Antihypertensives Flashcards
What are normal blood pressure values?
<120/80
What is prehypertension?
120-139/80-89
What are hypertensive blood values?
> 140/90
T/F Hypertension can include only high values on systolic and diastolic pressures.
FALSE; if you have systolic or diastolic high, then it is considered hypertension.
What are some “classes” that differ in BP values?
- Gender (post-menopausal women have higher BP than men, pre-menopausal women have lower BP than men)
- Race (AA have higher BP than white counterparts)
- Age (elderly individuals have higher BP than younger counterparts)
What percentage of patients get adequate treatment in HTN?
50%
What is essential to diagnose HTN?
Screening programs
What diseases or drugs contribute to Secondary HTN? (6)
(1) Renal disease
(2) Endocrine disease
(3) Hyperthyroidism (increased CO)
(4) Narrowing of aorta (coarctation)
(5) Toxemia of pregnancy
(6) Oral contraceptives (2-3x more than the others- especially in obese and older women)
What are the factors for Essential HTN? (5)
(1) Alterations in cardiovascular control
(2) Humoral factors: R-A-A, catecholamines
(3) Genetic factors (30%)
(4) Life-style: SALT, diet, weight, working conditions
(5) Psychogenic factors (STRESS)
What are the multi-target complications of HTN? (5)
(1) Brain: Hemorrhage, stroke
(2) Eye: Retinopathy
(3) Vasculature: Peripheral vascular disease (atherosclerosis)
(4) Kidney: renal failure (nephrosclerosis)
(5) Heart: heart disease
In the presence of this disease, all complications of HTN become worse in what situation?
Diabetes
What are the increased work loads on the heart during HTN?
(1) L.V. hypertrophy (enlargement)
(2) Ischemic Heart disease –> M.I.
(3) Heart Failure (10-20% of all deaths)
What are the 4 anatomic sites of blood pressure control?
(1) Resistance- arterioles
(2) Capacitance- venules
(3) Pump Output- heart
(4) Volume- KIDNEYS
What are the 2 BP control mechanism in HTN patients?
(1) Baroreceptors
(2) Renal blood volume- pressure control systems
What happens to these BP control mechanisms in HTN patients?
The baroreceptors and renal blood volume systems are at a higher value (therefore, HTN remains)
What is the short-term BP mechanism?
Baroreflexes (moment-to-moment adjustments)
What is the long-term BP mechanism?
Kidneys (intravascular blood volume)
How many classes of drugs are there to treat HTN?
10
What are the major sites of action of Antihypertensive drugs?
(1) SNS (CNS also)
(2) Renal loop
(3) Vascular smooth muscle
What are some aspects of non-pharmalogical therapy of HTN? (8)
(1) Low sodium chloride diet
(2) Weight reduction
(3) Exercise
(4) Cessation of smoking
(5) Decrease in excessive alcohol consumption
(6) Psychological methods (e.g. relaxation)
(7) Dietary increase in polyunsaturated fat intake
(8) Dietary increase in fruits, vegetables
What are the Non-selective and Beta-1 selective Beta-Blockers?
(1) Propranol: Nonselective
(2) Metoprolol: B-1 selective
What are the responses to Beta-blockers (Propranolol, Metoprolol)? Which one is predominant?
- *(1) Decrease contractility, HR, CO, BP**
(2) Decrease renin release, prevents ANG-II formation, decrease BP
What are the precautions for Beta-blockers?
(1) Heart failure
(2) Diabetes- interferes with glucose metabolism
(3) Asthma
What are the adverse effects of Beta-blockers?
(1) Fatigue, disturbing dreams, nausea
(2) GI discomfort
(3) Insomnia
(4) Occasional impotence
What Beta-blocker are the asthmatics prescribed? Why?
Metoprolol; because the non-selective beta-blockers will antagonise B-2 as well and cause bronchial constriction
What are the Thiazide Diuretics?
Hydrochlorothiazide
What does Hydrochlorothiazide do?
(1) Inhibits Na transport by depleting Na stores (decreases the constrictor response)
(2) Decreases blood volume, CO, BP
(3) Chronic use: decrease PR, BP
What are the adverse effects of Hydrochlorothiazide?
(1) Hypokalemia
(2) Drowsiness
(3) Increase LDL cholesterol
(4) Apathy
What happens when you use Hydrochlorothiazide over 6-8 weeks?
The CO goes back to normal, yet you have a decrease in peripheral resistance that in turn keep the decrease in BP
What are the ACE inhibitors? What does ACE stand for?
(1) Captopril
(2) Enalapril;
Angiotensin Converting Enzyme
<p>
| What are the responses of ACE inhibitors? Which one is most important?</p>
<p>
**(1) Decrease formation of ANG II: decreases PR** (2) Blocks release of aldosterone (slight decrease in blood volume) (3) Increases bradykinin release- increased vasodilation</p>
Which ACE inhibitor has a longer duration?
Enalapril
T/F There is a CNS effect in ACE inhibitors.
FALSE
Which drugs are used to also treat congestive heart failure?
(1) ACE inhibitors
(2) Angiotension II Receptor Antagonists
What are the limitations of ACE inhibitors?
Cannot give to pregnant/nursing mothers (fetal/neonatal morbidity and mortality)
What are the adverse effects of ACE inhibitors?
(1) Coughing (5-20% pts)
(2) Reversible rash
(3) Taste alteration
(4) Hyperkalemia
What are the Angiotensin II Receptor Antagonists? Is it selective or non-selective?
