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55 Cards in this Set
- Front
- Back
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What is essential hypertension? What is secondary hypertension?
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Essential- elevated without any identifiable cause
Secondary- identifiable cause (apnea, CKD, aldosteronism, etc.) |
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What are the key targets of antihypertensives?
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Volume
Flow Radius or resistance |
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What are the acute effects of diuretics? What are the chronic effects?
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Lower BP by increasing sodium excretion
Acute- decreased plasma volume and cardiac output Chronic- CO and volume return to normal, but resistance decreases. |
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What are the thiazide-like diuretics? What is the mechanism? Where do they act?
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Hydrochlorothiazide
Chlorthalidone Matalazone Inhibit sodium chloride symporter Acts in the distal convoluted tubule |
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What are the indications for thiazide diuretics?
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Mild HTN
Edema Hypercalciuria |
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What are adverse effects of thiazide type diurects?
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Hypokalemia
Hyperuricemia Hypercalcemia Hyperglycemia Hyperlipidemia ED |
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What are the loop diuretics? What is the mechanism? Where do they work?
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Furosemide
Ethacrynic acid Bumetanide Torsemide Inhibit sodium potassium chloride symporter Ascending loop of Henle |
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What are the indications of loop diuretics?
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Edema
HTN (with renal insufficiency) Hypercalcemia |
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What indication does ethacrynic acid have that the other loop diuretics do not have?
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Can be used in patients with sulfa allergy. Others will cause SJS reaction
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What are adverse effects of loop diuretics?
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Dehydration
Hypokalemia Hyponatremia Hypomagnesemia Hyperglycemia Dyslipidemia Ototoxicity |
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What are potassium sparing diuretics? What is the mechanism? Where do they work?
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Amliloride
Triamterene Block sodium channels and potassium channels Collecting duct |
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What are the indications for potassium sparing diuretics?
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Combination with other diuretics
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What are the adverse effects for potassium sparing diuretics?
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Hyperkalemia
N/V/D Leg cramps, megaloblastic anemia (triamterene) |
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What are mineralocorticoid receptor antagonists? What is the mechanism?
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Spironolactone
Eplerenone Block aldosterone, reducing sodium reabsorption and loss of potassium. |
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What are indications for mineralocorticoid receptor antagonists?
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Combination with diuretics.
CHF |
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What are adverse effects for spironolactone?
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Gynecomastia
Menstrual abnormality GI disturbance |
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What is the ending for ACE inhibitors? What is the mechanism? What is affected?
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-pril
Blocks angiotensin converting enzyme. Causes buildup of angiotensin I and bradykinin |
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What are the indications for ACE inhibitors?
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CHF
Mild-moderate HTN CKD/diabetes Not used in black patients |
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What are the adverse effects of ACE inhibitors?
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Cough
Angioedema Hyperkalemia Hypotension |
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What are the contraindications for ACE inhibitors?
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Renal stenosis
Pregnancy |
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What is the ending for ARBs? What is the mechanism? What is affected?
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-sartan
Antagonist of the angiotensin II receptor. Decreased levels of aldosterone, but no change in bradykinin. |
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What are the adverse effects of ARBs?
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Similar to ACE, no cough or angioedema
Contraindicated in renal stenosis and pregnancy |
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What is aliskiren? What is the mechanism?
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Direct renin inhibitor
Blocks conversion of angiotensinogen to angiotensin I |
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What is the mechanism of calcium channel blockers?
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work on L type channels
Blocks entry of calcium into smooth muscle, inhibiting depoloarization and constriction. |
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What are the two classes of calcium channel blockers?
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Dihydropyridine- greater vascular effects; -dipine
Non-dihyropyaridin-greater cardiac effects; diltiazem, verapamil |
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What are the adverse effects of dihydropyridine calcium channel blockers? Non-dihydropyridine?
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Dihydro- tachycardia, peripheral edema
Nondihydro- AV block, bradycardia, heart failure, constipation |
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What are the effects mediated by beta 1 receptors?
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Heart rate and contractility
Kidney renin release Hypothalamus ADH release |
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What are the acute effects of beta blockers? What are the chronic effects?
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Acute- decreased CO, reflex rise in resistance
Chronic- low CO, resistance returns to normal |
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What are the non-selective beta blockers?
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N-Z-olol
Beta 1 and beta 2 |
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What are the cardioselective beta blockers?
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A-M-olol
Beta 1 more than 2 |
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What is the withdrawal syndrome of beta blockers?
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Up regulation of beta receptors cause worsened CAD and rebound hypertension.
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What are adverse effects of beta blockers?
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Bradycardia
Exercise intolerance Bronchospasm Masks hypoglycemia in diabeteics Depression Hallucinations Dyslipidemia |
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How is beta blocker overdose treated?
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Glucagon improves HR and contractility.
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What are the indications for beta blockers?
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Hypertension with additional CV complications
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What are the contraindications for beta blockers?
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Conduction block
Bradycardia CHF COPD Diabetes |
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What is the function of ISA in beta blockers? What are the indications?
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Provides some sympathetic activity on the beta receptors.
HTN with arrhythmias or peripheral vascular disease. |
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What are beta blockers with alpha blocking activity? What is the effect?
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Carvedilol, labetalol
Alpha block reduces resistance, beta block reduces reflex HR and renin |
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What is the beta blocker with NO activity?
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Nebivolol
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What are the acute effects of alpha receptor antagonists? Chronic effects?
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Acute- decrease arterial and venous resistance; reflex increase in HR and renin
Chronic- vasodilation; CO, HR and renin return to normal |
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What is the ending for alpha blockers? What are the indications?
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-zosin
HTN, not as a sole drug |
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What are the adverse effects of alpha blockers?
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First dose postural hypotension
Dizziness/vertigo Sedation Salt and water retension |
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What is the function of central alpha 2 agonists?
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Act on the NTS at the alpha 2 receptor to inhibit sympathetic system.
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What are the central alpha2 agonists?
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Clonidine
Methyldopa |
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What are the adverse effects of central alpha 2 agonists?
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Sedation
Bradycardia Heart block Withdrawal reaction |
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What is reserpine? What are the side effects?
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Sympatholytic that depletes nerve terminals of transmitter by blocking storage.
Depression, GI problems |
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What are the vasodilators? What are the mechanisms?
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Minoxidil- opens potassium channels to hyperpolarize the cell.
Hydralazine- unclear mechanism Nitroprusside sodium- produces NO |
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What drugs are used for hypertensive crisis?
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Nitroprusside
Hydralazine (pregnant) Fenoldopam Labetalol |
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What are adverse effects of hydralazine?
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Lupus like syndrome
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What are adverse effects of minoxidil?
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Pericardial effusion
Hypertrichosis |
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What are adverse effects of nitroprusside?
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Cyanide accumulation
Thiocyante toxicity |
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What drugs must be given along with vasodilators?
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Diuretics- decrease fluid retention
Beta blockers- counter reflex tachycardia |
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What is fenoldopam? What is the use?
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Dopamin agonist
Hypertensive emergency |
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What are the first choice drugs in general hypertension?
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Thiazide
ACE inhibitor ARB Calcium channel blocker |
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What is the first choice drugs in black patients?
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Diuretics
Calcium channel blockres |
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What drugs can be used during pregnancy? Which should be avoided?
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Methyldopa or labetalol
Avoid ACE inhibitors, ARBs, atenolol, diuretics |
