B4.043 - Pharmacology of Drugs to treat Hypertension Flashcards
What are common types of end organ damage that can be caused by hypertension
MI Stroke Renal Failure Death
what is the most common etiology of HT
Primary aka we dont know really
epidemiological evidence shows involvement of what factors in HT
genetic inheritance phycological stress environmental dietary factors
high prevalence of HT is driven by what factors
increased age of population obesity high salt intake
what are steps you need to take to be sure you’re getting an accurate measurement on BP
Pt. should avoid caffeine, exercise, smoking 30 minutes prior No talking during measurement Remove clothing covering cuff location placement Use validated device with correct cuff size Support patients arm Record BP on both arms at first visit
what is stage 1 hypertension
systolic 130-139 diastolic 80-89
what is stage 2 hypertension
systolic > 140 diastolic >90
what is elevated BP
120-129, <80
what demographic is more likely to have HT and worse HT
african americans
what drug intervention do african american patients respond to
calcium channel blockers and diuretics
what drug classes should you not start treatment of HT with
ACE inhibitors, Beta blockers they are better for add on therapy
what do diuretics do
Deplete body of sodium and reduce blood volume
what do agents that interact with angiotensin do
reduce peripheral vascular resistance
what do direct vasodilators do
relax vascular smooth muscle and dilate resistance
what do sympatholytic agents do
reduce peripheral vascular resistance, inhibit cardiac function, and increase venous pooling
what should you always start with therapy wise in hypertensive patients
lifestyle change
why can drug treatments for HT be a hard sell
the patients are usually asymptomatic so they dont feel the need to take anything
what is the most common cause of treatment failure
Non-compliance
primary agents used in treatment of HT
thiazide diuretics ACE I/ARBs CCBs
what are thiazides
inhibit NaCl reabsorption in distal convoluted tubule
what are 2 main clinical uses for thiazides
1.) At low dose to lower BP 2.) at high dose second to loop diuretics in congestive heart failure
what are some drug names of thiazides
Hydrochlorothiazide Chlorthaidone Indapamide Metolazone
what is the preferred thiazide
chlorothalidone because fo the long t1/2 and proven trial reduction of CV disease
how do thiazides treat nephrolithiasis and nephrogenic diabetes insipidus
to reduce urinary calcium concentration and to reduce polyuria and polydipsia; paradoxical effect due to plasma volume reduction
what are side effects of thiazide diuretics
Hyperglycemia
Hyperlipidemia
Hyperuricemia
Hypercalcemia
what are the drug classes that affect the renin angiotensis system
ACE Is
ARBs
Aldosterone inhibitors
why are ACE I more efficient than ARBs
Bradykinin is inactivated by ACEs so an ACE I will increase bradykinin and can lead to vasodilation
what are the ACE Is
Benazepril
captopril
enalapril
fosinopril
lisinopril
moexopril
perindopril
quinapril
ramipril
trandolapril
what ACEI is an active drug
captopril
What is a side effect of ACEIs
coughing - due to increased bradykinin
what demographic are ACE most effecting in
middle aged caucasion
diabetes patients
what are the major AEs of ACE inhibitors
Dry hacking, non productive cough
Hyperkalemia
Angioedema and anaphylaxis
what are ACEIs not supposed to be used with and when are they contraindicated
Do not use in combo with ARBs
Avoid in pregnancy especially in 2nd and 3rd trimerster
what are the ARBs
Azilsartan
candesartan
eprosartan
irbesartan
losartan
olmisartan
telmisartan
valsartan
what are two major differences between ARBs and ACEIs
- more specific than ACE Is (dont affect bradykinin)
- More complete inhibition of angiotensis action
what are AEs for ARBs and how do they differ from ACEIs
Pretty much the same except no coughing
Hyperkalemia
reduced renal function
pregnancy
what are the calcium channel blockers
Verapamil
diltiazem (mainly at heart)
Amlodipine
Felodipine
Isradipine
Nicardipine
Nifedipine
Nimodipine
Nisoldipine
what is an improtant AE of peripheral Ca blockers
reflex tachycardia
what is special about verapamil and diltiazem
they act on heart (SA and AV conduction directly)
SOOOOOO no reflex tachycardia but potentially bradycardia
what are peripheral antagonists
block receptors at nerve endings
what are central agonists
stimulate medullary receptors
cardioselective beta blockers
Atenolol
betaxolol
bisoprolol
metoprolol
what are teh cardioselective and vasodilatory beta blockers
nebivolol
what are the non cardioselective beta blockers
nadolol
propranolol
what are the beta blockers with intrinsic sympathomimemtic acitvity
acebutolol
penbutolol
pindolol
carteolol
what are the drugs that are combined alpha and beta blockers
carvedilol (alpha 1 antagonists, clocks calcium entry)
labetalol (alpha 1 antagonist)
beta blockers are more effective in what demographic
caucasian and young hypertensives
beta adrenergic antagonists can be combined with what and for what purpose
antihypertensive drugs to counteract:
- reflex tachycardia
- increased renin secretion caused by thiazide and loop diuretics
how do beta blockers affect atherogenesis
can predispose bc of increaseing plasma TGs and decreasing HDL
what do beta blockers do to exercise tolerance
in angina treatment - helps
in HF treatment - may hurt bc of reduced CO –> earlier onset of fatigue
why do beta blockers have a significant risk of new onset diabetes
beta blockade delays recovery of nromoglycemia because it inhibits hyperglycemic response mediated by epi
what can abrupt cessation of beta blockers cause
tachycardia
hypertension
angina
MI
what are the direct renin inhibitors
aliskiren
what are drugs that block renin secretion
clonidine
what are the alpha 1 adrenergic antagonists
Doxazonsin
Prazosin
Terazosin
what happens to BP in pts on alpha 1 adrenergic antagonists
falls bc of decreased peripheral resistance
centrally acting sympatholytic drugs
clonidine
methyldopa
guanfacine
what do centrally acting sympatholytic drugs do
act in CNS as agonist on presynapyic alpah 2 recetpros in breain stem and reduce peripheral vascular resistance
sudden withdrawal of clonidine can cause what
hypertensive crisis, headache. termor, abdominal pain
what are the direct vasodilators
hydralazine
sodium nitroprusside
diazoxide
fenoldopam
analaprilat
nicardipine
how do direct vasodilators work
act directl yon vascular smooth muscle to cause relaxtion and lowe BP by reducing vascular resistance `
AEs of vasodilators
headaches
reflex tachy
fluid retention
flushing
palpitations
dizziness
what can hydralazine cause as an AE
lupus like syndrome
what is an AE of minoxidil
hypertrichosis
topical ointment to treat male baldness (rogaine)
recommendatins for treatmen in pregnancy
beta blocker (labetalol) or CCB (nifedipine); methyldopa and hyralazine may also be used
