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Pharmacology > Antihypertensives > Flashcards

Antihypertensives Flashcards

1
Q

What are examples of medications that are ACE inhibitors?

A

enalapril, fosinopril

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2
Q

What are examples of medications that are angiotensin receptor blockers?

A

losartan, candesartan

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3
Q

What are medications that are vascular calcium channel blockers? What about cardiac channel blockers?

A

Vascular: nifedipine, amlodipine
Cardiac: verapamil, diltiazem

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4
Q

What is an example of an alpha 1 receptor antagonist?

A

prazosin

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5
Q

What is an example of a alpha 2 receptor agonsit?

A

clonidine

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6
Q

What vasodilators are used to treat hypertension?

A
  • hydralazine, minoxidil, nitroprusside
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7
Q

What is the formula that shows the regulation of blood pressure?

A

BP = cardiac output x total peripheral resistance

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8
Q

What does cardiac output depend on?

A
  • venous return
  • venous tone
  • blood volume
  • heart rate
  • contractility
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9
Q

What does total peripheral resistance depend on?

A
  • resistance vessel diameter

- arterial tone

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10
Q

Chronic increases in blood pressure is normally due to an increased ________

A

arterial resistance

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11
Q

90% of hypertension is considered to be _____ hypertension

A

essential (the cause is unknown)

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12
Q

10% of hypertension is considered to be from a ______

A

definable cause

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13
Q

What are some medications that can cause hypertension?

A
  • estrogens (oral contraceptives)
  • NSAIDS
  • antidepressants, cyclosporin, amphetamines
  • decreased compliance
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14
Q

What other medical conditions can cause hypertension?

A
  • renal artery stenosis
  • coarctation of the aorta
  • phaeochromocytoma (catecholamine secreting tumor), primary hyperaldosteronism
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15
Q

What are the 3 mechanisms to correct a major decrease in blood pressure?

A
  1. decreasing RPP, therefore increasing sodium retention (this increases blood volume)
  2. Increasing RAAS, therefore increasing aldosterone (increase in TPR)
  3. Increase in SNA, therefore increasing NE (increases cardiac output)
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16
Q

What are the main non-pharmacological treatments of hypertension?

A
  • sodium restriction
  • weight loss (> 5 kg in those that are overweight)
  • exercise (45-60 minutes of moderate activity 4-5/week)
  • reduced alcohol intake (<2 drinks /day in those who drink excessively)
  • smoking cessation
  • relaxation
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17
Q

What is considered to be first line therapy for treating hypertension?

A

diuretics in uncomplicated hypertension

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18
Q

With diuretics, the dose response for blood pressure lowering is relatively ____

A

flat
(this means that increasing the dose will product little improvement in effect. Complications increase with dose- can cause hypokalemia, glucose intolerance, increased LDL)

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19
Q

What diuretic is useful in renal impairment and edematous states?

A
  • loop diuretics
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20
Q

Are loop diuretics typically used as an antihypertensive?

A

No

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21
Q

Are loop diuretics a good choice for long term treatment?

A

No -they are fast onset and have a short action, and there is potential for extreme electrolyte imbalance

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22
Q

What is the clinical use of potassium sparing diuretics?

A
  • useful with thiazides - decreases the potassium lost

- effective when increased BP due to mineralocorticoid excess

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23
Q

What diuretics typically will cause electrolyte problems?

A
  • thiazides and loop diuretics

hypokalemia, hypercalcemia-thiazides, hypocalcemia-loop

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24
Q

What are some general side effects of thiazides?

A
  • decreases insulin release- hyperglycaemia
  • increased LDL levels (bad)
  • increased incidence of erectile dysfunction
  • vascular volume contraction (decreased blood volume)
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25
Q

What are some general side effects of using loop diuretics?

A
  • deafness - if given with an aminoglycoside antibiotic

- vascular volume contraction- decreased blood volume

26
Q

What are some general side effects of using potassium sparing diuretics?

A
  • hyperkalemia

- estrogenic effects - gynecomastia, impotence

27
Q

What is the mechanism of action of an ACE inhibitor?

A
  • decerases TPR, decreases aldosterone (and increases Pk, useful?)
    (ACE inhibitors are thought to be better because it also increases bradykinin which decreases blood pressure)
28
Q

What is the mechanism of action of ARBs?

A
  • blocks all receptors

- decreases total peripheral resistance, decreases aldosterone (and increases Pk, useful?)

29
Q

Glucose levels in the blood are affected by ACEI’s and ARBs. True or false?

A

FALSE

30
Q

What are some potential AE associated with ACEI’s or ARBs?

A
  • rash, cough (ACEIs), hyperkalemia, proteinuria, angioedema
31
Q

What is considered to be the first line single therapy for uncomplicated hypertension?

A

ACEIs or ARBs

32
Q

ACEIs and ARBs are especially recommended if the patient has a concurrent condition such as what?

A
  • heart failure
  • left ventricle dysfunction
  • post MI
  • diabetes
  • systolic dysfunction
  • proteinuria (chronic kidney disease)
33
Q

There is little reflex ____ with using ACEIs or ARBs - due to a decrease in NE release

A

tachycardia

34
Q

There should be caution when using ACEIs or ARBs if the _______ are elevated q

A

angiotensin 2

35
Q

Are ACEI or ARBs safe to use in pregnancy?

