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Pharmacology - Winter > 4 - RAS & Antihypertensives > Flashcards

4 - RAS & Antihypertensives Flashcards

1
Q

What does cardiac output depend on?

A
  • Venous return (venous tone, blood volume)
  • Heart rate
  • Contractility
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2
Q

What does total peripheral resistance depend on?

A

Resistance vessel diameter (arterial tone)

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3
Q

What are chronic increases in BP normally due to?

A

Increased arterial resistance (total peripheral resistance)

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4
Q

What is preload?

A

Venous return

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5
Q

What is afterload?

A

Arterial resistance

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6
Q

What are some OTC and prescription drugs that can cause high BP?

A
  • Estrogens (oral contraceptives)
  • NSAIDs
  • Antidepressants, cyclosporin, amphetamines (stimulants)
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7
Q

What are the 3 main compensatory responses to decreased BP? What are causes for this decrease in BP?

A

1) Decrease renal perfusion pressure and increase sodium retention
2) Increase RAAS, A2, and aldosterone
3) Increase symp nerve activity and norepinephrine
- Causes = hypovalemia (hemorrhage, dehydration), postural, heart failure, antihypertensive

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8
Q

What are some non-pharms for tx of hypertension?

A
  • Sodium restriction
  • Weight loss
  • Exercise
  • Reduced alcohol intake
  • Smoking cessation
  • Relaxation
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9
Q

What are some first line single agents for hypertension tx?

A
  • ACE inhibitor
  • ARB
  • Diuretic
  • Calcium channel blocker
  • Beta-adrenergic receptor antagonist (but not in uncomplicated hypertension)
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10
Q

What is the dose response for lowering BP for diuretics?

A

Relatively flat, so increasing dose produces little improvement in effect

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11
Q

What problems arise when increasing dose of diuretics?

A
  • Hypokalemia
  • Glucose intolerance
  • Increased LDL
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12
Q

Loop diuretics are greater _____ but weaker ______ than thiazide diuretics

A

Greater diuretic but weaker antihypertensive

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13
Q

Are loop diuretics a good choice for long term tx of hypertension?

A

No, fast onset but short acting

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14
Q

When are potassium sparing diuretics useful for hypertension tx?

A
  • When used w/ thiazides to decrease potassium loss

- When increased BP is due to mineralocorticoid excess

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15
Q

Which drugs are ACE inhibitors?

A
  • Captopril

- Enalapril

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16
Q

What are the functions of ACE inhibitors?

A
  • Decrease A2 levels
  • Decrease TPR
  • Decrease aldosterone
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17
Q

Which drug is an ARB?

A

Losartan

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18
Q

What are the functions of ARBs?

A
  • Block A2 receptors
  • Decrease TPR
  • Decrease aldosterone
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19
Q

ACE inhibitors and ARBs are first line in _____

A

Hypertension, CHF and/or diabetic nephropathy

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20
Q

Do ACE inhibitors and ARBs cause a reflex increase in cardiac output?

A

No

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21
Q

What are some possible problems w/ ACE inhibitors and ARBs?

A
  • Rash
  • Cough (ACE inhibitors)
  • Hyperkalemia
  • Proteinuria
  • Angioedema
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22
Q

ACE inhibitors and ARBs are recommended for ____ hypertension w/ or w/o a concurrent condition of _____

A
  • Uncomplicated hypertension

- Concurrent condition = heart failure, left ventricle dysfunction, post MI, diabetes, systolic dysfunction, proteinuria

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23
Q

What happens if plasma A2 levels increase while a px is taking ACE inhibitors or ARBs? When might this occur?

A
  • Drastic drop in BP is possible

- Renal artery stenosis, hypovalemia, diuretic use

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24
Q

ACE inhibitors and ARBs are contraindicated in ______

A

Pregnancy

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25
Q

What is the first line choice for hypertension in pregnancy?

A

Thiazide diuretic

26
Q

Low plasma potassium increases _____

A

Digitalis toxicity

27
Q

What can decrease plasma potassium?

A
  • Increased aldosterone

- Diuretics

28
Q

What can increase plasma potassium?

A
  • ACE inhibitors

- Beta receptor blockers

29
Q

What is the function of calcium channel blockers?

A

Block L-type calcium channels, one predominantly vascular and the other predominantly cardiac

30
Q

What are the 2 types of calcium channel blockers and which drugs are in each category?

