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89 Cards in this Set
- Front
- Back
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calcium channel blockers
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inhibit calcium influx into cardiac and vascular SM
dilate arterioles to decrease TPR and decrease BP |
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nifedipine
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calcium channel blocker-DHP
arteriole vasodilation reflex tachycardia, flushing, peripheral edema |
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verapamil
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calcium channel blocker-non DHP
cardiac depression, bradycardia, constipation **caution in digitalized patients |
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diltiazem
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calcium channel blocker
action on cardiac and vascular beds |
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non DHP
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contraindicated with beta blockers
cardiac depression, bradycardia, av block contraindicated in CHF |
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DHP
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hypotension, reflex tachycardia, flushing, headache, edema, gingival hyperplasia
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vasodilators
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calcium channel blockers
open K channels (inoxidil, diazoside) direct vasodilator-hydralazine coupled to NO/cGMP-dilate veins dopamine agonist-fenoldopam for acute HTN alpha antagonist-prazosin, phenoxybenzamine |
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beta blockers (-olol)
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antihypertensive agents
decrease sympathetic tone decrease heart rate, decrease CO, decrease BP decrease renin that leads to decreased aldosterone, sodium and water retention, blood volume |
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adverse effects of beta blockers
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in diabetics, elderly
worsen raynands syndrome |
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alpha blockers
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ACUTE HTN crisis
used in combination therapies adverse effects: salt and fluid retention, postural hypotension, impotence |
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phenoxybenzamine
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irreversible, non competitive alpha 1 receptor blocker
reflex tachy, postural hypotension pheochromocytoma treatment |
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prazosin
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competitive alpha 1 blocker
NO reflex tachy benign prostate hypertrophy |
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phentolamine
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non selective alpha blocker
tachy reflex, not primary HTNq |
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hydralazine
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direct muscle relaxation
arterioles, not vein decrease in TPR causes reflex tachycardia which can produce angina |
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minoxidil
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open k cannels
dilate arterioles not veins reflex sympathetic stimulation so use in combo with beta blocker fluid retention hypertrichosis |
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sodium nitroprusside
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acute emergency HTN
CHF activate guanylyl cyclase dilates arteries and veins -reflex tachycardia reflex increase HR |
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diazoxide
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acute ypertensive crisis
open K channels as with other vasodilators- decrease TPR, increase HR, increase CO inhibits insulin release |
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fenoldopam
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acute hypertensive crisis to decrease TPR
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reflex compensatory systems
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mediated by baroreceptors, sympathetic NS, renin, angiotensin, aldosterone to counteract hypotensive effects of vasodilation
sympath: blocks increase in HR, contractility and renin level diuretics prevent fluid retension adn plasma volume expansion |
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alpha methyl dopa
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preferred agent for TN during pregnancy
alpha 2 agonist can cause dry mouth, drowsiness, lightheadedness, dizziness |
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clonidine
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sympatholytic agent, alpha 2 agonist
opiate and nicotine withdrawal treatment abrupt withdrawal effet (rebound HTN) |
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trimethahan
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ganglion blocking agents-earliest effective class to treat htn
rapid effect, short half life treatment of HTN, controlled hypotension, esp during surgery |
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mecamylamine
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orally active
side effects of trimethaphan and meca: sympathoplegia (excessive orthostatic hypotension), sexual dysnfunction parasympathoplegia: constippation, urinary retention, glaucoma, blurred vision, dry mouth |
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guanethidine
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adrenergic neuron blocker
inibits release of NE from nerve terminals causes postural hypotension, diarrea, impaired ejaculation |
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reserpine
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adrenergic neuron blocking agent
last resort antihypertensive inibit uptake of NE into storage vesicles (DA and 5HT) AE: sedation, depression, parkinsonism, gastric acid secretion |
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HTN-age
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beta blockers, ACEI/ARBs may decrease with age
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htn-race
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beta blockers and ACEI/ARBs less effective in blacks than whites
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renin
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patients with increased renin may respond better with beta blocker, ACEI/ARBs
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htn-smoker
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beta blockers are less effective
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htn-diabetes
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ACEI and ARBs improve renal function
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htn-chronic nsaids
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decrease response of diuretics, ACEI, betablockers
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htn-compliance
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treat pt not just bp
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htn-lifestyle
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important to not smoke, be overweight, exercise, alcohol intake
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hypertension and pregnancy
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ACEI/ARBs are contraindicated
recommended for use: alpha-methyl dopa, beta blockers, prazosin, nifedipine, labetalol, hydralazine |
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front line agents
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thiazides, ACEI/ARBs, Ca-blockers, beta-blockers
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stage I htn treatment
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ACE inhibitors, ARB, beta blocks, ccb,
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stage II htn
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thiazide type diuretic, ACE inhibitor, ARB or Bblocker and CCB
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htn + angina pectoris
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beta blockers
CCB |
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htn + diabetes
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diuretics, ACE inhibitors, ARBs
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htn + recurrent stroke
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ACE inhibitors
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htn + heart failure
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diuretics, beta blocker, ACEI, ARBs
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htn + MI
