02 hypertension Flashcards
what are the values for systolic and diastolic that define hypertension?
sys above 139 and/or
dia above 89
what are the four types of antihypertensive agents that are most commonly used?
1st: diuretics (if patient has no complications)
- Renin/AgLL (ACEI, ARBs) for diabetic
- Calcium-antagonists
- Beta-antagonists
what is an adverse effect of thiazide use?
HYPOkalemia, this happens bc an increase in Na in the collecting tubule causes a larger exchange of Na for K and K is excreted
- also increase in uric acid retention which can lead to gout
- they can cause hyperglycemia/glucose intolerance
examples of thiazides:
Hydrochlorothiazide, Metolazone
what do thiazides do, and where?
they inhibit sodium and chloride cotransporter (thus inhibit Na reabsorption) in the distal convoluted tubule
what other antihypertensive agents are often combined with thiazides?
beta-blockers or vasodilators
spironolactone
Potassium sparing diuretic
- used for hypertension and HF
- act on collecting tube, no K+ loss, blocks Aldosteron (antagonist), block Na channel
potassium sparing duretics
ex: spironolactone
- no usually used alone, but in combination with something else like the thiazides
when might thiazides be contra-indicated?
for a diabetic bc they can cause hyperglycemia/glucose intolerance
Loop diuretics
- not used as antihypertensive agents
- commonly used in heart failure
- usually used to decrease edema
examples of loop diuretics:
-Furosemide, bumetanide, Torsemide, Ethacrynic acid “F-BUT”
if the drug ends in “pril” what kind of drug is it?
ACE inhibitor
ex: lisinopril, captopril, enalapril,
adverse side effects of ACE Inhibitors:
Dry cough, due to increased levels of bradykinin
- could use an ARB (angiotensin receptor blocker) instead
- hypotension in hypovolemic patiets
- angioedem, hyperkalemia
- glossitis, oral ulceration, rash
- altered sense of taste (loss of zinc, 10-20%)
- contraindicated in pregnancy (tetrogenic)
- contraindicated in renal artery stenosis
- drug interaction with K-sparing diuretics
Actions of ACE Inhibitors:
- decrease angiotensin II production
- decrease TPR, O unchanged, HR unchanged
- no reflex increase in HR
- decrease aldosterone production leads to a decrease in Na/water retention
- increase in bradykinin level can=dry cough
- imporves intrarenal hymodynamics
- less effective in elderly and afro-Americans
when are ACE inhibitors contraindicated?
in pregnancy (tetrogenic) and in renal artery stenosis