A

1) Vascular/dihydropyridines - amlodipine, nifedipine

2) Cardiac and vascular/non-dihydropyridines - verapamil, diltiazem

31
Q

For dihydropyridines, ___ acting agents are preferred for hypertension

A

Long

32
Q

What are dihydropyridines used for?

A
  • Angina
  • Raynauds
  • Hypertension
  • Hypertensive crisis
33
Q

What effect do diuretics and nidefipine have together?

A

Diuretics may block nifedipine effects on BP

34
Q

What are non-diphydropyridines used for?

A
  • Hypertension if also concerned about heart rate control in atrial fibrillation
  • Px w/ angina
35
Q

What is diltiazem used for?

A

Treat angina and hypertension

36
Q

What should verapamil should not be used w/ and why?

A

Beta receptor blocker b/c both block AV node

37
Q

Verapamil is contraindicated in ______

A

Heart failure

38
Q

What is the first line single therapy in uncomplicated hypertension?

A

Calcium channel blockers

39
Q

When are calcium channel blockers especially useful for hypertension tx?

A
  • When beta blockers are contraindicated (COPD or diabetes)

- Elderly and African Americans

40
Q

What are some adverse effects of calcium channel blockers?

A
  • Headache, flushing, edema, constipation

- Increased mortality post MI w/ short acting preparations

41
Q

Calcium channel blockers can be used to treat hypertension in the presence of what other coexisting conditions?

A
  • Angina pectoris
  • Raynaud’s
  • Asthma or COPD
42
Q

What is the mechanism of beta blockers to decrease BP?

A

Unknown

43
Q

When are beta blockers best used for hypertension tx?

A
  • As a second drug to block reflex activation of the heart by SNS
  • Given for hypertension when concomitant diseases also benefit (post MI, heart failure, angina, glaucoma)
44
Q

What are some problems w/ beta blockers?

A
  • May increase triglycerides and decrease HDL
  • Increased incidence of erectile dysfunction
  • Increased incidence of type 2 DM
45
Q

Which drugs for hypertension protect against stroke?

A

ACE inhibitors and ARBs

46
Q

When would beta blockers be used in an asthmatic?

A

W/ post MI or heart failure

47
Q

Is prazosin a good single agent to use for chronic BP lowering?

A
  • Alpha 1 antagonist, so vasodilates arteries and veins

- Not effective

48
Q

What are problems w/ prazosin?

A
  • Fluid retention w/ long term tx (so give w/ diuretic**)
  • First dose effect – initial large decrease in BP
  • Orthostatic hypotension
49
Q

What is the dosing for clonidine for hypertension tx?

A

2 unequal doses, high dose at night

50
Q

What can rapid cessation of clonidine cause?

A

Rebound hypertension

51
Q

Is hydralazine (vasodilator) used alone for chronic BP lowering?

A

No

52
Q

What should hydralazine be given w/ for hypertension tx? Why?

A
  • Beta blocker to prevent increase in heart rate and contracility
  • Diuretic to increase excretion of water
53
Q

Can hydralazine be given during pregnancy?

A

Yes

54
Q

What are problems w/ hydralazine (vasodilator)?

A
  • May cause lupus-like syndrome
  • May increase myocardial stimulation
  • Headache, nausea, hypotension, tachycardia, angina pectoris
55
Q

What is another vasodilator used besides hydralazine?

A

Minoxidil

56
Q

What is sodium nitroprusside and what is it used for?

A
  • Venous and arteriolar dilator

- Used for hypertensive encephalopathy

57
Q

What is the target BP for px under 80 y/o w. uncomplicated hypertension?

A

140/90 mmHg or less

58
Q

What is the target BP for px w/ hypertension and other conditions (ex: atherosclerotic CV disease, DM, chronic kidney disease)?

A

Below 140/90 mmHg

59
Q

Which agents do younger px w/ hypertension better respond to?

A
  • ACE inhibitors, ARBs, or beta antagonists

- Beta blockers are inferior to protect against stroke

60
Q

Which agents do black px and elderly px w/ hypertension better respond to?

A
  • Thiazide diuretics or long acting calcium channel blockers

- If px has other indications, may need ACE inhibitor or ARB

Pharmacology - Winter (18 decks)

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