39 Antihypertensive Flashcards
Is mono therapy or combination therapy used more for hypertension?
Combination therapy–2/3
What are the 4 advantages of combined therapy?
- Different classes with complementary actions.
- Lower dose
- Fewer side effects
- Improved compliance
What are the 5 classes of antihypertensive drugs?
- Diuretics
- RAS Blockers
- Ca Channel blockers
Sympatholytics
4 Vasodilators
What are the targets of antihypersensitivity therapy?
Fluid balance
RAS
central and peripheral SNA
tone of vascular smooth muscle
What are three ways the long term use of decreasing vascular resistance is brought about by diuretics?
- decreased response of VSM to vasoconstrictors
- Impaired release of NE and Epi
- Cellular mechanism- decrease in VSM Na and then decrease in Ca
Is the diuretic effect reduced by NSAIDS in thiazides?
yes
Do thiazides decrease calcium excretion?
Yes…major difference from Loop besides ability to secrete Na
What loop agent is not a sulfonamide?
ethacrynic acid
Do blood levels of RAS inhibitors correlate with effects? wHy?
- No
- Non Renal RAS
- ACE/Aldosterone escape
- Non Renal RAS
What are the angiotensin II actions?
- Vasoconstriction of peripheral micro vessels
- Stim thirst and secretion of aldosterone and ADH.
- Increased SNA activation
- Cardiac and vascular remodeling
- Feedback inhibition of renin release
Do ACE inhibitors decrease aldosterone?
Yes and increase Na and H2O excretion
What do ARBs increase in regards to fluid homeostasis?
Increase Na and H2O
Increase plasma renin and renin activity
What type of drug increases plasma renin but not plasma activity?
Renin inhibitors (aliskiren)
What are the 2 cardioselective calcium channel blockers?
verapamil and ditiazem
What are the 3 VSM selective Ca channel blockers?
nifedipine, nicardipine, amlodipine
What 4 sites of actions are there for antihypertensives that act on the SNA?
- beta adrenergic antagonists
- alpha adrenergic antagonists
- inhibitors of peripheral adrenergic transmission
- central mediated
What are beta blockers effects on renin?
decreases secretion
[also decreases central sympathetic outflow, and resets baroreceptors]
Why is it good to use a beta blocker or diuretic with alpha 1 blockers?
Because alpha 1 blockers cause fluid retention
Does reserpine cause sodium and water retention?
Yes
Vasodilators are usually used in combination with what?
diuretics and beta-antagonists
What types of vessels are preferred with hydralizine? minoxidil? Nitroprusside? Nitroglycerine?
- arterioles vs. arteries and veins
- arterioles vs. veins
- arteries and veins
- veins
How must epoprostenol be administered?
acute, continuous IV
What do we usually combine riociguat with?
ET receptor blockers
