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86 Cards in this Set
- Front
- Back
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Chronic hypertension can lead to ?
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stroke, congestive HF, M inf, renal damage
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cardiac output is controlled by
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baroreflexes, renin-angiotensin
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most antihypertensive acts by
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lowering cardiac output and peripheral resistence
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How does baroreceptors act?
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changes activity of sympatetic system
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angiotensin II is a potent
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vasoconstrictor
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Current recommendations to give (antihypertensive)
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Thiazide Diuretic
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which 2 additional drugs can be given to a diuretic
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B-blocker and lastly a vasodilator
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If ACE initial drug what can be added to treat hypertension?
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a diuretic
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In blacks you can give? treat hypertension
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diuretic and a calcium channel blocker
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Elderly what to give for hypertension
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CCB, Ace-inhibitor, Diuretics
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what is Dash diet?
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exercise, low alcohol intake
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in elders give b-blocker or a diuretic ?
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diuretics has been shown more effective
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How does Thiazide lower blood pressure
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by increase excretion of sodium and water
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Thiazide side effetcs ?
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hypokalemia,
hyperuricemia 70%, hyperglycemia 10% |
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Can you give loop diuretics in a patient with poor renal function
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YES
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Give 3 examples of loop diuretics
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furosemide, bumetanide, torsemide
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Loop diuretics also increase ? which thiazides do not
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Calcium
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Potassium sparing drugs
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Spironolactone Epleronone Amiloride Triaterene
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Amiloride and triaterene inhibits
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inhibts epithelium sodium transport and late distal and collecting tube
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What is first line treatmen in naturally occurind disease is present such as MYI
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B-blockers
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Propranolol acts on?
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B1 and B2 receptors
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Metaprolol and Atenolol
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Only B1 receptor
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Nebivolol
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B1 receptor , also increases nitric oxide leading to vasodilation
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Nadolol
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B1 and B2
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Use b-blocker catiously in
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acute heart failure and peripheral vascular disease
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B-blockers more preffered in
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young white patients
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B-blocker good to use when this is present
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supreventricular tachyarrhytmia
previous myocardial infarction angina pectoris, chronic HF |
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B-blocker take how long to have full effect
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may take several weaks to develop
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Beta blockers adverse effects
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hypotension, bradychardia fatique, Insomnia, Sexual dysfuction.
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can you abrupt treatment of b-blocker suddenly ?
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no lower dose first then quit
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Mention 2 ace inhibitors in Hypertensive care
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Enalapril and Lisinopril
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Enalapril and Isinopril use in?
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hypertensive patient when can not use b-blocker and diuretics
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Enalapril and Isinopril actions ?
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lower BP by reducing peripheral vascular resistance
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ACE inhibitors increases what levels
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Bradykinin levels
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ACE inhibitors reduce
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preload and afterload
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ACE inhibitor first line treat in
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systolic dysfunction
hypertens+chronic renal diseas increased risk coronary artery |
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ACE Inhib adverse effects
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Dry cough due to bradykinin
Hyperkalemia Skin rash, Fever Hypotension, Fetal malformation |
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ARB acts on
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AT1 receptor
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Ex of a ARB
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Losartan
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What do not ARBs elevate such as ACE-inhibitors does
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do not elevate bradykinin
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ARBs attractive in ?
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Hypertensive diabetes
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ARBs is also toxic to ?
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Fetus
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a Renin Inhibitor ?
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Aliskiren
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Aliskiren action ?
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directly inhibits renin
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adverse effect of aliskiren
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diarrhea at higher doses. contraindicated pregnancy
cough and angioedema |
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CCB effective in ?
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Hypertensive with angina or diabetes.
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high doses of short CCB risk for ?
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increased risk for myocardial infarction
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Verapamil is for hypertension and what ?
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for angina and SVTA also. its a CCB
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Calcium channel blockers adverse effects are
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first degree av-block and constipation
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CCB blockers do not ?
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dilate any veins only arteries
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CCB good in ?
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asthma, diabetes, angina, peripheral vascular disease
blacks |
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Diphenylalkylamines ?
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Verapamil
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Benzothiazepines ?
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Diltiazem
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Dihydropyridines ?
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Nifedipine
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a-adrenoreceptor blockers
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Prazosin Doxazosin Terazosin
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a/b adrenoreceptor blockers
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Labetalol Carvedilol
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Labetalol and Carvedilol are ?
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non selective alpha and beta blockers.
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Carvedilol is mostly used in ?
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heart failure, also some anti-hypertensive effects
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Clonidine is a
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central a2-agonist
which decreases cardiac output |
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Clonidine decreases ?
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decreases firing rate of sympathetic on heart
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Clonidine used when other
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other drugs have failed
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If hypertensive patient with renal disease use ?
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Clonidine
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Clonidine adverse
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constipation and dry mouth
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How should Clonidine be abrupt
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slowly and not directly
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a-Methyldopa is a
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a2-agonist
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a-Methyldopa reduces
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peripheral resistance and
decreases blood pressure |
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a-Methyldopa good to give in
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hypertensive patient with renal insufficiency
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a-Methyldopa adverse is
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sedation, drowsiness
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Vasodilators in antihypertensive patients
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Hydralazine, Minoxidil, Nitroprusside
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Hydralazine and Minoxidil
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decreases blood pressure and resistance
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Hydralazine and Minoxidil acts by
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activating potassium channels increases efflux, this inhibits Ca2+ entry
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Vasodilators also increases ?
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renin plasma levels
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Hydralazine acts primary on?
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arteries and arterioles
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Hydralazine induces ? should be given together with a ?
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induces elevated heart rate,
give together with a b-blocker and a diuretic |
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Hydralazine adverse
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headache, tachycardia, nausea, sweating, arrhythmia
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Minoxidil is a
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Vasodilator,
regrowth of hair |
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Minoxidil causes
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severe sodium and water retention
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Nitroprusside
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can reduce blood pressure despite origin. reflex tachycardia
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Nitroprusside acts also on
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veins
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Nitroprusside reduces
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preload
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Nitroprusside halflife ?
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minutes
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Nitroprusside is toxic how ?
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if given orally hydrolysis to cyanid.
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When is it hypertensive emergency ?
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systolic over 210
diastolic over 150 |
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Labetalol is a ?
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alpha and beta blocker
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Fenoldopam can be used in
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all emergencies
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Fenoldopam in the periphery ?
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dopamine - 1 receptor agonist
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