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125 Cards in this Set
- Front
- Back
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What is the short term regulator of BP? Long term?
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1. baroceptor reflex
2. RAAS |
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What is the formula for BP?
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CO x PVR
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How does a drop in BP affect the RAAS?
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1. low BP in afferent arteriole->renin release->angiotensin II release->AT1 receptors on arterioles and venules->vasoconstriction->increased PVR->increased BP
2. low BP in afferent arteriole->renin release->angiotensin II release->increased aldosterone->increased Na+ and H2O retention->increased BP 3. low BP in afferent arteriole->renin release->angiotensin II release->SNS activation->increased BP 4. low BP in afferent arteriole->renin release->angiotensin II release->thirst and vasopressin release->increased BP |
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Explain the acute and chronic effects that diuretics have on HTN.
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1. acute-increased Na+ and H2O excretion->decreased blood volume->decreased CO->decreased BP
chronic- CO returns to normal and PVR decreases (by lowered Na+) |
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What are the 5 first line antihypertensive drugs classes?
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ABCD:
1. ARB's 2. ACEI's 3. BB's 4. CCB's 5. diuretics |
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Which diuretics are the first line drugs for treating HTN? Are these given in high or low doses?
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thiazide diuretics in low doses
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Will thiazide diuretics work in patients with decreased renal function? Which diuretics are indicated here?
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no, loop diuretics are indicated here
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In addition to treating HTN in patients with reduced renal function, how else can loop diuretics be used?
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used in patients with severe HTN who are taking other drugs which can increase Na+ retention
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What drugs can be used to counteract the K+ loss from loop or thiazide diuretics when treating HTN?
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K+ sparing Na+ channel blockers
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What are some disadvantages to using loop diuretics instead of thiazide diuretics in HTN?
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short half-life and they don't work as well
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In what ways does aldosterone affect CVD?
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1. kidney->reabsorbs Na+->HTN
2. brain->HTN 3. blood vessels->endothelial dysfunction->decreased NO release, inflammation, vascular fibrosis->HTN 4. heart->myocardial fibrosis and fibroblast proliferation->cardiac remodeling |
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Spironolactone vs. eplerenone: which can be used by itself or as a combo drug?
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eplerenone can be used as monotherapy or in combination with other HTN drugs
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T or F: must have a compelling indication to use eplerenone instead of thiazide diuretics.
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true
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T or F: high doses of thiazide diuretics will lower BP further.
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false
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How do beta-blockers help to treat HTN?
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1. cardiac: block beta-1 receptors on heart->reduces HR and contractility->decreases CO->lowers BP
2. renal: block beta-1 receptors on kidneys->decreased renin->decreased angiotensin II->decreased vasoconstriction and decreased aldosterone->decreases H2O and Na+ retention->lowers BP 3. CNS: blocks beta-1 receptors->decreases SNS response->lowers BP |
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Which are more effective in treating HTN: selective or non-selective beta-blockers?
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both are equally effective
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T or F: beta-blockers are first line drugs for treatment of HTN with compelling indications.
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true
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What feature of beta-blockers makes them a less than ideal choice for HTN?
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intrinsic sympathomimetic activity (partial agonist effect)
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What is one compelling indication to use a beta-blocker in cases of HTN?
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post-MI therapy
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What are 6 non-selective beta blockers?
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1. propranolol
2. nadolol 3. timolol 4. pindolol 5. carteolol 6. levobunolol |
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What are 7 beta-1 blockers?
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1. metoprolol
2. atenolol 3. acebutolol 4. betaxolol 5. levobetaxolol 6. bisoprolol 7. esmolol |
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Is esmolol used for chronic treatment of HTN? Why or why not?
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no, because of its short half-life
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What are 6 clinical uses of beta-blockers?
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1. CVD
2. pheochromocytoma 3. open angle glaucoma 4. migraine 5. essential tremor 6. esophageal variceal bleeding |
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What are some adverse effects of beta-blockers?
