Chapter 11: Drugs Used in Hypertension Flashcards
Primary autonomic mechanism for blood pressure homeostasis; involves sensory input from carotid sinus and aorta to the vasomotor center and output via the parasympathetic and sympathetic motor nerves
Baroreceptor reflex
Hypertension of unknown etiology; also called primary hypertension
Essential hypertension
Hypotension on assuming upright posture; postural hypotension
Orthostatic hypotension
Elevated blood pressure (usually above pretreatment levels) resulting from loss of antihypertensive drug effect
Rebound hypertension
Hypertension caused by a diagnosable abnormality, eg, aortic coarctation, renal artery stenosis, adrenal tumor, etc.
Secondary hypertension
Older patients of most races respond better to what antihypertensive drugs?
Diuretics = β blockers > ACE inhibitors.
African Americans of all ages respond better to
Diuretics = CCB
They respond less well to ACE inhibitors.
What diuretic blocks the NaK2Cl transporter in thick ascending limb?
Furosemide
Toxicity:
Hypokalemia, hypovolemia, ototoxicity
What diuretic blocks the Na+/Cl− transporter in distal convoluted tubule?
Hydrochlorothiazide, chlorthalidone
Toxicity:
Hypokalemia, hyperglycemia, hyperuricemia, hyperlipidemia
Centrally acting-sympathoplegic which acts as an agonist at α2 receptors (in CNS this results in decreased SANS outflow)
Clonidine
Toxicity:
Sedation, danger of severe rebound hypertension if suddenly stopped
Centrally acting-sympathoplegic prodrug converted to methylnorepinephrine in CNS, with effects like clonidine
Methyldopa
Toxicity:
Sedation, induces hemolytic antibodies
Ganglion blocker-sympathoplegic.
Obsolete prototype nicotinic ACh receptor blocker in ganglia (blocks all ANS transmission).
Hexamethonium
Postganglionic neuron blockers that blocks vesicular pump (VMAT) in adrenergic neurons
Reserpine
Selective α1 blocker that reduces peripheral vascular resistance, prostatic smooth muscle tone
Prazosin
Prototype nonselective β blocker which reduces cardiac output and possible secondary reduction in renin release
Propranolol
Calcium channel blockers acting as prototype L-type calcium channel blockers (combine moderate vascular effect with weak cardiac effect)
Dihydropyridines (e.g. Nifedipine)
Toxicity:
Constipation; risk of myocardial infarction from prompt- release nifedipine
CCBs with greater cardiodepressant effects
Non-dihydropyridines (Verapamil, diltiazem)
Renin inhibitor/antagonist
Toxicity: Angioedema, renal impairment
Aliskiren
Angiotensin antagonists that reduces angiotensin II synthesis
ACE inhibitors
Toxicity:
Cough • hyperkalemia • teratogen
Angiotensin antagonists that blocks AT1 receptors
Angiotensin II receptor blockers (ARBs)
Toxicity:
Hyperkalemia • teratogen
Toxicities of thiazides:
HYPER-GLUC
G-lycemia
L-ipidemia
U-ricemia
C-alcemia
Countercurrent multiplier
Loop of Henle
Countercurrent exchanger
Vasa recta
Toxicities of Loop diuretics:
OH-DANG!
O-totoxicity H-ypokalemia D-ehydration A-llergy to sulfa N-ephritis G-out
What drugs are used to control blood pressure in pheochromocytoma?
- Phenoxybenzamine
- Phentolamine
- Labetalol
What medications may cause drug-induced lupus?
“It’s HIPP to have LUPUS!”
- Hydralazine
- Isoniazid
- Procainamide
- Penicillamine
CCB symptoms:
Dihydropyridine vs. Non-Dihydropyridine
Gingival Hyperplasia
“NapaCa-Pangit ng gingiVa mo”
- Nifedipine
- Cyclosporine
- Phenytoin
- Verapamil
Effects of electrolyte imbalance on ECG:
- HyperKalemia: peaked T-waves
- HypoKalemia: T-wave inversion
- HyperCalcemia: decreased PR-interval
- HypoCalcemia: increased PR-interval
