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Hypertension Flashcards

1
Q

Hypertension stages

A

Normal BP : 120 /80

Prehypertension : 120-139 / 80-89

Hypertension I : 140-159/ 90-99

Hypertension II: > 160/100

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2
Q

Risk factors for Hypertension

A 
Secondary hypertension
Family history
Obesity
Smoking
Sedintery Lifestyle
Diabetes
Dyslipidemia
Micro albumin uria / GFR < 60ml/min
Age > 55 men,.  > 65 women
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3
Q

Hypertension types

A

Primary: cause unknown , above 90% cases, age 35 and above

Secondary: 2- 5 % cases, underlying disease, age 30 and above

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4
Q

Target organ damage in HTN

A 
Brain
Kidney (renovascular damage, kidney damage)
Heart
Brain
Peripheral arterial disease
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5
Q

Blood pressure formula

A

Cardiac output x Total Peripheral Resistance (TPR)

Cardiac Output = stroke volume x heart rate

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6
Q

Physiology of hypertension

A

Sympathetic Nervous system:
Baroreceptors (carotid & aortic arch) —> respond to change in BP. Symp system causes them to constrict–> contraction force increase, HR increase, causing hypertension

Renin- Angiotensin- Aldosterone System:
Renal hypotension –> kidney releases renin–> renin enzyme for angiotensin to make angiotensin I –> angiotensin I to Angiotensin II by ACE (in pulmonary endothlium) –> Angiotensin II potent vasoconstrictor & releases Aldosterone from Adrenal gland–> Aldosterone

Aldosterone function:
Reabsorption of Sodium and water thus Blood volume increase .
releases ADH and Vasopressin (Pituitary)
Myocardial hypertrophy & vascular hypertrophy
Facilitate release and inhibit uptake of nor Adrenaline

Mosaic theory: many factors
Genetics, endothelial dysfunction, bradykinin, nitric oxide, ANP

Fluid Volume regulation: increased fluid volume increase TPR

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7
Q

Secondary HTN causes

A 
Cushing Syndrome 
Pheochromocytoma
Drug induced
Chronic kidney disease
Renal Artery Stenosis
Primary Aldosteronism
Thyroid , parathyroid disease
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8
Q

Drugs that induce secondary HTN

A 
Corticosteroids (chronic)
Estrogen and oral contraceptive
NSAIDs
Nasal decongestant
TCA
MAOs
Appetite suppressants
Cyclosporine
Erythropoietin
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9
Q

Lab findings in Secondary HTN

A

RFT:
BUN, creatinine elevation

Urinary test:
Vanilyll mandelic acid & metanephrine ( pheochromocytoma)

Hyperkalemia (primary Aldosteronism or Cushing Syndrome)

Renal arteriography, Ultrasound or renal venography

ECG

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10
Q

JNC Target BP for patients with diabetes or renal disease

A

130/80 mmHg

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11
Q

Thiazide Diuretics Classification with brand names

A 
Chlorothiazide (Diuril)
Hydrochlorothiazide (Microzid, hydroDiuril)
Polythiazide ( Renese)
Metyclothiazide
Chlorthalidone
Metolazone (Zaroxolyn, Mykrox)
Indapamide (Lozol)
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12
Q

Doses for thiazide Diuretic JNC 7

A

mg/day

Chlorthiazide  125 - 500 
Chlorthalidone 12.5 - 25
Hydrochlorothiazide 12.5 - 50
Polythiazide 2-4
Indapamide 1.25 - 2.5
Metolazone mykrox  0.5 - 1.0
Metolazone Zaroxolyn 2.5 - 5
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13
Q

Mechanism thiazide Diuretics

A

Urinary excretion of Sodium & water & chloride reabsorption
Urinary excretion of potassium & little bit Bicarbonate
Increase effect of other antiHTN by reducing and preventing more blood volume

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14
Q

Interaction of thiazide Diuretics

A

NSAIDs

Reduce effect of diuretic

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15
Q

Side effects thiazide Diuretics

A 
Hypokalemia
Hypomagnesemia
Uric acid retention
Hyperglycemia
Hypercalcemia
Fatigue , headache, palpitations, rash, vertigo, transitory impotence
Hyperlipidemia
Dehydration
Hypovolemia in extreme cases
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16
Q

Loop Diuretics Classification

A

Bumetanide ( Bumex)
Furosemide (Lasix)
Torsemide (Demadex)
Ethacrynic Acid (Edecrin)

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17
Q

Loop Diuretics mechanism

A

Act on ascending loop of Henle
Decrease Na reabsorption
Intense action but short acting

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18
Q

Interaction loop Diuretics

A

NSAIDs

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19
Q

Side effects loop Diuretics

A

Hypokalemia
Hypovolemia
Renal function monitoring BUN & creatinine
Transient Deafness (especially with Amino glycoside)

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20
Q

Doses Loop Diuretics

A

Bumetanide 0.5 - 2
Furosemide 20 - 80
Torsemide 2.5 - 10
Ethacrynic Acid 25 - 100

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21
Q

Potassium Sparing diuretics classification

A

Spironolactone (Aldactone)
Amiloride ( Midamor)
Triamterene (Dyrenium)
Eplerenone ( Inspra)

22
Q

Interaction K sparring

A

ACE inhibitors

Potassium Supplement

23
Q

Precautions sode effects

A

Acute renal failure hyperkalemia

Not in patients of recent kidney stones or hepatic disease

24
Q

Doses K sparring diuretic

A

Amiloride 5 - 10
Spironolactone 25 - 100
Triamterene 50 - 100 mg
Eplerenone 50 - 100