A

no

36
Q

Are calcium channel blockers first line or second line in the management of hypertension?

A
  • second line
37
Q

What are the 2 classes of calcium channel blockers and what are some examples of them?

A
  1. vascular (dihydropridines) - amlodipine, nifedipine

2. cardiac and vascular (non-dihydropridines) - verapamil, diltiazem

38
Q

Describe dihydropyridines. What are they used for specifically?

A
  • have a greater affinity for vascular calcium channels
  • used for angina, raynauds and hypertension
  • reduce TPR without apparent cardiac actions
  • diuretics may block nifedipine effects on BP
  • used for hypertensive crisis
39
Q

Describe non-dihydropyridines. What are they used for?

A
  • used in hypertension if also concern about heart rate control in atrial fibrillation or in patients with angina
40
Q

Diltiazem is used to treat ___ and _____

A

angina and hypertension

both vascular and cardiac effects

41
Q

What is the action of verapamil?

A
  • blocks mainly in the heart (limited vascular tissue)
  • should not be combined with a beta adrenegeric receptor blocker (both drug classes block AV node)
  • contraindicated in heart failure
42
Q

When are calcium channel blockers especially useful?

A
  • when beta blockers are contraindicated in obstructive airway disease or diabetes
  • in the elderly and african americans
  • low incidence of side effects, but expensive
  • neutral metabolic profile
43
Q

What are the adverse effects associated with calcium channel blockers?

A
  • headache, flushing, edema, constipation
  • increased mortality post MI with short acting preparations
  • should NEVER decrease BP rapidly
  • published concerns about the increased risk of cancer to increased GI bleeding seem unfounded
44
Q

Can calcium channel blockers be used with angina pectoris, raynaud’s phenomenon, asthma or COPD?

A

Yes

45
Q

How can you tell whether or not a beta blocker is working?

A
  • if you take the blood pressure of a person sedentary, and then you take the blood pressure of a person that has some exercise, there should be no increase
46
Q

There is an increased incidence of what with B-adrenergic receptor antagonists?

A
  • type 2 diabetes
47
Q

Are beta blockers useful as mono therapy?

A

NO, it is not useful

  • if a person is only hypertensive, lowers blood pressure but unclear if decrease in cardiovascular mortality
  • useful as a second drug however - blocks reflex activation of the heart by the SNS (mostly used only in post MI/heart failure)
48
Q

Are beta blockers considered metabolically neutral?

A
  • no, they are not

- they can increase TGs potentially and decrease HDLs

49
Q

Beta blockers cause an increased incidence of what 2 conditions?

A
  • erectile dysfunction

- increased incidence of type 2 diabetes

50
Q

Should avoid the use of beta blockers in what conditions?

A
  • asthma, COPD, peripheral vascular disease, insulin dependent diabetes, physical activity?
51
Q

Beta blockers are good to use in what conditions?

A
  • glaucoma, supraventricular arrhythmia, heart failure, MI, angina
52
Q

Describe the use of prazosin (a alpha adrenergic receptor antagonist) in hypertension?

A
  • not effective as a single agent for chronic BP lowering (vasodilates the arteries and the veins)
  • decreases insulin resistance
  • useful in BPH
  • shown to decrease nightmares in PTSD
53
Q

What are the problems associated with alpha adrenergic receptor antagonists?

A
  • fluid retention with long term treatment (give with a diuretic)
  • first dose effect - initial large decrease in blood pressure
  • orthostatic hypotension
54
Q

Describe clonidine (alpha 2 receptor agonists)

A
  • acts on the central vasomotor centres
  • decreases sympathetic nerve activity form the CNS
  • autonomic system remains intact - reflexes intact (orthostasis rare, given as 2 unequal doses)
  • limited use- sedation and dry mouth
  • rebound hypertension upon rapid cessation of the drug
  • more common as adjunct to general anesthetic
55
Q

Are vasodilators used alone for chronic blood pressure lowering?

A

No

56
Q

When is hydrazine useful? (vasodilator)

A
  • greater arteriolar effect
  • give with beta blocker and diuretic
  • used in pregnancy
57
Q

What are the problems associated with hydralazine?

A
  • may cause lupus-like syndrome
  • may increase SNA - myocardial stimulation
  • can cause headache, flushing nausea, hypotension, tachycardia, angina pectoris
58
Q

When is minoxidil useful?

A
  • arteriolar dilator
  • give with a beta blocker and diuretic
  • for severe hypertension (refractory)
  • may cause pericardial effusion
  • hirsutism
59
Q

Describe the effects of sodium nitroprusside?

A
  • venous and arteriolar dilator
  • rapid onset, rapid offset
  • blood pressure is titratable
  • for hypertensive encephalopathy
  • potential for cyanide toxicity
60
Q

What should be used as mono therapy in younger patients?

A
  • respond best to ACEI, ARB or beta adrenergic receptor antagonist - BUT beta adrenergic antagonist may be inferior to protect from a stroke
61
Q

What should be used as mono therapy in black patients and elderly patients?

A
  • respond best to thiazide diuretics or long acting CCBs

- however, patients may have other indications that suggest the need for ACEI or ARB (heart failure, post MI)

Pharmacology (23 decks)

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