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Pharmacology > Antihypertensive > Flashcards

Antihypertensive Flashcards

1
Q

• Hypertension is the most common

A

CV disease

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2
Q

Management of hypertension
Non-pharmacologic management; includes
4 things

A
  • -Diet(increase consumption of potassium and calcium with moderate decrease in sodium intake).
  • -Exercise.
  • -Weight reduction.
  • -Stop smoking & alcohol intake
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3
Q

Management of hypertension
Pharmacologic:
5 things

A
  • Diuretics.
  • Sympatholytics.
  • Calcium channel blockers (CCBs)
  • Inhibitors of angiotensin (ACEI &ARAs/ARBs).
  • Direct vasodilators
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4
Q

Hypertension cause ———- like ——-4things

A 
Target organ damage 
cerebrovascular accidents
congestive heart failure
MI
renal damage
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5
Q

Inc. CO affect ————more

A

Systolic pressure

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6
Q

Inc. PR affect ——–more

A

Diastolic pressure

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7
Q

• Normal regulation of BP:

BP=—————-

A

COXPR

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8
Q

Hypertension : 5-10% is secondary to ————

9 things

A 
renal disease
pheochromocytoma
Cushing
hyperaldosteronism or drugs (either VC as phenylephrine in flu medication 
volume expanders as glucocorticoids
NSAlDs and oral contraceptives
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9
Q

Essential or primary where no———–

A

where no specific cause can be found.

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10
Q

chronic use of Morphine cause ———-

A

Salt and Water retention which cause hypertension

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11
Q
  • Normal regulation of BP:

* CO= ————-

A

HR X stroke volume

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12
Q

• BP is regulated by:———————,

long term control ——————-

A
  • Baroreceptors: rapid, responsible for moment to moment control.
  • Renin angiotensin aldosterone system (RAAS): kidney is responsible for long term control of BP through this system.
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13
Q

Antihypertensive drugs act by —————–

A

interfering with these normal mechanisms.

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14
Q

Potassium is considered as ——–

A

Vasorelaxent

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15
Q

Smoking cause hypertension due to——

A

Nicotine which is vasoconstrictive

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16
Q

————-Act primarily by depleting body sodium stores thus reducing blood volume & CO.Peripheral resistance(PR) may ——————-

A

Diuretics - increase

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17
Q

Diuretic:Long term treatment causes CO to return to ———-while PR—–

A

normal - decrease

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18
Q

Diuretics: Thiazides are used in ————-to———– hypertension

A

mild to moderate

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19
Q

while loop diuretics are used in———— and in patients with———- or those ———–.

A

severe type- renal affection(not renal failure )-not responding to other diuretics

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20
Q

In more severe hypertension they are combined with —————–or———- to control tendency towards Na retention caused by these drugs—————

A

vasodilators (VDs) or sympatholytic agents- vasodilator and sympatholytic

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21
Q

The least expensive ———-

A

diuretics

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22
Q

Sympathoplegic or sympatholytic drugs :Centrally acting sympathoplegic drugs (—————):

A

alpha methyl dopa & clonidine

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23
Q

centrally acting Sympathoplegic or sympatholytic have mechanism :2 things

A
  • decerese sympathetic outflow from vasopressor centers in the brain stem
  • Bind to central alpha2 adrenoceptors(dec. norepinephrine) ( decreasing central sympathetic outflow)
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24
Q

1st choice in hypertensive pregnant patients is ————–

A

alpha methyl dopa

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25
Q

Side effects of Alpha methyl dopa :9 things

A

CNS adverse effects: night mares, depression, sedation, extra pyramidal symptoms.
Hemolytic anemia, hepatitis, systemic Lupus Erythematosis (SLE) & positive Coomb’s test. Lactation (hyperprolactinemia).

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26
Q

drug use in hypertension with renal failure

A

clonidine

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27
Q

ß-adrenoceptor blockers like ——

A

propanolol

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28
Q

• Mechanism of action of beta adreno receptor blocker

4 things

A
  • dec HR, contractility and CO primarily.
  • dec central sympathetic outflow.
  • dec Renin release.
  • decPR
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29
Q

Advantages of Betadrenoreceptor blocker

A
  • dec morbidity & mortality & protect against heart disease.
  • Relatively not expensive.
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30
Q

• Indications of using beta-adrenoreceptor blocker

5 things

A

• Hypertension complicated with myocardial infarction, angina, supraventricular dysrhythmia, migraine, essential tremors

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31
Q

we dont give diuretic at night, we give it early in the morning, why ?

