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7 Vascular Pathology > 7.2 Hypertension > Flashcards

7.2 Hypertension Flashcards

1
Q

alpha 1 blockers

-list them (3)

A
  1. prazosin
  2. terazosin
  3. doxazosin
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2
Q

Direct arterial vasodilators:

  • adverse effects of all (2)
  • specific drug effects (hydralazine, minoxidil)
A

Hydralazine: lupus like syndrome

minoxidil: hair growth
- reflect tach–give with B blocker
- Na/fluid retention–give with diuretic

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2
Q

hair growth: which drug’s side effect

A
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2
Q

Clonidine: side effects

A
  • anticholinergic side effects
  • also rebound HTN if discontinued without weaning pt off of it
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3
Q

what is malignant HTN?

-how does it present? (3 important symptoms/clinical findings)

A
  • when BP is above 180/120, emergency.
  • presents with end organ damage:
    1. acute renal failure
    2. headache
    3. papilledema
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3
Q

central alpha 2 agonists

  • list them (3)
  • mech
A
  • clonidine, guanabenz, methyldopa
  • stimulate A2 in brain
  • reduce sympathetic, increase vagal tone
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4
Q

lupus like syndrome: which drug’s side effect?

A

hydralazine

(also procainamide)

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4
Q

renin inhibitor

-side effects

A

Aliskiren

  1. orthostatic hypotension
  2. hyperkalemia
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5
Q

how are alpha 1 blockers different from A1/A2 blockers?

A

alpha 1:

  1. smaller increase in HR
  2. no stimulation of renin release (B1 effect)
  3. does not block A2–therefore NE inhibit its own release.
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5
Q

beta 2 receptors:

where located? (4 main places among many)

what are sympathetic effects on each?

A
  1. arterial smooth m
  2. lungs–bronchodilation
  3. liver–glycogenolysis
  4. pancreas (stimulate insulin secretion)
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6
Q

causes of renovascular HTN (2)

-classically seen in what populations

A
  1. atherosclerosis (elderly males)
  2. fibromuscular dysplasia (young females)
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6
Q

alpha 1 blockers

-why give at night before bedtime?

A
  • First Dose Effect. minimize effect when sleeping
  • orthostatic HTN
  • dizziness, faintness, possible syncope
  • reflex tach
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7
Q

ACE-I

-adverse effects

A
  1. cough 20%
  2. angioedema
  3. hyperkalemia–esp in pts with CKD and DM
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8
Q

ACE-I, ARBs–precautions

-what disorder can lead to acute kidney failure if you use these drugs?

A

-severe bilateral renal artery stenosis

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9
Q

beta 1 sympathetic effects?

A
  • heart
  • kidney–increase renin
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10
Q

B blockers: which pts be careful when using for:

(3)

A
  1. diabetics: glucose intolerance, masked hypoglycemia
  2. high cholesterol: increase lipids
  3. asthma -bronchospasm
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12
Q

Direct arterial vasodilators:

-list them

A
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13
Q

HTN urgency vs emergency

A

urgency: no acute/progressing organ injury
emergency: acute/progressing organ damage

15
Q

Young female has HTN secondary to renal stenosis. Suspect what?

A

Fibromuscular dysplasia.

-congenital vessel wall defect, leads to thickening of large/med sized arteries.

16
Q

Neuronal and ganglionic blockers for HTN

-list them (4)

A
  1. guanethidine
  2. guanadrel
  3. reserpine
  4. trimethaphan (ganglionic)
18
Q

Kidney: how affected by autonomic nervous system?

A

Increase renin release from sympathetic:

  • B 1 receptors
  • lesser extent, A 1 receptors
19
Q

Hypertensive emergency:

  • what are 2 main drugs to use
  • their precautions
A
  1. sodium nitroprusside (caution with high intracranial pressure, azotemia, CKD)
  2. fenoldopam (caution with glaucoma)
20
Q

Fenoldopam

  • mech
  • clinical use
A
  • selective D1 partial agonist–D1 vasodilates systemic arteries, keeps kidney blood flow open
  • use in HTN emergency
21
Q

how is renin release affected by B blockers?