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beta blockers, ACEI
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htn+ renal disease
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ACEI, ARBs
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contraindicatons of beta blockers
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bronchospasm, bradyycardia, decomponsated HF and depression
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heart failure mechanism
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cardiac output inadequate for body demand of oxygen
compensated vs. decompensated increased sympathetic NS and renin angiotensin aldosterone system tissue remodeling leading to hypertrophy and decreased CO |
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hemodynamic changes in CHF
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increased sympathetic tone
decreased parasympatetic tone activation of RAAS increased blood volume increased vasopressin release |
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consequences of CHF
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decreased force of contraction
decreased CO, increased TPR, decreased SV increased venous pressure, decreased tissue perfusion cardiac hypertrophy na and water retention edema |
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digitalis glycosides (digoxin)
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lipophilic
inhibitors of Na/K ATPase --> increased contractile force due to increased calcium increased sensitivity of baroreceptor reflex narrow therapeutic window: tachycardia, delirium, fatigue, vision/light disturbances with halo effect-yellow and green) |
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effects of CG
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increased CO
decreased HR decreased heart size decreased oxygen demand increased renal blood flow decreased RAAS (increased Na excretion) |
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EKG changes in cardiac glycosides
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T wave inverted
ST segment depressed PR interval prolonged CHF - Frank Starling Reflex - CG - revered Frank glycoside |
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Digoxin
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incomplete GI absorption (85% excreted unchanged)
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digitoxin
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complete GI absorption
metabolism to other active glycosides (5-10% excreted unchanged) another ex: ouabin |
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CG+hypokalemia
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increased CG binding and effect
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cg+qunidine
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displaces CG from plasma binding to increase effect
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cg + ccb
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enhance effect and increase toxicity
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cg + amiodarone
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increase serum concentration of cardiac glycoside to decrease clearance
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cg + antibiotics
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increase CG bioavailability
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cg + alteration in renl fnc
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digoxin plasma concentration
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catecholamines-dobutamine
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use in ACUTE emergency CHF
increase cAMP to increase calcium influx and increase CO |
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inamrinone
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phosphodiesterase inhibitor
inhibit phosphodiesterase III leading to increase cAMP to increase contractile force (CO) mortality with chronic use bronchodilation-beneficial for asthma use |
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other CHF tx
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converting enzyme inhibitors (prils, sartans)
diuretics (loop diuretics, thiazides, K sparing vasodilator (bidil, hydralazine, nitrates) beta blockers |
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class I HF
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ACEI
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class II HTN
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digoxin, furosemide, beta blocker, ACEI
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class III
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thiazide, K-sparing, digoxin, furosemide, beta blocker, ACEI
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class IV
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beta-natruretic peptidethiazide, K-sparing, digoxin, furosemide, beta blocker, ACEI
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improved survival
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ACEI, beta blockers, K sparing
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increased mortality
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Phosphodiesterase III inhibitors
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neutral on survival
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digoxin, loop diuretics, thiazides
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quality of life
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digoxin, loop diuretics, thiazides, beta blockers
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reduction of edema
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loop diuretics, thiazides
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tissure remodeling
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ACEI, ARBs, K sparing
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prevention of ischemia
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Bblockers, anticoagulant therapy
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improve hemodynamics
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ACEI, ARBs, digoxin, diuretics, beta blockers, K sparing
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nicotine
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nicotinic agonist
convulsions |
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acetazolamide
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glaucoma, mountain sickness tx
proximal tube |
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metolazone, hydrochlorothiazide
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diuretic
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furosemide, bumetanide, torseide, ethacrynic acid
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loop diuretics
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spironolactone
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potassium sparng
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mannitol
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diuretic-acute renal failure-proximal tube
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captopril, lisinopril, enalapril, losartan, aliskiren
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ACEI
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propanolo, pindolol, timolol, metoprolol, atenolol, sotalol, labetalol, carvedilol
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beta blockers
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verapamil, diltiazem, nifedipine, amidipine
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calcium channel blockers (il, pine)
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dopamine
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increase blood pressure, precursor to NE, MAOI interaction
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fenoldopan
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acute htn
D receptor agonist |
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hydralazine, niroprusside, minoxidil, diazoxide
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vasodilators for htn crisis
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milrinone, amrinone
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ACEI
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bidil
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vasodilator for CHF
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nitroglycerin,isosorbide dinitrate
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treatment of angina pectoris to increase NO, cGMP
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aspirin
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peripheral vascular disease
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