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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.
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]
Before we go on, tell me, what is the difference with Primary and Secondary Hypertension???
Primary: No identifiable cause. AKA essential hypertension. Most frequent.

Secondary: Following another disease.
Goals for antihypertensive therapy:
Objective—Reduce HTN-associated morbidity & mortality related to target-organ damage

‘Surrogate’ Objective—Achieve desired BP
General information on drug types.
Put your thinking caps on!
What do Drugs for Beta 1 receptors do? What drugs are in relation to this?
Beta1 receptors of the juxtaglomerular cells:
Blockage suppresses release of renin, decreasing angiotensin II levels
Beta-blockers (e.g. propranolol, metoprolol)
What do Drugs for Angiotensin converting enzyme do? What drugs are in relation to this?
Angiotensin-converting enzyme:
Inhibition decreases formation of angiotensin II
ACE inhibitors (e.g. captopril, enalopril)
What do Drugs for Angiotensin 2 receptors do? What drugs are in relation to this?
Angiotensin II receptors:
Blockage prevents action of angiotensin II
Angiotensin II receptor blockers (e.g. losartan)
What do Drugs for Kidney Aldosterone receptors do? What drugs are in relation to this?
Kidney aldosterone receptors:
Blockage promotes excretion of sodium (and water), reducing blood volume
Aldosterone receptor blockers (e.g. spirolactone)
Anti Hypertensive Treatment for *Stage 1 HTN (140-159/90-99)
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)
Anti Hypertensive Treatment for *Stage 2 HTN (>160/>100)
Stage 2 HTN (>160/>100)
Thiazide diuretics: combined with ONE of the following
ACE Inhibitors
ARB
Beta1-Adrenergic Blockers
Calcium Channel Blockers
Antihypertensive Drug:
Thiazide diuretics
What is this drug called?
Hydrochlorothiazide [HydroDIURIL; Oretic]
Hydrochlorothiazide Mechanism of Action:
Mechanism of Action
MOA:
*Reduction of blood volume (causes initial effects)
*Reduction of arterial resistance (causes long-term effects)
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
Antihypertensive Drugs:
High-ceiling (loop) diuretics
What is this drug called?
Furosemide [Lasix]
Furosemide [Lasix] Mechanism of action:
MOA:
Reduction of blood volume, promoting vasodilation
Furosemide [Lasix] adverse effects:
Adverse Effects:
Same as Thiazide diuretic as well as *Hearing Loss
Antihypertensive Drugs:
Potassium-sparing diuretics
What is this drug called?
Spirolactone [Aldactone]
Spirolactone [Aldactone] MOA:
Spirolactone [Aldactone] MOA:
LESS diuresis than other drugs
Often used to balance K loss
Spirolactone [Aldactone] adverse effects:
What do you think? It would be too much of what this drug does.
Spirolactone [Aldactone] adverse effects:
Hyperkalemia
On to an adrenergic antagonist that we have learned already. Antihypertensive Drugs Sympatholytics BETA BLOCKERS Propanolol and Metoprolol
Propranolol, Metoprolol are among the most widely used anti-HTN meds. However, it is LESS EFFECTIVE in African American pts.
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
Significant Side Effects for Propranolol, Metoprolol:
SE for Propranolol, Metoprolol:
*May have intrinsic sympathomimetic activity
*Blocks beta 2 in lungs
*CNS effects: depression, insomnia, sexual dysfunction
PRAZOSIN:
Antihypertensive Drugs
Alpha1 adrenergic antagonists
MOA:
Promotes dilation of arterioles and veins by....doing what? what was it's name again?
Side Effect for Prazosin:
Orthostatic Hypotension
CARVEDILOL:
Antihypertensive Drugs
Alpha/beta blockers
MOA:
Blocks BOTH alpha 1 (promotes dilation) and Beta receptors (reduce HR, contractility, and renin)!
Carvedilol side effects:
Carvedilol side effects:
*Similar to beta blockers
brachycardia, slowed AV conduction, asthma
*Hypotension (similar to alpha blocker)
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
Clonidine, methyldopa side effects:
Clonidine, methyldopa SE:
Dry mouth, sedation, rebound hypertension (clonidine), and anemia (methyldopa)
RESERPINE
Antihypertensive Drugs
Adrenergic neuron blockers
MOA:
Blockage of nerve terminals causes NE depletion and causes decreased sympathetic stimulation of heart and blood vessels
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
HYDRALOZINE, MINOXIDIL
Antihypertensive Drugs
Direct-acting vasodilators
Hydralozine, minoxidil MOA:
Relaxation of vascular smooth muscle causes vasodilation (ONLY IN ARTERIOLES thus producing minimal hypotension)
Hydralozine, minoxidil Side effects:
Hydralozine, minoxidil side effects:
Reflex tachycardia, renin release, fluid retention
Beta blocker can inhibit tachycardia and renin
Diuretic can prevent fluid retention
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
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
VERAPAMIL [Calan] & NIFIDEPINE [Adalat]
Side Effects:
VERAPAMIL & NIFIDEPINE SE:
*Reflex Tachycardia
*Constipation (most common complaint for verapamil)
CAPTORIL [Capoten] & ENALOPRIL [Vasotec]

These drugs are ___ Inhibitors
Captopril [Capoten] & Enalopril [Vasotec]
Antihypertensive Drugs
ACE Inhibitors
Captopril [Capoten] & Enalopril [Vasotec] Mechanism of Action:
Captopril & Enalopril MOA:
*Inhibition of angiotensin-converting enzyme decreases formation of angiotensin II
Protect kidney in diabetic/HTN pts
LESS EFFECTIVE in African American
Captopril [Capoten] & Enalopril [Vasotec] Side Effects:
Captopril & Enalopril SE:
*Persistent Cough
*Hyperkalemia (due to suppression of aldosterone release)
*Contradicted during pregnancy
Whats the name for the prototype for:
Antihypertensive Drugs
Angiotensin II receptor blockers??
Angiotensin II receptor blockers
LOSARTAN [Cozaar]
Losartan [Cozaar] Mechanism of action:
Losartan [Cozaar] MOA:
Blockage of actions of angiotensin II and release of aldosterone
Losartan [Cozaar] Side effects:
Losartan [Cozaar] SE:
Doesn't produce cough or significant hyperkalemia (like ACE inhibitors do)
Angioedema
**Contraindicated during pregnancy
What is the prototype for Antihypertensive Drugs
Aldosterone receptor blockers??
You've learned this one already.
SPIROLACTONE [Aldactone]:
Aldosterone receptor blocker
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
Spirolactone [Aldactone]
Side Effects:
Spirolactone [Aldactone] SE:
Retention of K may lead to *hyperkalemia
Not combined with K supplements
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)
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