A

to make pateint sleep عشان لا يحشر

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32
Q

pateint has hypertension and renal failure , what would you get him to have ?

A

clonidine

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33
Q

adverse effects of clonidine ?

4 things

A
  • Dry mouth, sedation, depression.

* Sudden withdrawal *hypenensive crisis (treated by alpha & beta blockers).

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34
Q

Sudden withdrawal of Clonidine treated by ——— and ——-

A

alpha and beta blokers

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35
Q

ß-adrenoceptor blockers for hypertension act on which receptor —–

A

beta 1

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36
Q

• Adverse effects of beta-adrenoceptor blockers :

6 things

A

1- CNS: depression, fatigue, insomnia.
2-Bradycardia & hypotension.
3-dec libido & impotence in males (dec compliance)
4-Glucose intolerance (mask signs and symptoms of hypoglycemia and delay recovery from hypoglycemia in IDD) & dyslipidemia
5-Brochospasm, cold extremities, heart block (less with ßl selective).
6-Abrupt(sudden) withdrawal —rebound hypertension, nervousness, myocardial infarction may occur(must be withdrawn over 2-3weeks)

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37
Q

betadrenorecetpor blocker must be withdrawn over —–to——–weeks

A

2-3 weeks

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38
Q

any thing affect libido means it affect on ————–receptor

A

alpha and beta receptor

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39
Q

Someone has hypertension and prostatic hyperplasia, what drug can he use ?

A

prazosin & doxazosin

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40
Q

• Selective alpha1 blockers as ———-and———-

A

prazosin & doxazosin

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41
Q

————————–cause less reflex tachycardia (as they allow norepinephrine to exert feed back inhibition on its own release through unblocked a2) than non-selective a blockers like ———- that use for hypertension cause by ——–

A
  • Selective alpha 1 blockers as prazosin & doxazosin

- phenoxybenzamine - pheochromocytoma

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42
Q

alpha-adrenoceptor blocker act by blocking alpha1 receptors———– in—————— and ———-PR

A

arterioles -venules- decrease

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43
Q

adverse effects of alpha-adrenoceptor?

3 things

A
  • Postural hypotension occurs with these drugs.
  • Also salt & water retention headache and nasal congestion may occur.
  • Sexual dysfunction in males may occur
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44
Q

alpha-adrenoceptors may be combined with ———————or—————-

A

with diuretic or beta blocker (for tachycardia).

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45
Q

alpha-adrenoceptor blocker Indicated in patients with prostatic hypertrophy ( ————–but has a ——antihypertensive activity).

A

tamsulosin-weak

46
Q

Labetalol and———–block both al and ß adrenoceptors

A

carvedilol

47
Q

What is the type of alpha receptor that found in base of bladder and prostatic gland ?

48
Q

—————–producing peripheral vasodilatation, thereby reducing blood pressure

A

a and ß adrenoceptor blockers like

• Labetalol and carvedilol

49
Q

———-is the drug of choice in athletic hypertensive patients

50
Q

————–decreases lipid peroxidation and endothelial dysfunction thus having benefits in patients with heart failure.

A

• Carvedilol

51
Q

• They do not alter blood glucose or serum lipids

A

a and ß adrenoceptor blockers like

• Labetalol and carvedilol

52
Q

————- is used treatment of hypertensive emergencies

53
Q

———-an alternative to methyl dopa in pregnant hypertensive patients.

54
Q

• Adverse effects of a and ß adrenoceptor blockers like
• Labetalol and carvedilol ?
2 things

A

postural hypotension and dizziness.

55
Q

————-Block al subunit of L-tvpe channel located in conductive tissues (SAN, AVN), cardiac myocytes & vascular smooth muscles including coronaries lead to smooth muscle—— &———- of arterioles.

A

CaIcium channel blockers (CCBs)-relaxation-dilatation

56
Q

Dihydropyridines (DHP): ———- (short acting), ——,——and—— (long acting).
• All have a much greater affinity for vascular calcium channels than for calcium channels in the heart

A

nifedipine-amlodipine, nicardipine, felodipine

57
Q

in marked tachycardia & acute myocardial ischemia in coronary disease (————)bad side effect of short acting .which drug ?