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1. cardiac-bradycardia, AV block, decreased contractility
2. CNS-nightmares, depression, insomnia (especially with propranolol and metoprolol) 3. NVD 4. sexual dysfunction 5. lipidemia 6. glucose intolerance 7. bronchospasm 8. rebound HTN 9. unopposed vasoconstriction in PVD patients |
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What are the 2 types of Ca++ channel blockers?
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dihydropyridine and non-dihydropyridine
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What are the 2 types of non-DHP Ca++ channel blockers?
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verapamil and diltiazem
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What are the 9 DHP Ca++ channel blockers?
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1. nifedipine
2. adalat 3. amlodipine 4. isradipine 5. felodipine 6. nisoldipine 7. nimodipine 8. nicardipine 9. clevidipine |
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What is the MOA of DHP and non-DHP Ca++ channel blockers?
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1. both block L-type Ca++ channels
2. non-DHP's block smooth muscle and cardiac Ca++ channels 3. DHP's block mainly Ca++ channels on smooth muscle |
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When used for vasodilation, in what order from best to worst do you put DHP's and non-DHP's?
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DHP's>verapamil>diltiazem
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When used for cardiac, in what order from best to worst do you put DHP's and non-DHP's?
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verapamil>diltiazem>DHP's
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Which Ca++ channel blockers will not cause reflex tachycardia? Why?
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1. non-DHP's
2. because these work on cardiac and smooth muscle cells to decrease CO and PVR simultaneously |
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T or F: short acting Ca++ channel blockers are better at treating HTN than long acting Ca++ channel blockers.
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false-using short acting drugs like nifedipine will drop BP too quickly and can cause MI or death
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What can nimodipine be used to treat?
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subarachnoid hemorrhage because this dilates blood vessels in the brain
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Which Ca++ channel blockers will display the most adverse cardiac effects?
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non-DHP's
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What are the adverse effects of Ca++ channel blockers?
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1. sinus bradycardia
2. AV block 3. exacerbation of heart failure or pulmonary edema 4. constipation (verapamil) 5. reflex tachycardia in DHP's 6. vasodilatory sx (flushing, h/a, dizziness, peripheral edema) |
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Which Ca++ channel blocker cause the most peripheral edema?
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nifedipine
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How do Ca++ channel blockers cause peripheral edema?
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they dilate arterioles, but leave veins constricted; fluid from arterioles is too great for constricted veins to take, therefore the fluid moves to the interstitium
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How do you treat peripheral edema caused by nifedipine?
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ACE inhibitors, as these will dilate the veins
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Which drugs can you give to treat HTN and migraines?
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1. propranolol
2. timolol 3. metoprolol 4. nadolol 5. atenolol |
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Which alpha-1-blockers can you give to treat HTN and BPH?
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1. prazosin
2. terazosin 3. doxazosin |
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Which drugs can you give to treat HTN and essential tremor?
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beta-blockers
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Which drugs can you give to treat HTN and pheochromocytoma?
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phentolamine and phenoxybenzamine
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Why aren't alpha-blockers first line drugs for HTN?
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they are too powerful and they cause a higher incidence of heart failure
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In addition to its vascular properties, what additional things will angiotensin to cause?
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1. hypertrophy and hyperplasia of vascular smooth muscle cells, cardiac myocytes, mesangial cells, and cardiac fibroblasts
2. myocyte apoptosis 3. inflammatory mediator 4. helps regulate GFR |
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What are 10 ACE inhibitors?
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1. captopril
2. enalapril 3. lisinopril 4. ramipril 5. quinapril 6. fosinopril 7. benazepril 8. moexipril 9. perindopril 10. trandolapril |
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T or F: ACE inhibitors are first line drugs for HTN with compelling indications.
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true
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What are some clinical uses of ACE inhibitors?
