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38 Cards in this Set

  • Front
  • Back
Goals of treatment in regards to hypertension.
Reduce blood pressure to acceptable levels (140/90 or 120/80 in diabetics or those with renal disease.
Reduce incidence of end organ damage.
Avoid adverse drug effects.
Use least expensive agent possible.
Blood Pressure=
Heart Rate X Volume X Total Peripheral Resistance
Potent Vasoconstrictor
Angiotensin II
Released by kidneys
Causes sodium and water retention
Prevents the formation of Angiotensin II
ACE Inhibitors
Mechanism of Action for Diuretics
Reduce extracellular volume and total peripheral resistance
Special considerations for Diuretics
Very Inexpensive
Very Effective in the black population
Use with caution in patients with diabetes or those with elevated cholesterol or triglycerides.
Monitor electrolyte , glucose and lipoprotein concentrations.
CNS Mediated effects of Beta Blockers
Sleep disturbances
Peripherally Mediated Effects of Beta Blockers
Slow AV conduction
Muscle fatigue
Increased LDL and triglyerides
Decreased HDLs
Cold extremities
Special Considerations for Beta Blockers
Very Inexpensive
Work well in white population
Should be considered in patients with angina, migraines, or those with history of MI.
Avoid in patients with pulmonary disease, CHF, diabetes and/or peripheral vascular diseases.
Alpha 1 Antagonists: Mechanism of Action
Block postsynaptic alpha 1 receptors thus reducing total peripheral resistance.
Side effects of Alpha 1 Antagonists
Orthostatic hypotension
"First Dose Effect"
Special Considerations for Alpha 1 Antagonists
Work well in all age and racial groups.
Reduce total cholesterol and triglycerides while increasing HDL
Prazosin inexpensive
Thiazide-Type Diuretics
Chlorothiazide (Diuril)
Chlorthalidone (Hygroton)
Hydrochlorothiazide (Esidrix)
Indapamide (Lozol)
Metolazone (Zaroxolyn)
Examples of Loop Diuretcs
Bumetanide (Bumex)
Furosemide (Lasix)
Torsemide (Demadex)
Examples of Potassium Sparing Diuretics
Amiloride (Midamor)
Spironolactone (Aldactone)
Triamterene (Dyrenium)
Examples of Beta Blockers
Acebutolol (Sectral)
Atenolol (Tenormin)
Betaxolol (Kerlon)
Bisoprolol (Zebeta)
Metoprolol (Lopressor)
Metoprolol (Toprol XL)
Nadolol (Corgard)
Pindolol (Visken)
Propranolol (Inderal)
Propranolol (Inderal-LA)
Examples of Alpha 1 Antagonists
Doxazosin (Cardura)
Prazosin (Minipress)
Terazosin (Hytrin)
Mechanism of Action for ACE Inhibitors
Reduces total peripheral resistance by inhibiting the conversion of angiotensin I to angiotensin II
Reduces both preload and afterload in CHF
Side Effects of ACE Inhibitors
Renal Insfficiency
Neutropenia (rare)
Special Considerations for ACE Inhibitors
Good choice in treating patients with CHF. diabetic neuropathy, and following a MI.
Do not affect lipid levels.
Examples of ACE Inhibitors
Benazepril (Lotensin)
Captopril (Capoten)
Enalapril (Vasotec)
Fosinopril (Monopril)
Lisinopril (Zestril)
Moexipril (Univasc)
Perindopril (Aceon)
Quibapril (Accupril)
Ramipril (Altace)
Trandolapril (Mavik)
Mechanism of Action for Angiotensin Receptor Antagonists
Blocks Angiotensin II at the receptor level thus reducing total peripheral resistance and volume.
Side Effects of Angiotensin Receptor Antagonist
Same as ACE Inhibitors but with less incidence of cough and angiedema
Special considerations for Angiotensin Receptor Antagonists
Useful alternative in patients who cannot tolerate ACE Inhibitors because of cough.
Examples of Angiotensin Receptor Antagonists
Candesartan (Atecand)
Eprosartan (Tevetan)
Irbesartan (Avapro)
Losartan (Cozzar)
Olmesartan (Benicar)
Telmisartan (Micardis)
Valsartan (Diovan)
Direct Renin Inhibitor Example
Aliskiren (Tekturna)
Mechanism of Action for Direct Renin Inhibitor
Blocks the action of renin thus inhibiting activation of the renin-angiotensin-aldosterone cascade.
Side effects of direct renin inhibitors
Diarrhea (at higher doses)
Cough and angioedema (less common than with ACE-I).
Special considerations for direct renin inhibitors
Use second line if ACE-I not tolerated
Only indicated for HTN
Contraidicated in pregnancy
Mechanism of Action for Calcium Channel Blockers
Decrease total peripheral resistance by blocking calcium which is needed for smooth muscle contraction
Side effects of calcium channel blockers
Peripheral edema
Gingival hyperplasia
Tachycardia - Dihydropyridines only
Bradycardia- Verapamil, Diltiazem only
Constipation- Verapamil only
Special Considerations for calcium channel blockers
Work well in black population
Consider in patients with hyperlipidemias
Useful in patients with angina and supraventricular arrhythmias (Verapamil and Diltiazem)
Examples of Calcium Channel Blockers
Diltiazem (Cardizem)
Diltiazem (Cardizem CD)
Mibefradil (Posicor)
Verapamil (Calan)
Verapamil (Calan SR)
Examples of Calcium Channel Blockers
Amlodipine (Norvasc)
Felodipine (Plendil)
Nicardipine (Cardene SR)
Nifedipine (Procardia XL)
Nisoldipine (Sular)
Isradipine (DynaCirc)
Treatment for Stage I HTN
No compelling indications: Thiazide diuretics
Compelling Indications: BB, ACE-I, ARB's, or CCB.
If no response, add a second agent (second should be thiazide if not already taking)
Treatment for Stage II HTN
Begin therapy with 2 drugs : thiazide diuretic plus BB, ACE-I, ARB, or CCB.
Add aditional drugs if optimal blood pressure control not achieved.