Cardiovascular Flashcards
Isolated Systolic Hypertension
Eti: Tends to occur in eldery due to loss of elasticity of arterial system
S/sx: Generally asymptomatic, wide pulse presure (SBP-DBP). Difficult to treat
Tx: Use ACE or ARBs, diuretics and CCBs, not beta blockers
Essential hypertension
S/sx: Generally asymptomatic, left untreated can develop end organ damage.
Dx: must establish multiple episodes of hypertension, unless upon inital pressentation profoundly hypertensive greater than 200/125
Work up: EKG, UA, Blood glucose, lipids, GFR, K, HCT
Primary aldosteronism
Eti: elevated serum aldosterone leads to Na retention and then water retention. Generally caused by adrenal adenoma or bilateral adrenal hyperplasia
S/sx: HTN that is refractory to multiple drugs
Dx: workup, plasma aldosterone/renin ration (discontinue ACE/ARB?Clonidine and beta blockers and spironolactone before testing
Renal parenchymal disease
Chronic kidney disease
Eti: increased intravascular volume (lower GFR) and increase activity of renin-angiotnesion-aldosterone system RAAS
Cause by chronic kidney disease
Renal artery stenosis
Eti: in young caused by fibromuscular dysplasia, others it is caused by atherosclerotic arteries. Lower kidney perfussion causes increase in renin which boost BP, decreased renal perfussion also caused less salt loss.
Dx: consider if HTN before 20 or after 50, multi drug resistant, if renal or epigastric bruits
Tests: renal arteriography is test of choice, can use MRI or CT or US if lower suspicion
Tx: if due to arteriosclerosis give ACE/ARB and statin
Coarctation of the Aorta
Eti: congenital malformation of the aorta that results in narrowing past the arch.
S/sx: systemic HTN most common symptom, asymmetry of pulses, delay of pulses between upper and lower extremities
Dx: tranthoracic echo or MRI, ECG and CXR
Tx: surgical
Pheochromocytoma
Hypertension caused by catecholamine excess (epi and norepi)
S/sx: HTN generally comes in episodes along with s/sx (HA, diaphoresis, palpitations, anxiety, nausea, angina, pulmonary edema)
Dx: 24 hour urine for fractionated metanephrines
Tx: surgery
Drug induced HTN, which drugs?
Cyclosporines, tacrolimus, angiogenesis inhibitors, erythrocyte-stimulating agents, cocaine, ETOH, pseudoepherine, phynylephrine
Thyroid/parathyroid disease
Increase in HR and vasular tone due to sympathetic activation leading to increased BP
-Hyperthyroidism
S/sx: lid lag, moist skin, palpitations, elevated HR, brittle hair, anxiety, exophthalmos, wt. loss, heat intolerance
Dx: check TSH, T3 and T4, check for graves diesase
Beta-adrenergic blocking agents
Drugs and MOA
Cardioselective (atenolol, metoprolol, esmolol) Non selective B1 and B2 (propranolol), Alpha and B1/2 (labetalol, carvedilol) MOAcatecholamine inhibitor (blocks adrenergic renin release), decreases heart rate allow vessels to dialate
Beta blocker indications
Indic: HTN, tachycardias, angina, acute MI, HF, pheochromocytomas, migraines
CI: 2nd/3rd heart block, decompenasted HF
AE: fatigue, depression, impotence, dizziness, lightheadedness, nausea, hypotension
Alpha blockers
Drugs: prazosin, terazosin, doxazosin
MOA: inhibits postsynaptic alpha adrenergic receptors, causing arterial and venous dilation which decreases BP
Indication: HTN (also increases HDL and decreases LDL, improves insulin sensitivity
Peripheral agents
Drug: reserpine
MOA: antiadrenergic agents
… need more here
Central alpha-agonists
Drugs: clonidine, methyldopa
Clonidine: Used primary for HTN that has not responded well to two or more drugs. It does not decrease renal blood flow or GFR so good for HTN complicated by renal disease
Methyldopa: Used primarily to manage HTN in pregnancy, where it has a record of saftey
Clonidine AE
Black box warning: for obstetrics postpartum or perioperative because of risk of hemodynamic instability
hypertensive crisis is d/c abruptly
direct vasodilators
drugs: hydralazine, minoxidil
MOA: directly relaxes vascular smooth muscle.
Hydralazine: pregnancy induced HTN
AE: MI, HR, angina, arrhythmia, sweating
Minoxidil: used mainly for male pattern baldness (rogaine)
AE: hypertrichosis
ACE inhibitors
Drugs: captopril, lisinopril, benazepril
MOA: cardio protective and renoprotective, synergistic effect when used with thiazides
Decreases angiotensin 2, decreases secretion of aldosterone, decreases Na and H2o retention
CI: prego cat X, angioedema
Adverse: cough, hyperkalemia, skin rash, hyperurecemia
ARBs
Drugs: losartan, valsartan
MOA: directly blocks angiotensin 2, no cough
CI: pregnancy, angioedema
Calcium channel blockers
Dihydropyridines (amlodipine, nifedipine)
- potent vasodilators (little effect on cardiac contraction or conduction)
Indic: most commonly used in HTN
Non-dihydropyridines (diltiazem, verapamil)
- affects cardiac contract and conduction
Indic: used with HTN with afib
CI: beta blockers, CHF, 2nd/3rd heart blocks
AE: vasodilation(HA, dizziness, flushing, peripheral edema, constipation esp with verapamil)
carbonic anhydrase inhibitors
Drug: acetazolamide (Diamox)
MOA: inhibits CA which inhibits H ion excretion in PCT, increaseing Na, HCO2 and water excretion producing alkaline diuresis
Indic: HTN, glaucoma, CHF, seizures, altitude sickness
CI: hypokalemia, hyponatremia, …
AE: hypotension, dizziness
Thiazide diuretics
HCTZ, chlorthalidone
MOA: inhibits reabsorption of Na in DCT, decreasing blood volume, decreasing BP
Indic: 1st line for HTN, cardioprotective
AE: hypoNa, hypoK, hyperuricemia, hyperglycemia
Potassium sparring diuretic
Spironolactone, amiloride, eplerenone
MOA: inhibits aldosterone mediated Na/H2O absorption, weak diuretic
Indic: primary hyperaldosteronism, edematous conditions, CHF, hypokalemia
AE: gynecomastia, hyperkalemia
Loop diuretic
Furosemide, toresmide, bumetanide
MOA: Inhibit cotransport Na+/K+/2Cl- in the asending loop of henly, greatest diuretic effect
Indic: HTN, CHF, hypercalcemia, severe edema
CI: Black box: can produce profound diuresis and electrolyte dysfucntion, sulfa allergy
AE: volume depletion, electrolye imbalance
Osmotic diuretics
Mannitol
MOA: These substances are filtered out and experience very little reabsorption, increasing the osmolarity of the tubular fluid
Indic: used more for cerebral edema, increased intracranial pressure or acute renal failure due to shock, drug toxicities, and trauma.
CI: ??
