Antihypertensive Meds Flashcards
What is the definition of stage I hypertension?
SBP btw 140-159
DBP btw 90-99
What is the definition of stage 2 hypertension?
SBP over 160; DBP over 100
What are the 5 potential targets for antihypertensive therapy?
- Heart (decr. contractility and HR)
- Arteries/arterioles (decr. TPR)
- Veins (incr. capacitance, decr. preload)
- Kidneys (decr. fluid)
- CNS (regulatory systems)
What class of drug is frequently the first line antihypertensive drug?
thiazide diuretic
What is the general treatment goal for hypertension? What if the pt is diabetic?
goal: 140/90
diabetic goal: 130/90
Diuretics: what do they all have in common? advantages?
all promote Na and H2O loss
good for elderly, those w chronic renal failure and CHF
good for combo therapy
inexpensive
What is a prototypical loop diuretic?
lasix/furosimide
How do loop diuretics work?
inhibition of the Na-K-2Cl cotransporter in the thick ascending limb (the countercurrent multiplier. this keeps more fluid in the tubule –> more water lost in urine
most are short acting
remember, example of loop diuretic is lasix/furosimide
How do thiazide diuretics work?
inhibit the Na-Cl cotransporter in the distal convoluted tubule. promotes sodium loss. relatively long duration.
What do diuretics of the collecting tubule do?
aka potassium-sparing diuretics
act on the principal cells of the late DCT, collecting tubule and collecting duct.
What are the three key side effects of loop diuretics?
hyperuricemia
impaired glucose tolerance
ototoxicity
What are four main side effects of thiazide diuretics?
hypercalcemia
hyperuricemia
imparied glucose tolerance
pancreatitis
What are two side effects of potassium sparing/colleting tubule diuretics?
hyperkalemia and gynecomastia
describe the renin/angiotensin cascade.
angiotensinogen converted to angiotensin I by renin from juxtoglomerular cells in kindey that detect low bp.
angiotensin I converted to angiotensin II by ACE (angiotensin converting enzyme)
angiotensin II
angiotensin II is a potent chemical that raises bp. these effects are mediated by angiotensin II receptors.
What are the main effects of ACE inhibitors?
decr. angiotensin II-mediated vasoconstriction and resistance. little effect on heart (angiotensin II generated by methods that don’t use ACE)
What are some long-term effects of ACE inhibitors?
decr. NE release from peripheral nerves
incr. bradykinin
decr. aldo secretion (less Na and water retention)
incr. renal blood flow (and are sometimes renal protective)
incr. vasodilatory prostaglandins
What is the suffix for an ACE inhibitor drug?
-pril
What are some benefits of ACE inhibitors and ARBs?
BP reduction, less LV hypertrophy, less afterload for pts with CHF, good for remodeling after MI, slower progression of DM nephropathy
What are two side effects sometimes seen with ACE inhibitors?
dry cough
angioedema
What are the main contraindications for ACE inhibitors and ARBs?
PREGNANCY
major renal problems (renal artery stenosis, severe renal insufficiency)
What are ARBs?
stand for angiotensin receptor blockers
the are competitive antagonists of angiotensin II at AT1 receptors.
What is the deal with non-selective alpha blockers? What is the main example? How are they used?
PBZ (pnehoxybenzamine) is the main non-selective alpha blocker
it is a noncompetitive oral drug
lots of side effects: basically only used for phenochromocytoma
What is the deal with selective alpha 1 blockers? side effects?
like other classes, they do reduce bp. may also help with cholesterol profile, incr. insulin sensitivity
side effects: very rapid first dose response. can cause syncope, ED
What are the four net effects of beta blockers?
- decr. contractility
- decr. HR
- decr. renin/angiotensin/aldo
- decr. cardiac output
