7.2 Hypertension Flashcards
alpha 1 blockers
-list them (3)
- prazosin
- terazosin
- doxazosin
Direct arterial vasodilators:
- adverse effects of all (2)
- specific drug effects (hydralazine, minoxidil)
Hydralazine: lupus like syndrome
minoxidil: hair growth
- reflect tach–give with B blocker
- Na/fluid retention–give with diuretic
hair growth: which drug’s side effect
Clonidine: side effects
- anticholinergic side effects
- also rebound HTN if discontinued without weaning pt off of it
what is malignant HTN?
-how does it present? (3 important symptoms/clinical findings)
- when BP is above 180/120, emergency.
- presents with end organ damage:
1. acute renal failure
2. headache
3. papilledema
central alpha 2 agonists
- list them (3)
- mech
- clonidine, guanabenz, methyldopa
- stimulate A2 in brain
- reduce sympathetic, increase vagal tone
lupus like syndrome: which drug’s side effect?
hydralazine
(also procainamide)
renin inhibitor
-side effects
Aliskiren
- orthostatic hypotension
- hyperkalemia
how are alpha 1 blockers different from A1/A2 blockers?
alpha 1:
- smaller increase in HR
- no stimulation of renin release (B1 effect)
- does not block A2–therefore NE inhibit its own release.
beta 2 receptors:
where located? (4 main places among many)
what are sympathetic effects on each?
- arterial smooth m
- lungs–bronchodilation
- liver–glycogenolysis
- pancreas (stimulate insulin secretion)
causes of renovascular HTN (2)
-classically seen in what populations
- atherosclerosis (elderly males)
- fibromuscular dysplasia (young females)
alpha 1 blockers
-why give at night before bedtime?
- First Dose Effect. minimize effect when sleeping
- orthostatic HTN
- dizziness, faintness, possible syncope
- reflex tach
ACE-I
-adverse effects
- cough 20%
- angioedema
- hyperkalemia–esp in pts with CKD and DM
ACE-I, ARBs–precautions
-what disorder can lead to acute kidney failure if you use these drugs?
-severe bilateral renal artery stenosis
beta 1 sympathetic effects?
- heart
- kidney–increase renin
B blockers: which pts be careful when using for:
(3)
- diabetics: glucose intolerance, masked hypoglycemia
- high cholesterol: increase lipids
- asthma -bronchospasm
Direct arterial vasodilators:
-list them
HTN urgency vs emergency
urgency: no acute/progressing organ injury
emergency: acute/progressing organ damage
Young female has HTN secondary to renal stenosis. Suspect what?
Fibromuscular dysplasia.
-congenital vessel wall defect, leads to thickening of large/med sized arteries.
Neuronal and ganglionic blockers for HTN
-list them (4)
- guanethidine
- guanadrel
- reserpine
- trimethaphan (ganglionic)
Kidney: how affected by autonomic nervous system?
Increase renin release from sympathetic:
- B 1 receptors
- lesser extent, A 1 receptors
Hypertensive emergency:
- what are 2 main drugs to use
- their precautions
- sodium nitroprusside (caution with high intracranial pressure, azotemia, CKD)
- fenoldopam (caution with glaucoma)
Fenoldopam
- mech
- clinical use
- selective D1 partial agonist–D1 vasodilates systemic arteries, keeps kidney blood flow open
- use in HTN emergency
how is renin release affected by B blockers?
Remember, renin is stimulated by B2 (and little bit of A1)
-so, B2 blockers will decrease renin release, similar to ACE-I effect
What pressure readings define HTN?
How about malignant HTN?
140/90
180/120
fibromuscular dysplasia
- more common in young females
- developmental defect of vessel wall, leads to thickening of large/med vessels, esp renal a
- cause of renovascular HTN
alpha 1/alpha 2 blockers:
- list them (2)
- mech
- phenoxybenzamine
- phentolamine
- block alpha 1 constriction in vessels, block alpha 2 in sympathetic nerve ending to inhibit NE release
Direct arterial vasodilators:
-how to administer it, why?
- 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
primary vs secondary HTN, difference?
proportion of HTN cases?
causes?
primary: 95%, secondary: 5%
- primary: idiopathic
- secondary: -renovascular HTN is one common cause
use ACE-I in pts with diabetes?
- be careful of renal disease
- can worsen side effect of hyperkalemia
what drug can cause hepatitis and hemolytic anemia?
methyldopa
ACE-I:
-what lab tests to do within 4 weeks of initiation or dose increase?
- serum K
- serum creatinine
- serum K
- worry about renal disease, which will worsen hyperkalemia
what is resistant HTN?
-use 3 drug types including diuretic, cannot lower HTN
HTN target goal for pts older than 60. Difference?
JNC8 strongly recommends:
instead of 140/90
central alpha 2 agonists:
-side effects
- abrupt discontinuation may cause rebound HTN!
- Na/water retention
- depression
- orthostatic HTN
B blocker effect for HTN pts with high, med, low baseline renin levels. Outcome comparison?
B blockers much more effect at lowering HTN for pts with higher renin levels. (B1 effect on renin)
Diuretics:
-short vs long term effects
- 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
You see pt with HTN and suspect renovascular HTN. What blood test to differentiate btwn primary and renovascular HTN?
- plasma renin
- higher in renovascular HTN
cyanide toxicity
-which drug
-Nitroprusside
ARBs
side effects
- orthostatic hypotension
- renal insufficiency
- hyperkalemia
Mixed alpha 1/beta blockers:
- list them
- how side effects compare with alpha 1 blockers
carvedilol, labetalol
- similar side effects, less severe:
1. mild orthostatic HTN
2. headaches
reserpine and guanethidine:
adverse effects
Both: -fluid retention–use with thiazide diuretic
reserpine: depression, sedation
what drug class not to give to diabetics?
why
- 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)
Direct arterial vasodilators::
-usually give with which other drugs at the same time? why?
Side effects:
- reflex tach– use B blocker
- Na/fluid retention – use diuretic
