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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
Ace inhibitors are contraindicated in
Pregnancy
26
ARBs are similar to ace inhibitors but…
Do not cause dry cough
27
Example of ARBs
Losartan
28
Mechanism of angiotensin II receptor blockers
Block receptors that angiotensin II activates, blocks ang II mediated vasoconstriction and release of aldosterone
29
Indications of angiotensin II receptor blockers
-hypertension -adjunctive agents for the treatment of HF -may be used alone or with other agents
30
angiotensin II receptor blockers are good alternatives for
Those who cannot tolerate ACE inhibitors
31
angiotensin II receptor blockers are contraindicated in
Pregnancy
32
calcium channel blockers deal with
-hypertension -angina -dysrhythmias
33
CCB: diltiazem
Benzothiazepine (cardiac + vascular)
34
CCB: verapamil
Phenylalkamines (cardiac + vascular)
35
CCB: Amlodipine, nifedipine
Dihydropyridines - DHPs (vascular selective)
36
CCBs on cardiac muscle
Block cardiac muscle Ca channels -alters electrical activity of cardiac muscle cells
37
Alters electrical activity of cardiac muscle cells affects
SA, AV, nodes and cardiac muscle
38
CCBs on vascular muscle
Inhibits Ca entry into arteriolar vascular smooth muscle cells -causes relaxation
39
CCBs on vascular muscle: decreased peripheral resistance
Decreased blood pressure
40
What does CCBs vascular muscle cause
-baroreceptor reflex -amlodipine -less with dilitazem/verapamil
41
Adverse effects of verapamil/diltiazem
-cardiovascular -gastrointestinal -skin
42
Adverse effects of verapamil/diltiazem: cardiovascular
-hypotension causing dizziness -flushing, peripheral edema
43
Adverse effects of verapamil/diltiazem: gastrointestinal
Constipation and nausea
44
Adverse effects of verapamil/diltiazem: other
Rash and dermis is
45
Adverse effects of DHPs
-cardiovascular -gastrointestinal -other
46
Adverse effects of DHPs: cardiovascular
-hypotension causing dizziness -palpitations -tachycardia -flushing -peripheral edema
47
Adverse effects of DHPs: gastrointestinal
Very little constipation
48
Adverse effects of DHPs: other
Rash and dermatitis
49
Thiazide diuretics
Decrease the plasma and Extracellular fluid volume
50
A decreased plasma and Extracellular fluid volume causes
Decreased preload, cardiac output and total peripheral resistance
51
Thiazide allow for decreased ____ of the heart and ____ blood pressure
-decreased workload of the heart -decreased blood pressure
52
Diuretics are the first line
For hypertensive drugs
53
Hydrochlorothiazide can cause
Possible hypokalemia
54
Chlorthalidone
Thiazide like diuretic -longer acting
55
What type of diuretic is preferred
Longer acting (thiazide like) drugs
56
What are longer acting- thiazide like drugs
Chlorthalidone, indapamide
57
What are shorter acting - thiazides
Hydrochlorothiazide
58
Recommended single pill combinations
-ACEI and CCB -ACEI and diuretic -ARB and diuretic -ARB and CCB
59
What are the four adrenoceptor subtypes to consider
A1, a2, b1, b2
60
B adrenergic receptor blockers act in
The periphery, mainly the heart
61
B adrenergic receptor blockers reduce/decrease
-heart rate -force of heart muscle contraction -stroke volume
62
B adrenergic receptor blockers act in the periphery of the heart… blocking the
Norepinephrine, epinephrine action in heart
63
B adrenergic receptor blockers examples
Metoprolol -atenolol, propranolol
64
Metoprolol and atenolol are
B1 selective
65
Propranolol is
Non selective
66
B blockers indications
-hypertension -HF -angina -dysrhythmias
67
B blockers are intolerance to
Exercise
68
B blockers are avoided in patients with
Asthma
69
Where do dual a1 and b receptor blocker act
In the periphery at heart and blood vessels
70
Dual a 1 and b receptor blockers reduce
Heart rate -b1 receptor blockade
71
Dual a1 and b receptor blockers cause
Vasodilation -a1 receptor blockade
72
Examples of dual a1 and b receptor blockers
Labetalol, carvedilol
73
Two adrenergic agents (agonists and antagonists)
-centrally acting a2 adrenoceptor agonists -peripherally acting a1 adrenoceptor antagonists
74
If blood pressure is not controlled consider (4)
-non adherence -secondary HTN -inferring drugs or lifestyle -white coat effect
75
If blood pressure is still not controlled or there are adverse effects other classes of anti hypertensive drugs may be combined such as…
Alpha blockers or centrally acting agents
76
Centrally acting a2 receptor agonists stimulate…
A2 adrenergic receptors in the brain stem
77
Stimulating a2 adrenergic receptors in the brain stem causes
Norepinephrine release to be decreased
78
Centrally acting a2 receptor agonists cause
SNS outflow from CNS to be decreased adn vasodilation -which will decrease blood pressure
79
Examples of centrally acting a2 receptor agonists
-clonidine -methyldopa
80
Clonidine
Rarely used -centrally acting a2 receptor agonists
81
Methyldopa
First line therapy for hypertension in pregnancy -pro drug
82
centrally acting a2 receptor agonists indications
Treatment of hypertension, either alone or with other agents
83
centrally acting a2 receptor agonists are usually used after
Other agents have failed or in combination with other drugs
84
Why are centrally acting a2 receptor agonists used after agents have failed or in cominbatino with other drugs?
-due to adverse effects -sedation and dry mouth
85
Peripherally a1 adrenoceptor antagonists block..
Block a1 adrenergic receptors AND NE contraction of blood vessels
86
Examples of Peripherally a1 adrenoceptor antagonists
Prazosin
87
Indications of Peripherally a1 adrenoceptor antagonists (3)
-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
Adverse effects of adrenergic agents - a receptors MOST COMMON
-dry mouth -drowsiness -sedation -constipation
89
Adverse effects of adrenergic agents - a receptors OTHER
-headaches -sleep disturbances -nausea -rash -cardiac disturbances
90
Adverse effects of adrenergic agents - a receptors have a high incidence of
Orthostatic hypotension
91
Mechanism of action for vasodilators
Directly relax arteriolar smooth msucle -peripheral vasodilation
92
Vasodilators indications
-treatment of hypertension -used in combination with other agents
93
Examples of vasodilators
-hydralazine -sodium nitroprusside
94
Sodium nitroprusside
IV sodium nitroprusside and diazoxide are reserved for management of hypertensive emergence’s
95
Hydralazine adverse effects
Dizziness, headache, anxiety, nausea, vomiting, diarrhea, anemia, dyspnea, edema, nasal congestion TACHYCARDIA
96
Sodium nitroprusside adverse effects
Bradycardia, possible cyanide toxicity HYPOTENSION
97
Vasodilators: drugs should not be
Stopped abruptly -as they may cause rebound hypertensive crisis, and perhaps lead to stroke
98
Clients should avoid
Smoking, eating foods high in sodium (tinned soups or packaged meals)
99
Instruct clients to
Change potions slowly to avoid syncope from postural hypotension
100
What would aggravate low blood pressure (things to stay away from)
Hot tubs, showers, baths, hot weather, prolonged sitting or standing, intense physical exercise, alcohol ingestion

Pharmacology (37 decks)

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