Antihypertensives Flashcards
this is defined as sustained systolic bp of >140 mm Hg OR sustained diastolic BP of greater than 90 mm Hg
HTN
results from increased peripheral arteriolar resistance and reduced capacitance of the venous system
HTN
stroke, heart failure, heart disease/heart attack , and renal damage can be caused by
chronic HTN
what are the four classifications of blood pressure
normal, prehypertension, stage 1, and stage 2
90 % of pts. have what type of HTN
essential HTN ( unknown origin)
T or F: HTN has higher incidence in blacks, middle aged men, and it increases with age
True
arterial bp is directly proportional to what…
cardiac output and peripheral vascular resistance
which two systems control cardiac output and peripheral resistance
baroreflexes( heart, arterioles, and venules), and renin angiotensin -aldosterone system( kidney)
these act by changing the activity of the sympathetic nervous system ( rapid, moment to moment control)
baroreflexes
when there is a fall in bp, these ______ will send fewer impulses to cardiovascular centers in the spinal cord; reflex response of increased sympathetic and decreased parasympathetic output -> vasoconstriction and increased cardiac output
baroreflexes
what provides long term control of BP ( alters blood volume)
kidney
what in the kidney responds to reduced arterial pressure and sympathetic stimulation of B1 receptors
baroreceptors
low Na intake and greater Na loss increases what?
renin release
what converts angiotensinogen to angiotensin I
renin
what converts angiotensin I to angiotensin II
ACE
this is a potent circulating vasoconstrictor
angiotensin II
T or F, Angiotensin II stimulated aldosterone secretion
T ( leads to increased renal Na absorption and increased blood volume)
what is the goal of tx of antihypertensives
reduce cardiovascular and renal morbidity and mortality
these class of drugs lower bp by reducing cardiac output and/ or decreasing peripheral resistance
antihypertensives
what are the categories of Antihypertensive drugs
diuretics, sympathoplegic agents, direct vasodilators, angiotensin agents
which class of anti HTN drugs decrease Na and reduce blood volume
diuretics
which class of anti HTN drugs reduce peripheral resistance and decrease cardiac output
sympathoplegic agents
which class of anti HTN drugs relax vasodilator smooth muscle and decrease peripheral resistance
direct vasodilators
which class of anti HTN drugs reduce peripheral resistance and blood volume
angiotensin agents
T or F: BP = cardiac output x peripheral vascular resistance
T
what is the most common reason for therapy failure
lack of pt compliance
therapy is directed at preventing future or present disease?
future
these class of drugs are the first line in drug therapy ; safe, inexpensive and effective; better for tx in older adults
diuretics
side effects of this class of drugs includes: K depletion increased uric acid concentrations , impaired glucose tolerance
diuretics
this type of diuretic is the most commonly used ie. HCTZ; increases Na and water excretion ; chronic use leads to decreased peripheral vascular resistance
thiazide diuretics
therapeutic uses of this type of diuretic includes decreased bp, counteract Na and water retention seen with other anti HTN
thiazide diuretics
adverse effects of this type of diuretic includes hypokalemia, hyperuricemia, hyperglycemia
thiazide diuretics
these type of diuretics act quickly ; increase Ca content of urine-> decreased renal vascular resistance and increased renal bf
loop diuretics
this type of diuretics reduce K loss in the urine
K sparing diuretics
which drug of the K sparing diuretics decreases the cardiac remodeling that occurs in heart failure
spironolactone
this drug is a centrally acting adrenergic drug ; its a central alpha 2 agonist ; used in HTN tx when 2 or more drugs have failed; useful in renal disease
clonidine
this drug may cause Na and water retention ; adverse effects : sedation,dry mouth, constipation, rebound HTN
clonidine
this drug is a centrally acting adrenergic drug; its a central alpha 2 agonist; its converted to methylnorepinephrine; does NOT decrease cardiac outout and bf to vital organs is not decreased ; can be used in pregnancy
methyldopa
side effects of this drug include sedation/ drowsiness
methyldopa
these produce competitive block of alpha 1 receptors-> relaxation of arterial and venous smooth muscle -> minimal changes in cardiac output , renal bf, and glomerular filtration rate ie. Prazosin, doxazosin, and terazosin
alpha Adrenoceptor blocking agents
adverse effects of this drug include reflex tachycardia and first dose syncope ( loss of consciousness) ; seldom used as monotherapy
alpha Adrenoceptor blocking agents
these drugs lower bp by decreasing cardiac output ; selective blockers are more commonly prescribed
beta Adrenoceptor blocking agents
