Ch 46 Drugs For Hypertension

Front 1

There are two broad categories for hypertension primary and secondary. What is the difference between the two?

How are both treated?

Back 1

Primary hypertension (essential hypertension), defined as hypertension with no identifiable cause, is the most common form of hypertension. Primary hypertension can lead to significant morbidity.

Secondary hypertension is defined as an elevation of BP brought on by an identifiable primary cause. Secondary hypertension, which usually occurs as a consequence of another disease process, also can lead to significant morbidity.

Both are treated with antihypertensives and diuretics

Front 2

Untreated hypertension can lead to ___ ____, ____ ____, or __________.

Back 2

heart disease
kidney disease
stroke

Front 3

• Evaluation of patients with hypertension has two major objectives. Specifically, we must assess for

Back 3

1) identifiable causes of hypertension, and (2) factors that increase cardiovascular risk. To aid evaluation, diagnostic tests are required.

Front 4

The ultimate goal in treating hypertension is to reduce _______and ____ morbidity and mortality.

Back 4

cardiovascular
renal

Front 5

The goal for hypertensive patients in therapy (used to decrease mortalitity and morbidity)

what BP's want to maintained both for a normal person and for a diabetic?

Back 5

maintaining BP below 140/90 mm Hg or below 130/80 mm Hg for those with diabetes or chronic kidney disease.

Front 6

With aging, ______blood pressure tends to rise. The primary cause of this is a ______ in compliance and an ______ in stiffness of the large arteries.

Back 6

systolic
decrease
increase

Front 7

Physiological factors that affect BP control include:

Back 7

Cardiac output
peripheral vascular resistance
baroreceptor reflex, kidneys, and RAAS system

Front 8

How does Cardiac output affect BP?

Back 8

An increase in HR, contractlility, blood volume, or venous return to heart will increase BP.

Front 9

In reference to peripheral resistance
arteriole constriction is going to increase BP so what is given to decrease?

Back 9

vasodilator

Front 10

baroreceptor reflex kidneys, and RAAS system can oppose our attempts to lower BP with drugs.

how these be corrected?

Back 10

We can counteract the baroreceptor reflex with a beta blocker

the kidneys with a diuretic

the RAAS with an angiotensin-converting enzyme (ACE) inhibitor, angiotensin II receptor blocker (ARB), direct renin inhibitor (DRI), or aldosterone antagonist.

Front 11

As an antihypertensive how can beta blockers be used to decrease BP?

What AE is possible with this beta blockade if ther is already an AV block?

Back 11

(eg, propranolol) appear to lower BP primarily by reducing peripheral vascular resistance; the mechanism is unknown. They may also lower BP by decreasing myocardial contractility and suppressing reflex tachycardia (through beta1 blockade in the heart) and by decreasing renin release (through beta1 blockade in the kidney). Because of beta1 receptor blockade, use of beta blockers can result in reduced atrioventricular conduction or could intensify already existing AV block.

Front 12

Clonidine (Catapres) is a centrally acting Alpha 2 agonist, can cause dry mouth, drowsiness (sedation), and constipation.

What are the more serious AE's it can cause?

Back 12

Clonidine can also cause severe rebound hypertension.


Because it causes vasodilation of the skin, it can also cause flushing.

Front 13

Thiazide diuretics (eg, hydrochlorothiazide) and loop diuretics (eg, furosemide) reduce BP in two ways: they reduce blood volume (by promoting diuresis), and they reduce arterial resistance (by an unknown mechanism). Both loops and thiazides are potassium ________ and can exacerbate hypokalemia. Thiazides can elevate blood glucose.

Back 13

wasting

Front 14

Loop diuretics should be reserved for two situations what are they?

Back 14

1) patients who need greater diuresis than can be achieved with thiazides and (2) patients with a low glomerular filtration rate (GFR) (because thiazides don’t work when GFR is low).

Front 15

ACE Inhibitors may cause hyperkalemia and are contraindicated with ______ _______ ________, which also cause hyperkalemia. ACE Inhibitors may be given with thiazide diuretics to help eliminate some of the potassium in the body. ACE Inhibitors may also be given with beta blockers and calcium channel blockers, because these are not contraindicated.

Back 15

potassium sparing diuretics

Front 16

_______ can affect blood pressure by blunting the effect of antihypertensive medications.

Back 16

NSAIDS

Front 17

________ diuretics are preferred drugs for initial therapy of uncomplicated hypertension in order to reduce blood volume and arterial resistance (as long as the patient does not have renal failure

Back 17

Thiazide

Front 18

Patients with comorbid conditions, such as renal _______and ______, require special considerations regarding drugs selection. See Tables 46-7 and 46-8.

Back 18

renal disease

diabetes

Front 19

Although all antihypertensive drugs are effective in older adults, only two kinds (______ ______ and _____) have been shown in controlled trials to reduce morbidity and mortality.

Back 19

beta blockers and diuretics

Front 20

Why are beta blockers cardio protective?

Back 20

they decrease heart rate and contractility

Front 21

Thiazide diuretics tend to be effective in______ ____ as antihypertensive agents.

Alpha 1, alpha/beta, and alpha 2 blockers should not be used in older adults

Back 21

older adults

Front 22

What is considered a hypertensive emergency in terms of diastolic BP and ongoing end-organ damage.

Back 22

120 mm Hg Diastolic

Front 23

What is the DOC for hypertensive emergencies?

Back 23

Nitroprusside (Nitropress)

Front 24

__________ is a drug of choice for treating chronic hypertension of pregnancy. . The drug of choice for lowering blood pressure in a woman with severe pre-eclampsia is _______.

Back 24

Methyldopa (Aldomet)

hydralazine