13 Hypertension, Hypotension and Therapeutic Intervention Flashcards
Why might people be resistant to taking antihypertensives?
many patients are asymptomatic
In what ways is BP physiologically maintained?
Baroreceptor reflex
ANS (symp + paraS)
RAAS (kidneys + vessels)
What 3 factors determine drug choice?
Age
Genetics
Comorbidities
What are the 4 classes of anti-hypertensives?
A
B
C
D
Name 2 types of class A antihypertensives
ACEi
ARBs
Name 2 types of ACEi
lisinopril
enalapril
What is the MOA of ACEi?
decrease Ang II
(decreases TPR and CO)
reduced degradation of vasodilator kinins (more vasodilation)
What are the side effects of ACEi?
dry cough
sudden, severe hypotension if taken with diuretics (short lives)
Who is prescribed ACEi?
first line treatment for uncomplicated, mild hypertension in younger patients
Name 2 types of ARBs
Losartan
Irbesartan
What is the MOA of ARBs?
decreased vasoconstriction (indirect vasodilator) decreases TPR and CO
What are the side effects of ARBs?
non found yet!
Why might ARBs be preferable over ACEi?
because they’re now about the same price and aren’t associated with side effects
Name a type of Calcium channel blocker
Amlodipine
What are the side effects associated with calcium channel blockers?
possible side effects on heart
decreased GIT activity
When are calcium channel blockers prescribed?
first line treatment for uncomplicated, mild hypertension
What is the initial mechanism of action for diuretics?
increased water/Na excretion from kidneys
decreased blood volume and CO
What are the compensatory effects of diuretics?
longer term effect of arterial dilation
reduces TPR
what are the side effects of diuretics?
hypokalaemia
When are diuretics prescribed?
first line treatment for uncomplicated, mild hypertension
What is the MOA of beta blockers?
decrease HR/contractility (decreases CO)
decrease renin secretion (decreases Ang II, and TPR/CO)
What side effects are associated with beta adrenoreceptor antagonists?
bronchospasm
exercise intolerance
long term DM2
When are beta blockers prescribed?
recent guidance is to avoid
however, there are some well controlled patients on it
What is the MOA of alpha1 adrenoreceptor antagonists?
block vasoconstriction
decreases TPR/CO
What side effects are associated with alpha 1 adrenoreceptor antagonists?
postural hypotension
When are alpha 1 adrenoreceptor antagonists prescribed?
severe hypertension
Which 2 classes of antihypertensives directly use RAAS?
Ace inhibitors
Beta blockers
Which 2 classes of drugs have no direct effect on RAAS?
calcium channel blockers
diuretics
What might you do if hypertension continues to get worse?
DO NOT INCREASE DOSE
this will cause complications
combination therapy
What are the preferred combination therapies?
A+C
A+D
one of each category
