Continue HTN Flashcards
بسم الله الرحمن الرحيم
يا أخي بالله عليك قل لي فيم شابت تلك الرؤوس؟!
ياحسرة علي العباد والله ياحسرة علي العباد !
ربنا لاتجعلها اكبر همنا ولا مبلغ علمنا ولا تجعل مصيبتنا في ديننا ربنا أصلح لنا ديننا الذي هو عصمة أمرنا !
Reliever Medications OF Asthma Mention
✓ Rapid-acting inhaled β2-agonists
✓ Systemic glucocorticosteroids
✓ Anticholinergics
✓ Short-acting oral β2-agonist
Thiazida is a drug of good position in treatment of hypertension so tell me why ?
This is becasuse its diuretic and 2ry vasodilator effect :
Its diuretic effect leads to decrese in blood volume then the VR and COP
and exretion of Na in urine leading to hyponatremia and migration of sodium form the wall of blood vessel into the blood for compensation causing the VD effect on the wall of blood vessel casuing decresed TPR
DECREASED COP DUE TO DIURESIS
DECREASED TPR DUE TO VD
BOTH LEADS TO DECRESED BLOOD PRESSURE GIVING
THIAZIDE IT HYPOTENSIVE EFFECT
إن الله كتب الإحسان علي كل شئ!
إن الله لايضيع أجر المحسنين
TIP
في الكبار والسود و اصحاب السمنة الكلية مخلوقة عندها قدرة عالية علي اعادة امتصاص الصوديوم والماء من غير رنين عشان كده بيبيقي عندهم ضغط دم مرتفع و رنين قليل
البيض بيبقا عندهم نقص في امتصاص الصوديوم والماء فعشان كده بيطلع منه رنين كتير عشان يسحبهم تاني
عشان كده بيبيقي عندهم ضغط مرتفع مع رنين مرتفع
Mention indications of the Thiazide IN HTN
1-Elderly obese black and low renin hypertension
2-Osteoprosis or recurrent ca stone companion to HTN
-Osteoprosis or recurrent ca stone companion to HTN WE USE THIAZID GR!
Due to its effect on decrasing the GFR and increasing Ca reabsorption from the PCT
and this leads to improve osteopriss and less risk of renal ca stones
فلا تخشوهم واخشوني ولأتم نعمتي عليكم ولعلكم تهتدون
يا أيها الذين آمنوا استعينوا بالصبر والصلاة إن الله مع الصابرين
Adverse effects in antihypertensive thiazide low doses
- Sulfonamide hypersensitivity (absolute contraindication).
- Impotence (relative contraindication).
- Sleep disturbances.
N.B.: Metabolic side effects may occur if used in high dose.
low dose of hydrochlotalidone is more effctive than higher one in HTN ?
THIS is due to no activation of RAS in lower doses
• Not associated with metabolic adverse effects.
a long acting thiazide in treatment of HTN?
Chlorthalidone
2ry hypertension due to volume expansion in case of RENAL IMAPAIRMENT The Drug of choice is ?
Metolazone of thiazides
When do we give loop diretics in HTN ?
This in case of volume overload due to heart failure and renal failure.
Resistant HTN .
Compare between Thiazides and loops in HTN .
• Thiazides are preferred in mild to moderate
hypertension
• Loop diuretics are needed in:
➢ Fluid overload due to heart failure or
renal disease.
➢ Resistant hypertension
اهمBB
في علاج الضغط ؟
Labetalol in eclampsia in pregnancy .
severe hypertension carvedilol and nebivlol are VD BB
Mechanism of action of BB in HTN ? and what types are prevneted?
-B1 BLOCKADE:
decreasing renin release 65%
decrasing cardiac propertirs and COP 15%
-B2 Blockade casuign decreased sympathtic out flow and release of NE
Resseting of baroreceptors ?!
SOME OF THEM HAS VD EFFECT
Any β blocker can be used except those with intrinsic sympathomimetic activity (ISA
Indications of BB IN HTN !
IT is not given in abscence of specific indication Coronary Heart disease Systolic HF Atrial flutter or fibrillation CoSA
Indications of BB IN HTN !
IT is not given in abscence of specific indication
Coronary Heart disease
Systolic HF
Atrial flutter or fibrillation
Advantage of BB in HTN Mention
It protects against coronary heart diseases and
decrases mortality of Cardiovascular diseases
DisAdvantage of BB in HTN Mention
No protect against cerebrovasuclar diseases
glucose intolerance and delayed recovery from hypoglycemia in daibets
increase risk of prediabetic>diabetic
ACEI is preferred in ?
HTN WITH
- DM
- IHD & post MI
- HEART FAILURE
- RENAL FAILURE with proteinuria
It is used in most cases of hypertension but contraindicated in pregnancy
ACEI mechanism of action in HTN DISCUSS !
It destroy the work of ACE Leading to : 1-increasing BK With its VD EFFECT 2-DECRASING THE Ang 2 so : a-decrase vasoconstricon b-decrease aldosterone preventing water and na reteniton
all of that decreases the BP !
ARBs are alternatives if
ACEIs are not tolerated.
Is ACEI good in Renal failure .?
it depends , it can decreaisng GFR and distances between endolthelium so decrasing the proteiun uria but in case of serum creatinine aboe 30% it must be stopped!
