Antihypertensives Flashcards
What are some examples of beta receptor blockers?
Propranolol and metoprolol
What does cardiac output depend upon?
Venous return (venous tone, blood volume) Heart rate and contractility
What does total peripheral resistance depend upon?
Resistance vessel diameter (arterial tone)
What could cause secondary hypertension?
OTC and prescription drugs (estrogens, NSAIDS, stimulants, decreased compliance) Other conditions (renal artery stenosis, coarctation of the aorta, primary hyperaldosteronism)
What are some non-pharmacological treatments of hypertension?
Sodium restriction, weight loss, exercise, alcohol, smoking cessation and relaxation
What are the first line single agents for hypertension?
Diuretic, ACEI or ARB, CCB and beta-adrenergic antagonists (not in uncomplicated)
What else can be used in the treatment of hypertension?
alpha 1 adrenergic receptor antagonists, alpha 2 adrenergic agonists and vasodilators
What does the dose response curve look like with diuretics for blood pressure lowering?
Relatively flat (increasing dose produces little improvement in effect)
What are loop diuretics useful in?
Renal impairment (GFR
When are K sparing diuretics useful in hypertension?
When the increased blood pressure is due to mineralcorticoid excess.
What are some problems with K sparing diuretics?
Hyperkalemia and estrogenic effects (gynecomastia, impotenence)
How do ACEI’s work in hypertension?
Decrease AII levels, total peripheral resistance and aldosterone. Increases plasma potassium
Little or no reflex increase in cardiac output
How do ARB’s work in hypertension?
Blocks AII receptors, decreases total peripheral resistance and aldosterone. Increases plasma potassium
Little or no reflex increase in cardiac output
When are ACEI’s and ARB’s recommended?
In uncomplicated hypertension, recommended if concurrent condition (heart failure, post MI, systolic dysfunction, proteinuria, left ventricle dysfunction)
When are dihydropyridines used for hypertension?
Need the long acting agents
Reduce resistance without apparent cardiac actions
Useful when beta blockers are contraindicated
When are non-dihydropyridines used for hypertension?
If there is also a concern about heart rate control in atrial fibrillation or in patients with angina
What is a medication that every post MI or heart failure patient should be on?
beta-blocker, unless there is a concomitant disorder (asthma) where you must weigh the pros and cons.
When are beta blockers used for hypertension?
Not uncomplicated. In hypertension when concomitant disease also benefit (post MI, heart failure)
What are some problems with beta-blockers?
Not metabolically neutral (increase TGs/decrease HDLs), avoid sudden withdrawal, erectile dysfunction, increased incidence of type 2 diabetes, doesn’t protect against strokes
When should you avoid beta blockers?
Asthma, COPD, peripheral vascular disease, insulin dependent diabetes (caution), physically active
What disorders are beta blockers good to use in?
Glaucoma, supraventricular arrhythmia, heart failure, MI, angina
When would an alpha 1 antagonist be used in hypertension?
Not effective as a single agent
Decreases insulin resistance, BPH and decreases nightmares in PTSD
What are some problems with alpha 1 antagonists?
Fluid retention with long term treatment (give with diuretic)
With first dose there is an initial large blood pressure drop
Orthostatic hypotension
When are alpha 2 agonists used?
Adjunct to general anesthetic (sedation)
What happens when you rapidly come off of alpha 2 agonists?
Rebound hypertension
What should vasodilators be given with for hypertension?
Given with a beta-blocker and a diuretic
Used in pregnancy
What are some problems with vasodilators?
Lupus-like syndrome
Increased SNS-myocardial stimulation
Headache, flushing, nausea, hypotension, tachycardia, angina
When is sodium nitroprusside used?
For hypertensive encephalopathy
What is the rule about dose titration for antihypertensives?
Should only use one dose titration. Increasing initial dose has limited effect on decreasing blood pressure further but does increase side effects
What should you do if you are looking for a new hypertensive treatment for a patient?
Switch between drug classes before combining or adding drugs.
What is the goal blood pressure for hypertension generally?
140/90 mmHg or less
What antihypertensives are best for younger patients?
ACEI. ARB or beta antagonist
What antihypertensives are best for black or elderly patients?
thiazides or long acting calcium channel blockers
Patients with other indications (post MI) might need an ACEI or ARB
