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Pharmacology Unit 4 > Hypertension > Flashcards

Hypertension Flashcards

1
Q

Define the stages of hypertension and differentiate between essential and secondary HTN

A

Stage I - 140-159/90-99
Stage II - >160/>100
Essential - no known cause (95% patients)
Secondary - caused by another medical problem

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2
Q

Name potential causes of secondary HTN (4 main categories and specific diseases within each)

A
  • renal (CKD, renal artery stenosis)
  • drugs (ETOH, oral contraception, NSAIDS, TCAs, MAOIs, appetite suppressants)
  • endocrine (pheochromocytoma, Cushings, hyperaldosteronism, hypo/hyperthyroid, hyperPTH)
  • pulmonary (obstructive sleep apnea)
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3
Q

Name factors contributing to HTN that are modifiable

A
  • sodium intake, diets low in potassium and calcium
  • obesity or sedentary lifestyle
  • heavy ETOH intake
  • meds
  • stress
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4
Q

Name factors contributing to HTN that are NOT modifiable

A
  • genetics
  • race
  • gender
  • age
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5
Q

What two demographics have a higher risk of end organ disease, and therefore should be treated more aggressively?

A
  • African Americans and premenopausal women
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6
Q

What is the ultimate effect of using diuretics to treat HTN?

A
  • decrease intravascular volume and reduce preload
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7
Q

What is the effect of using angiotensin blockers to treat HTN?

A
  • inhibit production/action of angiotensin II (a potent vasoconstrictor) to therefore reduce PVR
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8
Q

What is the effect of using direct vasodilators to treat HTN?

A
  • relax vascular smooth muscle and reduce PVR
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9
Q

What is the effect of using sympathoplegic agents to treat HTN?

A
  • decrease sympathetic tone and reduce PVR
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10
Q

What effects do antihypertensive medications have on the plasma volume?

A
  • all antihypertensives (especially sympatholytics) increase plasma volume, except diuretics (which decrease) and ACEI/ARBs/renin inhibitors (no effect)
  • increasing volume can be bad for a hypertensive patient!
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11
Q

What are indications for use of loop diuretics, thiazide diuretics, and potassium sparing diuretics in the setting of HTN?

A
  • loop - high potency, used acutely in extreme HTN, CHF, cirrhosis, acute renal failure (prostaglandins vasodilate)
  • thiazides - medium potency, used long term for mild-moderate HTN
  • potassium sparing - low potency, used in combo with above to prevent hypokalemia
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12
Q

When comparing ACEIs and ARBs, how does each work and which is more potent in treating HTN?

A

ACEIs: blocks ACE (no conversion to angiotensin II), inhibits breakdown of bradykinin (a vasodilator)

ARBs:competitive receptor binding of angiotensin II

ACEIs are more potent! Can also remodel heart in a good way

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13
Q

What are the side effects of ACEIs and ARBs?

A
  • cough (ACEIs only)
  • hypotension
  • decreased renal function (efferent vasodilation to decrease GFR - this is what you want in chronic kidney disease!)
  • angioedema
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14
Q

List the short acting ACEI, the longer acting ACEIs (5), and the ARBs (3)

A

SA ACEI: captopril
LA ACEI: lisinopril, benazepril, quinapril, ramipril, enalapril
ARB: losartan, valsartan, irbesartan

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15
Q

How does aliskirin work?

A
  • renin inhibitor, but its not very effective
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16
Q

What calcium channel blocker is most frequently used for HTN, and what are the effects on BP, HR, and contractility?

A
  • dihydropyridines (amlodipine) which inhibit contraction of vascular smooth muscle
  • LOWER BP, have no effect on HR or cause slight reflex tachycardia, and have no effect on contractility
17
Q

What beta blocker is used for difficult to treat HTN?

A

labetolol

18
Q

A 45 yo male presents to your office with a history of HTN that has been difficult to control. You have ruled out any potential secondary causes. You notice he is also balding! What do you prescribe?

A
  • minoxidil, which opens K channels and results in arteriolar vasodilation
19
Q

In general, what are the side effects you expect from drugs that treat hypertension by altering the SNS (alpha2 agonists, alpha1 antagonists, beta blockers)

A
  • no reflex tachycardia
  • orthostatic hypotension
  • increased secretions, GI/GU disturbances (PNS takes over)
20
Q

What antihypertensives can be used in pregnancy?

A
  • alpha methyldopa (alpha 2 agonist)

- hydralazine (NO)

Pharmacology Unit 4 (9 decks)

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