Cubeddu Hypertensive Drugs

Front 1

Why are Beta blockers less effective for lowering BP in elderly and African Americans?

Back 1

Elderly and African americans have less renin.

Front 2

What conditions can Beta Blockers be used for?

Back 2

hypertension, Cardiac protection, Abnormal rythem, Migraine Prevention, Tremor (must be non-selective), Hyperthyroidism, Glaucoma,

Front 3

Why is a Beta blocker given to patients who had a heart attack.

Back 3

Because using a beta blocker after a first attack lessens the chances of a 2nd attack by 30 to 40 percent Regardless of race, age, gender)

Front 4

How do Beta Blockers protect the heart?

Back 4

By lowering Heart Rate, Contractility, and Blood pressure thus lowering the work the heart does.

Front 5

True or False. Hypertension is usually fixed through the use of just one anti-hypertensive.

Back 5

False, The body tries to get blood perfusion in the brain back to what it was before the drug so often a 2nd drug will be need to prevent the body's response.

Front 6

True or False. A beta blocker will only protect the heart at resting heart rates.

Back 6

False, the beta blocker will decrease tachycardia caused by exercise.

Front 7

Which is less disruptive to the brain, Hyperglycemia, or hypoglycemia?

Back 7

Hyperglycemia can be handled by the brain for years, hypoglycemia can only last less than minutes before a coma.

Front 8

Hypoglycemia causes what?

Back 8

Adrenaline release which causes Tremor (B2 receptors), heart palpitations (B1 receptors), and vasoconstriction Pale look (alpha 1), and adrenaline releases glucose from liver.

Front 9

Adrenaline is ______ effective with Beta blockers.

Back 9

Less. Less glucose release in the liver, and less signs of Hypoglycemia. Beta selective is less interfering with Glucose release

Front 10

Beta blockers side effect of parathesin (tingly exteremities) caused by what?

Back 10

B1, B2 vesodilating restriction. Only the A1 vesoconstricting receptors are still working.

Front 11

Side effects of Beta Blockers.

Back 11

Low Blood Pressure increased Sensitivity to hypoglycemia Worsening of asthma, cold hands, sleep problems, Dec exercise performance, increased lipids.

Front 12

A Hypertensive patient of 65 years, African American, history of heart attack 1 year ago. Exercizes. Currently on Metoprolol, Valsartan, Lipitor.
Patient complains of Nightmares, insomnia, fatigue, and heart rate is 45. What can the Dr. do?

Back 12

Metoprolol is lipid soluble, so change to Atenolol so Beta Blocker won't cross BBB.

Front 13

Which Beta blockers are Lipid soluble?

Back 13

Metoprolol, Propranolol, Timolol, Pondolol, Carvedilol, Labetalol.

Front 14

Which Beta blockers will not offer cardiac protection?

Back 14

Acebutolol, Pindolol, Celiprolol. Don't use ISA beta blockers.

Front 15

What are the selective Beta blockers?

Back 15

Metaprolol, Acebutolol, Celiprolol

Front 16

Which Beta Blocker also has an alpha 1 blocker as well?

Back 16

Carvediol.

Front 17

True or false. It is important to slowly stop taking Beta blockers.

Back 17

True. Acute withdrawal of beta blockers can cause death.

Front 18

What are the 2 major systems to increase blood pressure?

Back 18

Sympathetic nervous system (Alpha 1 block, beta block, Decrease SNS activity block release of NE), and
Renin Angiotensin system.

Front 19

How does Clonadine work?

Back 19

Inhibits SNS discharge, and inhibits NE release by attaching to Alpha 2 receptors (auto receptors). Decreases Co and TPR

Front 20

A patient 45 years old male, Caucasian overweight, BP 160/90 HR 70, Patient takes clonadine BID. also takes a diuretic. New BP 140/80 HR 68 Why didn't HR increase?

Back 20

Because Clonadine lowers SNS action preventing Compensatory mechanisms.

Front 21

If BP is increased, what will be CNS response?

Back 21

Inhibition of SNS to compensate and lower BP.

Front 22

What are side effects of Clonadine?

Back 22

Low BP, dizziness, fatigue, drowsy, orthostatic dizziness, sleepiness is the major Side effect. Dry mouth, and constipation.

Front 23

Orthostatic dizziness is a side effect of what?

Back 23

Alpha blockers and Clonadine.

NOT Beta blockers.

Front 24

Contra-indrications for clonadine?

Back 24

Anticholinergics, Verapamil, opiods, (all cause constipation), and antihistamines, alcohol, (increased drowsiness)

Front 25

Clonadine is a _____ line drug.

Back 25

Third or fourth.

Front 26

Alpha 2 agonists and Clonadine have what withdrawal symptoms?

