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Pharmacology > Antihypertensive Drugs (21, 47-50) > Flashcards

Antihypertensive Drugs (21, 47-50) Flashcards

1
Q

Cause of hypertension: unknown cause

A

Essential, idiopathic, primary hypertension
90% of the cases

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2
Q

Cause of hypertension: known cause

A

Secondary hypertension
10% of teh cases

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3
Q

What is the Number 1 leading risk for death in North America

A

Hypertension

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4
Q

Target organ damage of hypertension

A

-cerebrovascular disease’-hypertensive retinopathy
-left ventricular dysfunctions
-left ventricular hypertrophy
-corona artery disease
-chronic kidney disease
-peripheral artery disease

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5
Q

Benefits of treating hypertension: decrease in liklihood of…

A

-heart failure
-stroke
-heart attack
-death

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6
Q

What aids in reliving hypertension (other than drugs)

A

Lifestyle considerations
-obesity
-physical exercise

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7
Q

BP treatment targets: general population

A

< 140/90

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8
Q

BP treatment targets: high risk (CV disease)

A

< 120/NA

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9
Q

BP treatment targets: diabetics

A

< 130/80

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10
Q

Ace inhibtiors group of drugs

A

Large group of safe and effective drugs

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11
Q

Ace inhibitors are often used as + for

A

First line agents for HF and hypertension

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12
Q

What are Ace inhibitors often combined with

A

Thiazide diuretic or calcium channel blocker

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13
Q

Example of Ace inhibitors

A

Captopril

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14
Q

Ace inhibitors examples end in

A

PRIL

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15
Q

Captopril

A

Shortest half life of the prils

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16
Q

Indications of Ace inhibitors

A

-hypertension
-HF

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17
Q

Indications of Ace inhibitors: hypertension

A

May be used alone or with other agents
-renal protective effects in clients with diabetes

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18
Q

Indications of Ace inhibitors: HF

A

Drugs of choice in hypertensive clients with HF
-slows progression of left ventricular remodelling after an MI

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19
Q

Mechanisms of action Indications of Ace inhibitors

A

-prevents Ang II vasoconstriction
-prevents aldosterone release
-also prevents breakdown of bradykinin

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20
Q

Preventing ang II vasoconstriction causes

A

Reduction in peripheral resistance (afterload)

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21
Q

Preventing aldosterone release causes

A

Reduction in salt and water reabsorption

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22
Q

Preventing breakdown of bradykinin causes

A
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23
Q

Adverse effects of Ace inhibitors

A

-dry non productive cough
-first dose hypotension effect may occur
-Hyperkalemia

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24
Q

Interactions with Ace inhibitors

A

k supplements and K sparing diuretics

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25
Q

Ace inhibitors are contraindicated in

A

Pregnancy

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26
Q

ARBs are similar to ace inhibitors but…

A

Do not cause dry cough

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27
Q

Example of ARBs

A

Losartan

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28
Q

Mechanism of angiotensin II receptor blockers

A

Block receptors that angiotensin II activates, blocks ang II mediated vasoconstriction and release of aldosterone

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29
Q

Indications of angiotensin II receptor blockers

A

-hypertension
-adjunctive agents for the treatment of HF
-may be used alone or with other agents

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30
Q

angiotensin II receptor blockers are good alternatives for

A

Those who cannot tolerate ACE inhibitors

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31
Q

angiotensin II receptor blockers are contraindicated in

A

Pregnancy

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32
Q

calcium channel blockers deal with

A

-hypertension
-angina
-dysrhythmias

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33
Q

CCB: diltiazem

A

Benzothiazepine (cardiac + vascular)

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34
Q

CCB: verapamil

A

Phenylalkamines (cardiac + vascular)

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35
Q

CCB: Amlodipine, nifedipine

A

Dihydropyridines - DHPs (vascular selective)

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36
Q

CCBs on cardiac muscle

A

Block cardiac muscle Ca channels
-alters electrical activity of cardiac muscle cells

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37
Q

Alters electrical activity of cardiac muscle cells affects

A

SA, AV, nodes and cardiac muscle

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38
Q

CCBs on vascular muscle

A

Inhibits Ca entry into arteriolar vascular smooth muscle cells
-causes relaxation

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39
Q

CCBs on vascular muscle: decreased peripheral resistance

A

Decreased blood pressure

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40
Q

What does CCBs vascular muscle cause

A

-baroreceptor reflex
-amlodipine
-less with dilitazem/verapamil

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41
Q

Adverse effects of verapamil/diltiazem

A

-cardiovascular
-gastrointestinal
-skin

42
Q

Adverse effects of verapamil/diltiazem: cardiovascular

A

-hypotension causing dizziness
-flushing, peripheral edema

43
Q

Adverse effects of verapamil/diltiazem: gastrointestinal

A

Constipation and nausea

44
Q

Adverse effects of verapamil/diltiazem: other

A

Rash and dermis is

45
Q

Adverse effects of DHPs

A

-cardiovascular
-gastrointestinal
-other

46
Q

Adverse effects of DHPs: cardiovascular

A

-hypotension causing dizziness
-palpitations
-tachycardia
-flushing
-peripheral edema

