HTN Flashcards
Physiologic Control of Blood Pressure and MOAs of Antihypertensives
[ BP = CO x PVR]
essential HTN
Systolic BP > 140 mmHg or diastolic BP > 90mmHg with no underlying or specific identifiable cause
when to start treatment for pts 60 and older?
150/90
when to start tx for those pts younger than 60?
diastolic BP 90 or greater (30-59 grade A)
systolic BP < 140
initial treatment for blacks?
thiazide diuretics or CCBs
how to treat population aged 18 years or older with CKD and hypertension
ACE or ARB
what classes should not be used together?
ACE and ARB
first line treatment in most cases?
- thiazide diuretics (hydrochlorothiazide (HCTZ), chlorthalidone)
- blocks reabsorption of NaCl at the distal convoluted tubule
- DO NOT use in pts w/ gout, hyperuricemia or Hx of severe hyponatremia
loop diuretics
- blocks reabsorption of Na+ in ascending loop of Henle
- Furosemide (Lasix)
K sparing diuretics
- block reabsorption of Na+ via Na+ channels in collecting duct but reduce K+ secretion into urine
- can cause hyperkalemia w/ACE I
- spironolactone (Aldactone)
- Unique ADRs - gynecomastica, ED, amenorrhea
ACE Inhibitors MOA
- block the conversion of Angiotensin I to Angiotensin II (potent vasoconstrictor), also blocks degradation of bradykinin (potent vasodilator), thereby reducing PVR blood pressure
- C/I in pregnancy
ACE ADRs
nonproductive cough (10-20%), rash, angioedema, hyperkalemia, decreased renal function, dizziness, abnormal taste. Little or NO sexual dysfunction
ACE endings
“pril”
ARB MOA
block the binding of angiotensin II to its receptors in vascular smooth muscle vasodilation PVR blood pressure
blocks the binding of angiotensin II to its receptors in the adrenal cortex aldosterone secretion blood volume stroke volume cardiac output blood pressure
ARB endings
“SARTAN”
beta blockers
- useful post MI
- avoid abrupt withdrawls
- “LOL”
cardioselective (B1) specific beta blockers
- atenolol
- metoprolol
carvedilol
labetalol
alpha/beta blocker used for CHF
alpha/beta blocker, can be used in pregnancy
CCB precautions
ADRS
- peripheral edema and reflex tachycardia are common
- constipation, bradycardia, flushing, fatigue, headache, dizziness, peripheral edema, reflex tachycardia (if too much vasodilation), CHF, heart block and hypotension (w/ diltiazem and verapamil)
DHP vs
non DHP CCBs
- amlodipine (all end in pine)….little effect on cardiac tissue
- diltiazem and verapamil
A1 blockers
- used mainly for BPH
- Causes significant orthostatic hypotension and syncope
- C/I w/PDE-5 inhibitors
- “azosin”
centrally acting agents
- refractory HTN after all else fails, avoid rapid withdrawal
- clonidine, alpha 2 agonist
- methyldopa, may cause coombs positive hemolytic anemia
- ADRs – bradycardia, heart block, impotence, dry mouth, sedation, depression and other CNS side effects b/c centrally acting
direct vasodilators are reserved for…
refractory HTN, can cause reflex tachy or angina
- hydralazine, HTN secondary to pre-eclampsia, Lupus like syndrome
- minoxidil (rogaine)
direct renin inhibitor
aliskiren, MOA – inhibits renin-angiotensin-aldosterone system earlier in cascade than ACE inhibitors or ARBs
hyptertensive crisis
Diastolic blood pressure > 120 mmHg
hypertensive emergency vs
urgency
target organ damage
no target organ damage
Intravenous Therapeutic Options for Hypertensive Emergency
Dopamine receptor agonist Fenoldopam
Good choice in pts w/ renal dysfunction
