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ASDOH Pharm II > E1 Anti-Hypertensive > Flashcards

E1 Anti-Hypertensive Flashcards

All things E1

1
Q

__% of patients with known

hypertension are treated

A

Only 50%

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2
Q

Complications of Sustained Hypertension

A

 Kidney disease
 Heart disease
 Cardiovascular problems (MI, stroke) – Problems increased if also smoking

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3
Q

Essential hypertension

A

– Also known as idiopathic or primary HTN

– 85-90% of cases

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4
Q

– Associated with disease process of endocrine or renal system
– Drugs: NSAIDS, birth control pills, decongestants, tricyclic
antidepressants

A

Secondary hypertension

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5
Q

– Develops in 5% of patients with primary or secondary HTN

– BP very high or rapidly rises; evidence of retinal and renal damage

A

Malignant hypertension

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6
Q

3 basic methods used to obtain the overall goal

of decreasing blood pressure:

A
  1. Reduce peripheral resistance
     SNS can affect peripheral resistance: agents used to
    block SNS reduce BP by decreasing peripheral resistance
  2. Reduce cardiac output
  3. Decrease blood volume
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7
Q

Family of Antihypertensive drugs acting at CNS:

A

Alpha-2 agonist

Beta Blockers

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8
Q

Family of Antihypertensive drugs acting at Heart:

A

Beta Blockers

Calcium channel blockers

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9
Q

Family of Antihypertensive drugs acting at Kidney:

A 
ACE inhibitors
Aliskiren
AT-1 Receptor antagonists
Beta Blockers
Diuretics
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10
Q

Family of Antihypertensive drugs acting at Blood vessels:

A

Ace inhibitors
Alpha-1 receptors antagonist
Calcium channel blockers
Vasodilators

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11
Q

Diuretics work by?

A

increasing the rate of ruin formation

Block kidney tubular reabsorption of Na+

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12
Q

Where is aldosterone made?

A

Adrenals

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13
Q

Classes of diuretics:

A 
– Mercurials
– Thiazides
– Loop (high ceiling)
– Carbonic anhydrase inhibitors
– Potassium-sparing diuretics
– Osmotics
– Acidifying agents
– Xanthines
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14
Q

Diuretics help secrete?

A

Sodium into the urine

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15
Q

Potassium-sparing diuretics also known as?

A

Aldosterone Blockers

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16
Q

Not used anymore but the first diuretics made

A

Mercurials

mercaptomerin (Thiomerin); meralluride
Mercuhydrun

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17
Q

First choice agents for hypertension and

congestive heart failure**

A

Thiazides (Benzothiazides)

Or HCTZ

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18
Q

Thiazides (Benzothiazides) ACTION:

A

 Inhibition of active Na+ reabsorption in the
proximal and distal tubules

 Inhibition of carbonic anhydrase = decreased
availability for H+ exchange with Na+

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19
Q

Starling’s Law =

A

if decrease amount of blood

returning to the heart (preload), heart doesn’t have to work as hard to eject blood back into the systemic circulation

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20
Q

Desired Effects of Thiazide Diuretics

A 
 Lower blood pressure:
– Decreased plasma volume
– Decreased extracellular fluid
 Decreased peripheral resistance
 Normalization of cardiac output after several days
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21
Q

“HCTZ” (MICROZIDE) is

A

hydrochlorothiazide

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22
Q

HCTZ USE

A

hypertension, edema from congestive heart failure

and nephrotic syndrome

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23
Q

HCTZ Therapeutic Category:

A

thiazide diuretic

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24
Q

HCTZ Oral complications:

A

xerostomia, lichenoid drug reaction, photosensitivity

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25
Q

Drugs of choice for serious edema*

A

Loop (High Ceiling) Diuretics

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26
Q

Loop Diuretics Drugs are toxic due to such rapid loss of

A

electrolytes*

– All loop diuretics are ototoxic to some degree
cause hearing loss/deafness

27
Q

Common Loop Diuretics

A

 *ethacrynic acid (Edecrin)

 *furosemide (Lasix)

28
Q

False autoimmune response **observed with thiazide and loop diuretics

A

Lichenoid Drug Reaction

29
Q

Potassium-sparing diuretics
(also called potassium retaining diuretics or aldosterone blockers)

ACTION

A

Competes with aldosterone for receptor sites in
the distal renal tubules, increasing Na+, Cl-
and water excretion while conserving K+ and
H+

 Blocks the effect of aldosterone
 Prevents the usual loss of K+

30
Q

Xanthines in general

A

 Respiratory drugs (theopylline) for asthma and
COPD
 Xanthines are also stimulants (think caffeine
which is also a xanthine)
 What happens when you drink caffeine or other
stimulants? PEE

31
Q

xanthines inhibit

A

ADH = increases
bloodflow and decreases reabsorption of
water in collecting duct

32
Q

Rank diuretics from most potent to least potent:

A

– Loop
– Thiazides
– Carbonic anhydrase inhibitors (very mild)
– Potassium-sparing

33
Q

Beta Receptors Blockers two classes of families

A

cardioselective and non-cardioselective

Cardioselective
(block beta-1)

Noncardioselective
(Beta-1 Beta-2)

34
Q

Beta Receptors Blockers Mechanism of action:

