Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
101 Cards in this Set
- Front
- Back
|
Equation for Blood Pressure?
|
Cardiac Output X Peripheral Vascular Resistance
|
|
|
Definition of HTN?
|
Arterial BP above 140/90
|
|
|
How many cases of HTN have no clear cause?
|
90%
|
|
|
Different categories that often contribute to the multifactorial causes of HTN?
|
Genetics
Stress Environment (smoking) Diet (high sodium) |
|
|
Most common clinical presentation of HTN?
|
asymptomatic
|
|
|
Possible Sx's of HTN?
|
HA
Visual Disturbances (papilledema, optic swelling) often coincide w/ morning surge in BP |
|
|
Normal BP?
|
<120/80
|
|
|
Prehypertensive?
|
120-139/80-89
|
|
|
Stage 1 HTN?
|
140-159/90-99
|
|
|
Stage 2 HTN?
|
>160/100
|
|
|
Results of Chronic HTN?
|
Decreased Vessel Diameter
Diminished distribution of oxygen to target tissues Cardiac Hypertrophy Major End-Organ damage (MI, stroke, renal failure) |
|
|
Classes of Antihypertensive Drugs?
|
Diuretics
Ca Channel Blockers Beta Blockers ACE Inhibitors ARBs Central Alpha-2 Receptor Agonists Adrenergic Neuron Blockers Peripheral Alpha Antagonists Vasodilators |
|
|
General Ways to Lower BP?
|
Reduce Plasma Volume (diuretics)
Reduce Cardiac Output (beta blockers, Ca channel blockers) Reduce PVR (vasodilators) |
|
|
Main Actions of CCB's?
|
Block Ca in Cardiac/Smooth Muscle
Dilate Peripheral Arterioles Reduce PVR |
|
|
Classes of CCB's?
|
Dihydropyridines
Phenylalkylamines Benzothiazepines |
|
|
Example of Dihydropyridine?
|
Amlodipine
Nifedipine |
|
|
Phenylalkylamine example?
|
Verapamil
|
|
|
Benzothiazepine example?
|
Diltiazem
|
|
|
Kickers for Dihydropyridines?
|
Block Ca in vascular smooth muscle (vasodilate)
Dec PVR No affect on AV node conduction Good for angina |
|
|
Kickers for Verapamil?
|
Direct negative inotropic and chronotropic action (CARDIODEPRESSIVE)
Can cause HF in pts w/ LV dysfunction |
|
|
Kickers for Diltiazem?
|
Dec AV Conduction and HR
Weaker neg inotrope than verapamil |
|
|
SE's of CCB's?
|
Hypotension
Cardiac Depression (diltiazem, verapamil) Reflex Tachycardia (nifedipine) HA Flushing Edema (nifedipine) Constipation |
|
|
Drug Interactions of CCB's?
|
Verapamil or Diltiazem + Beta-Blockers = possible marked bradycardia and conduction blockade = BAD
Verapamil or Diltiazem + Digoxin can = greated inhibition of AV conduction Amlodipine + ACE Inhibitor = reduced CV events in HTN pts (GOOD) |
|
|
CCB Indications
|
Low Renin HTN (more common in blacks and old folks)
Good for pts w/ isolated systolic HTN (esp old folks) |
|
|
Cardiac Effects of a Beta-1 Adrenergic Receptor?
|
Increase CO!
Inc HR Inc Contractility |
|
|
Difference between inotropy and chronotropy?
|
inotropy = contractility
chronotropy = heart rate |
|
|
Beta-1 receptor cascade in the heart
|
Receptor is Gs-coupled-->
activates adenylyl cylcase--> Inc cAMP--> Activates PK-A--> Phosphorylates L-type Ca Channels and MLC-K--> Inc Inotropy and Inc Chronotropy |
|
|
Beta-2 receptor cascade in vessels?
|
Gs coupled-->
inc cAMP--> INHIBITS MLC-K in VSMC--> modest vasodilation |
|
|
Beta-Blocker effect on kidneys?
|
Decrease Renin Production
Decrease Vessel Tone |
|
|
Antihypertensive Beta Blocker Examples?
|
Propanolol
Atenolol Petoprolol Nadolol |
|
|
MOA for Propanolol?
|
Nonselective, competitive antagonist of Beta-1's and 2's
|
|
|
Results of Propanolol actions?
|
Dec HR
Dec contractile force Dec CO Delays AV Node Conduction Neutralize Reflex Tachycardia induced by vasodilators Reduce Central SNS output Small vasoconstriction (inc PVR) Reduces Renin release (Beta-1) |
|
|
SE's of Propanolol?
