Hypertension Flashcards
Which loop diuretic is used in management of HTN?
What transporter does it block?
It blocks absorption of which ions?
Furosemide
Competitively inhibit Na/K/Cl cotransporter @ TAL –> inhibit Na, Ca reabsorption –> inhibit H20 reabsorption
What type of diuretic is Furosemide?
It is used to treat what type of HTN in what 3 settings?
Describe Furosemide in terms of potency and onset of action, relative to other types of diuretics.
Loop Diuretic
Severe HTN in setting of CHF, cirrhosis, or renal insufficiency
Most potent, Fast acting
Name the 4 medium potency, Thiazide diuretics that are used in the treatment of mild to moderate HTN?
(Hint: H-C-I-M)
What is their mechanism?
- Hydrochlorothiazide
- Chlorthalidone
- Indapamide
- Metolazone
Thiazide Diuretics inhibit the Na/Cl cotransporter @ the early DT luminal membrane
Name the 3 low potency, Potassium-sparing diuretics that are combined with loop/thiazide diuretics to prevent diuresis-induced hypokalemia.
What is their general mechanism?
- Spironolactone
- Triamterene
- Amiloride
Inhibit Na reabsorption in the distal tubule
What are some side effects of loop & thiazide diuretics?
Electrolyte abnormalities?
Glucose/Lipids?
Other?
Hypokalemia, Hypomagnesemia
Impaired glucose tolerance, Increased lipids
ED, Volume depletion (if sick)
What are some side effects of the potassium-sparing diuretics?
Hormonal? (4)
Electrolyte? (1)
Gynecomastia (Spironolactone)
Menstrual irregularities, Menorrhagia
Nipple tenderness
Hyperkalemia
There are 6 examples of ACE Inhibitors (they all end in -pril) that are used in treatment of HTN.
The 1 short-acting ACE-I is…
The 4 long-acting ACE-I are…
(B-L-Q-R)
The ACE-I that is converted to an active metabolite…
Short acting
–Captopril
Long acting
- -Benazepril
- -Lisinopril
- -Quinapril
- -Ramipril
Converted to active metabolite
Enalapril
What is the mechanism of action of the ACE-Is?
inhibit ACE –> prevent formation of Ang2 + inhibit breakdown of bradykinin –> vasodilation
Besides lowering BP, ACE-I and ARBs have can be beneficial in the following conditons:
- chronic kidney disease & proteinuria
- CHF
- ?
- ?
- chronic kidney disease and proteinuria
- CHF
- LV remodeling post-MI
- Reducing risk of diabetes
Name the 3 Angiotensin Receptor Blockers (ARBs) used in treatment of HTN. (they end in -sartan)
What is their mechanism of action?
- Losartan
- Valsartan
- Irbesartan
Competitive inhibition of Ang2 Receptors @ vascular endothelium –> vasodilation
((Ang2 = potent vasoconstrictor))
What are the 4 common side effects of ACE-Is and ARBs? (one of them is not present in ARBs…)
What are 4 contraindications for ACE-I/ARB use?
Side Effects
- cough (ACE-Is only)
- Hypotension
- Decreased renal function
- Angioedema
Contraindications
- Renal artery stenosis
- Hyperkalemia
- Pregnancy
- Cautious use in renal failure
For calcium channel blockers…
Which two are Dihydropyridines?
Which two are Non-Dihydropyridines?
What is their common mechanism?
Dihydropyridines
- Amlodipine
- Nifedipine
Non-Dihydropyridines
- Verapamil
- Diltiazem
Mechanism
block Ca entry –> inhibit vasc sm muscle contraction –> reduced systemic vasc resistance
What 3 therapeutic effects do all Calcium Channel Blockers share?
What extra therapeutic use is associated with Non-Dihydropyridines?
All Ca Chnl Blockers:
- lower BP
- anti-angina
- Raynaud’s syndrome
Non-Dihydropyridines
1. decrease HR –> lower myocardial O2 demand
All Calcium Channel Blockers share what three side effects?
Dihydropyridines have what unique side effect?
Non-Dihydropyridines?
Common Side Effects
–constipation, leg edema, AV nodal block
Dihydropyridines
–reflex tachycardia
Non-Dihydropyridines
–bradycardia & heart failure
There are 8 Beta Blockers used in the treatment of HTN.
The non-selective Beta Blocker that is rarely used?
What are the 7 Beta1 selective BBs?
(Hint: ABC - E - LMN)
Non-selective: Propranolol
Beta1 Selective
- Atenolol
- Bisoprolol
- Carvedilol
- Esmolol
- Labetolol
- Metoprolol
- Nadolol
How do Beta-1 Receptor blockers affect the following:
contractility
renin
NE
sympathetic tone
Block B1 Rs –>
- lower contractility –> reduce CO
- inhibit renin release
- reduce NE release from neurons
- lessen sympathetic tone
There are 4 BBs that are used for treatment of plain old HTN, CHF, and CAD.
Name them. Which two are long-acting?
- Atenolol
- Metoprolol
Long acting
- Bisoprolol
- Nadolol
There are two really potent BBs…
- -Which one is used for BP control in a hypertensive emergency?
- -Which one can be used for BP control in Acute Coronary Syndrome or CHF?
What BB is unique because it is given by IV and is used for AV nodal blocking?
Hypertensive Emergency
–Labetolol
Acute Coronary Syndrome/CHF
–Carvedilol
AV nodal blocking
–Esmolol
7 Side Effects of BBs are listed below. Of these side effects, which 3 are the moderately selective BBs less likely to cause?
- decreased exercise capacity
- bronchospasm
- bradycardia
- CHF
- masking of diabetes
- crossing BBB to cause depression
- worsened symptoms of peripheral vascular diease
Moderately selective BBs (ie, all BBs not named Propranolol) are less likely to cause…
bronchospasm
masking of diabetes
depression
What are the alpha1 antagonists that are useful in treatment of BPH, and 2nd tier for treating HTN?
Side effects of these drugs include orthostatic hypotension, fluid retention, and worsening angina…which is secondary to what process?
Terazosin, Doxazosin
Side Effects
- orthostatic hypotension
- fluid retention
- worsening angina, due to reflex tachycardia
There are 2 vasodilators that act by relaxing sm mm at peripheral arterioles.
Which one is used for hypertensive emergencies, and patients with chronic/advanced CHF & HTN?
Which one is used in refractory HTN and hair loss?
Hydralazine
- -hypertensive emergency
- -patients with advanced CHF/HTN
Minoxidil
- -refractory HTN
- -hair loss
There are 3 centrally-acting sympathoplegics which act on alpha2 Rs to reduce sympathetic outflow.
Which drug is the only one used?
Which drug is used for HTN in pregnancy?
Side effects include sedation, dry mouth, fatigue, orthostatic hypotension, and depression. Sudden discontinuation of the drug can result in what?
Clonidine is routinely used
Alpha-methyl dopa is used for pregnancy HTN
(FYI: The 3rd drug is Guanabenz)
Sudden discontinuation –> rebound HTN