A

nifedipine

58
Q

CCBs —–heart rate , —— contractility , vaso——

A

dec-dec-vasodilation

59
Q

Dihydropyridines (DHP): works more on

A

Vascular smooth muscle

60
Q

———— never use with hypertension because it cause marked tachycardia & acute myocardial ischemia in coronary disease

A

Nifedipine

61
Q

• Amlodipine(2nd generation) Adverse effects

5 things

A

hypotension, headache, flushing, lower limb edema and fewer interactions.

62
Q

Non-DHP include 2 classes————and————

A

verapamil and Diltiazm

63
Q

Verapamil is —————depressor act mainly on ———

A

myocardium

64
Q

————–Used in angina, prophylaxis in supraventricular tachycardia and migraine

65
Q

———with digoxin —it inc. level of digoxin(Toxcitiy) as a result of decreased tissue binding binding and dec. excretion

A

• Verapamil

66
Q

• Verapamil adverse effects ? 3 things

A

• Causes constipation(impo), bradycardia & heart block

67
Q

——————-contraindicated in any one have AV conduction abnormalties

68
Q

—————–contraindicated in patient has brnochial asthma and hypertension but can has CCBs —————we don’t give them verabmil and diltiazem because they are —————

A

Beta blocker- Amlodipine- cardiac depressent

69
Q

we dont give CCBs with ————because they both myocardial depressent except the 1st grop of CCBs because it act mainly on————

A

Beta blocker-blood vessels

70
Q

Diltiazem Affects both ————-and———

A

vascular & cardiac tissues

71
Q

• Diltiazem has——– negative inotropic effect than verapamil

72
Q

Side effects of Diltiazem ? 3 things

A

• Causes CHF, bradycardia & heart block

73
Q

Angiotensin converting enzyme inhibitors (ACEls):

• e.g. 5 things

A

Captopril(not a prodrug) ,EnalapriI, perindopril, and fosinopril& Lisinopril

74
Q

•————–mechanism of action :Vasodilatation due to inhibition of ACE and decreased conversion of angiotensin I to Il, also by increasing vasodilator bradykinin,•Inhibition of aldosterone lead to Na+ loss

75
Q

Adverse effects of ACEIs ?

6 things

A

1-Initial hypotension (start with a small dose at bed time).
2-Acute angioedema & chronic dry cough (t BK).
3-Hyperkalemia (potassium supplement or spironolactone are Cl).
4-Renal impairment (in renal artery stenosis, high renin states as CHF).
5-Metallic taste (captopril), neutropenia in some
cases.
6-Fetotoxic (Cl in pregnancy) (Teratogenic)

76
Q

Patient has hypertension and nephropathy, what drug should he has ?

77
Q

Angiotensin Il receptor blockers (ARBs) :

• ———– is the prototype

78
Q

block angiotensin Il receptor I (ATI) responsible for most damaging effects of ———–—VD & block secretion.

A

angiotensinIl-aldosterone

79
Q

ACEIs contraindicated in —————-

80
Q

in ARBs there is —————–bradykinin production that lead to ——– angeioedema or cough but other adverse effects as ACEIs and contraindicated in —————

A

no -no - pegnancy

81
Q

————-Relax vascular smooth muscle lead to ——- resistance lead to ———-BP

A

Vasodilators- dec - dec

82
Q

chronic use of Vasodilators lead to —————due to

———————————-lead to

A

tolerance-reflex activation of sympathetic and RAAS -reflex tachycardia , salt & water retention

83
Q

Vasodilators must be combined with ——— to dec. Tachycardia and —— for edema

A

Beta blocker and Diuretic

84
Q

Vasodilator

————–Arteriolar VD, used in moderately sever hypertension.

A

Hydralazine

85
Q

Vasodilator

headache, flushing, sweating, angina, Lupus syndrome (high dose) are Adverse effect of ————–

A

Hydralazine

86
Q

Vasodilator

•———Used as monotherapy (1st choice) in sever hypertension with pregnancy

A

Hydralazine

87
Q

Vasodilator

——- Arteriolar VD , used in sever hypertension.Causes hirsutism (used in treat of baldness).

