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106 Cards in this Set
- Front
- Back
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What receptors are activated when BP is decreaed?
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B1 and A1
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Where are B1 receptors found and what do they do?
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found in the heart
activated to increase CO |
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Where are A1 receptors found and what do they do?
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found in smooth muscle
activated to increase TPR |
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what is the most potent vasoconstrictor?
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angiotensin II
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what does endothelin result in? (3)
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vasoconstriction
cardiac hypertrophy cardiofibrosis |
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primary htn
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90-95% of patients
positive family history |
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secondary htn
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due to some underlying cause (chronic renal disease)
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normal blood pressure
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< 120/80
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prehypertension
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120-139 / 80-89
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stage 1 hypertension
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140-159 / 90-99
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what is the treatment for stage 1 htn?
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thiazide diuretics for most patients
other options include ACE inhibitors, ARB, beta-blockers, calcium channel blockers |
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stage 2 hypertension
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>160/100
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what is the treatment for stage 2 htn?
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two drug combination as initial therapy (thiazide diuretic + ACE inhibitor)
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In patients with CHF, always begin htn treatment with
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ACE inhibitor and a low-dose beta blocker
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what is the therapeutic goal of htn treatment?
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reduce to below 140/90 (below 130/90 for diabetic or chronic renal disease pts)
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what is an example of a thiazie diuretic
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hydrochlorothiazide
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what type of drug is hydrochlorothiazide
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a thiazide diuretic
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when are thiazides ineffective?
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in renal dysfunction
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side effects of thiazides (5)
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hypokalemia
hypercalcemia hyponatremia hyperuricemia lithium toxicity |
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when are loop diabetics used
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reserved for patients with renal compromise, CHF, or associated hepatic/renal dysfunction
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what are two loop diuretcis
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furosimide
ethacrynic acid |
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where do loop diuretics act?
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thick ascending limb
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2 K-sparing diuretics
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spironoloactone
eplerenone |
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MOA of loop diuretics
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inhibits reabsorption of NaCl --> increased excretion of NaCl and water --> decreased extracellular volume
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side effects of loop diuretics (6)
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hypokalemia
metabolic alkalosis hypomagnesemia hypocalcemia ototoxicity sulfa sensitivity in furosimide |
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when are k-sparing diuretics used
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as an adjunct with other diuretics to prevent hypokalemia; inhibition of Na+ reabsorption further reduces blood pressure
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side effect of K-sparing diuretics
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inhibits aldosterone
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MOA of beta1 blockers
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located chiefly in cardiac muscle and kidney --> reduction in rate and force of cardiac contractility --> reduction of sympathetic outflow and renin activity
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example of non-selective beta blocker
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propranolol
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what type of drug is spironolactoe?
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k-sparing diuretic
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what type of drug is eplerenone?
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k-sparing diuretic
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what type of drug is propranolol?
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non-selective beta blocker
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what type of drug is atenolol?
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selective beta blocker
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what is a selective beta blocker
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atenolol
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what are the indications of beta-blockers in htn?
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more effective in younger patients
co-existing conditions like MI, angina, and CHF (always added on for underlying compelling conditions) |
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why should you never abruptly discontinue a beta blocker?
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it can send sympathetics into overdrive
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side effects of beta blockers (4)
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hypotension
bradycardia fatigue decreased libido |
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ACE inhibitors are required in
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required in all diabetic hypertensive patients by slowing the progression of diabetic nephropathy
excellent add-ons for patients not responding well to monotherapy |
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who are ACE inhibitors contraindicated in?
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patients with bilateral renal artery stenosis and pregnant patients
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side effects of ACE inhibitors
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dry hacking cough
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two ACE inhibitors
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enalapril
captopril |
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what type of drug is enalapril?
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ACE inhibitor
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what type of drug is captopril?
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ACE inhibitor
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metabolism of enalapril
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activated in phase I metabolism
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when is captopril used?
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fast acting way to treat extremely high bp within 15 mins
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two agtII receptor antagonists
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losartan
valsartan |
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what type of drug is losartan?
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agtII receptor antagonist
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what type of drug is valsartan?
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agtII receptor antagonist
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what are agtII receptor antagonists used for?
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effective for mild htn
heart failure and diabetic nephropathy |
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when is agtII receptor antagonists contraindicated?
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pregnancy and hyperkalemia
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MOA of renin inhibitor
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inhibits conversion of angiotensinogen to angiotensin I (thus reduces agtII)
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who is renin inhibitors contraindicated in?
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pregnant women
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who are calcium channel antagonisits first line drugs for?
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patients with htn and angina
indicated for patients with angina, diabetes, peripheral vascular disease, and asthma |
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MOA of calcium channel antagonists
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inhibits Ca influx into vascular smooth muscle cells
decreases smooth muscle tone and vasuclar resistance reduces peripheral resitsance direct vasodilator |
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Group 1 calcium channel blockers
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cardiospecific
includes verapamil and ditiazem |
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what type of drug is verapamil?
