Anti-Hypertensive Flashcards
Cardiovascular mortality risk doubles with each what BP increment?
20/10mmHG
What is hypertension?
> 130/>80
CO=
SV X HR
SV=
EDV-ESV
BP=
CO X SVR
Rationale for reducing CO?
Reduce blood volume
Reduce HR
Reduce SV
Rationale for reducing SVR?
Dilate systemic vasculature
5 anatomical site of BP control:
- Resistance arterioles
- Capacitance venules
- Pump output heart
- Volume kidneys
- CNS- sympathetic nerves
4 Renin angiotensin aldosterone system (RAAS) antagonists
- Angiotensin-converting enzyme (ACE) inhibitors
- Angiotensin II receptor blocker (ARBs)
- Neprilysin inhibitor plus ARBs
- Aldosterone antagonists (Potassium sparing diuretics)
Pathway for renin angiotensin aldosterone system (RAAS)
Angiotensinogen (liver) Angiotensin I from renin (kidney) Angiotensin II from ACE (lungs) Arteriole vasoconstriction and adrenal cortex Aldosterone Sodium retention
What does ACE inhibit
Angiotensin I and bradykinin
5 common clinical uses for ACE inhibitors
- Heart failure
- CAD
- HTN
- Chronic renal disease with proteinuria
5 adverse effects from ACE inhibitors
- Increase serum potassium
- Acute renal failure
- Pregnancy
- Dry cough and angioedema (rare)
- Hypotension in patients with volume and/or salt depletion
What does ACE inhibitors drug name end with?
“pril”
What does ARBs inhibit?
Angiotensin II attaching to the receptors to allow for vasoconstriction and aldosterone secretion
4 common clinical uses for ARBs
- Heart failure
- CAD
- HTN
- Chronic kidney disease with proteinuria
When is ARBs most common used?
As an alternative to ACE inhibitors when patients develop dry cough
4 adverse effects for ARBs
- Increase serum potassium
- Acute renal failure
- Pregnancy
- Hypotension in patients with volume and/or salt depletion
What does ARBs dug name end in?
“sartan”
What does neprilysin inhibitor plus ARBs inhibit?
Block break down of peptides (valsartan and LBQ675)
Block angiotensin II connecting to it’s receptors
Common clinical uses for neprilysin inhibitor plus ARB
Heart failure
5 Adverse effects of neprilysin inhibitor plus ARB
Hyperkalemia Cough Angioedema Renal function deterioration Hypotension
3 Contraindications for neprilysin inhibitor plus ARB
36 hours of ACE inhibitors (angioedema)
Pregnancy
Bilateral renal artery stenosis
What does direct renin inhibitor (DRI) inhibit?
Renin
Clinical uses for DRI
HTN
What is DRI available to be in combo with?
Amlodipine + HCTZ
What is the is the drug name for DRI?
Aliskiren (tekturna)
5 Adverse effects for DRI
Hyperkalemia Angioedema Renal function deterioration Diarrhea Hypotension in patients with volume and/or salt depletion
2 Contraindications for DRI
Aliskiren with ARBs or ACEIs in patients with DM
Pregnancy
Risk of hyperkalemia and renal impairment elevates when DRI is used with what in DM patients?
ARBs and ACEIs
Aldosterone antagonists inhibit what?
Sodium and water retention
What 2 drugs are aldosterone antagonists
Spironolactone
Eplerenone
How does aldosterone antagonists increase BP?
Induce sodium and water retention
4 clinical uses for aldosterone antagonists
Hyperaldosteronism
Resistant HTN
Heart failure
MI with LV dysfunction
3 Adverse effects for aldosterone antagonists
Renal dysfunction
Hyperkalemia
Endocrine abnormalities
What can aldosterone antagonists cause?
Myocardial, renal, and vascular fibrosis
Contraindication for aldosterone antagonists
- SCr >2.5 (men) >2 (women)
2. Potassium >5
2 mechanism of actions for diuretics (decrease BP)
- Depleting body of sodium and H2O
2. Reducing blood volume (decrease SV)
6 types of diuretics
- Loop diuretics
- Thiazide diuretics
- Potassium sparing diuretics
- Osmotic diuretics
- Carbonic anhydrase inhibitors
- Vasopressin (ADH) antagonists
3 uses for loop diuretics
- Edematous
- Hyperkalemia
- HTN (2nd line)
7 Adverse effects for loop diuretics
- Na/volume depletion
- Hypokalemia
- Hypocalcemia
- Hypomagnesemia
- Metabolic alkalosis
- Hyperuricemia
- Ototoxicity
4 thiazides
Hydrochlorothiazide
Chlorthalidone
Indapamide
Metolazone
Is thiazide 1st or 2nd line to treat HTN?
First line
Is thiazide more or less potent than loops?
Less potent
8 adverse effects of thiazide
- Hypovolemia
- Hypokalemia
- Hypoatremia
- Hypochloremia
- Hypomagnesemia
- Hyperkalemia
- Hyperuricemia
- Metabolic alkalosis
2 different potassium sparing diuretics
Sodium channel blockers
Aldosterone receptor antagonists
Are potassium sparing diuretics weak or strong diuretics
Weak
What is the adverse effect for potassium sparing diuretics?
Hyperkalemia
What do central anti-adrenergics target?
Adrenergic neurons in CNS
What does central anti-adrenergics prevent?
Releasing of catecholamines
How is central anti-adrenergics controlled?
Negative feedback inhibition (alpha 2= inhibit NE release)
Where on the brain is the inhibitory effect on NE located at?
Prefrontal cortex
What drug is a central anti-adrenergic (alpha2 agonists)
Clonidine
What 4 things specifically lower BP in central anti-adrenergics?
- Lower venous return
- Lower TPR
- Lower HR
- Lower SV
What does methyldopa get converted into?
Methylnorepinephrine
What does methylnorepinephrine do when released?
NOT activate adrenergic receptors
CAN act on the alpha2 receptors (further inhibit NE release)
What is a big adverse effect of central anti-adrenergic?
Rebound HTN with withdrawal
4 clinical uses of central anti-adrenergic
- HTN (NOT 1st line and resistant HTN)
- ADHD
- HTN in pregnancy
- Treatment of withdrawal
2 non-selective alpha antagonists
Phenoxybenzamine
Phentolamine