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47 Cards in this Set
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Hypertension
Fall '09 |
There are many drugs that can be given to help with Hypertension. 4 of these you have learned already in a session prior to this study set.
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Diuretics: Hydrochlorothiazide [Oretic], Sprionolactone [Aldactone]
ACE Inhibitors: Captopril [Capoten], Enalapril [Vasotec] Angiotensin II Receptor Blockers: Losartan [Cozaar] |
Beta1-Adrenergic Blockers: Propranolol [Inderal], Metoprolol [Lopressor]
Calcium Channel Blockers: Verapamil [Calan], Nifedipine [Adalat] |
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Before we go on, tell me, what is the difference with Primary and Secondary Hypertension???
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Primary: No identifiable cause. AKA essential hypertension. Most frequent.
Secondary: Following another disease. |
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Goals for antihypertensive therapy:
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Objective—Reduce HTN-associated morbidity & mortality related to target-organ damage
‘Surrogate’ Objective—Achieve desired BP |
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General information on drug types.
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Put your thinking caps on!
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What do Drugs for Beta 1 receptors do? What drugs are in relation to this?
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Beta1 receptors of the juxtaglomerular cells:
Blockage suppresses release of renin, decreasing angiotensin II levels Beta-blockers (e.g. propranolol, metoprolol) |
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What do Drugs for Angiotensin converting enzyme do? What drugs are in relation to this?
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Angiotensin-converting enzyme:
Inhibition decreases formation of angiotensin II ACE inhibitors (e.g. captopril, enalopril) |
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What do Drugs for Angiotensin 2 receptors do? What drugs are in relation to this?
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Angiotensin II receptors:
Blockage prevents action of angiotensin II Angiotensin II receptor blockers (e.g. losartan) |
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What do Drugs for Kidney Aldosterone receptors do? What drugs are in relation to this?
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Kidney aldosterone receptors:
Blockage promotes excretion of sodium (and water), reducing blood volume Aldosterone receptor blockers (e.g. spirolactone) |
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Anti Hypertensive Treatment for *Stage 1 HTN (140-159/90-99)
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Stage 1 HTN (140 to 159/90 to 99)
Thiazide diuretics ACE Inhibitors Angiotensin II Receptor Blockers Beta1-Adrenergic Blockers Calcium Channel Blockers (given individually or as a combination) |
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Anti Hypertensive Treatment for *Stage 2 HTN (>160/>100)
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Stage 2 HTN (>160/>100)
Thiazide diuretics: combined with ONE of the following ACE Inhibitors ARB Beta1-Adrenergic Blockers Calcium Channel Blockers |
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Antihypertensive Drug:
Thiazide diuretics What is this drug called? |
Hydrochlorothiazide [HydroDIURIL; Oretic]
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Hydrochlorothiazide Mechanism of Action:
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Mechanism of Action
MOA: *Reduction of blood volume (causes initial effects) *Reduction of arterial resistance (causes long-term effects) |
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Hydrochlorothiazide Adverse Effects:
Do you remember? This is for most diuretics except for spironolactone. |
Adverse Effects:
*Hypokalemia (take k-rich foods such as bananas and citrus fruits) Dehydration, hyperglycemia, and hyperuricemia |
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Antihypertensive Drugs:
High-ceiling (loop) diuretics What is this drug called? |
Furosemide [Lasix]
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Furosemide [Lasix] Mechanism of action:
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MOA:
Reduction of blood volume, promoting vasodilation |
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Furosemide [Lasix] adverse effects:
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Adverse Effects:
Same as Thiazide diuretic as well as *Hearing Loss |
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Antihypertensive Drugs:
Potassium-sparing diuretics What is this drug called? |
Spirolactone [Aldactone]
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Spirolactone [Aldactone] MOA:
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Spirolactone [Aldactone] MOA:
LESS diuresis than other drugs Often used to balance K loss |
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Spirolactone [Aldactone] adverse effects:
What do you think? It would be too much of what this drug does. |
Spirolactone [Aldactone] adverse effects:
Hyperkalemia |
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On to an adrenergic antagonist that we have learned already. Antihypertensive Drugs Sympatholytics BETA BLOCKERS Propanolol and Metoprolol
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Propranolol, Metoprolol are among the most widely used anti-HTN meds. However, it is LESS EFFECTIVE in African American pts.
