HTN Path and Mgmt Flashcards
What is HTN (give me a number)?
at least 140/90
Should a hypertensive person lift weights?
No, it raises BP
Where is renin released? What does it do?
Kidneys: Juxtaglomerular apparatus
Stimulated formation of angiotensin
Stimulates release of aldosterone from adrenal cortex
PreHTN
120-139/80-89
Stage 1 HTN
140-159/90-99
Stage 2 HTN
> 160 / >100
Most common adverse affect of diuretics?
Hypokalemia
Hydrochlorothiazide (HCTZ)
Inhibits NaCl absorption in the DCT of the nephron.
May precipitate hyponatremia
Generally first-line
Ineffective if creatanine in >2.5
Patients allergic to sulfa may be allergic
Loop diuretics
Selectively inhibit NaCl absorption in the ascending thick loop of henle.
Used when renal fxn declines
Stronger incidence of hypokalemia
Reserve for patients with chronic renal dz
Loop diuretic types
Furosemide (Lasix)
Torsemide (Demedex)
Bumetanide (Bumex)
Metolazone (Zaroxolyn)
K+ Sparing Diuretics
Antagonize the effects of aldosterone at the late distal and cortical collecting tubule in the nephron.
Weak when used alone
K+ sparing diuretic types
Aldactone (Spironolactone)
Midamor (Amiloride)
Dyrenium (Triamterene)
All can be combined with HCTZ
Beta Blockers
Effect is on the ANS Reduced HR and CO Antagonize catecholamine at Beta receptors Decrease renin release Cardioprotective
What does cardioprotective mean?
Negative inotropic effect (Decreased squeeze, man)
Negative chronotropic effect (lower rate)
Beta blocker SE
Bradycardia Heart failure Bronchospasm Impotence Depression Sedation/fatigue Cold extremities Hypotension
Do not use Beta blockers with…
NSAIDS
Epi
CCB
ACE Inhibitors
Block the conversion of angiotensin I to angiotensin II.
Leads to dilation, decreased cardiac workload
Renal Protective
Cardioprotective
Types of ACE Inhibitors
Captopril
Lisinopril (Zestril)
Enalapril
Others
When are ACE inhibitors first-line?
Diabetics
CHF
Chronic kidney failure
MI
ACE inhibitor SE
Cough Acute renal failure (bilateral renal artery stenosis) Angioedema Hypotension Rash Hyperkalemia ***Contraindicated in pregnancy***
Angiotensin II Receptor Blockade (ARB’s)
Alternative to AVE inhibitors
Block angiotensin II receotirs
Same profile as ACE
DOes no cause cough
ARB types
Irbesartan (Avapro)
Candesartan (Atacand)
Losartan (Cozaar)
Calcium Channel Blockers (CCB’s)
Dilate peripheral arterioles by blocking calcium influx into smooth muscle cells.
Decrease contractile force
Reduce cardiac work load
Good in combo w/ diuretics for black pts
Dihydropyridine CCB’s
Highly vascular selective end in dipine Amlodipine (norvasc) Felodipine (Plendil) Nifedipine (Procardia)
Dihydropyridine SE
Reflex tachycardia flushing HA Hypotension Edema
Non-dihydropyridine CCB’s
Verapamil
DIltiazem
Non-dihydropyridine SE
Excessive bradycardia
Impaired electrical conduction
depressed contractility
concern with beta blockers
Alpha 1 Blockers
Block alpha receptors in small arterioles and venules
Lower peripheral vascular resistance
May cause orthostatic hypotension
Used for men with prostate issues
Alpha 1 blocker types
Prazosin (minipress)
Terazosin (Hytrin)
Doxazosin (cardura)
Alpha 2 Receptor Agonists
Stimulate alpha 2 receptors in brain
Decreased sympathetic outflow from vasomotor center
Causes decreased vasoconstriction
May cause fluid retention
Alpha 2 Receptor Agonist Types
Clonidine (Catapres) 2nd or 3rd line
Methyldopa (Aldomet) Frequently used in pregnancy
Vasodilators
Causes direct arteriolar smooth muscle relaxation by increasing cGMP
Have to take along side another antihypertensive agent long-term
Vasodilator types
Hydralazine
Minoxadil
Reserpine
Moderate HTN emergency Tx
Captopril oral
Amlodipine
Severe HTN Mgmt
Admission
Nitroprusside IV drip
Nitroglycerine IV drip
Nitroprusside
IV only Short 1/2 life Immediate onset of action ICU only Start slow, go slow
Which type of therapy should be used for a BP above 160/100?
2 drug therapy
Average BP at birth?
78 systolic
Which group is HTN more common in?
African Americans
Around 35% of the pop has it
Also women over the age of 60
BP Circadian Rhythm
Lowest in the morning and midday
Highest at end of the day
Also higher in cold weather
HTN Eye damage
Hard exudates Flame hemorrhage Cotton wool spots AV nipping Copper wiring
Oral contraceptives cause?
HTN
Most common cause of secondary HTN
Renovascular HTN
Which meds are contraindicated for renovascular dz?
ACE and ARB’s.
Make the renal failure worse.
Alpha 1 blockers end in?
Zosin
Which med is used in pregnancy?
Methyldopa: Alpha 2 Blocker
Spironolactone causes what?
Gynecomastia in males
K+ sparing diuretic
Why shouldn’t ACE inhibitors be used in women of child bearing age?
Pregnancy category X
Which meds cause angioedema?
ACE and ARB
ARB’s end in?
Sartan
Dihydropyridines are highly _______ selective.
Vascular
Dihydropyridine CCB’s all end in
ipine
CCB’s are contraindicated in?
CHF
Which med should be used in pregnancy?
Methyldopa: Alpha 2 antagonist
What do you need to watch for with nitroprusside?
Cyanide Toxicity