Back 26

Rebound Hypertension.

Front 27

Alpha Methyl Dopa is a Pro drug, what is it converted to in the body?

Back 27

Alpha methyl N.E. - an alpha 2 agonsit.

Front 28

What are the side effects with Alpha methyl dopa?

Back 28

Hemolytic anemia, Jaundice, and Decreased WBCs.

Front 29

Fenoldopam has what mechanism of Action?

Back 29

Dopamine D1 Receptor agonist. Arteriolar dilator (mainly renal and mesenteric arteries)

Front 30

What does Fenoldopam do?

Back 30

decreases BP, increases renal blood flow/Urine flow.

Front 31

Which is a contra-indication of fenoldopam?

Back 31

Glaucoma.

Front 32

What is the major problem with both fenoldopam?

Back 32

hyperpotencia. has to be very closely monitored.

Front 33

Dopamine has what action at
Low
Intermediate and
High doses.

Back 33

Low - DA-D1, Dilates renal Blood flow, and urination.
Intermediate - Above and Beta 1
High Dose - alpha1 stimulation

Front 34

What are the actions of Alpha 1 receptors?

Back 34

Vesoconstriction, ...

Front 35

What receptor causes vesoconstriction through Renin?

Back 35

Beta 1

Front 36

What do Beta 2 Receptors do?

Back 36

Mobilized Glucose, bronchiodilate, smooth muscle relaxation, inhibit Histamine release, increase Gluconeogenesis, and Glycogenolysis.

Front 37

What is the drug of choice for alergic reactions.

Back 37

Epinephrine through Injection.

Front 38

Which last longer amphenamines or catacholamines?

Back 38

Amphetamines.

Front 39

What 2 variables is blood pressure determined by? Which is more important in Hypertension?

Back 39

Cardiac Output and Total Peripheral Resistance, TPR is the most important in lowering BP.

Front 40

What is the major effect of the SNS on BP?

Back 40

The SNS releases Norepinephrine to activate alpha 1 receptors causing vasoconstriction and increased TPR.

Front 41

How does the RAAS effect BP?

Back 41

Renin causes activation of Angeotenson II to act on AT1 receptors causing arteriol and venous constriction, Inc TPR, Inc BP.

Front 42

What are the 3 actions of Nitric Oxide?

Back 42

Vasodilator, Antiplatelet drug, Inhibits growth and proliferation of smooth muscle cells.

Front 43

How does Nitric Oxide inhibit constriction of smooth muscle?

Back 43

it increases cGMP and decreases Ca++ and causes muscle relaxation.

Front 44

What receptors does endothelium act on?

Back 44

ETa Receptors to increase TPR.

Front 45

True or false. TPR is primarily determined by arteriole tone not venule tone.

Back 45

True.

Front 46

What do Drugs like Sildenafil do to increase muscle relaxation?

Back 46

They prevent disruption of cGMP by phosphodiesterace 5. Increasing the effect of N.O.

Front 47

What are some expected side effects of Sexual disfunctional drugs?

Back 47

Headache and hypotension.

Front 48

Where does the majority of N. O. come from?

Back 48

Endothelium.

Front 49

What are endothelium dependant vasodilators?

Back 49

Ach: acting on M2 receptors inc. N.O.
Substance P
Bradykinan: acts on BK receptors increasing N.O.
Seratonin: Works like Bradykinan

Front 50

What is the main stimulus for N.O. production?

Back 50

Pulsatile blood flow. N.O. is made in response to increase in pressure after every heart beat.

Front 51

What are the Endothelium Independant vasodilators?

Back 51

Epinephrine: acts on B2 receptors increasing cAMP
Atrial naturetic factors
Organic Nitrates
Prostacyclin PCI2.

Front 52

What is the IV drug for Hyptertension that can cause syanide poisoning?

Back 52

Sodium Nitropursside.

Front 53

What are the Vasoconstrictors?

Back 53

Angeotenson II
Norepinephrine
endothelium
Beta 1 receptor activation.

Front 54

What are the vasodilators?

Back 54

Sildenafil
N.O.
Epinephrine
Atrial Naturetic Factors.

Front 55

True or false. A II is more effective on efferent arteries decreasing GFR.

Back 55

False it is more effective on Efferent arteries, but increases GFR.

Front 56

True or false. A II increases Sodium retention directly.

Back 56

False Angiotensen II activates aldosterone to increase Sodium reabsorption.

Front 57

What is required for Angio genesis formation of new blood vessils and amniotic fluid?

Back 57

Angiotensin II

Front 58

What are the 2 variables in Cardiac Output?

Back 58

Heart Rate
Stroke volume.

