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101414 HTN pharm Flashcards

1
Q

what is the JNC 8 recommendation for target BPs for pts over 60?

A

below 150 systolic and 90 diastolic (thought that higher BP was necessary for elderly to keep blood flow to vital organs)

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2
Q

anti hypertensive drugs classification

A

vasodilators

agents affecting adrenergic fxn

agents affecting renin angiotensin system

diuretics

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3
Q

effect of vasodilators

A

decreases peripheral arterial resistance, decreasing BP

baroreceptor activation can cause compensatory increase in sympathetic outflow. increases HR. reflex release of renin.

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4
Q

direct arterial vasodilators ex

A 
hydralazine
minoxidil
diazoxide
nitroprusside
fenoldopam
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5
Q

how do you counteract the compensatory reflexes created by direct arterial vasodilators?

A

give concurrent beta blocker

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6
Q

hypertensive crisis is

A

BP over 180/120 mmHg

you will want to reduce the BP gradually

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7
Q

hypertensive urgency

A

elevated BP

no acute or progressing target-organ injury

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8
Q

hypertensive emergency

A

acute or progressing target organ damage (encephalopathy, intracrnial hemorrhage, acute left ventricular failure with pumonary edema, dissecting aortic aneurysm, unstable angina, eclampsia)

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9
Q

how should you approach hypertensive emergency?

A

treat quickly but not too quickly b/c if lower BP too fast, will get low perfusion to organs

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10
Q

MOA of nitric oxide donors

A

they form NO, which results in formation of cGMP, which activates protein kinase G to affect calcium and promote relaxation

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11
Q

what part of the vasculaure do nitric oxide donors work on?

A

primarily arterial but has venous component

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12
Q

ex of nitric oxide donor

A

nitroprusside

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13
Q

what is a side effect of nitroprusside

A

cyanide toxicity, so don’t want to use this for a long time

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14
Q

adverse effects of direct arterial vasodilators

A

sodium/water retention
tachycardia/angina

hydralazine-lupus like syndrome
minoxidil-hair growth

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15
Q

how do you prevent some of the side effects of direct arterial vasodilators?

A

use with diuretic (preferably thiazide) and beta blocker to reduce fluid retention and reflex tachycardia

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16
Q

effect of calcium ch blocker

A

decreases vascular tone to decrease BP

will see small increase in HR

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17
Q

ex of calcium channel blockers

A

nifedipine
diltiazem
verapamil
amlodipine

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18
Q

effects of dihydropyridines

A

baroreceptor mediated reflex tachycardia due to potent vasodilating effects

do NOT alter conduction through AV node

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19
Q

effects of non-dihydropyridines

A

decrease HR and slow AV node conduction

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20
Q

side effects of calcium ch blockers

A

flushing
headaches
negative ionotropic effect (greatest in verapamil)
constipation (greater in verapamil)
decreased AV conduction (greater in verapamil and diltiazem)
edema (greatest in nifedipine)
refractoriness (nifedipine)

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21
Q

vasoconstriction of arterioles in skin and viscera is mediated by which adrenergic receptor

A

alpha 1

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22
Q

vasodilation of skeletal muscle and liver arterioles is mediated by which adrenergic receptor

