HTN Flashcards
What makes up BP
What makes up CO
CO and SVR
HR and SV
What makes up SV
What makes up preload
Contractility and preload
Venous tone and intravascular volume
What makes up SVR
Direct innerv, circulating and local regulators
What effects venous tone: 4
A1 antagonists, ACEI, ARB, NTP
What affects na and h20 retention, upstream effect
Diuretics, acei, arb. Intravascular volume, preload, and SV
Direct innervation SVR
A1 antagonists, A2 agonists
Circulating BP regulators
A1 antag, A2 agonist, ACEI, ARB
Local BP regulators
Endothelin antagonist, ntp, acei, arb
DM or renal disease pts do specifically well on which drugs
ACEI or ARB, target RAAS and improve vascular flow to kidneys (underlying atherosclerosis)
Renin secreted by what
Results in what
Synergistic with what
Juxtaglomerular apparatus
Vasoconstriction and na retention
SNS inc release of noradrenaline
What controls ang I to II conversion
What leads to dry cough and which drugs impact this/dont
Renin
Bradykinin, relaxes smooth muscle w ACEI but not ARB
Angitotensin II effects: 4
Adrenal cortex- aldosterone- inc nacl reabs
Renal proximal tubule- inc nacl reabs
Renal efferent arterioles vasoconstriction
Hypothalamus- thirst and inc ADH
Acei first line therapy for 3, delays progression in what
Htn, CHF, mitral regurg. Renal disease (esp in DM pts)
Ang II vasoconstricts where, inc ___ secretion
Mediated mainly at which receptor
Arterial smooth muscle
Aldosterone
AT 1 > AT2
AT 1 receptor effects 4
Generalized vasoconstriction (esp afferrent arterioles)
Inc norepi release
Prox tubule reabs of na
Secretes aldosterone renal cortex
ACEI MOA
Blocks conversion Ang I to II in vasc endo by interact w zinc ion of ACE (Peptidyl-dipeptidase). Thus prevents vasoconstriction, na retention, and SNS stim
ACE: highly ___, minimal __ __, good patient __
Potent, SE, compliance
ACEI:
Pharm fx: fall in 2
Clinical uses: 5
Arterial pressure, cardiac work load
Htn, HF, post MI, diabetic neuropathy, CRI
ACEI SE: 6
Prolonged hypotension intra op, granulocytopenia, angioedema, proteinuria, persistent cough, hyperkalemia
ACEI contraindications: 2
Pregnancy, renal artery stenosis (aCEI causes efferent arteriole constriction)
Captopril
Onset
1/2 life
Decreases __, doesnt affect __ __
15 min
2 hrs
SVR, SNS outflow
Captopril
SE: 4
Drug interaction: main 1
Rash, loss of taste, hyperkalemia, angioedema
NSAIDs antagonize its effects
Enalapril
Route
What it has that makes it special why
IV
No sulfahydryl group, no rash or renal ins caused by it
Lisinopril
Excretion
Unchanged in kidney
Ace prodrugs and what it means
Enalapril and ramipril, longer onset
Ace effects __ system more than ___ system
Arterial, venous
ARBs
Antagonizes which receptor/MOA
Ang II AT1 receptor, competitive binding to inhib ang II at receptor. Doesnt affect ACE. Results in Less peripheral vasoconstriction
Contra ARB: 2
Renal artery stenosis, pregnancy
Arterial vasodilator: 2
Minoxidil, hydralazine
Hydralazine
MOA
Activates guanylate cyclase, directly relaxes vascular smooth muscle. Arteries > veins. Alters ca trans into smooth muscle
Hydralazine
Dose
Peak
Duration
2.5-10 mg IV
10-20 min peak
6 hrs
Hydralazine
Metabolism
1/2 time
When in kidney
Extensive hepatic 1st pass
3 hrs
After IV <15% unchanged in kidney
Hydralazine SE
Many
Reflex tachycardia, DBP reduced >SBP, dec SVR, inc HR/SV/CO, tachyphylaxis, na and h20 retention, angina w ekg changes
Hydralazine
Clinically used with __ and __ to limit what
BB and diuretic, inc SNS activity
Minoxidil
MOA
Route
Directly relaxes arteriolar smooth muscle, little venous effect. PO
Minoxidil
Clinical uses: 3
Used with what
Severe htn due to: renovascular disease, renal failure, transplant rejection
BB and diuretic
Minoxidil
MOA cellular level
K channel opener leading to hyperpolarization and vasodilation
Minoxidil Absorption Peak E 1/2 What in urine
90% abs in GI
1 hr
4 hrs
10% unchanged in urine
Minoxidil SE (many)
Inc HR and CO, inc NE and renin leads to: na and h20 ret, wt gain, edema, hypertrichosis, pulm htn, pericardial effusion/cardiac tamponade
Minoxidil EKG effects
Flat or inverted T wave, inc voltage of QRS- due to altered K conductance in heart
Peripheral vasodilator
Uses: 3
Facilitate forward LV flow in AR/MR/CHF, control htn in OR, tx htn crisis