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1. diabetic and non-diabetic nephropathy
2. HTN 3. decreases hypertrophy of mesangial cells 4. acute and post-MI (give within first 24 hours of an acute MI and give indefinitely) |
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How are ACE inhibitors renoprotective?
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decrease BP->vasodilation of the efferent arteriole>decreases intraglomerular hydrostatic pressure->decreases damage and proteinurea
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What is the pathway from angiotensinogen to the AT1 receptor?
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angiotensinogen->renin->angiotensin I->ACE->angiotensinogen II->AT1
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What is the pathway for kininogen?
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kininogen->bradykinin->ACE->inactive bradykinin
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What is bradykinin?
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vasodilator
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What are the two ways that ACE inhibitors lower BP?
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1. inhibits angiotensin II
2. prevents breakdown of bradykinin |
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Do ACE inhibitors lower PVR or CO to reduce BP?
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PVR-they have little effect on CO, HR, or blood volume
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Is the PVR from ACE inhibitors based mainly upon the arteriole vasodilation or venule vasodilation or both?
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arteriolar vasodilation
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Describe ACE inhibitor's effects on the SNS.
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reduced SNS stimulation, but the resultant lowered BP will cause reflex activation of the SNS
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In addition to their effects on HTN, ACE inhibitors are also first line treatment for what 2 diseases?
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diabetes and renal insufficiency
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How can ACE inhibitors actually cause functional renal insufficiency in some patients?
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1. normally, lowered BP is autoregulated and GFR remains normal
2. in some patients, the ACE inhibitor will vasodilate the efferent arterioles, which will lower the intraglomerular hydrostatic pressure->lowered GFR |
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What are some predisposing conditions for functional renal insufficiency?
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1. microvascular renal disease
2. renal artery stenosis and a solitary kidney 3. bilateral renal artery stenosis 4. dehydration 5. heart failure 6. NSAID's |
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How do ACE inhibitors affect patients with renal artery stenosis?
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1. in renal artery stenosis, the afferent arteriole is constricted->renin->efferent arteriole constriction->normalizes GFR
2. ACE inhibitors will vasodilate the efferent arteriole->decreased intraglomerular pressure->decreases GFR |
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What are some adverse effects of ACE inhibitors?
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1. hypotension
2. hyperkalemia (due to reduced aldosterone) 3. hematologic effects (neutropenia, agranulocytosis, anemia) 4. renal insufficiency in predisposed patients 5. collagen vascular disease 6. angioedema and cough |
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Captopril has what specific adverse effects?
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1. loss of taste
2. metallic taste 3. skin rash |
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What causes the angioedema and cough with ACE inhibitors?
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increased levels of bradykinin or substance P
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What are the contraindications and absolute contraindications in ACE inhibitors?
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contraindications-prior hx of angioedema
absolute-renal artery stenosis and bilateral renal artery stenosis |
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Describe the effects of ACE inhibitors on pregnancy?
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teratogenic in at least the 2nd and 3rd trimester-fetal hypotension, skull hypoplasia, anuria, renal failure, oligohydramnios, and death
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What antihypertensive should be given for HTN during pregnancy?
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methyldopa
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Describe the compensatory system of alpha-blockers.
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alpha blocker->vasodilation->decreased PVR->decreased BP->renin release->increased H2O and Na+ reabsorption->increased CO->increased BP
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Describe the compensatory system of direct acting vasodilators.
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direct acting vasodilator->activation of smooth muscle K+ channels >hyperpolarization-> arterial relaxation/vasodilation->reflex tachycardia and renin release->increased CO->increased BP
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Why don't you want to use non-selective alpha blockers in treating HTN?
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too powerful
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Which alpha-1-blockers are used to treat HTN?
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1. prazosin
2. terazosin 3. doxazosin |
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What are tamsulosin and alfuzosin used to treat?
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BPH (tamsulosin is selective for alpha-1-receptors in prostate)
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What happens to the alpha-1-receptors of the CV system when alpha-1-blockers are used?
