue
Centrally acting alpha2 agonists
Action
Stimulate alpha2 receptors
Decrease cardiac output
Decrease epinephrine, norepinephrine, and renin release
Methyldopa, clonidine, guanabenz
, and
guanfacine
Contraindicated w/impaired liver function :warning:
Avoid abruptly stopping drug as rebound hypertension may result
:warning:
SE:Sodium and water retention
Dry mouth, bradycardia
Alpha-adrenergic blockers
Action
Block the alpha-adrenergic receptors
Result in vasodilation and decreased blood pressure
Doxazosin, prazosin, terazosin
SE: Orthostatic hypotension
Headache, drowsiness
Adrenergic neuron blockers
Action
Block norepinephrine release from the sympathetic nerve endings, decrease in norepinephrine release, result lower BP
Reserpine
SE:Orthostatic hypotension, tachycardia
Dizziness, drowsiness, headache
Alpha1- and beta1-adrenergic blockers
Action
Blocks alpha1 receptors
Labetalol, carteolol
SE: Hypotension
Bradycardia
Direct-Acting Arteriolar Vasodilators
Action
Relax smooth muscles of blood vessels, especially arteries causing vasodilation
Hydralazine, minoxidil
SE: Tachycardia, palpitations, edema
Headache, dizziness, nasal congestion
(ACE) Inhibitors
Action
Inhibits formation of angiotensin II
Blocks release of aldosterone
Benazepril, captopril, enalapril maleate, fosinopril, lisinopril, moexipril, perindopril, quinapril, ramipril, trandolapril
SE: Nonproductive cough, fatigue, insomnia
Nausea, vomiting, diarrhea, hyperkalemia
African-American adults and older adults Do not respond with ACEI monotherapy
Contraindications
Pregnancy :red_cross:
Potassium-sparing diuretics :red_cross:
Salt substitutes that contain potassium :red_cross:
Angiotensin II Receptor Blockers (ARBs)
SE: Dizziness, hypotension, headache
Hyperkalemia, hyperglycemia
Action
Prevent release of aldosterone
Act on renin–angiotensin–aldosterone system
Block angiotensin II from angiotensin I receptors
Losartan, valsartan, irbesartan, eprosartan, candesartan, olmesartan, telmisartan
Direct Renin Inhibitor
Action
Bind with renin causing a reduction of angiotensin I, angiotensin II, and aldosterone levels
SE: Hypotension, peripheral edema
Hyperkalemia, diarrhea, renal failure
Stevens-Johnson syndrome
Aliskiren
Calcium Channel Blockers
Action
Slow calcium channels in myocardium and vascular smooth muscle cells promoting vasodilation
SE: Bradycardia, hypotension, palpitations
Flushing, headache, dizziness
Peripheral edema, fatigue
Verapamil, diltiazem, amlodipine, felodipine