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calcium channel blocker
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what type of drug is diltiazem?
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calcium channel blocker
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what calcium channel blocker is the most cardiospecific?
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verapamil (reduces the actin-myosin interaction and is thus negatively ionotropic)
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group 2 calcium channel blockers
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acts on calcium channels in the heart and in the vasculature
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who responds best to group 2 calcium channel blockers?
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the elderly
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what type of drug is nicardipine?
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group 2 calcium channel blocker
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half life of calcium channel blockers
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short, thus a sustained release formula is preferred
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side effects of calcium channel blockers (5)
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dizziness
headache fatigue constipation (verapamil only, slows down GI motility) GERD (all lower the gastro-esophegeal sphincter pressure resulting in reflux) |
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examples of alpha 1 antagonists (3)
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prazosin
terazosin doxazosin -zosin drugs |
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what type of drug is prazosin?
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alpha 1 antagonist
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what type of drug is terazosin?
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alpha 1 antagonist
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what type of drug is doxazosin?
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alpha 1 antagonist
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MOA of alpha 1 antagonists
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inhibition of alpha receptors in resistance vessels of skin, mucosa, intestine, and kidney --> dilation of resistance and conductance vessels
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side effects of alpha 1 antagonists
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water retention in the kidney
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when are alpha1 and beta antagonists indicated?
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hypertensive emergencies and pheochromocytoma (a catecholamine that causes htn)
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examples of alpha1 and beta antagonists (2)
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labetalol
carvedilol |
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what type of drug is labetalol?
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alpha1 and beta antagonist
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what type of drug is carvedilol?
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alpha1 and beta antagonist
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MOA of alpha1 and beta antagonist
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reduces HR and contractility (via beta blockade)
vasodilation and reduction of TPR (via alpha blockade) |
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when are vasodilators used?
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last line for extreme patients
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examples of vasodilators (2)
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hydralazine
sodium nitroprusside |
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what type of drug is hydralazine?
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vasodilator
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what type of drug is sodium nitroprusside?
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vasodilator
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hydralazine co-administration
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given with a diuretic to avoid Na+ and water retention
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what does hydralazine cause?
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only causes arteriolar vasodilation
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what type of vasodilation does sodium nitroprusside cause?
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both arterial and venous vasodilation
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side effect of sodium nitroprusside and treatment
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because it acts so fast, too fast an infusion will cause cyanide poisoning
treat with sodium nitrate or amyl nitrate + sodium thiosulfate |
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action of centrally acting sympathomimietic agents
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synaptic alpha-2 receptor agonists
alpha-2 are the most predominant in pre-synaptic autoreceptors; any time you acitvate them you will slow down sympathetic stimulation and the release of norepi |
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examples of sympathomimetic agents (2)
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clonidine
methyldopa |
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what type of drug is clonidine
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sympathomimetic agents
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what type of drug is methyldopa
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sympathomimetic agents
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action of clonidine
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direct action on alpha-2 receptors
reduction of TPR |
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clonidine should be combined with
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a diuretic
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side effects of clonidine (3)
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sedation
restlessness rebound htn is discontinued abruptly |
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methyldopa is the drug of choice for
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pregnancy induced htn or pre-eclampsia
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how does methyldopa work?
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activates presynaptic inhibitor, alpha adrenoreceptors, and postsynaptic alpha 2 receptors in the CNS
reduces sympathetic outflow and TPR |
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side effects of methyldopa (4)
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edema
hepatitis hemolytic anemia may cause a positive coombs test |
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definition of hypertensive emergency
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highly elevated BP associated with an acute or immidiately progressing organ injury
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definition of hypertensive urgency
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highly elevated BP not associated with acute or immidiately progressing organ injury
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treatment of hypertensive urgency (3)
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increase dose of current meds
addition of new agent acute admin of short acting oral agent (captopril, labetalol) |
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treatment of htn in the elderly
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go low, go slow
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treatment of htn in African Americans
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diuretics
may not respond well to monotherapy with beta blockers or ACE inhibitors |
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treatment of htn in COPD
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avoid beta blockers
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treatment of htn in diabetes
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ACE inhibitors and agtII receptor blockers to control bp and slow renal deterioration
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treatment of htn in pregnancy
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ACE inhibitors and agtII receptor blockers are contraindicated
methyl-dopa, hydralazine, and calcium channel blockers are widely used |
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treatment of htn with angina (2)
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beta blockers
calcium channel blockers |
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treatment of htn with diabetes (3)
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diuretics
ACE inhibitors ARB (when ACE inhibitors are intolerable) |
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treatment of htn with recurrent stroke (1)
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ACE inhibitors
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treatment of htn with heart failure
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diuretics
beta blockers ACE inhibitors ARB (when ACE inhibitors are intolerable) |
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treatment of htn with previous MI
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beta blockers
ACE inhibitors |
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treatment of htn with chronic renal disease
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ACE inhibitors
ARB (when ACE inhibitors are intolerable) |