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1. arterioles->vasodilation->decreased PVR
2. veins->vasodilation->decreased venous return->decreased CO |
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Why are alpha-1-blockers not used chronically?
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HR, CO, and plasma renin will return to pre-treatment levels
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What class of drugs will treat pheochromocytoma?
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non-selective alpha-blockers
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What mechanism is most effective in treating HTN in alpha-blockers?
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decreasing PVR
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What is the MOA for alpha-blockers?
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1. NE binds to vascular smooth muscle->increases Ca++->causes contraction
2. alpha blockers block the NE receptors |
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What are the alpha-1-blockers and what do they treat?
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1. prazosin-HTN and reynaud's disease
2. terazosin-HTN and BPH (improves urine flow) 3. doxazosin-HTN and BPH (improves urine flow) 4. tamsulosin-used for BPH (specific alpha-1a receptor on prostate) 5. alfuzosin-used for BPH (improves urine flow) |
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What are some adverse effects of alpha-blockers?
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1. orthostatic hypotension and syncope on 1st dosing
2. reflex tachycardia 3. nasal congestion 4. vasodilatory side effects 5. H2O and Na+ retention 6. inhibition of ejaculation |
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Occurence of angioedema with use of ACE inhibitors primarily occurs in what population?
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blacks
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T or F: alpha blockers are first line drugs for treating HTN.
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false (not as effective as diuretics according to ALLHAT)
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What are the 7 angiotensin II receptor antagonists (ARB's)?
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1. losartan
2. valsartan 3. candesartan 4. irbesartan 5. telmisartan 6. eprosartan 7. olmesartan |
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What is the MOA for ARB's?
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they block the AT1 receptors->blocks smooth muscle contraction, SNS activation, and aldosterone release
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What are the adverse effects of ARB's?
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same as ACE inhibitors
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What is the renin inhibitor drug currently being used?
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aliskiren
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Do ARB's and aliskiren prevent breakdown of bradykinin?
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no
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When would you use either ARB's or aliskiren?
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used for HTN as an alternative to ACE inhibitors (e.g. when you want to avoid angioedema/cough)
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What are the 3 alpha/beta blockers?
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1. labetalol
2. carvedilol 3. bucindolol |
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What are carvedilol and bucindolol used to treat?
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heart failure
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What is the MOA for labetalol?
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1. blocks alpha-1 on vascular smooth muscle and beta-1 receptors on the heart
2. partial agonist for beta-2 receptors 3. decrease PVR is major effect on BP |
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What are the clinical uses of labetalol?
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1. second line treatment of chronic HTN
2. hypertensive emergency/urgency |
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What are the adverse effects of labetalol?
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1. hypotension
2. orthostatic hypotension 3. sexual dysfunction 4. N&V 5. bronchospasm 6. prolongs or enhances hypoglycemia |
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What are the 4 centrally acting alpha-2-agonists?
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1. methyldopa
2. clonidine 3. guanabenz 4. guanfacine |
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What is the MOA for the centrally-acting alpha-2-agonists?
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1. alpha-2 receptors are CNS inhibitory receptors
2. activating alpha-2 receptors will decrease SNS->decrease HR, CO, and PVR->decrease BP |
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Which centrally-acting alpha-2-agonist is a prodrug?
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methyldopa
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Which centrally-acting alpha-2 agonist can cause rebound HTN?
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clonidine (2-3 days off drug)
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Which is more effective on decreasing CO: methyldopa or clonidine?
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clonidine
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What are the clinical uses of centrally-acting alpha-2 agonists?
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1. second line drugs for HTN
2. hypertensive emergency/urgency 3. HTN in pregnancy |
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What form of clonidine is well-tolerated?
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transdermal patch
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What are the adverse effects of the centrally-acting alpha-2-agonists?
