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105 Cards in this Set
- Front
- Back
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When is a drug required to control hypertension?
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When SBP>140mm Hg OR DBP> 90mm Hg
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Increased peripheral vascular smooth muscle tone, leads to increased arteriolar resistance and decreased capacitance of venous system results in _____.
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Hypertension
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Chronic hypertension is a risk factor for:
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CHF, MI, kidney disease, & CVA
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Normal BP
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100-119/70-79 mmHg
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Prehypertension
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120-139/80-89 mmHg
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Stage 1 hypertension
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140-159/90-99 mmHg
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Stage 2 hypertension
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>160/>100 mmHg
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Causes of secondary hypertension
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chronic kidney disease, pheochromocytoma, Cushing's syndrome, hyperthyroidism, primary aldosteronism, pregnancy
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Essential hypertension is more common in ______ Americans than Caucasian Americans.
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African
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Essential hypertension occurs more often in middle-age ____ than middle-age ______.
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males, females
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Predisposing environmental factor for essential hypertension:
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stress
high Na+ obesity smoking |
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Cardiac output & peripheral vascular resistance are controlled by:
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baroreceptor reflexes (sympathetic nervous system)
RAAS |
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Most antihypertensives decrease blood pressure by ____cardiac output and/or peripheral vascular resistance.
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decreasing
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____ blood pressure causes baroreceptors, pressure-sensitive neurons in aortic arch and carotid sinuses, to decrease action potentials sent to spinal cord.
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Low
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Baroreceptor reflex ____sympathetic input & ____ parasympathetic input to heart & vascular, resulting in vasoconstriction & increased C.O.=>increased BP.
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increases, decreases
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RAAS
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Renin Angiotensin Aldosterone System
long-term control of BP is managed by kidneys which alter blood volume |
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Pressure receptors in kidneys respond to low arterial pressure by secreting the enzyme ___.
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renin
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Sympathetic stimulation of ___ adrenergic receptors in kidneys also causes secretion of renin.
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B1
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Renin (peptidase) converts angiotensinogen to ______.
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Angiotensin I
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______ converts angiotensin I to angiotensin II
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ACE (angiotensin converting enzyme)
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Angiotensin II is a very potent ______ which causes an increase in blood pressure.
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vasoconstrictor
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Angiotensin II also stimulate aldosterone secretion in the adrenal ____ which increases renal Na+ reabsorption and increases blood volume which also increases BP.
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cortex
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Atenolol
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B-blocker
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Lisinopril
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ACE-I
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Losartan
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ARB (angiotensin II receptor blocker)
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Amlodipine
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Calcium channel blocker
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Terazosin
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a1-blocker
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Hydrochlorothiazide
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diuretic
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Spironolactone
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aldosterone antagonist
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Stage 1 hypertension is often controlled w/ _______ monotherapy
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thiazide diuretic
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Stage 2 hypertension is often controlled w/ a thiazide diuretic and a ______.
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ACE-I
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African Americans respond well to ____ and _____.
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Thiazide diuretics, calcium channel blockers
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Elderly respond well to ____ and ____.
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thiazide diuretics, ACE-I
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Treating HTN and Left Ventricular Dysfunction
which drugs would you prescribe? |
Diuretic + ACE-I
and possibly a B-blocker later on down |
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Treating HTN and Post Myocardial Infarction
which drugs would you prescribe? |
B-Blocker
and possibly an ACE-I or ARB later on down |
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Treating HTN and Coronary Artery Disease
which drugs would you prescribe? |
B-Blocker
and possibly an ACE-I or ARB later on down |
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Treating HTN and Diabetes Mellitus
which drugs would you prescribe? |
ACE-I or ARB
*remember they are renal protective! |
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Treating HTN and Chronic Kidney Disease
which drugs would you prescribe? |
ACE-I or ARB
*remember they are renal protective! |
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Treating HTN and Recurrent Stroke Prevention
which drugs would you prescribe? |
Diuretic + ACE-I
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Most common reason for antihypertensive therapy failure
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patient nonadherence
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side effect of B-blockers on men causing patients to discontinue drug therapy..
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decreased libido and impotence in middle-aged men
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Atenolol
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cardioselective B1 antagonist
may be used cautiously in patients with asthma! (better option than propranolol) |
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_____ are 1st line drugs in treating HTN w/ post myocardial infarction and CAD
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B-blockers
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B-Blockers mechanism of action
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decrease C.O. & decrease renin secretion from kidneys, therefore decreasing Ag II and aldosterone
*more effective in young patients, and Caucasians |
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B-Blocker side effects
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bradycardia, hypotension, fatigue, insomnia, hallucinations, male sexual dysfunction, decreased HDL, increased Trigs
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Abrupt withdrawal of B-blockers may cause ____ and _____, therefore must slowly taper off.
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rebound HTN, arrhythmias
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1st line drugs in treating HTN with HF, post MI, diabetes mellitus, kidney disease, stroke
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ACE-I
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ACE-I mechanism of action
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decreases peripheral resistance w/out reflex tachycardia; inhibits ACE which converts Ag I into Ag II; also cleaves Bradykinin releasing NO and Prostaglandin I2 for vasodilation
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Decrease Ag II--> decreased aldolesterone & Na+ & ___ retention
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H2O
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ACE-I are most effective in ___ and ___.
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Caucasians, young
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ACE-I and ARBs slow progression of diabetic ______ & decrease albuminemia.
