Ch 47: Drugs for Hypertension Flashcards
How many classes of drugs can be used to treat hypertension?
14 classes!
p. 499
In the 2014 hypertension guidelines, treatment of hypertension should be initiated at a SBP > or equal to…
…140, or DBP > or equal to 90.
The same apples to the over 60 population, with the exception of not initiating treatment until SBP is > or equal to 150.
(p. 499)
In the U. S., primary hypertension affects about…
…30% of adults.
p. 500
What is the formula for arterial pressure?
Cardiac output x peripheral resistance
p. 502
Cardiac output is determined by…
…heart rate, contractility, blood volume, venous return.
p. 502
Peripheral resistance is determined by…
…arteriolar constriction.
p. 502
Fortunately, when BP has been suppressed with drugs for an extended time, the baroreceptors…
…become reset at a lower level.
p. 503
What are the 5 categories of sympatholytic drugs? (a.k.a. antiadrenergic drugs)
1) beta blockers
2) alpha1 blockers
3) alpha/beta blockers
4) centrally acting alpha2 agonists
5) adrenergic neuron blockers
(p. 507)
Which 3 classes of drugs are contraindicated during pregnancy?
ACE inhibitors, ARB’s, and direct renin inhibitors
p. 508
What is the only direct renin inhibitor available right now?
aliskiren
p. 508
In patients with renal disease (i.e. nephrosclerosis), which two classes of drugs work best for treating hypertension?
ACE inhibitors and and ARB’s
p. 510
Why must beta blockers be used with caution in patients with diabetes?
They can suppress glycogenolysis and mask early signs of hypoglycemia.
(p. 511)
The incidence of secondary hypertension in children is…
…much higher than in adults.
p. 511
By age 65, most Americans have…
…hypertension. It almost always presents as isolated systolic hypertension.
(p. 511)
Why does treatment of hypertension in older adults carry a significant risk of orthostatic hypotension?
Because cardiovascular reflexes are blunted.
p. 512
In terms of adverse effects of antihypertensive drugs, practically all of these drugs can…
…interfere with sexual function.
p. 512
The major cause of treatment failure in patients with chronic hypertension is…
…lack of adherence to the prescribed program.
p. 512
A hypertensive emergency exists when…
…diastolic BP exceeds 120 mm Hg.
p. 513
What are the guidelines for how rapidly hypertensive crisis should be treated?
It must be treated rapidly (BP lowered within an hour) if there is papilledema, intracranial hemorrhage, MI, or acute congestive heart failure.
If these things are not present, it is preferable to lower the BP more slowly (over 24-48 hrs) in order to reduce the risk of cerebral ischemia, MI, and renal failure, all of which can occur with a rapid reduction in BP.
(p. 513)
What is the usual rate for nitroprusside?
0.3 to 3 mcg/kg/min.
(Dosage range in Epic is 0.25 - 10 mcg/kg/min.)
(p. 513)
Fenoldopam lowers BP by…
…activating dopamine1 receptors on arterioles to cause vasodilation.
(p. 513)
As a result of its MOA, fenoldopam differs from other hypertensives in that it…
…helps maintain (or even improve) renal function.
p. 513
What is the most common complication of pregnancy?
What is the incidence?
Hypertension
about 10%
(p. 513)
Patients who have chronic hypertension during pregnancy are at increased risk of developing preeclampsia. Unfortunately, reducing BP…
…does not lower this risk.
p. 513
What drug is given for seizure prophylaxis during pregnancy?
Magnesium sulfate
p. 514
When started before 16 weeks of gestation, low-dose _______ reduces risk of preeclampsia by about 50%.
aspirin
p. 514
Which two drugs are usually used for treating chronic hypertension of pregnancy?
methyldopa and labetalol
p. 513, 515
Hyperuricemia is a common side effect of thiazide diuretics. What is the normal range for serum uric acid?
2.2 - 8.0 mg/dl
from patho textbook
What are 2 examples of commonly used alpha1 blockers?
doxazosin and terazosin
p. 507
What classes of drugs are preferred for treating hypertension in diabetic patients?
ACE inhibitors, ARB’s, CCB’s (and diuretics in low doses)
p. 511
Which classes of drugs are recommended for management of hypertension following an MI?
beta blockers, ACE inhibitors, and aldosterone antagonists
p. 509
How do the alpha1 blockers work?
By preventing stimulation of alpha1 receptors on arterioles and veins, thereby preventing sympathetically mediated vasoconstriction.
(p. 507)
Name 5 alpha1 blockers.
prazosin terazosin doxazosin tamsulosin phentolamine
Three of the beta-blockers have a trait known as intrinsic sympathomimetic activity (ISA), which means they can produce mild activation of beta receptors while…
…blocking receptor activation by strong agonists (like norepinephrine). As a result, HR at rest is slowed less than with other beta blockers.
(p. 507)
What are the 3 beta blockers that have ISA?
acebutolol
penbutolol
pindolol
(p. 506)
Which two sympatholytic drugs block both alpha and beta receptors?
carvedilol and labetalol
p. 506