Front 59

_______NS increases HR, and _______ Decreases Hr.

Back 59

Sympathetic
Parasympathetic

Front 60

Dilated Veins (Low Venous tone) increases/decreases stroke volume.

Back 60

Decreases.

Front 61

The SNS acts on ____ to increase Heart rate.

Back 61

Mainly B 1 receptors, but B 2 on some individuals.

Front 62

The PSNS acts on _____ to decrease heart rate.

Back 62

SA node.

Front 63

_______ venous tone = High preload.

Back 63

High Venous tone.

Front 64

_______ TPR = High afterload

Back 64

High TPR.

Front 65

What are the 4 groups for lowering blood pressure?

Back 65

Anti SNS
Anti RAAS
Diuretics
Anti Ca+

Front 66

________ is responsible for increasing our blood pressure when we stand so we don't faint.

Back 66

SNS activating A1 receptors,
B1 receptors increasing HR
Renin Release.

Front 67

What are the 4 ways of inhibiting the SNS?

Back 67

Block the nerve impulse from Brain
Activate A2 receptors
Block release of N.E.
Block Receptors Alpha or Beta on effector organ.

Front 68

Flomax (Tamsulosin) acts on what?

Back 68

Alpha 1 alpha (Prostate selective) receptors relaxing the prostate.

Front 69

What are the Alpha 1 blockers and their durations?

Back 69

Prazosin - short
Doxazosin - Intermediate
Terazosin - Long

Front 70

How do Alpha 1 blockers work?

Back 70

They block the Alpha 1 receptors preventing venoconstriction. lowers pre-load.

Front 71

Why aren't Alpha 1 inhibitors first chose in lowering BP?

Back 71

Because alpha 1 inhibitors will lower BP, but the body uses compensatory measures (tachycardia) to move it back up. Without other drugs alpha 1 blockers effects are minimal.

Front 72

What are the compensatory mechanisms for low BP?

Back 72

Increased
B1 receptors HR and contractions go up
B1 on kidneys increased reabsorption of salt and water.

Front 73

When starting an Alpha blocker the first dose should be given at bedtime and started slowly why?

Back 73

Because first dose syncope could happen if too high a dose is given. This is when a large dose causes massive compensatory actions.

Front 74

what is the Lowering BP equation?

Back 74

Lower BP = (effect of Drug) - (Reflex compensatory mechanisms)

Front 75

Blood pressure difference between supine and standing should be less than ___.

Back 75

10.

Front 76

True or False? Alpha 1 antagonists cause lower lying blood pressure.

Back 76

False they cause lower standing BP and can cause fainting.

Front 77

True or False? Non selective Alpha blockers such as Phentolamine and phenoxybenzamine are not used at all.

Back 77

False Phentolamine is sometimes used in the Operating Room.

Front 78

What are Diuretics?

Back 78

the most common and cheapest drug used for hypertension. Increases secretion of water and salt.

Front 79

What do we expect for levels of renin and epinephrine levels of Diuretic patients?

Back 79

High levels of each as compensatory mechanisms.

Front 80

Long term use of diuretics causes Vasopressure drugs (increase TPR) do what?

Back 80

respond less causing less vascular reactivity. overall drop in TPR.

Front 81

What is the cause of the decrease in Bp, Co, and TPR when using diuretics?

Back 81

Loss of salt. Causing blood vessels to be less reactive.

Front 82

Major mechanism for Diuretics is...

Back 82

Lowering salt levels.

Front 83

What classes of diuretics are used for BP?

Back 83

Thiazide - Thiazide like Looses K+
Loop Diuretics - looses K+
Potassium Sparing - saves K+

Front 84

What are the Thiazide Diuretics?

Back 84

These are the Most common for Hypertension.
HCTZ, Chlorthalidone.

Front 85

What are the loop diuretics?

Back 85

Mainly used for edema but still Lower BP.
furosemide, Bumetanide, Torsemide.

Front 86

Do Loop diuretics or Thiazide diuretics lower BP more?

Back 86

They work the same.

Front 87

What is the one condition to use Loop Diuretics instead of Thyazides?

Back 87

When the patients renal function is bad, CrCL less than 30 mL/Min, and use in HIGH DOSE.

Front 88

Loop diuretics get there name from what?

Back 88

From the loop of henley, where they act to increase secretion of Na+ and water.

Front 89

Where do each Diuretic work?

Back 89

Thiazide work on the upper acending loop of henley
Loop work in the lower acending loop of henley,
Potassium sparing works on the distal and collecting duct.

Front 90

Potassium sparing diuretics are?

Back 90

Block Sodium Transport
Amiloride
Triamterene

Aldosterone antagonists
spironolactone
Eplerenone

Front 91

*What are side effects of Thiazide and loop diuretics?