A

beta 2

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23
Q

bronchodilation is mediated by which adrenergic receptor

A

beta 2

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24
Q

increased renin secretion is mediated by which adrenergic receptor

A

alpha 1, beta 1

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25
effect of alpha1/alpha2 combined blockers
decreases vascular tone alpha 2 blocking- causes decreased venous tone increases HR
26
effect of alpha1 blockers
decreases peripheral resistance | increases HR
27
ex of alpha 1 blockers
prazosin
28
alpha1 or alpha1/alpha2 blockers are more effective for anti-HTN?
alpha1 because of the lack of inhibition of alpha2 to inhibit NE release
29
what is the effect of alpha1 blockers on HR and renin release?
increase, but smaller increase than for alpha1/alpha2 blocker don't stimulate renin release
30
what is the first dose effect?
with alpha1 blockers- the first dose--can get orthostatic hypotension. transient dizziness, palpitations, syncope within 1-3 hrs. reflex tachycardia.
31
how do you minimize the first dose effect?
use alpha1 blocker at bedtime
32
compare alpha1 blocker and mixed alpha1/beta blocker in terms of side effects
prazosin-orthostatic hypotension. headaches/dizziness. labetalol/carvedilol-are alpha1 and beta1/beta2 blockers. mild orthostatic hypotension and headaches.
33
effect of beta blockers
decrease renin, decreasing peripheral resistance | decrease HR
34
ex of beta1 blockers
metoprolol | atenolol
35
where are beta2 receptors found
lungs liver pancreas arteriolar smooth muscle stimulation causes bronchodilation and vasodilation mediate insulin secretion and glycogenolysis
36
why do beta blockers work better in young adults
because CO has a greater contribution to BP in younger adults
37
potential adverse effects of beta blockers
glucose intolerance, masked hypoglycemia bradycardia, dizziness bronchospasm increased TGs and decreased HDL CNS-depression, fatigue, sleep disturbance reduced CO, exacerbation of heart failure impotence exercise intolerance
38
central alpha2 agonists' effect
work on CNS to decrease sympathetic nervous sys increases vagal tone decreases vascular tone decreases renin DECREASES HR
39
ex of central alpha2 agonists
clonidine guanabenz alpha-methyldopa
40
adverse effects of central alpha2 agonists
``` sodium/water retention abrupt discontinuation may cause rebound HTN depression orthostatic hypotension dizziness ```
41
effects of neuronal and ganglionic blocking agents
decreases sympathetic nerv sys activity-decrease renin, decreases HR
42
ex of neuronal and ganglionic blockers
guanethidine guanadrel reserpine trimethaphan
43
side effects of reserpine and guanethidine
``` sedation (reserpine) depression (reserpine) decreased CO sodium and water retention increased gastric acid secretion (reserpine) diarrhea bradycardia ``` use with diuretic (preferably thiazinde) to avoid fluid retention
44
effect of diuretics
decrease vascular volume, decreasing venous retruen and CO cause compensatory increase in peripheral vascular resistance
45
side effects of diuretics
``` electrolyte disturbances hyperglycemia hypotension, orthostasis lipid abnormalities photosensitiity ototoxicity hyperuricemia, gout ```
46
aldosterone antagonists MOA
inhibit renal action of aldosterone (Na and water retention) inhibit extrarenal action of aldosterone (fibrosis, inflammation)
47
ACE inhibitors, AT1 blockers, renin inhibitors effects
decrease vascular tone | decrease aldosterone to decrease venous return
48
what should yoo monitor with ACE inhibitors?
serum K and creatinine within 4 wks of initation or dose increase
49
adverse effects of ACE inhibitors
cough angioedema hyperkalemia acute renal failure
50
AT1 receptor effects
``` vasoconstriction vascular proliferation aldosterone secretion cardiac myocyte proliferation increased sympath tone ```
51
AT2 receptor effects
vasodilation antoproliferation apoptosis
52
when do you see the maximal effect with losartan?
after 6 wks | note-renin angitensin system agents take time to see effects!
53
what are side effects for all renin angiotensin system inhibitors?
orthostatic hypotension | hyperkalemia
54
precautions for ACE inhibitors/ARB
can cause acute kidney failure in certain pts (bilateral renal artery stenosis) pregnancy
55
what is a benefit of combo therapy?
diuretic decreases Na and will increase renin. so if you give an ARB, can counteract can reduce BP further than with solo agents
56
what are some mixed vasodilators
``` nitroprusside ACE inhibitors and ARBs alpha adrenergic blockers alpha2 central agonists nesiritide ( no longer recommmended) ```
57
graded recommendations are used in JNC8 or 7?
8
58
race, CKD, and diabetic subgroups are addressed in JNC 8or 7?
8
59
what is recommended for the general population for treating HTN in JNC8
thiazide, CCB, ACEi, ARB
60
recommendation for black population in JNC8 in treating HTN?
CCB or thiazide
61
if goal of BP isn't met after 1 month of treatment, according to JNC8, what should you do
increase dose of initial drug or | add second drug
62
what do African Am have increased risk of as side effect?
angioedema
63
what should be avoided in pregnancy?
ACEi and ARBs
64
in combo therapy, what should one of the agents be?
thiazide unless contraindicated a diuretic (preferably thiazide)
65
in a hypertensive emergency, what is given?
``` sodium nitroprusside (adverse effect is cyanide toxicity) fenoldopam ``` esmolol, labetalol

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