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Propranolol, Metoprolol MOA:
Block _______ _____ adrenergic receptors Suppress ______ ___________ (from vasodilation) Block beta1 receptors of the _______________ cells Long-term _________ in vascular resistance |
Propranolol, Metoprolol MOA:
Block cardiac beta1-adrenergic receptors Suppress reflex tachycardia (from vasodilation) Block beta1 receptors of the juxtaglomerular cells Long-term reduction in vascular resistance |
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Significant Side Effects for Propranolol, Metoprolol:
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SE for Propranolol, Metoprolol:
*May have intrinsic sympathomimetic activity *Blocks beta 2 in lungs *CNS effects: depression, insomnia, sexual dysfunction |
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PRAZOSIN:
Antihypertensive Drugs Alpha1 adrenergic antagonists |
MOA:
Promotes dilation of arterioles and veins by....doing what? what was it's name again? |
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Side Effect for Prazosin:
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Orthostatic Hypotension
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CARVEDILOL:
Antihypertensive Drugs Alpha/beta blockers |
MOA:
Blocks BOTH alpha 1 (promotes dilation) and Beta receptors (reduce HR, contractility, and renin)! |
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Carvedilol side effects:
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Carvedilol side effects:
*Similar to beta blockers brachycardia, slowed AV conduction, asthma *Hypotension (similar to alpha blocker) |
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CLONIDINE, METHYLDOPA:
Antihypertensive Drugs—Centrally acting alpha2 agonist |
Clonidine, methyldopa MOA:
Decreases outflow of sympathetic stimulation to heart and blood vessels causing vasodilation and lower cardiac output |
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Clonidine, methyldopa side effects:
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Clonidine, methyldopa SE:
Dry mouth, sedation, rebound hypertension (clonidine), and anemia (methyldopa) |
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RESERPINE
Antihypertensive Drugs Adrenergic neuron blockers |
MOA:
Blockage of nerve terminals causes NE depletion and causes decreased sympathetic stimulation of heart and blood vessels |
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RESERPINE Side Effects:
* These SE's causes this drug to be a LAST DRUG OF CHOICE* |
RESERPINE Side Effects:
*Severe hypotension *Depression: Contraindicated for pts with mood disorders |
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HYDRALOZINE, MINOXIDIL
Antihypertensive Drugs Direct-acting vasodilators |
Hydralozine, minoxidil MOA:
Relaxation of vascular smooth muscle causes vasodilation (ONLY IN ARTERIOLES thus producing minimal hypotension) |
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Hydralozine, minoxidil Side effects:
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Hydralozine, minoxidil side effects:
Reflex tachycardia, renin release, fluid retention Beta blocker can inhibit tachycardia and renin Diuretic can prevent fluid retention |
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VERAPAMIL [Calan] & NIFIDEPINE [Adalat]
What sort of drug is this for? (*hInt: a something channel blocker*) |
VERAPAMIL [Calan] & NIFIDEPINE [Adalat]
Antihypertensive Drugs Calcium channel blockers |
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VERAPAMIL [Calan] & NIFIDEPINE [Adalat]
Mechanism of Action: |
VERAPAMIL & NIFIDEPINE MOA:
Relaxation of vascular smooth mscle causes vasodilation of arterioles *Also effects myocardium, SA node, AV node |
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VERAPAMIL [Calan] & NIFIDEPINE [Adalat]
Side Effects: |
VERAPAMIL & NIFIDEPINE SE:
*Reflex Tachycardia *Constipation (most common complaint for verapamil) |
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CAPTORIL [Capoten] & ENALOPRIL [Vasotec]
These drugs are ___ Inhibitors |
Captopril [Capoten] & Enalopril [Vasotec]
Antihypertensive Drugs ACE Inhibitors |
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Captopril [Capoten] & Enalopril [Vasotec] Mechanism of Action:
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Captopril & Enalopril MOA:
*Inhibition of angiotensin-converting enzyme decreases formation of angiotensin II Protect kidney in diabetic/HTN pts LESS EFFECTIVE in African American |
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Captopril [Capoten] & Enalopril [Vasotec] Side Effects:
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Captopril & Enalopril SE:
*Persistent Cough *Hyperkalemia (due to suppression of aldosterone release) *Contradicted during pregnancy |
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Whats the name for the prototype for:
Antihypertensive Drugs Angiotensin II receptor blockers?? |
Angiotensin II receptor blockers
LOSARTAN [Cozaar] |
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Losartan [Cozaar] Mechanism of action:
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Losartan [Cozaar] MOA:
Blockage of actions of angiotensin II and release of aldosterone |
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Losartan [Cozaar] Side effects:
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Losartan [Cozaar] SE:
Doesn't produce cough or significant hyperkalemia (like ACE inhibitors do) Angioedema **Contraindicated during pregnancy |
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What is the prototype for Antihypertensive Drugs
Aldosterone receptor blockers?? You've learned this one already. |
SPIROLACTONE [Aldactone]:
Aldosterone receptor blocker |
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Spirolactone [Aldactone]
Mechanism of Action: |
Spirolactone [Aldactone] MOA:
Inhibits Na/K exchange in distal nephron Blockage promotes excretion of sodium and water, reducing blood volume |
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Spirolactone [Aldactone]
Side Effects: |
Spirolactone [Aldactone] SE:
Retention of K may lead to *hyperkalemia Not combined with K supplements |
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Individualizing Therapy Diabetes:
Preferred meds = ACE inhibitors, ARBs, CCBs, Diuretics only in low doses b/c cause hyperglycemia |
Individualizing Therapy Children:
Incidence of secondary HTN is high Treatment same as adults (with lower dosages) |
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Individualizing Therapy Elderly:
Diuretics and beta blockers most tested and shown efficacious Monitor for hypotension |
Individualizing Therapy Pregnancy:
HTN is most common complication of pregnancy Chronic HTN and severe preeclampsia both observed |