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CV > 101414 HTN pharm > Flashcards

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
Q

effect of alpha1/alpha2 combined blockers

A

decreases vascular tone
alpha 2 blocking- causes decreased venous tone

increases HR

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26
Q

effect of alpha1 blockers

A

decreases peripheral resistance

increases HR

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27
Q

ex of alpha 1 blockers

A

prazosin

28
Q

alpha1 or alpha1/alpha2 blockers are more effective for anti-HTN?

A

alpha1 because of the lack of inhibition of alpha2 to inhibit NE release

29
Q

what is the effect of alpha1 blockers on HR and renin release?

A

increase, but smaller increase than for alpha1/alpha2 blocker

don’t stimulate renin release

30
Q

what is the first dose effect?

A

with alpha1 blockers-

the first dose–can get orthostatic hypotension. transient dizziness, palpitations, syncope within 1-3 hrs. reflex tachycardia.

31
Q

how do you minimize the first dose effect?

A

use alpha1 blocker at bedtime

32
Q

compare alpha1 blocker and mixed alpha1/beta blocker in terms of side effects

A

prazosin-orthostatic hypotension. headaches/dizziness.

labetalol/carvedilol-are alpha1 and beta1/beta2 blockers. mild orthostatic hypotension and headaches.

33
Q

effect of beta blockers

A

decrease renin, decreasing peripheral resistance

decrease HR

34
Q

ex of beta1 blockers

A

metoprolol

atenolol

35
Q

where are beta2 receptors found

A

lungs
liver
pancreas
arteriolar smooth muscle

stimulation causes bronchodilation and vasodilation
mediate insulin secretion and glycogenolysis

36
Q

why do beta blockers work better in young adults

A

because CO has a greater contribution to BP in younger adults

37
Q

potential adverse effects of beta blockers

A

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
Q

central alpha2 agonists’ effect

A

work on CNS to decrease sympathetic nervous sys
increases vagal tone

decreases vascular tone
decreases renin
DECREASES HR

39
Q

ex of central alpha2 agonists

A

clonidine
guanabenz
alpha-methyldopa

40
Q

adverse effects of central alpha2 agonists

A 
sodium/water retention
abrupt discontinuation may cause rebound HTN
depression
orthostatic hypotension
dizziness
41
Q

effects of neuronal and ganglionic blocking agents

A

decreases sympathetic nerv sys activity-decrease renin, decreases HR

42
Q

ex of neuronal and ganglionic blockers

A

guanethidine
guanadrel
reserpine
trimethaphan

43
Q

side effects of reserpine and guanethidine

A 
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
Q

effect of diuretics

A

decrease vascular volume, decreasing venous retruen and CO

cause compensatory increase in peripheral vascular resistance

45
Q

side effects of diuretics

A 
electrolyte disturbances 
hyperglycemia
hypotension, orthostasis
lipid abnormalities
photosensitiity
ototoxicity
hyperuricemia, gout
46
Q

aldosterone antagonists MOA

A

inhibit renal action of aldosterone (Na and water retention)

inhibit extrarenal action of aldosterone (fibrosis, inflammation)

47
Q

ACE inhibitors, AT1 blockers, renin inhibitors effects

A

decrease vascular tone

decrease aldosterone to decrease venous return

48
Q

what should yoo monitor with ACE inhibitors?

A

serum K and creatinine within 4 wks of initation or dose increase

49
Q

adverse effects of ACE inhibitors

A

cough
angioedema
hyperkalemia
acute renal failure

50
Q

AT1 receptor effects

A 
vasoconstriction
vascular proliferation
aldosterone secretion
cardiac myocyte proliferation
increased sympath tone
51
Q

AT2 receptor effects

A

vasodilation
antoproliferation
apoptosis

52
Q

when do you see the maximal effect with losartan?

A

after 6 wks

note-renin angitensin system agents take time to see effects!

53
Q

what are side effects for all renin angiotensin system inhibitors?

A

orthostatic hypotension

hyperkalemia

54
Q

precautions for ACE inhibitors/ARB

A

can cause acute kidney failure in certain pts (bilateral renal artery stenosis)

pregnancy

55
Q

what is a benefit of combo therapy?

A

diuretic decreases Na and will increase renin. so if you give an ARB, can counteract

can reduce BP further than with solo agents

56
Q

what are some mixed vasodilators

A 
nitroprusside
ACE inhibitors and ARBs
alpha adrenergic blockers
alpha2 central agonists
nesiritide ( no longer recommmended)
57
Q

graded recommendations are used in JNC8 or 7?

A

8

58
Q

race, CKD, and diabetic subgroups are addressed in JNC 8or 7?

A

8

59
Q

what is recommended for the general population for treating HTN in JNC8

A

thiazide, CCB, ACEi, ARB

60
Q

recommendation for black population in JNC8 in treating HTN?

A

CCB or thiazide

61
Q

if goal of BP isn’t met after 1 month of treatment, according to JNC8, what should you do

A

increase dose of initial drug or

add second drug

62
Q

what do African Am have increased risk of as side effect?

A

angioedema

63
Q

what should be avoided in pregnancy?

A

ACEi and ARBs

64
Q

in combo therapy, what should one of the agents be?

A

thiazide unless contraindicated

a diuretic (preferably thiazide)

65
Q

in a hypertensive emergency, what is given?

A 
sodium nitroprusside (adverse effect is cyanide toxicity)
fenoldopam

esmolol, labetalol

CV (34 decks)

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