Losartan; selective
What responses does Losartan have?
(1) Decrease PR and BP
2) Decrease aldosterone release (slight decrease in blood volume
What is the different between ACE inhibitors and Ang-II receptor antagonists in reference to response?
Losartan (Ang-II receptor antagonist) has NO change in bradykinin levels
What are the limitations of Losartan?
Cannot give to pregnant/nursing mother
What are the calcium entry blockers?
(1) Verapamil
(2) Diltiazem
(3) Nifedipine
What do calcium channel blockers do?
Blocks Ca entry into the cells (L-type channels in the heart and some in smooth muscle)
What are the responses of calcium channel blockers?
(1) Vascular smooth muscle: Decrease PR, BP (N>V>D)
2) Cardiac muscle: Decrease contractility, decrease CO (V>N
Which calcium channel blocker has a mild reflex tachycardia?
Nifedipine
What population should not be given calcium entry blockers (Verap/Dil)? Why?
Elderly; because the blunt in reflex tachycardia can lead to heart disease
What are the limitations of calcium channel blockers?
(1) SA or AV nodal abnormalities
2) Congestive heart failure (Verapamil, Diltiazem
What are the adverse effects for Verapamil, Nifedipind, Diltiazem?
V- Constipation
N- Headache, flushing, dizziness
D and V- Bradycardia
What are the selective alpha-blockers?
Prazosin
What are the responses for Prazosin?
(1) Decrease PR, BP
(2) Minimal reflex tachycardia
(3) May increase blood volume
What are the adverse effects of Prazosin?
(1) First dose hypotension
(2) Dizziness, fatigue
What is the lipid profile for Prazosin?
High LDL and high HDL
What are the 2 CNS acting drugs? Which one acts on both the CNS and heart?
(1) Alpha-methyldopa
* *(2) Clonidine**
What are the responses to CNS acting drugs? Are they selective?
They are selective alpha-2 agonists
(1) A-methyldopa: Decrease PR –> decrease BP
(2) Clonidine: decrease sympathetic drive to the heart- decrease contractility, HR –>CO
What are the adverse effects of CNS acting drugs?
(1) Sedation, vertigo, nightmares, drug fever, dry mouth
(2) Increased water retention
What is commonly given with CNS acting drugs?
Diuretics
T/F Alpha-methyldopa is not safe for pregnant/nursing mothers.
FALSE
Which drug potentiates anti-hypertension action of other drugs?
Thiazide diuretics (Hydrochlorothiazide)
What do you occasionally see in CNS acting drugs?
Postural hypotension, impotence
What are the Vasodilators?
Hydralazine and Minoxidil
What are the vasodilators used for?
moderate, severe hypertension
What do Hydralazine and Minoxidil do?
- Dilates arteries, arterioles > veins
- Increases NO which activates guanylyl cyclase in smooth muscles
- Increases cGMP –> dilation (decreased PR and BP)
What are the responses of Hydralazine and Minoxidil?
- Reflex activity: increase HR, contractility –> increases CO
- Increases renin, angil, and aldosterone
- increases water retention
What do you need to use in combination with Hydralazine and Minoxidil?
Beta-blockers and diuretics
What are the adverse effects of Vasodilators (Hydralazine and Minoxidil)
(1) Headache
(2) Sweating
(3 Dizziness
(4) Flushing
(5) Nausea
(6) Tachycardia
(7) lupus like syndrome (fever, joint pain)
What is associated as another effect of Minoxidil? (that does not have to do with the heart)
It causes hair growth
What are the conditions that require rapid blood pressure reduction? (8)
(1) “Malignant” hypertension
(2) Pheochromocytoma
(3) Hypertensive encephalopathy
(4) Refractory hypertension of pregnancy
(5) Acute left ventricular failure
(6) Aortic dissection
(7) Coronary insufficiency
(8) Intracranial hemorrhage
What are the two drugs that you use for hypertensive emergencies?
(1) Na Nitroprusside
(2) Labetolol
What type of drug is Na Nitroprusside?
Nonselective vasodilator
How is Na Nitroprusside given? When is it given?
IV; for emergency use only because it as a rapid decrease in BP
What responses does Na Nitroprusside do?
Dilates arterioles and veins equally
- decreases PR and BP
T/F Reflex tachycardia in Na Nitroprusside is significant.
FALSE
What are the adverse reactions of Na Nitroprusside? What does chronic use cause?
Hypotension (Nausea, vomiting, nervousness); psychosis
What type of drug is Labetolol?
Combo
- non-selective beta blocker
- selective alpha-1 blocker
What are the responses of Labetolol?
- decrease PR: decreases BP (alpha) and Renin (beta)
- not consistent decrease in HP and CO
How is Labetolol taken?
Oral or IV
What are the adverse effects of Labetolol?
(1) Hypotension
(2) GI disturbances
(3) Fatigue
(4) Nervousness
What is the Adrenergic Neuron Blocking Agent?
Reserpine
What does Reserpine do?
Depletes nerve ending stores of catecholamines that blocks NE/Epi release and uptake
What are the responses of Reserpine?
- Slow decrease in BP: decrease CO, bradycardia
- Small decrease in reflex response
What are the adverse effects of Reserpine?
CNS- Sedation, depression, nightmares
Peripheral- cramps, diarrhea, increased water retention (use with diuretic)