ممكن يزود الرنين بظاهرة الهروب
write briefly about the aliskirin !
it is direct renin inhibitor as effectivs as ACEI
Ras inhibitors ( ACEI ARBS ALiskirin ) must not be combined together
RAS inhibotrs are contraindicated in case of what ?
pregnancy
CCB mechanism of action in HTN DISCUSS
1- its VD of peripheral artereis effect decreasingTPR AND the blood pressure
2-VD of renal vessels increasing diuresis and reducing the blood volume
3-decreasing aldosterone preventing Na and Water retentionمهمة جدا
Preparations OF CBB MENTION
Long acting Like Amlodipine less risk of reflex tachycardia
SR preparations of Shortacting drugs
• Non DHP CCBS are not recommended in hypertension with?
severe left ventrucular dysfunction
CCBs are used in combination with ………… initial therapy in ……………….hypertension
ACEI OR ARBS
IN uncomplicated HTN
• Non DHP CCBS are used in hypertension with……
Atrial fibrillation
CCBs are preferred in HTN with
2C 2P
1- Chronic kidney disease , COPD ,
2- Pregnancy , PVD
Mention indications of CCB IN HTN ?
is combined with ACEI in case of uncomplicated HTN Long acting is prefered why?
NON DHP in atrial fibrillation
CCB IN 2C 2P COPD chronic kidney disease PVD Pregnancy
contraindicated in case of severe left ventricular dysfunctions
Mention indications of CCB IN HTN ?
is combined with ACEI in case of uncomplicated HTN Long acting is prefered why?
NON DHP in atrial fibrillation
CCB IN 2C 2P COPD chronic kidney disease PVD Pregnancy
contraindicated in case of severe left ventricular tachycardia
Mention alpha 2 agonists centrally acting used in HTN with ex
Methyldopa>pregnancy
clonidine > Hypertensive emergency
قصة الخالة !
VDs in HTN MENTION
Hydralazine 2nd choice eclampsia severe reflex tahcycardia +tolerance rapidly
Na Nitroprusside this in Hypertensive emergencies
alpha 1 selective blockers describe in light of HTN .
like doxazosin it is not 1st choive in any type of HTN AS it leads to Postural hypotension tachycardia fluid retention and self tolerance
the best use of doxazosin is?
Benign prostatic hyperplasia
Thiazid # in ? why?
Gout becasue of hyperurecemia
ACEI # IN ?
1- Bilateral renal artery stenosis
2-hyperkalemia
3-pregnancy
4-previous angioedema !
OF CCB
1-AVN BLOCK & Bradycardia
2-severe left ventricular dysfunction !
ARBS #?
Bilateral renal artery stenosis
Hyperkalmia
pregnancy
previous angioedema?
BB and CBB COMBINATIONS
BB # with NON DHP WHY ?
THEY BOTH DECREASES HR CONTRACTILITY CONDUCTIVITY MAY CAUSE Heart block
BB is good with DHP CCB WHY ?
BB cons is VC effect which is deleted by the VD effect of DHPs
DHPs cons is increasing HR which is deleted by BB DECRASING THE HR
• Thiazides synergize with most antihypertensives by
↓ volume expansion.
What is the reason for the reduction of anthypertensive effect of the diuretic thiazide ?
in high dose casue RAS Activation AND Hypokalemia so they are counteracted by
ACEI
ARBS
BB
Hypertensive urgencies mean >?
Severe HTN grade 3 without HMOD
oral drugs of short acting
Hypertensive emergencies MEAN ?
Severe hypertension grade 3 ! with HMOD
Like HTN Enchepalophathy
Drugs in most hypertensive emergenceis are?
NLF Nitropresside Labetalol aplpha and beta blocker # heart failure Nicardipine intermediate DHP CCB Fenoldopam D1 agonist # glucoma
Mention drug on specific hypertensive emegencies .
Nitroglycrine in acute coronary syndrome STEMI NSTEMI
unstable angina
Esmolol ultra short cardiac selective BB in aortic disscetion
Combination treatment is recommended as initial therapy. Preferred combinations: RAS blocker with a CCB or diuretic
ACE inhibitors, ARBs, beta-blockers, CCBs, and diuretics: ↓ BP and CV events
Beta-blockers are combined with any of the other drug classes in specific clinical situations, e.g. Angina post myocardial infarction HF Atrial fibrillation
• TWO-drug combination, preferably in single pill combination (SPC) is recommended. Exceptions are
frail older patients and
those at low risk with grade 1 hypertension (use monotherapy)
• If BP is not controlled shift to THREE-drug combination: RAS blocker with CCB and thiazide diuretic (SPC)
• The combination of two RAS blockers is not recommended
• If BP is not controlled with a three-drug combination, ADD spironolactone or, if not tolerated, other diuretics such as amiloride
or higher doses of other diuretics,
a β-blocker,
or an alpha-blocker
Drug treatment strategy for hypertension
• ACE inhibitors, ARBs, beta-blockers, CCBs, and diuretics: ↓ BP and CV events
• Combination treatment is recommended as initial therapy. Preferred combinations: RAS blocker with a CCB or diuretic.
• Beta-blockers are combined with any of the other drug classes in specific clinical situations, e.g. angina, post-myocardial
infarction, heart failure or atrial fibrillation.
• TWO-drug combination, preferably in single pill combination (SPC) is recommended. Exceptions are frail older patients and those
at low risk with grade 1 hypertension (use monotherapy)
• If BP is not controlled shift to THREE-drug combination: RAS blocker with CCB and thiazide diuretic (SPC).
• If BP is not controlled with a three-drug combination, ADD spironolactone or, if not tolerated, other diuretics such as amiloride
or higher doses of other diuretics, a β-blocker, or an alpha-blocker.
• The combination of two RAS blockers is not recommended
تم بحمد الله الجزء الثاني وانتهت فارما الكارديو
الحمدلله حمدا كثيرا طيبا ملء السماوات والأرض ومابينهما و مل ماشئت من شئ بعد
