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Cardio > Antihypertensive > Flashcards

Antihypertensive Flashcards

1
Q

Baroreceptor Reflex

A

1) system senses pressure
2) parasympathetic bradycardia
3) sympathetic tachycardia
4) sympathetics increase epi and norepi from adrenals
(not useful for controlling blood pressure)

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2
Q

Filtration Properties

A 
120ml/min
1-2ml/min lost
98% Na+ re absorption
-70%in Proximal Tubule
-25% in Thick ascending limb
-5% in Distal Tubule
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3
Q

Loop Diuretic Mechanism

A

Blockade of Na+ transport in thick ascending limb
Increase waterloss
POWERFUL diuresis
can reset impaired renal function
venodilation
generally TOO POWERFUL but useful in RENAL PROBLEMS

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4
Q

Loop Diuretic Drugs

A

Ethacryinic Acid (rare and only non-sulphonamide)
Furosemide
Bumetanide
Torsemide

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5
Q

Furosemide

A

Loop Diuretic: most common, oral, short duration

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6
Q

Bumetanide

A

Loop Diuretic: similiar to Furosemide with increased potency

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7
Q

Torsemide

A

Loop Diuretic: similiar to Furosemide with increased potency

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8
Q

Thiazide Diuretic Mechanism

A

block reabsorption in distal tubule
SLIGHT diuresis
active orally
sustained action
USEFUL in people with NORMAL RENAL FUNCTION
(poor efficacy in impaired renal function)
African Americans have best response

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9
Q

Thiazide Diuretic Drugs

A 
Chlorthiazide
Hydrochlorthiazide
Clorthalidone
Metolazone
Indapamide
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10
Q

Chlorthiazide

A

Thiazide Diuretic: low bioaviliability

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11
Q

Hydrochlorthiazide

A

Thiazide Diuretic: commonly used

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12
Q

Clorthalidone

A

Thiazide Diuretic: slowly absorbed, long duration

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13
Q

Metolazone

A

Thiazide Diuretic: can be used in reduced renal function

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14
Q

Indapamide

A

Thiazide Diuretic: prominent vasodilation

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15
Q

Thiazide Diuretic Side Effects

A

hypokalemia + metabolic acidosis
Hyponatremia
increased serum glucose, cholesterol, triglycerides

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16
Q

Potassium Sparing Diuretic Mechanism

A

WEAK diuresis
No potassium excretion
No hypokalemia
Aldosterone Antagonists and Na+ permeability inhibitors

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17
Q

Aldosterone Antagonists

A

Block alderstone receptors
DECREASE MORTALITY
can cause hyperkalemia
Spironolactone, Eplerenone

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18
Q

Spironolactone

A

Aldosterone Antagonists: can cause gynecomastia

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19
Q

Eplerenone

A

Aldosterone Antagonists: no gynecomastia

20
Q

Na+ Permeability Inhibitors

A

block reabsorption in end of distal tubulecan cause hyperkalemia
Triamterene
Amiloride, Triamterene

21
Q

Amiloride

A

Na+ Permeability Inhibitor: Renal metabolism

22
Q

Triamterene

A

Na+ Permeability Inhibitor: Hepatic metabolism

23
Q

Angiotensin II

A

Increased peripheral resistance, increased blood volume, increased sympathetic activity

24
Q

Bradykinin

A

increased vasodilation through increased NO and increased prostaglandins

25
Q

ACE Inhibitor Mechanism

A

Blocks angiotensin converting enzyme (decreased Angiotensin II and increased Bradykinin)
In LV failure NO decreased BP w/ increased CO
In normal heart decreased BP w/ NO change in CO
Improves pulmonary congestion

26
Q

ACE Inhibitor Drugs

A
  • Anything ending in april

ex: Benzapril, Quinaprill

27
Q

ACE Inhibitor Side Effects

A

DRY COUGH, hyperkalemia, renal insufficiency, hypotension from volume depletion

28
Q

ACE Receptor Blockers

A
  • Blocks angiotensin converting enzyme but NO bradykinin
  • Use if cough from ACE Inh is prohibitive
  • anything ending in artan
    ex: Valsartan, Irbesartan
29
Q

ACE Receptor Blocker Side Effects

A

Same as ACE Inh.

30
Q

a2-adrenergic agonist mechanism

A
  • Blocks sympathetic response from spinal cord to ganglia

- NOT FREQUENTLY USED

31
Q

a2-adrenergic agonist drugs

A

Methyldopa

Clonidine

32
Q

a2-adrenergic agonist side effects

A

dry mouth
sedation
-VERY COMMON EFFECTS LIMITING DRUG USE

33
Q

a1-blocker mechanism

A

blocks a1 adrenergic receptors

34
Q

a1-blocker drugs

A

Prazosin
Terazosin
Doxazosin

35
Q

a1-blocker side effects

A

POSTURAL HYPOTENSION

increased in adverse outcomes vs thiazide

36
Q

Hydralazine

A
  • Opens up arteries
  • Fall in pressure, but reflex increase in HR
  • Must be given in tandem with drug to slow HR
  • Rarely Used
37
Q

Minoxidil

A
  • Open up potassium channels, causing a decrease in pressure
  • reflex HR increase
  • used in people who fail standard treatment
38
Q

Nitroprusside

A
  • dilates arteries and veins
  • rapid action and high potency
  • reflex tachycardia
  • only used in emergency situations
39
Q

Don’t forget about B-Blockers and Ca+2 blockers

A

The best and most beautiful things in the world cannot be seen or even touched - they must be felt with the heart.
Helen Keller

40
Q

Sildenafil

A

If your results last more than 3 awesome hours please call you doctor. Wait, that’s not right.

41
Q

Sildenafil

A
  • decreases vascular resistance
  • mainly used in pulmonary hypertension
  • SEVERE HYPOTENSION if used with NITRATES
42
Q

Hypertension Beginning Treatment Plan

A

1) Control underlying condition and factors

2) Thiazide

43
Q

Hypertension Treatment Plan with Cardiac Factors

A

Thiazide + B-blocker or ACE or mineralocorticoid

44
Q

Hypertension Treatment Plan with Diabetic Factors

A

Thiazide + ACE or Ca+2 blocker

45
Q

Hypertension Treatment Plan with Kidney Factors

A

Thiazide + ACE

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