A

– Decrease cardiac output (even though constrict
vessels via beta-2)

 Decrease the work of the heart 
– Decrease renin secretion 
– Reduce plasma volume and venous return 
– Decrease sympathetic outflow from CNS 
– Reduce peripheral resistance
35
Q

Beta blockers Side effects

A

consistent with over activity of the parasympathetic nervoussystem:

– GI upset 
– Xerostomia
– Weakness and fatigue
– Orthostatic hypotension 
– Sedation 
– Depressed mood 
– Sexual dysfunction (Impotence in men = #1 reason
for poor compliance)
36
Q

Contraindications to Beta Blockers

A

 Congestive heart failure** (already have decreased
cardiac output)

 Asthma** (don’t want to block B
bronchoconstriction = want to be able to use B
agonist to open the airway)
***– Use cardioselective beta blocker

 Heart block** (these drugs decrease heart rate and
force of contraction)

 Diabetes** (beta blockers decrease glycogenolysis
and glucagon secretion, so pronounced
hypoglycemia may occur after insulin injection)
– Use cardioselective beta blocker –

37
Q

Alpha-1 Blockers location

A

Postsynaptic receptor

38
Q

Blockers produce peripheral vasodilation in
arterioles and venules, decreasing peripheral
vascular resistance

A

Alpha-1 Blockers

39
Q

More effective when used with diuretics and/or

beta blockers

A

Alpha-1 Blockers

40
Q

 Used to improve urination in men with
enlarged prostate and those with bladder
problems
– benign prostatic hypertrophy = BPH

A

Alpha-1 Blockers

41
Q 
Prevents conversion of angiotensin I to
angiotensin II (a potent vasoconstrictor)
– “inhibit” vasoconstriction = vasodilation
A

ACE Inhibitors

42
Q

ACE Drugs end in…

A

-pril

43
Q

– Drugs of choice for hypertension in patients

with diabetes

A

PRINIVIL, ZESTRIL
 Generic Name: lisinopril
 Therapeutic Category: ACE inhibitor

44
Q

Side Effects of ACE Inhibitors (B/C ARB)

A

Chronic dry cough

– Patients use cough syrups, lozenges to suppress cough – no effect

Cough mediated by increased bradykinin
release in bronchial tree

Angioneurotic edema with first dose

45
Q

Blocks vasoconstrictor and aldosterone-secreting
effects of angiotensin II

THEN

increase in plasma renin level causing
vasodilation, decreased sodium and water
retention

A

Angiotensin Receptor Blockers (ARBs)

46
Q

Angiotensin Receptor Blockers (ARBs) preferred over ACE inhibitors because…

A

– More specific in site of action, fewer side effects – Better tolerated by patients

47
Q

Common ARBs

A

 losartan (Cozaar)
 valsartan (Diovan)
And more…
**study tip: these drugs end in “-sartan”

48
Q

aliskiren (Tekturna) =

A 
Renin Inhibitor
.....first in class drug
49
Q

Renin Inhibitor Action

A

Binds to renin which then reduces levels of

angiotensin I, angiotensin II and aldosterone

50
Q

Calcium Channel Blockers Uses

A

– Hypertension
– Angina
– Arrhythmias

51
Q

Calcium Channel Blockers Mechanism

A

Inhibits calcium ion from entering the “slow
channels” or select voltage-sensitive areas of
vascular smooth muscle and myocardium
during depolarization

Produces relaxation of coronary vascular
smooth muscle and coronary vasodilation

52
Q

Calcium Channel Blockers Effects

A

Increases myocardial oxygen delivery (good for

angina too)

53
Q

Common Calcium Channel Blockers

A

 amlodipine (Norvasc) - #1 in US sales (newest) less gingival hyperplasia

 nifedipine (Adalat, Procardia) – one of original drugs in
this class

 verapamil (Calan) – one of original drugs in this class

54
Q

verapamil effects

A

(Calan) has its major effects on the
heart
– Lowers heart rate by decreasing AV conduction in
addition to lowering blood pressure

55
Q

nifedipine effects

A

(Procardia) has more of an effect
on blood vessels
– Associated with the greatest number of cases of gingival hyperplasia for all drugs in this class

56
Q

clonidine (Catapres) is a… and does…

A

Alpha-2 Agonist

Decreases sympathetic outflow from CNS

57
Q

Block granular uptake and storage (depletion) of
norepinephrine = decrease sympathetic activity
due to lack of neurotransmitter supply

A

Catecholamine Release Blockers

58
Q

 reserpine**
 guanethidine** (no longer used in U.S.)

Type?

A

Catecholamine Release Blockers

59
Q

Dental Drug Interactions with Antihypertensive Medications

A

 Enhanced hypotension with general anesthetics and

CNS depressants

60
Q

– Remember safe cardiac dose of epinephrine =

A

0.04 mg

Two cartridges

61
Q

These common drugs for longer than 3 weeks may decrease effectiveness of some diuretics, beta blockers and ACE inhibitors

A

Use of NSAIDS

62
Q

Most potent vasoconstrictor in all medicine

A

Nicotine second cocaine

63
Q

 Diuretics make you_____ potassium

 ACEI and ARBs______ potassium

A

lose

increase

ASDOH Pharm II (9 decks)

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