which beta Adrenoceptor blocking agent increases production of NO
nebivolol
what is contraindicated in pts with asthma
beta Adrenoceptor blocking agents non selective ie. propranolol and nadolol
therapeutic uses of these drugs includes: subsets of the HTN population, Hypertensive pts with concomitant diseases
beta Adrenoceptor blocking agents
adverse effects of this drug include bradycardia, fatigue, lethargy, insomnia, hypotension, decreased libido, can disturb lipid metabolism, and drug withdrawal
beta Adrenoceptor blocking agents
these produce relaxation of vascular smooth muscle ; release NO ( hydralazine) and hyperpolarize smooth muscle by opening K channels ( minoxidil); produce reflex stimulation of the heart;increase plasma renin concentration
vasodilators
this type of vasodilator is always given with a beta blocker and a diuretic; can be used as monotherapy in pregnant pts; adverse effects : HA , tachycardia, nausea, sweating, arrthymias, angina
hydralazine ( vasodilator)
this type of vasodilator is admin. orally for tx of sever to malignant HTN that doesn’t respond to other drugs ; causes hypertrichosis
minoxidil
which drug is used to treat male pattern baldness
minoxidil
these drugs are recommended when preferred first line agents are contraindicated / ineffective; effective in treating HTN in pts with angina or diabetes
Ca channel blockers
what are the three chemical classes of Ca channel blockers
diphenylalkamines, benzothiazepines, dihydropyridines
these drugs block inward movement of Ca -> causes muscles to relax; stronger dilation of arteries than veins
Ca channel blockers
some therapeutic uses of these drugs includes : natural diuretic effect, useful in HTN pts with asthma, diabetes, angina, and /or peripheral vascular disease
Ca channel blockers
some adverse effects of these drugs includes: flushing, constipation, dizziness, HA, fatigue, and hypotension
Ca channel blockers
this is a system for controlling bp and electrolyte levels ; monitors Na, K, vascular volume, and bp
renin-angiotensin- aldosterone system
what results in a release of renin from the kidney
reduction in bp or a fall in the delivery of Na to the nephron
T or F: Angiotensin I is biologically active
F: its biologically inactive
this molecule has multiple actions that increase bp including : vasoconstrictor, enhances release of catecholamines, increases synthesis of aldosterone, also induces cardiac hypertrophy
angiotensin II
these drugs reduce peripheral vascular resistance; decrease angiotensin II and increases bradykinin ( vasodilator ) -> vasodilation and decreased Na and water retention
ACE inhibitors
therapeutic uses of these drugs include : slows progression of diabetic nephropathy, used in the care of pts following a heart attack; first line therapy for treating hf, HTN pts with chronic renal disease , and pts with increased risk for coronary artery disease
ACE inhibitors
some adverse effects of this drug include :dry COUGH, hyperkalemia, skin rash, hypotension, fever, fetotoxic
ACE inhibitors
these drugs are alternatives to ACE inhibitors; do not increase bradykinin levels, decrease nephrotoxicity ; fetotoxic
Angiotensin II receptor Blockers
these drugs inhibit renin; metabolized by P450 System; adverse effects include cough, hyperkalemia, CI in pregnancy
renin inhibitor
tis type of emergency is rare but life threatening ; diastolic BP over 150 mm Hg ( systolic over 210) in a health person ; or over 130 in a pt with preexisting conditions
HTN emergency
symptoms of this emergency include: severe HA, mental confusion, and apprehension , blurred vision
HTN emergency
tx of hypertension emergencies are
ICU with monitoring of BP, parenteral meds
which drug is used during hypertensive emergency that is admin. IV; causes release of NO with results of increased ic cGMP; works regardless of cause; metabolized rapidly; poisonous if given orally
nitroprusside
which drug is used during hypertensive emergency hat has peripheral dopamine 1 receptor agonist; given IV infusion; relaxes the renal and mesenteric arterial vessels and increases renal bf ; increases IOP
fenoldopam; CI in pts with glaucoma
which drug is used during hypertensive emergency that is a Ca channel blocker and is given as IV infusion
nicardipine
this is high blood pressure that does not respond to Tx
resistant HTN
most common causes of this type of HTN include : poor compliance, excessive ethanol intake, concomitant conditions, used of sympathomimetics, NSAIDS, or antidepressants, insufficient dose
resistant HTN
severe HTN during pregnancy treated with
labetalol
which drugs are CI during pregnancy for HTN
ACE inhibitors, ARBs, and Aliskiren
which drugs is CI during pregnancy for HTN due to possible cyanide poisoning
Nitroprusside
what type of therapy will lower bp quickly
combination therapy
what controls bp in up to 85% of pts
thiazide diuretics with beta blocker, ACE inhibitor, or ARB