A

Remember, renin is stimulated by B2 (and little bit of A1)

-so, B2 blockers will decrease renin release, similar to ACE-I effect

22
Q

What pressure readings define HTN?

How about malignant HTN?

A

140/90

180/120

24
Q

fibromuscular dysplasia

A
  • more common in young females
  • developmental defect of vessel wall, leads to thickening of large/med vessels, esp renal a
  • cause of renovascular HTN
25
Q

alpha 1/alpha 2 blockers:

  • list them (2)
  • mech
A
  1. phenoxybenzamine
  2. phentolamine
    - block alpha 1 constriction in vessels, block alpha 2 in sympathetic nerve ending to inhibit NE release
26
Q

Direct arterial vasodilators:

-how to administer it, why?

A
  • Titrate it instead of 1 dose
  • very quick action–if dose given at once, will bring hypotension–organs not perfused
  • Hypotension causes reflex tachycardia, give with B blocker
27
Q

primary vs secondary HTN, difference?

proportion of HTN cases?

causes?

A

primary: 95%, secondary: 5%
- primary: idiopathic
- secondary: -renovascular HTN is one common cause

28
Q

use ACE-I in pts with diabetes?

A
  • be careful of renal disease
  • can worsen side effect of hyperkalemia
29
Q

what drug can cause hepatitis and hemolytic anemia?

A

methyldopa

30
Q

ACE-I:

-what lab tests to do within 4 weeks of initiation or dose increase?

A
    1. serum K
      1. serum creatinine
  • worry about renal disease, which will worsen hyperkalemia
31
Q

what is resistant HTN?

A

-use 3 drug types including diuretic, cannot lower HTN

32
Q

HTN target goal for pts older than 60. Difference?

A

JNC8 strongly recommends:

instead of 140/90

34
Q

central alpha 2 agonists:

-side effects

A
  • abrupt discontinuation may cause rebound HTN!
  • Na/water retention
  • depression
  • orthostatic HTN
35
Q

B blocker effect for HTN pts with high, med, low baseline renin levels. Outcome comparison?

A

B blockers much more effect at lowering HTN for pts with higher renin levels. (B1 effect on renin)

36
Q

Diuretics:

-short vs long term effects

A
  • short: initial BP drop from diuresis. causes compensatory increase in peripheral resistance
  • long: volume returns to pretreatment levels, with chronic use
  • however, peripheral resistance is lower than pretreatment levels, so good for HTN
38
Q

You see pt with HTN and suspect renovascular HTN. What blood test to differentiate btwn primary and renovascular HTN?

A
  • plasma renin
  • higher in renovascular HTN
39
Q

cyanide toxicity

-which drug

A

-Nitroprusside

40
Q

ARBs

side effects

A
  • orthostatic hypotension
  • renal insufficiency
  • hyperkalemia
41
Q

Mixed alpha 1/beta blockers:

  • list them
  • how side effects compare with alpha 1 blockers
A

carvedilol, labetalol

  • similar side effects, less severe:
    1. mild orthostatic HTN
    2. headaches
42
Q

reserpine and guanethidine:

adverse effects

A

Both: -fluid retention–use with thiazide diuretic

reserpine: depression, sedation

43
Q

what drug class not to give to diabetics?

why

A
  • B blockers from their effects:
    1. glucose intolerance (B2 in pancrease increase insulin release, also B2 in liver increase glycogenolysis)
    2. masked hypoglycemia (no sympathetic response to let pt know)
44
Q

Direct arterial vasodilators::

-usually give with which other drugs at the same time? why?

A

Side effects:

  1. reflex tach– use B blocker
  2. Na/fluid retention – use diuretic

7 Vascular Pathology (5 decks)

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