Back 91

Decrease BP(maybe Hypotension)
Hypokalemia (bad)
uric acid is accumulated (don't use if you have gout)
Increase a little Glucose and lipids in blood

Front 92

What are the 2 ways to minimize side effects of loop and Thiazides?

Back 92

very low doses or mix with a potassium sparing diuretic.

Front 93

What are the drugs of choice for Hypertension for African Americans?

Back 93

Diuretics and Calcium channel blockers.

Front 94

True or false. High levels of Potassium are ok, but not Low levels.

Back 94

False Both High levels and low levels can cause the heart to stop.

Front 95

True or false. A patient with healthy kidneys will never get hyperkalimia.

Back 95

True. Healthy kidneys will always keep levels levels of potassium at good levels.

Front 96

Are Potassium diuretics used alone or in combination for Hypertension?

Back 96

Spironolactone (women only) and Eplerenone are used alone, but
Triamterine and amoloride is always used in combination.

Front 97

Hemolytic anemia, Jaundice, and Decreased WBCs are side effects of what?

Back 97

Alpha Methyl dopa.

Front 98

Beta receptors on the Heart effect what?

Back 98

Cardiac output. heart rate and contractility.

Front 99

What types of beta blockers are there?

Back 99

Selective (B2 selective have no clinical use) and Non-selective.

Front 100

What are the water soluble Beta blockers?

Back 100

Atenolol (B1 Selective) and Nadolol (non-selective).

Front 101

What are the lipid soluble Beta blockers?

Back 101

Metoprolol (B1 Selective), Propranolol, Timolol, Pindolol, Carvediol (has Alpha 1 blocker too), Labetolol (Alpha 1 blocker).

Front 102

What are the Beta blockers with ISA?

Back 102

Acebutolol (B1), Celiprolol (B1), and Pindolol(N-S)

Front 103

What is special about Acebutolol, Celiprolol, and Pindolol?

Back 103

They contain ISA. They all are very good antagonists, but slight agonists. This prevents excessive Bradycardia by still allowing small action when attached to Beta receptors on the heart.

Front 104

What is the difference between Atenolol and Metoprolol?

Back 104

Metoprolol is Lipid soluble and crosses the BBB Atenolol is Water soluble and doesn't.

Front 105

On a patient with asthma, why would you use Metoprolol instead of propranolol?

Back 105

Because B1 selectivity is key. Blocking of the B2 receptors prevents asthma medication from dilating Bronchi.

Front 106

What are the main side effects of Beta blockers?

Back 106

Bradycardia, tiredness both due to decreased cardiac output.

Front 107

What are the centrally acting Drugs?

Back 107

Alpha 2 receptor agonists. Clonadine and Alpha methyl dopa.

Front 108

How do the Alpha 2 receptor agonists work?

Back 108

They act on the brain medulla and inhibit sns outflow, and inhibit C.V.

Front 109

Which is more potent Fenoldipam or Sodium nitropuroside?

Back 109

Fenoldipam had more increase in kidnye blood flow and more urine excretion.

Front 110

What is a contra indication for Fenoldipam?

Back 110

Galucoma.

Front 111

What are the 2 main uses for Beta blockers?

Back 111

Lowering Blood pressure
Cardiac protection.

Front 112

What do beta blockers do for heart attack patients?

Back 112

Lower cardiac output and help prevent a second attack.

Front 113

People who are Salt resistant stop taking in salt, what will be the effect on their blood pressure?

Back 113

There will be no change in their blood pressure.

Front 114

True or False. Obesity is linked to salt sensitivity.

Back 114

True.

Front 115

Endothelian is a veso_______.

Back 115

constrictor

Front 116

Angiotensin II acts on what receptors?

Back 116

Angiotensin I and angeotensin II receptors, but there are many more AT I receptors so more effect from them.

Front 117

Reserpine does what to block NE?

Back 117

It removes the NE from the

Front 118

Guanethidine does what?

Back 118

inhibits the release of N.E. too many side effects not used anymore.

Front 119

Patients with type 2 diabetes are resistant to insulin. What drugs should you use?

Back 119

Ace inhibitors and Angiotension II blockers, to protect the kidneys.

Front 120

What is the major problem with Beta blockers and diabetics?

Back 120

Many of the signs of Hypoglycemia are blocked by beta blockers. and Epi is releasing glucose less quickly.

Front 121

Clonidine has what mechanism of action?

Back 121

they activate Alpha 2 receptors and block NE release.
In the brain Alpha 2 receptors are activated also, but in the Vasomotor center it inhibits SNS outflow.

Front 122

What drugs work equally well in young, old, black, white patients for Hypertension?

Back 122

Alpha 1, Beta/Alpha combos (Carvatelol, Labetalol), Diuretics.