|
Hypotension
AV block Severe bradycardia Possibly HF Bronchial constriction/spasm Acute Withdrawal Syndrome (can cause MI) Inc TG's and Dec HDL Induces glucose intolerance Nightmares/Depression (cause its lipid soluble and crosses BBB) |
|
|
Contraindications of Propanolol?
|
Bronchial Asthma
Peripheral Vascular Disease AV Block |
|
|
Atenolol selectivity and benefit?
|
Beta 1 antagonist
Once a day Less Lipid Soluble than other beta blockers (so less depression, nightmares) |
|
|
Metoprolol selectivity, benefit?
|
Beta 1's only
Good for asthmatics |
|
|
Nadolol selectivity and benefit?
|
Non-selective
Once a day |
|
|
Indications for Beta Blockers?
|
Mild and Moderate HTN
Good for pts on vasodilators Good for HTN pts w/ underlying heart condition (CHF, MI, etc) |
|
|
What is the RAS System?
|
Angiotensinogen + Renin = Angiotensin I
Angiotensin I + ACE = Ang II Ang II--> vasoconstriction and Na retention (via aldosterone) |
|
|
Other role of ACE b/c in RAS?
|
Breaksdown Bradykinin into inactive peptide
|
|
|
Suffix for ACE inhibitors?
|
-pril
|
|
|
examples of ACE-I's?
|
Enalapril
Ramipril Lisinopril Captopril |
|
|
Kickers for Enalapril?
|
Excretion is mostly renal so be careful
|
|
|
Kickers for Ramipril?
|
Peak plasma [] w/in 1 hr
half life = 2-4 hrs |
|
|
Kickers for Lisinopril?
|
Slow absorption
half life = 12 hrs Once a day |
|
|
Kickers for captopril?
|
sulfhydryl containing moiety can--> some taste changes
|
|
|
SE's of ACE-I's?
|
Severe Hypotension in hypovolemic pts
Hyperkalemia Angioedema (0.5%) Cough (10-20%) Skin Rash (10%) Taste Alterations (6%) |
|
|
Presentation of Angioedema w/ ACE'I's?
|
rapid swelling of nose, throat, mouth, larynx, lips, or tongue
|
|
|
possible cause of angioedema w/ ACE-I's?
|
bradykinin
|
|
|
greatest risk of angioedema w/ ACEI's?
|
in blacks
|
|
|
Contraindications of ACE-I's?
|
Hyperkalemia can be exascerbated w/ K-sparing diuretic
Some say ACEI's not effective in blacks ACEI suppress cell prolif, so bad for pregnancy |
|
|
What are ARB's?
|
Angiotensin I Receptor Blockers
|
|
|
Example of an ARB?
|
Losartan
|
|
|
Actions of Losartan?
|
Dec TPR
Inhibit Aldosterone release Block Na Reabsorption |
|
|
Typical role of Angiotensin I Receptor?
|
vasoconstriction
cell growth and prolif aldo release Central SNS activation Na and H2O retention |
|
|
SE's of Losartan?
|
Angioedema (subcu of eyes and lips)
Not during pregnancy Dizziness |
|
|
When do you use ACE-I and ARB?
|
Pts w/ HF, Renal Disease, and Diabetes
|
|
|
price difference between ACEI and ARB?
|
ACEI = $0.11/cap
ARB = $0.48-0.90/cap |
|
|
When do you use an ARB instead of an ACEI?
|
when the patient can't tolerate the ACEI (b/c of angioedema)
|
|
|
Examples of Peripheral Alpha-1 Adrenergic Receptor Blockers
|
Prazosin
Doxazosin Terazosin |
|
|
MOA for Prazosin?
|
Blocks Alpha-1's on Resistance Vessels
Dec Vascular Tone (vasodilates!) Dec PVR and BP |
|
|
SE's of Prazosin?
|
Postural Dizziness (14%)
HA (8%) Drowsiness (8%) First Dose Phenomenon |
|
|
What happens with Prazosin's first dose phenomenon?
|
Syncopal rxn and/or orthostatic hypotension
|
|
|
Kickers for Doxazosin and Terazosin?
|
Longer half lifes
Rx for BPH |
|
|
Another name for Adrenergic Neuron-Blocking Agents?
|
Sympatholytics
|
|
|
MOA of Sympatholytics?
|
Deplete Nor from presynaptic, postganglionic sympathetic nerve terminals
Inhibit Release of Nor in response to SNS activity Reduce CO and TPR |
|
|
Examples of Adrenergic Neuron-Blocking Agents?
|
Gaunethidine
Reserpine |
|
|
MOA of Guanethidine?
|
Enters peripheral nerve terminals via NE's transporter
Depletes stores of NE Its a FALSE Transmitter |
|
|
MOA for Reserpine
|
Blocks transport of dopamine into storage granules in nerve terminals
Depletes catecholamines and serotonin in CNS and PNS Dec Sympathetic Tone, TPR and CO |
|
|
SE's of Guanethidine and Reserpine?
