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Pharmacology > DRUGS FOR HYPERTENSION > Flashcards

DRUGS FOR HYPERTENSION Flashcards

1
Q

how many Canadian adults have hypertension?

A

1 in 4

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2
Q

what is the most prevalent risk for cardiovascular disease?

A

hypertension

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3
Q

what are common risk factors for hypertension?

A

diabetes mellitus, chronic kidney disease, diet and sedentary behaviour

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4
Q

primary “essential” hypertension

A
  • most common
  • no known cause - represents 90-95% of cases
  • asscociated with genetic predisposition, dietary salt intake, adrenergic tone
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5
Q

secondary hypertension

A
  • disease/condition causes BP rise
  • known cause - represents 5-10% of cases
  • examples: pheochromocytoma, adrenal cortical tumours, drugs
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6
Q

are most patients symptomatic or asymptomatic?

A

asymptomatic

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7
Q

what are physiological effects of hypertension?

A
  • prolonged force on vessels thicken muscles in the arterial system; reduced responsiveness
  • heart constantly works harder to expel blood against a greater force, increasing the workload of the heart; left ventricle thickens
  • increased force damages inner lining of arteries; susceptible to atherosclerosis and narrowing of the vessel lumen
  • microvascular damage leading to losses in vision, kidney and cerebral function
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8
Q

what diseases can occur from hypertension?

A

cerebrovascular disease, coronary artery disease, GHF, cardiac death, renal failure, peripheral vascular disease, dementia

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9
Q

what is blood volume driven by?

A

fluid loss
- dehydration
fluid retention
- aldosterone
- ADH

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10
Q

what is peripheral resistance/diameter of arterioles driven by?

A
  • sympathetic nervous system activity
  • renin/angiotensin II
  • increase in blood viscosity
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11
Q

what is cardiac output driven by?

A

stroke volume
- preload
-contractility
- after load
heart rate
- SNS
- parasympathetic nervous system
- epinephrine

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12
Q

what is automated office BP?

A

referes to multiple BP readings (3-6) with a fully automated sphygmomanometer with the pt resting done quietly.
- eliminates the white coat effect and provides readings which are more accurate/similar to the awake ambulatory BP and home BP

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13
Q

what is ambulatory BP monitoring (ABPM)?

A

worn by the pt for a 24 hour period. measurements taken at 20-to-30 minute intervals

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14
Q

lifestyle recommendations for hypertension

A
  • reduce sodium intake (2000 mg/day) (water follows salt which raises BP)
  • smoking cessaton
  • abstaining from alcohol or reducing it
  • maintenance of weight and waist circumference
  • physical exercise 30-60 min of moderate intensity, 4-7 days a week
  • healthy diet, low in saturated fats and cholesterol, high in veggies an fruit, protein from plant sources, low fat dietary products, whole grain food rich in dietary fibre
  • stress management/ relaxation therapies
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15
Q

what are the 6 drug classes that can be used to reduce BP?

A
  • thiazide/thiazide-like diuretic
  • ACE-I
  • ARB
  • long acting CCB
  • B blocker
  • single pill combination
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16
Q

what are the two renin angiotensin system (RAS) drug classes?

A

ACE-1, ARB

17
Q

Thiazide an thiazide-like diuretics

A
  • first line therapy for the management of hypertension
  • reduce stroke volume (block sodium/chloride transporter in the distal tubule, facilitating the urinary excretion of electrolytes (Na, K, Cl, Ca) an water, thereby reducing blood volume
  • should be used with caution in pt with renal disease, diabetes, gout, liver disease, hyperlipidemia
  • administer during the day to prevent nocturia
18
Q

what are adverse effects of Thiazide an thiazide-like diuretics?

A
  • GI upset, orthostatic hypotension, hyperglycaemia
    , fluid an electrolyte imbalance (hypokalemia; potassium-rich diet or potassium sparing diuretic)
19
Q

what drug should you give a patient experiences hypokalemia?

A

you can give them a potassium diuretic

20
Q

drug drug interactions (hypertension)

A

lithium (mood stabilizer), NSAIDS (hold onto water), anti diabetic drugs (hyperglycaemic effects)

21
Q

what should be monitored when starting diuretic therapy?

A

sodium an potassium levels, kidney function and BP in first 4-6 weeks
- pt should monitor fluid output and weight gain/loss, report dizziness and light headedness

22
Q

renin-angiotensin-aldosterone system

A

renin; released in response to decreased BP
- angiotensin II; very potent, encourages body to conserve H2O
^it increases BP by 1) increasing peripheral resistance in the vasculature and 2) stimulating secretion of aldosterone and ADH
^increases sodium an water retention
- ADH increases water reabsorption

23
Q

when RAAS inhibited, what is decreased?

A

TPR and blood volume; reducing BP

24
Q

angiotensin converting enzyme (ACE) inhibitors

A
  • decrease peripheral resistance and decrease blood volume
  • block conversion of angiotensin I to angiotensin II
  • increase production of vasodilatory kinins
  • inhibit aldosterone secretion
25
Q

what should be cautioned with angiotensin converting enzyme (ACE) inhibitors?

A
  • CONTRAINDICTATED IN PREGNANCY
  • use caution with potassium-sparing diuretics and supplements
  • decreased antihypertensive activity with NSAIDS
26
Q

adverse effects of angiotensin converting enzyme (ACE) inhibitors

A
  • persistent dry cough (up to 30%)
  • can cause hyperkalemia
  • GI irritation and constipation
  • first dose phenomenon, sudden drop in BP, tachycardia
  • allergic reaction of lips, mouth an throat, occurring during first month of admin, medical emergency (more common in black ppl)
27
Q

angiotensin II receptor blockers (ARBs)

A
  • decrease peripheral resistance and decrease blood volume
  • block angiotensin II (AT) receptors in arteriolar smooth muscle and in adrenal cortex
  • inhibit release of aldosterone
  • no effect on bradykinin (lower incidence of cough)
28
Q

how are ARBs and ACE inhibitors the same?

A
  • ARBs have similar adverse effects and drug drug interactions as ACE inhibitors
  • contraindicated in pregnancy
    -although ARBS are commonly prescribed to pt who cannot tolerate adverse effects of ACE inhibitors
29
Q

calcium channel blockers

A
  • block calcium ion channels
  • relax vascular smooth muscle, decreasing peripheral resistance
  • slows HR, receding cardiac output and cardiac workload
30
Q

when should calcium channel blockers be used with caution?

A

in those with liver an kidney impairment

31
Q

what ate adverse effects of calcium channel blockers?

A

dizziness, light headedness, fatigue, (hypertension and reflex tachycardia), flushing, nausea
- avoid grapefruit juice - increases serum CCB levels

32
Q

beta blockers

A
  • sympathetic division of the autonomic nervous system (SANS) increases heart rate and smooth muscle contraction of arterial walls
  • alpha 1 receptors
  • cardio selective B1 receptor antagonists
  • non selective B1 & B2 receptor antagonists
  • blocks effect of norepinephrine on arterioles
  • block action of NE and E on cardiac muscle reducing speed and force of contraction (HR)
  • decrease renin secretion by the kidneys, reducing the production of angiotensin I and decreasing TPR
33
Q

when are beta blockers most effective?

A

in patients under the age of 60 with concomitant cardiovascular conditions
- previous history of MI, angina
- reduction in heart rate my cause fatigue & activity intolerance

33
Q

when should beta adrenergic antagonists be used with caution?

A

diabetes, depression, Asthma, COPD (use cardio selective drugs only)

Pharmacology (20 decks)

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