88
Q

Vasodilator

———–Potent arteriolar and veinular VD lead to dec. preload and after load.

A

Sodium nitroprosside

89
Q

Vasodilator
————Immediate effect and very ——–action so given by IV infusion ( —— min)must be freshly prepared & protected from light by foil

A

Sodium nitroprosside - short -1

90
Q

Vasodilator
———-Causes sever hypotension (overdose) , and cyanide toxicity(treated by ———- less toxic thiocyanate excreted by the kidney). toxic if given —————–

A

dium nitroprosside-Na thiosulfate-orally

91
Q

Vasodilator

——————-: causes hyperglycemia

92
Q

• Hypertensive emergency:
• - If SBP is >———- mmHg or DBP is ——– combined with a complication as —————————-
—- — but not——- reduction in blood pressure is required.

A

210-130-encephalopathy, nephropathy, heart failure, retinal hemorrhage-Rapid -vigorous

93
Q

• All drugs must be given———— , as soon as reasonable blood pressure control is achieved, oral antihypertensive therapy should be substituted, because this allows smoother long-term management of hypertension

A

parenterally

94
Q

• The goal of treatment in the first few hours or days is not complete——— of blood pressure because chronic hypertension is associated with ———– in cerebral blood flow. Thus, rapid normalization of blood pressure may lead to cerebral——— and brain injury. Rather, blood pressure should be lowered by about—– , maintaining diastolic blood pressure at no less than ———— Hg. Subsequently, blood pressure can be reduced to normal levels using oral medications over several weeks

A

normalization- autoregulatory changes-hypoperfusion-25% -100-1 10 mm

95
Q

treatment of Hypertensive emergency —————

A

Sodium nitroprosside

96
Q

treatment of Hypertensive emergency:
a dopamine receptor 1 agonist —increase renal blood flow, especially effective in renal———- . Contraindicated in ————–

A

insufficiency-glaucoma

97
Q

treatment of Hypertensive emergency

Labetalol: a and ß———— .

98
Q

treatment of Hypertensive emergency
1-Nicardipine: a—————- .The major limitation of this drug in hypertensive emergency is its ———— half life which prevents rapid ————–of the dose
2-Nitroglycerine.
3- Diazoxide and hydralazine.
4-Diuretics to overcome volume expansion which occurs with powerful

A

CCB-long-titration- VDs

99
Q

pregnant women can use ————–for hypertension

100
Q

pregnant women can use during labor ( Preeclampsia) ——————

A

Labetalolo and Hydralazine

101
Q

Patient with DM can use low dose of ———
and —————-because that will —————and—————
they can also use ——————–

A

Thiazides
ACEIs / ARBs
Rilmenidine

102
Q

Diabetic patients sholudnt use full dose of ————– because that will lead to inc ——————–

A

Thiazides

glucose

103
Q

Asthma (COPD) pateints can use —————-(relax bronchi) and ————-and they should not use ——- special ——– because will cause————-

A

CCBs - Thiazides diuretics- BETA Blocker - non selective - Bronchospasm

104
Q

Angina patient should use —————–(of choice ) and —–

A

Beta Blockers - CCBs

105
Q

Angina patient shouldnot use ————–in vasoppspastic angina

A

Beta blocker

106
Q

CHF patient can use ——————- , ——————— ,————-
and should not use ———————,————–

A

ACEIs or ARBs - Diuretics , Spronolactone

Verapamil -Diltiazem

107
Q

Chronic kidney disease pateint should use ————————– , —————- in renal failure and should not use
———–,————-in renal hypoperfusion states

A

ACEIs and/or ARBs
Furosemide
not use : ACEIs and /or ARBs in renal hypoperfusion states

108
Q

preipheral vascular disease pateints can use ————– and they shouldn’t use —————–

A

CCBs

Beta blocker

109
Q

Isolated systolic hypertension can use ———–,————

A

Thiazide diuretics

CCBs

110
Q

Diabeteic or non diabetic pateint has nephropathy and hypertension can use ?

111
Q 
Most expensive class because it ----incidence of stroke by 25%
after blocking receptor----------it will work on --------------- and cause vaso--------------and has antithrombotic and antiplatelet effect
A

Angiotension 2 type 1 receptor blocker- Dec-1 -2-dilation

Pharmacology (6 decks)

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