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51 Cards in this Set
- Front
- Back
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in people over 50, what is the most important cardiovascular, diagnostic risk factor
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systolic BP ove 140
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with what incremental inc in systolic and diastolic BP does your risk of cardiovascular disease double
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20/10 mmHg
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what BP is considered pre-hypertensive
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120-139/80-89
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what is the initial drug of choice for the treatment of early, uncomplicated HTN
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thiazide type diuretics
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what high risk categories would lead you to use an initial hypertensive medication other than thiazide meds
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DM
renal disease Ischemic heart disease heart failure cerebrovascular disease |
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when should you consider giving two drugs as an initial treatment of uncomplicated HTN
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if the BP is 20/10 mmHg above target goal
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what is the polypill
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statin
ACE inhib thiazide B-blocker aspirin folic acid |
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how do thiazides lower BP
initially? 6-8 weeks? long term? |
Ini- reducing Na+ stores (& H2O c it)
6-8 weeks- activate K+ channels = dec in peripheral resistance long term- dec Na+ in musculature & dec sensitivity to vasopressors |
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what are the common side effects af thiazides
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inc in lipids
reduced glucose tolerance |
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what pt population are thiazides more effective on
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african americans
elderly |
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what are the centrally acting sympatholytic drugs
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clonidine (catapres)
methyldopa (adomet) |
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what is the method of action for centrally acting sympatholytic drugs (clonidine & methyldopa)
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stimulate a-2 receptors
-presynaptic= inhibit NE and Ach release -postsynaptic= inhibition of the symp neuron I.E- vasodilation and dec in renin release |
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which is a prodrug, clonidine or methyldopa
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methyldopa
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what are the adverse effects of sympatholytic drugs like clonidine and methyldopa
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CNS effects- not good as a monotherapy for this reason
dry mouth sudden withdrawal = hypertensive crisis methyldopa might induce hemolytic anemia c pos Coombs tect |
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what agents inhibit the therapeutic effects of clonidine
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TCAs
yohimbine |
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what are the 2 ganglion blocking agents
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Reserpine
guanithidine (Ismelin) |
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method of action for reserpine
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inhibits uptake of NE,DA,5-HT,
dec symp tone= dec BP |
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method of action for guanithidine
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replaces NE in the vesicles, blocking its release
horrible side effects, so it isnt used in US |
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a-1 antagonists
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prazosin
terazosin doxazosin tamulosin |
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mech and use of prazosin and other a-1 blockers
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dilation of arteries and veins without causing reflex tachy
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what drugs are used in cases of pheochromocytoma
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phentolamine
phenoxybenzamine a-1 & 2 blockers |
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side effects associated with prazosin and other a-1 blockers
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postural hypotension- "first dose phenom'
does not effect lipids though |
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what group are B-blockers a reccomended monotherapy for
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young white males
exact opposite of diuretics |
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mech for B-blockers
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reduce CO
reduce renin secretion reduce sympathetic motor tone (CNS effect) |
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nebivolol is a B-1 selective antagonist that has this unique feature
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NO release that causes vasodilation
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adverse effects of propranolol (non-selective B-blocker
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negative inotropic, chronotropic, dromotropic effect
bronchoconstriction diarrhea, constipation, N/V insomnia, lassitude, nightmares, depression inc triglycerides, dec HDL delayed recovery from hypoglycemia |
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propranolol is contraindicated in:
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DM
severe CHF heart block asthma |
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B-blockers are the preferred drugs for
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angina
post MI migraines |
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B-blockers are least preferred in
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high physical activity
african descent asthma DM hypercholesterolemia peripherial vascular disease |
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what drugs cause SLE in slow acetylators
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Hydralazine
Isoniazid Procainamide HIP |
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drugs that act through NO release
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(nebivolol- not main fxn)
hydralazine sodium nitroprusside (nitropress) |
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hydralazine
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NO stimulation
arterioles, not veins oral severe HTN |
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sodium nitroprusside (nitropress)
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NO stimulation
fast onset, short halflife IV only cyanide accumulation |
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K+ channel regulators
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minoxidil (lonitin)
diazoxide |
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Minoxidil (loniten)
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K+ channel regulator
dilates arterioles oral hypertrichosis* |
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Mech of action for diazoxide
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activates ATP-sensitive K+ channels
vasodilation and hyperglycemia used in pts with an insulinoma (counteracts the hypoglycemia) |
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adverse rxns with diazoxide
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hyperglycemia
Na+ and H2O retention hyperuricemia excessive hair growth (hypertrichosis) |
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fendolpam
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D1 agonist
arteriolar dilation IV c 5min half life |
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Ca+ channel blockers (arteriole vasodilators)
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dyhydropyridines (nifedipine)- strong vasodiator
verapamil- strong cardiac effects diltiazem- inbetween the first two nimodipine- most lipid soluable |
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common side effects of dihydropyridines (nifedipine)
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vascular side effects
reflex tachy gingival hyperplasia |
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what is the most common side effect of verapamil
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constipation
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why are verapamil and diltiazem associated withbradycardia
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because of their effect on SA and AV nodes
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what are the fxns of ACE
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convert angiotensin I into II
inactivate bradykinin |
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what are the fxns of angiotensin II
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direct vasoconstriction
simulate the adrenal cortex to release aldosterone |
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theraputic characteristics of ACE inhibitors
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lower blood pressure without heart, brain, kidney side effects or reflex tachy
oral enhance the effectiveness of diuretics and vise versa |
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adverse effects and contraindications for ACE inhibitors
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cough
angioedema renal failure in pts c bilateral renal a. stenosis contraindicated in the second and third trimester of pregnancy |
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what are the differences in angiotensin II receptor blocker side effects
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mostly the same, but:
no cough or angioedema and induces fetal toxicity |
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what are the ACE inhibitors
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Captopril (capoten)
Enalapril (vasotec) |
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what are the angiotensin II receptor blockers
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Losartan (Cozaar)
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what is the Renin inhibitor
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Aliskirin (tekturna)
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Aliskirin gen info
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renin inhibitor
oral hepatobiliary clearance pregnancy risk category D drug |