25
B Blockers Classification
``` Atenolol (Tenormin) Acebutolol (Sectrat) Betaxolol (kerlone) Bisoprolol (Zebesta) Carvedilol (Coreg) Labetalol (Normodyn, Trandate) Metoprolol (Lopressor) Metoprolol ER (toprol xl) Nadolol (cograd) Penbutolol (levatol) Pindolol Propranolol ( Inderal) Timolol (Blocarden) ```
26
B blockers side effects
Cardiac decompensation due to decrease heart rate ECG monitor for bradyarrythemia Asthma COPD Withdrawal (dose should be started and ended with titration) Impotence Caution in patients with: Diabetes (masks hypoglycemia) Raynaud phenomenon Neurology disorders : fatigue lethargy, poor memory, weakness, depression
27
Propranolol
Inderal B blocker non selective 40 - 160 mg Rapid acting and long acting dosage form
28
Metoprolol
Lopressor Toprol XL (sustained release) Selective b1 blockage 50 - 100 mg /day
29
Timolol
Blocarden Prevents death in Acute MI Non selective blocker 20 - 40 mg
30
Labetalol
Labetalol effective in hypertensive crisis a b both Labetalol 200 - 800
31
Esmolol
Brevibloc Ultrashort action Used in surgery for htn and tachycardia 150 - 300 mcg/kg/min
32
Peripheral a blockers
Prazosin (Minipress) Terazosin( hytrin) Dixazosin( Cardura)
33
a blocker action
Indirect vasodilator Block postsynaptic a adrenergic receptors Causing vasodilation both arteries and veins Low incidence of reflex tachycardia tham direct vasodilator No adverse effects on lipid serum and other cardiac risks
34
Precautions in a blockers
First dose risk
35
Doses a blocker
Prazosin 2 - 20 Terazosin 1- 20 Dixazosin 1 - 16
36
Centrally Active A agonist
Methyldopa (Aldomet) Clonidine (catapress) Reserpine Guanfacine (Terex)
37
Methyldopa side effects
``` Orthostatic hypotension Fluid accumulation Rebound hypertension Sedation Fever flu like symptoms Positive Coombs test. 1% develops reversable hemolytic anemia. Dry mouth Lactation in either gender Impotence Depression ```
38
Clonidine
Catapres Effective in patients with renal impairment Stimulation of a2 rec centrally to decrease heart rate Initial paradoxical i crease in BP followed by a prolonged decrease Sedation and dry mouth Worsen depression Dose 0.1 to 0.8 mg
39
Guanabenz & Guanfacine
``` Centrally acting a² agonist When initial therapy fails Sedation dry mouth bradycardia dizziness Caution in Coronary insufficiency MI CVA hepatic renal patients Dose 1 - 3 mg ```
40
Postganglionic Neuron blockers
Best avoided. Unless there's severe refractory hypertension unresponsive to all other therapy Reserpine (0.05mg) in combo with diuretic Central acting, depletes catecholamines stores in brain and periphery Can cause severe depression that lingers for months after last dose Peptic ulcer contra
41
ACE inhibitors
``` Benazapril (Lotensin) Captopril ( Capoten) Enalapril (Vasotec) Fosinipril Lisinopril (zestril) Moexipril (Univasc) Perindopril (Aceon) Quinapril (Accupril) Ramipril (Altace) Trandola pril (Mavick) ```
42
ACE mechanism
Disrupts Renin Angiotensin Aldosterone System by inhibition of ACE . Thus Angiotensin II is decreased. No aldosterone
43
ACE inhb interactions
NSAIDs | Potassium Sparring diuretic ( hyperkalemia)
44
Adverse effects
``` Neutropenia (renal or autoimmune disease) Proteinuria (renal disease) Hyperkalemia Renal insufficiency, renal stenosis Dry cough Dysgeusia (altered taste) Rashes Vertigo Headache fatigue First dose hypotension Minor GI disturbance ```
45
Captopril
Capoten 12.5 to 25 mg 3 times daily Increased to 25 to 100
46
Enalapril
Vasotec Prodrug Enalaprilat (active) 5 mg daily increased upto 40 mg later Enalaprilat drug readily available. Used to treat acute hypertension crisis
47
Lisinopril
Zestril Long acting analog of enalapril 5 to 10 mg. Later 10 to 40 mg
48
ARBs
``` Angiotensin II inhibitors Azilsartan (Edarbi) Candesartan (Atacand) Eprosartan( Teveten) Irbesartan (Avapro) Losartan (Cozaar) Olmesartan (Benicar) Telmisartan( micardis) Valsartan (Diovan) ```
49
Ca channel blockers
``` Amlodipine (Norvasc) Clevidipine (cleviprex) Diltiazem (cardizem) Felodipine (plendil) Isradipine (DynaCirc CR) Nicardipine (Cardene SR) Nifedipine (procardia XL) Nisoldipine (Sular) Verapamil (Calan) ```
50
Action ca channel blockers
Ca channel blocker inhibit influx of Ca throw slow channel in vascular smooth muscle and cause relaxation Best response in black, low renin hypertensive and elderly patients
51
Ca channel blockers interaction
B blocker
52
Adverse effects
``` SA AV node disturbance contra Digitalis toxicity contra Nifedipine association with Headache, flushing, peripheral edema. Sustained release dosage lowers these effects Verapamil causes constipation ```

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