47
Q

Adverse effects of DHPs: gastrointestinal

A

Very little constipation

48
Q

Adverse effects of DHPs: other

A

Rash and dermatitis

49
Q

Thiazide diuretics

A

Decrease the plasma and Extracellular fluid volume

50
Q

A decreased plasma and Extracellular fluid volume causes

A

Decreased preload, cardiac output and total peripheral resistance

51
Q

Thiazide allow for decreased ____ of the heart and ____ blood pressure

A

-decreased workload of the heart

-decreased blood pressure

52
Q

Diuretics are the first line

A

For hypertensive drugs

53
Q

Hydrochlorothiazide can cause

A

Possible hypokalemia

54
Q

Chlorthalidone

A

Thiazide like diuretic
-longer acting

55
Q

What type of diuretic is preferred

A

Longer acting (thiazide like) drugs

56
Q

What are longer acting- thiazide like drugs

A

Chlorthalidone, indapamide

57
Q

What are shorter acting - thiazides

A

Hydrochlorothiazide

58
Q

Recommended single pill combinations

A

-ACEI and CCB
-ACEI and diuretic
-ARB and diuretic
-ARB and CCB

59
Q

What are the four adrenoceptor subtypes to consider

A

A1, a2, b1, b2

60
Q

B adrenergic receptor blockers act in

A

The periphery, mainly the heart

61
Q

B adrenergic receptor blockers reduce/decrease

A

-heart rate
-force of heart muscle contraction
-stroke volume

62
Q

B adrenergic receptor blockers act in the periphery of the heart… blocking the

A

Norepinephrine, epinephrine action in heart

63
Q

B adrenergic receptor blockers examples

A

Metoprolol
-atenolol, propranolol

64
Q

Metoprolol and atenolol are

A

B1 selective

65
Q

Propranolol is

A

Non selective

66
Q

B blockers indications

A

-hypertension
-HF
-angina
-dysrhythmias

67
Q

B blockers are intolerance to

A

Exercise

68
Q

B blockers are avoided in patients with

A

Asthma

69
Q

Where do dual a1 and b receptor blocker act

A

In the periphery at heart and blood vessels

70
Q

Dual a 1 and b receptor blockers reduce

A

Heart rate
-b1 receptor blockade

71
Q

Dual a1 and b receptor blockers cause

A

Vasodilation
-a1 receptor blockade

72
Q

Examples of dual a1 and b receptor blockers

A

Labetalol, carvedilol

73
Q

Two adrenergic agents (agonists and antagonists)

A

-centrally acting a2 adrenoceptor agonists

-peripherally acting a1 adrenoceptor antagonists

74
Q

If blood pressure is not controlled consider (4)

A

-non adherence
-secondary HTN
-inferring drugs or lifestyle
-white coat effect

75
Q

If blood pressure is still not controlled or there are adverse effects other classes of anti hypertensive drugs may be combined such as…

A

Alpha blockers or centrally acting agents

76
Q

Centrally acting a2 receptor agonists stimulate…

A

A2 adrenergic receptors in the brain stem

77
Q

Stimulating a2 adrenergic receptors in the brain stem causes

A

Norepinephrine release to be decreased

78
Q

Centrally acting a2 receptor agonists cause

A

SNS outflow from CNS to be decreased adn vasodilation
-which will decrease blood pressure

79
Q

Examples of centrally acting a2 receptor agonists

A

-clonidine
-methyldopa

80
Q

Clonidine

A

Rarely used
-centrally acting a2 receptor agonists

81
Q

Methyldopa

A

First line therapy for hypertension in pregnancy
-pro drug

82
Q

centrally acting a2 receptor agonists indications

A

Treatment of hypertension, either alone or with other agents

83
Q

centrally acting a2 receptor agonists are usually used after

A

Other agents have failed or in combination with other drugs

84
Q

Why are centrally acting a2 receptor agonists used after agents have failed or in cominbatino with other drugs?

A

-due to adverse effects
-sedation and dry mouth

85
Q

Peripherally a1 adrenoceptor antagonists block..

A

Block a1 adrenergic receptors AND NE contraction of blood vessels

86
Q

Examples of Peripherally a1 adrenoceptor antagonists

A

Prazosin

87
Q

Indications of Peripherally a1 adrenoceptor antagonists (3)

A

-treatment of hypertension (not 1st line)

-relief of symptoms of BPH (benign prostatic hypertrophy)

-management of severe HF when used with cardiac glycosides and diuretics

88
Q

Adverse effects of adrenergic agents - a receptors MOST COMMON

A

-dry mouth
-drowsiness
-sedation
-constipation

89
Q

Adverse effects of adrenergic agents - a receptors
OTHER

A

-headaches
-sleep disturbances
-nausea
-rash
-cardiac disturbances

90
Q

Adverse effects of adrenergic agents - a receptors have a high incidence of

A

Orthostatic hypotension

91
Q

Mechanism of action for vasodilators

A

Directly relax arteriolar smooth msucle
-peripheral vasodilation

92
Q

Vasodilators indications

A

-treatment of hypertension
-used in combination with other agents

93
Q

Examples of vasodilators

A

-hydralazine
-sodium nitroprusside

94
Q

Sodium nitroprusside

A

IV sodium nitroprusside and diazoxide are reserved for management of hypertensive emergence’s

95
Q

Hydralazine adverse effects

A

Dizziness, headache, anxiety, nausea, vomiting, diarrhea, anemia, dyspnea, edema, nasal congestion

TACHYCARDIA

96
Q

Sodium nitroprusside adverse effects

A

Bradycardia, possible cyanide toxicity

HYPOTENSION

97
Q

Vasodilators: drugs should not be

A

Stopped abruptly
-as they may cause rebound hypertensive crisis, and perhaps lead to stroke

98
Q

Clients should avoid

A

Smoking, eating foods high in sodium (tinned soups or packaged meals)

99
Q

Instruct clients to

A

Change potions slowly to avoid syncope from postural hypotension

100
Q

What would aggravate low blood pressure (things to stay away from)

A

Hot tubs, showers, baths, hot weather, prolonged sitting or standing, intense physical exercise, alcohol ingestion

Pharmacology (23 decks)

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