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1. sedation
2. dry mouth 3. depression 4. impotence 5. increased Na+ and H2O retention 6. contact dermatitis from transdermal patch |
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What can be given in conjunction with a centrally-acting alpha-2-agonist to decrease Na+ and H2O retention?
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thiazide diuretic (loops with severe edema)
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Are adverse effects more common with methyldopa or clonidine?
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clonidine
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Which of the centrally-acting alpha-2-agonists produces more blood and liver adverse effects, methyldopa or clonidine?
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methlydopa
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What are the adverse effects specific to methyldopa?
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1. positive coombs test
2. hemolyltic anemia (rare) 3. hepatotoxicity |
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Which 2 drugs can cause rebound HTN?
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clonidine and beta-blockers
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What is the major problem with the adrenergic neuron blocking agents that makes them virtually obsolete?
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causes suicidal depression
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What is the MOA of adrenergic neuron blocking agents?
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depletes cells of NE and serotonin->lowers CO and PVR
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What are the direct acting vasodilators?
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1. hydralazine
2. fenoldopam 3. sodium nitroprusside 4. minoxidil |
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What is the MOA of hydralazine?
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unknown
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What is the MOA of minoxidil?
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activates K+ channels on arteriole smooth muscle->hyperpolarization->vasodilation->decreased PVR->decreased BP
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What is the MOA of fenoldopam?
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1. activates dopamine D1 receptors on peripheral aa.->vasodilation->decreased PVR->decreased BP
2. D1 receptors on renal arteries->vasodilation->renoprotective against renal insufficiency |
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What are the major effects of hydralazine, minoxidil, and fenoldopam? What about nitroprusside?
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1. dilates arteries
2. dilates veins and arteries |
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What are hydralazine (PO) and minoxidil (PO) used to treat?
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chronic severe HTN therapy
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Minoxidil is problematic for what? What can be given to counteract these problems?
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1. reflex tachycardia and H2O/Na+ retention
2. beta blockers and diuretics |
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What are the adverse effects of minoxidil and hydralazine?
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1. excessive vasodilation and hypotension
2. palpitations 3. reflex tachycardia (minoxidil especially) 4. angina-due to increased HR, which causes increased oxygen demand 5. nausea 6. sweating 7. Na and H2O retention 8. vasodilatory side effects |
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Aside from HTN treatment, what else is minoxidil used to treat?
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hair loss
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What is fenoldopam used to treat?
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hypertensive emergencies
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What are the side effects from fenoldopam?
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vasodilatory side effects
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What is the MOA for nitroprusside?
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sodium nitroprusside converts to NO in body->increases cGMP->vasodilation->decreases PVR (main thing)
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What happens after nitroprusside causes vasodilation?
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1. decreased PVR->decreased venous return->decreased BP->increases HR and decreases CO
2. little change in the CO |
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What is nitroprusside used for?
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1. hypertensive emergencies
2. controlled BP during surgery |
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What are some adverse effects of nitroprusside?
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1. cyanide and thiocyanate toxicity
2. hypotension |
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How does cyanide toxicity occur in use of nitroprusside?
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nitroprusside contains cyanide->metabolized into thiocyanate in liver (unless liver has problems)->excreted by kidney (unless renal failure)
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Which direct acting vasodilator can cause lupus like reaction?
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hydralazine
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Which drugs have an increased risk of causing new onset diabetes?
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beta-blockers and thiazide diuretics
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What are some oral drugs for hypertensive urgency?
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1. captopril-short duration of action
2. clonidine 3. labetalol-don't use in asthma or heart failure |
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What are some parenteral drugs for hypertensive urgency/emergency?
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1. nicardipine-not used in acute heart failure
2. clevidipine 3. enalapril 4. phentolamine-HTN with pheochromocytoma 5. esmolol 6. propranolol 7. labetalol 8. hydralazine 9. fenoldopam 10. nitroprusside 11. nitroglycerin 12. morphine 13. magnesium sulfate |
