Cardio - hypertension Flashcards by Vegard Jacobsen

What is the formula for BP? BP = ?

BP = CO x PVR (cardiac output x resistance)

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What is the mechanism and clinical uses(3) of thiazide diuretics?
(Hydrochlorothiazide, Chlorthalidone)

Block Na/Cl transporter
in distal convoluted tubule

Mild to moderate hypertension
combination therapy
GFR >30ml/min

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What is the mechanism and clinical uses(4) of loop diuretics? (Furosemide)

Block Na/K/2Cl transporter
in thick ascending limb

severe hypertension
GFR < 30ml/min
heart failure (fluid excess)
hypercalcemia

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What is the mechanism and clinical use of potassium sparing diuretics? (Epleronone, Spironolactone)

Aldosterone receptor antagonists

used in HF (RAS antagonism)

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What is the mechanism and use of Methyldopa?

Stimulates centrall α2 receptors
-> less sympathethic activity -> less PVR,HR and CO

Use: hypertension in pregnancy

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What is the mechanism of:
clonidine
guanabenz
guanfacin

Stimulation of central α 2 adrenoceptors

-> less sympathethic activity -> less PVR,HR and CO

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What is the mechanism of:
guanethidine 
guanadrel 
bethanidine 
debrisoquin

replaces NA in transmitter vesicles

inhibits NA release from postganglionic sympathetic neurons

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What is the mechanism of Reserpine?

Blocks VMAT in adrenergic neurons
(blocking uptake of biogenic amines)
-> less CO and PVR

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What is the effect of blocking ß1± ß receptors?

Less HR,CO and maybe less PVR

Less RAS activity (inhibits renin relase)

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What does the following drugs have in common?
atenolol
acebutolo
esmolol
betaxolol
bisoprolol
metoprolol
Nebivolol

They are all cardioselective ß1&raquo_space; ß2 blockers

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Which ß - blocker also induces nitric oxide synthase?

Nebivolol (ß1 + NO)

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Which ß-blockers also blocks α receptors?

Labetalol and Carvedilol

ß1+ß2+α

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What is the mechanism and uses(2) of:
phentolamine
phenoxybenzamine

α-blockers: nonselective

Use:
pheochromocytoma
Clonidine withdrawal

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What is the mechanism and uses(2) of:
doxazosin
prazosin
terazosin

Selecive α1 -blockers

Use:
hypertension
prostatic hyperplasia

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What is the mechanism and uses(2) of Hydralazine?

Release of NO by endothelial cells

Use:
hypertension
chronic heart failure
with isosorbide dinitrate

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What is the mechanism and uses(2) of Minoxidil?

Opens K+ channels leading to
arteriolar vasodilation

Use:
hypertension
stimulates hair growth

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What is the mechanism and uses(2) of Diazoxide?

K+ channel opening
-> arteriolar vasodilation

Use:
hypertension
insulinoma (inhibits insulin release
by opening K+ channels)

What is the mechanism and use of sodium nitroprusside (i.v.)?

Release of NO from the molecule
-> POWERFUL arteriolar and venous dilation

Use:
hypertensive emergencies
(1-10m duration of action)

What is the mechanism and use of Fenoldopam?

D1 agonist, stimulates natriuresis,
causing arteriolar vasodilation

Use:
Hypertensive emergencies

What is the mechanism of:
Captopril
Benazepril
Enalapril
Lisinopril

Blocks ACE and thus:
Angiotensin I -> angiotensin II
Bradykinin -> inactive metabolite
-> cough, less PVR

What are the uses(6) of ACE inhibitors?

Hypertension
MI
chronic heart failure
stroke prevention
Chronic kidney disease(CKD)
diabetes+cardiovasc risk factors

What are toxicities(6) of ACE inhibitors?

Cough
angioedema
hypotension
hyperkalemia
TERATOGENICITY
renal failure
(avoid NSAIDs, aminoglycosides,
 and vancomycin)

Which two ACE inhibitors are not eliminated via kidneys?

Fosinopril

Moexipril

What is the mechanism and uses of:
Losartan
Candesartan
Irbesartan

Blocks Angiotensin receptor 1

Use: hypertension

What are the toxicities of sartans? (AT1 blockers)

Like ACE inhibitors | but no coughing

What is the mechanism and use of Aliskiren

Renin inhibitor Use: hypertension

What is the mechanism and uses(2) of | Verapamil and Dilitazem?

Non dihydropyridines: Cardioselective Ca-channel blockers Use: hypertension arrythmias

What is the mechanism and uses(2) of Nifedipine and other dihydropyridines?

L-type Ca-channel blocker -> vasodilation Use: Hypertension angina

What is the downside of to rapid normalization of high BP? And when is it indicated?(3)

cerebral hypoperfusion(stroke symptoms) ``` Indicated if: pulmonary edema aortic dissection hemorrrhagic stroke NOT in ischemic stroke ```

What is the mechanism and use of: ambrisentan bosentan macitentan

Endothelin receptor antagonists Use: non-vasoreactive pulmonary hypertension

What is the mechanism and use of: Sildenafil Tadalafil Vardenafil

PDE 5 inhibitors Use: non-vasoreactive pulmonary hypertension

``` What is the mechanism and use of: beraprost epoprostenol inhaled iloprost treprostinil selexipag ```

prostacyclin analogues and prostacyclin receptors agonists Use: non-vasoreactive pulmonary hypertension

What agents are used in the treatment of pulmonary hypertension with vasoreactivity? (test with NO)

- calcium channel blockers: | nifedipine, amlodipine, diltiazem

What is the contraindication for using diuretics in the treatment of hypertension?

Gout

What is the contraindications(2) for using B-blockers in the treatment of hypertension?

``` Asthma AV block (2 or 3) ```

What is the contraindications(3) for using non DHP CCB in the treatment of hypertension?

``` AV block (2 or 3) severe LV dysfunction heart failure ```

What is the contraindications(4) for using ACE inhibitors or sartans in the treatment of hypertension?

Pregnancy hyperkalemia bilateral renal stenosis angioneurotic edema (ACE inhib)

What is the contraindications(2) for using mineralocorticoid receptor antagonists in the treatment of hypertension?

eGFR < 30mL/min | hyperkalemia

Which drugs(5) are the first line treatment for hypertension?

``` Thiazides Sartans ACE inhibitors Calcium channel blockers ß-blockers ``` Start from any of them, but beware of comorbidities!

Which to pairs of antihypertensive drugs should never be combined?

Sartans + ACE ihibitors ß-blockers + Verapamil

Why is ACE inhibitors preferred over Sartans? When is Sartans preferred?

They are much more effective. Sartans is preferred if coughing is a problem