|
Orthostatic Hypotension (guanethidine)
Depression Nasal Congestion Bradycardia Impotence (G) Diarrhea (G) Salt and Water Retention |
|
|
Drug Interactions of Guanethidine and Reserpine?
|
Drugs that alter amine pump can block uptake (TCA's, MAO inhibitors)
After Chronic use of Guanethidine, the above guys can cause HTN due to supersensitivity |
|
|
Indications for Guanethidine and Reserpine?
|
RARELY INDICATED!
b/c of SE's Can be last resort for refractory (unmanageable) HTN |
|
|
MOA of Central Alpha-2 Agonists
|
DECREASE:
HR CO TPR Renin activity Baroreceptor fxn Can cause vasoconstriction in VSMC if given IV (so don't) |
|
|
Examples of Central Alpha-2 Agonists?
|
Clonidine
Alpha-Methyldopa |
|
|
Pharmacokinetics of Clonidine?
|
Long Half Life (12-16hrs)
Transdermal Patch (1 per week) |
|
|
SE's of Clonidine?
|
Dry Mouth (44%)
Drowsy (50%) Dizzy (15%) Can cause sodium retention, but at low doses doesn't require a diuretic |
|
|
Drug Interactions of clonidine?
|
TCA's can reverese antihypertensive effects
|
|
|
SE's of Methyldopa?
|
Sedation
Dry Mouth Na Retention Dizzy Prolonged Use-->hemolytic anemia (rare) |
|
|
Other Drug Interactions of Clonidine and methyldopa?
|
Barbituates may reduce efficacy via inducing hepatic metabolism
MAO Inhibitors may lead to HTN and CNS Stimulation |
|
|
Indications for Methyldopa?
|
PREGNANCY!!! first choice
|
|
|
Indications for Clonidine?
|
useful in Dx of pheochromocytoma in HTN pts
|
|
|
Two Vasodilators?
|
Hydralazine
Minoxidil |
|
|
MOA for Hydralazine?
|
Direct Vasodilation on arterioles by altering SMC Ca by hyperpolarizing cell
Dec TPR REFLEX: inc HR inc Contractility inc renin activity |
|
|
half life of Hydralazine?
|
1 hr, but antiHTN for 12 hours due to storage in arterial walls
|
|
|
SE's of Hydralazine
|
Reflex Tachycardia (can --> MI, block w/ propanolol)
Na and H2O retention (use diuretic) HA, Nausea, Dizziness LUPUS SYNDROME!!!! |
|
|
MOA for Minoxidil?
|
Activates ATP-sensitive K channels to cause hyperpolarization and SMC relaxation
=Arteriolar Vasodilation =Dec TPR |
|
|
Half Life of Minoxidil?
|
4 hrs, but hypotensive effect for 12-24 hrs
|
|
|
How to activate minoxidil?
|
must be metabolized by liver to form minoxidil N-O sulfate
|
|
|
SE's of Minoxidil?
|
Hypertrichosis
other stuff like hydralazine |
|
|
Indications for Minoxidil?
|
Severe HTN
Must be given w/ diuretic and a sympatholytic agent (like a beta blocker) |
|
|
Examples of Vasodilators used in Hypertensive Crises?
|
Sodium Nitroprusside
Diazoxide Labetalol Carvedilol |
|
|
MOA for SNP?
|
Liberates Nitric Oxide--> dilation of VSMC= dec TPR
|
|
|
Administration of SNP?
|
IV infusion, effect stops when IV stops
|
|
|
SE's of SNP?
|
Rebound HTN
Tolerance Toxic accumulation of cyanide (from metabolism) leading to lactic acidosis |
|
|
MOA of Diazoxide?
|
Dilates Arterial Smooth Muscle via K channels
Little or no effect on venous smooth muscle Dec TPR |
|
|
SE's of Diazoxide?
|
Tachycardia
Angina |
|
|
MOA of Labetalol and Carvedilol?
|
Mixture of Alpha-1 and non-selective Beta Receptor Antagonism in both heart and vessels.
Dec TPR w/o reflex tachycardia |
|
|
Selectivity of Labetalol vs Carvedilol?
|
Labetalol = 1:3 ; alpha-1:beta
Carvedilol = 1:10 ; alpha1:beta |
|
|
administration of Labetalol and carvedilol?
|
Oral or IV
IV for HTN crisis |
|
|
Half Life of Labetalol and Carvedilol?
|
2 hrs PO
5 hrs IV |
|
|
Indication for Labetalol?
|
HTN in a pt w/ pheochromocytoma
|