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nephropathy
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Side effects of ACE-I include:
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dry cough (due to bradykinin); rash; fever; altered taste; hypotension (1st dose syncope); hyperkalemia; angioedema (bradykinin); teratogenic effects; Renal failure (involved w/ renal artery stenosis)
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ACE-I have drug interactions with:
(hint: 3 types of drugs) |
Spironolactone
K+ supplements NSAIDs |
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Losartan acts on Angiotensin type 1 receptor as an _____.
(hint: agonist or antagonist?) |
antagonist
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Blocking angiotensin II leads to _____ vasoconstriction and aldosterone release, which promotes vasodilation and decrease in Na+/H2O retention.
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decreased
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Angiotensin II is synthesized by other enzymes such as _____.
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chymases
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ARBs have ____ affect on bradykinin metabolism
(hint: little, no, some) |
no
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ARB side effects
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hyperkalemia; hypotension; renal failure; teratogenic effects; cough (rare); angioedema (rare)
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ARBs interact with
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ACE-I, NSAIDs, K+ supplements
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Aliskiren (drug type)
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renin inhibitor
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Side effects of Aliskiren
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rash; diarrhea; cough; hypotension; angioedema; teratogen
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Aliskiren is a substrate for _____.
(hint: cytochrome) |
CYP3A4
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Verapamil is a _____ type calcium channel blocker
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diphenylalkylamine
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Diltiazem is a ___ type of CCB
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benzothiazepine
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Amlodipine is a ____ type of CCB.
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dihydropyridine
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CCB are used when ____ are contraindicated or ineffective.
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1st line
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____ are effective in treating hypertension in patients w/ DM and CAD.
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CCB
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High does of CCB increase risk of _____.
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MI
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Verapamil is least selective, it effects both _____ and ____ smooth muscle.
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Cardiac; vascular
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Diltiazem effects both cardiac and vascular SM, and is less negative _____ effect, with a favorable side effect profile.
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inotropic (alters contractility of heart)
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Amlodipine is selective for _____ Ca2+ channels.
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vascular
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Ca2+ enters thru voltage sensitive ___-type Ca2+ channels, which triggers release of Ca2+ from SR and mitochondria to increase Ca2+ conc'n.
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L
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_____ bind to L-type Ca2+ channels which inhibits the inward flow of Ca2+, therefore relaxing VSM and cardiac muscle.
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CCBs
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CCBs have a ____ effect, and usually do not require a diuretic.
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natriuretic
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Verapamil, Diltiazem and Amlodipine can all be used for ___ and ___.
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HTN; angina
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CCBs used to treat arrhythmias
(hint: 2 of them) |
Verapamil, Diltiazem
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CCBs have a ___ half-life; usually require 3x/day dosing or Sustained Release
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short
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Side effects of CCBs
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constipation; hypotension; dizziness; fatigue headache
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CCBs interact with _____
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grapefruit
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Avoid _____ with congestive heart failure because its negative inotropic effect.
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Verapamil
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a1-Blockers (terazosin) decreased peripheral resistance and blood pressure by relaxing ______ and ______ smooth muscle.
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arterial, venous
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a1-Blocker (terazosin) side effects
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postural hypotension (1st dose syncope); dizziness; headache; reflex tachycardia; edema; male sexual dysfunction
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Clonidine
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a2-AGONIST
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Clonidine mechanism of action
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decreases central adrenergic outflow; no decrease in renal blood flow/glomerular filtration
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Clonidine therapeutic uses:
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HTN, Renal disease treatment w/ diuretic, withdrawal symptoms for opioids and benzodiazepines, ADHD
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Clonidine side effects:
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hypotension; Na+/H2O retention; sedation; dry nasal mucosa
Abrupt withdrawal-->rebound HTN |
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a-Methyldopa mechanism of action
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CNS, converted to a-methylnorepinephrine, decreases central adrenergic outflow therefore decreases TPR and BP
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a-methyldopa
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a2-AGONIST; symp. nervous system false neurotransmitter
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a-methyldopa can be used in _____, _____ and _____.
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primary HTN, pregnancy, emergency
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a-methyldopa side effects
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drowsiness, fatigue, dizziness, postural hypotension
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Hydralazine mechanism of action
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relaxation of arteriolar SM, decreasing Ca2+ and Peripheral vasc. resistance; can lead to reflex tachycardia
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Hydralazine is given with a B-Blocker for hypertension to decrease reflex ____ and with a diuretic to decrease Na+.
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tachycardia
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Hydralazine is given with a _____ to treat HTN and HF in African Americans
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nitrate
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Hydralazine Side effects:
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headache, nausea/vomiting, sweating, arrhythmia, angina, lupus-like syndrome
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Hypertensive emergency
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>210/>150mmHg
goal: 160/100mmHg in 2-6 hours & normal BP in 24-48 hrs |
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Nitroprusside, Nitroglycerin, Fenoldopam, Nicardipine, Labetalol, Hydralazine IV can be given for treatment of _____.
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hypertensive emergency
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Nitroprusside & Nitroglycerin mechanism of action
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converted into NO, increases guanylyl cyclase activity, increasing cGMP, leading to dephosphorylation of myosin LC=vasodilation
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Nitroprusside side effects
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reflex tachycardia, hypotension, cyanide poisoning
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Cyanide poisoning due to nitroprusside treated with
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Na+ thiosulfate
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Nitroprusside action & duration
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1-2 mins.
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Nitroglycerin used for:
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hypertensive emergency, angina, CHF, MI
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Nitroglycerin side effects
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headache, hypotension, rash
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Fenoldopam mechanism of action
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D1-AGONIST, vasodilation or increased renal perfusion while lowering BP
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Fenoldopam used in hypertensive emergency, onset is 2-5 mins, duration of action is ____
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30 mins.
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Fenoldopam side effects:
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tachycardia, flushing, headache
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