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22 Cards in this Set

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1st dose effect - what it is & what causes it
postural hypotension & syncope; alpha antagonists
labetolol effects
the β2 stimulation (vasodilation) enhances the α1 block; the β1 block (↓HR & BP) prevents reflex stimulation of HR caused by vasodilation; the α1 block prevents ↑ in peripheral resistance in response to ↓ BP
beta blocker side effects
bradycardia; fatigue (related to ↓ in muscle K+ (β stim. usually drives K+ into tissues); ↑ plasma lipids
causes bradykinin cough
ACE inhibitors
hydralazine MOA
vasodilator -
↓ IP3-mediated release of Ca from the SR
opens ATP-dependent K+ channels --> hyperpolarization
Blood-borne vasoactive substances
ACh, vasopressin, bradykinin, serotonin, ADP & ATP
3 stimuli for renin secretion
1. increased renal symp. nerve impulses 2. decreased pressure in renal afferent arterioles 3. decreased sodium ions to macula densa of kidney nephrons
Loop diuretics MOA
block the Cl site of the Na-K-2Cl symporter in the ascending loop
Thiazide diuretics MOA
block the Cl site of the Na-Cl symporter (NCC1) in the distal convoluted tubule
1st step in HTN tx algorithim
Lifestyle modifications
Tx algorithim: initial drug choices without compelling indications (e.g. comorbidities)
Stage 1: thiazides for most (can consider ACEI, ARB, BB, CCB or combo)
Stage 2: 2 drug combo, usually thiazide + ACEI/ARB, or BB or CCB
recommended Rxs to tx HTN in pts w/ chronic kidney dz
ACEI and ARB
recommended Rxs to tx HTN in pts w/ HF
all but CCB
recommended Rxs to tx HTN in pts w/ DM
all but aldosterone antagonist
sequence of Rxs for pts w/ BP >130/80 in DM or kidney dz w/ any level of albuminuria
1. ACEI or ARB, then if not at goal 2. add thiazide or CCB/BB, then 3. add CCB (add other subgroup if already using CCB), then 4. add vasodilator
hypertensive urgency vs. emergency
urgency: very high BP w/o end organ damage, must be lowered within hours
emergency: very high BP with end organ damage, must be lowered in minutes
first treatment priority in hypertensive emergency
lower blood pressure (e.g. organic nitrates)
beta-blocker with intrinsic sympathetic activity
Pindolol - useful for HTN pts w/ bradycardia
nitroprusside complication from chronic infusion or in pts with decreased renal function
toxicity from accumulation of cyanide or thiocyanate
normal metabolism: NO--> cyanide --> thiocyanate
minoxidil effects on arteries & veins
dilates arteriolar vessels without significant effect on venous vessels
causes strong baroreflex increase in CO --> renin release & fluid retention
minoxidil MOA
activates K+ channels --> K efflux --> hyperpolarization & relaxation of vasc. smooth muscle
indications to look for secondary causes for HTN
age <30 or >55, refractory (uncontrolled on 3 or more meds), caucasian males, abrupt onset or escalation, lab values/exam consistent w/ secondary cause