hypertension 3 Flashcards

1
Q

what are the two types of pharmacological therapy for hypertension?

A

1- Sympatholytic Agents

2- Directly-acting Vasodilators

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2
Q

what are the two types of sympatholytic agents?

A

a-Adrenoceptor Blocking Drugs

Centrally-acting Drugs

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3
Q

what are the 3 types of directly acting vasodilators?

A

Hydralazine
Minoxidil
Na nitroprusside

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4
Q

what is the main A- adrenoceptor blocker and whats its MOA?

A

block a-1-adrenoceptors in arterioles & venules and decrease PVR

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5
Q

what are the characteristics of the anti-hypertensive effect of A-adrenoceptor blockers?

A

fall in BP with associated -decrease TPR
little/no change in CO
orthostatic/postural hypotension

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6
Q

benefits of A-adrenoceptor blockers?

A

favourable effects on plasma lipid & glucose levels
equal efficacy in all age & racial groups
most beneficial in patients with benign prostatic hypertrophy (BPH)

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7
Q

what kind of therapy is A-adrenoceptor blocking drugs?

A

it is an add on therapy with BB and thiazide like diuretics- recommend for patients with resistant hypertension

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8
Q

what are the adverse effects of a-adrenoceptor blocking drugs?

A

first-dose hypotension & syncope
postural hypotension
dizziness, fatigue, drowsiness, headaches
fluid retention & tolerance

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9
Q

what are the 3 main centrally acting agents?

A

Clonidine
Moxonidine
a-Methyldopa

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10
Q

what agonist is clonidine selective for clonidine?

A

a2- adrenoceptor agonist

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11
Q

what is moxonidine selective for?

A

relatively selective a2-adrenoceptor & I1-imidazoline receptor agonist

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12
Q

what is a-methyldopa selective for?

A

converted to a-methylnoradrenaline

a1-adrenoceptor agonist

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13
Q

how do centrally acting agents produce their antihypertensive effect?

A

act centrally in lower brainstem/medullary vasomotor centre
a2-receptor activation -decrease sympathetic outflow to heart & blood vessels -decrease HR, CO & PVR -decrease BP
a2-receptor activation- increase cardiac vagal tone decrease HR and BP

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14
Q

are the efffects of metabolism & plasma lipids favourable or unfavourable in centrally acting agents?

A

favourable

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15
Q

what centrally acting agent is safe to use in pregnancy?

A

a-Methyldopa

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16
Q

what are the 4 side effects of centrally acting agents?

A

1-sedation, drowsiness, mental lassitude, dry mouth
2-rebound effect
3-Na & fluid retention ->pseudotolerance
4- hypersensitivity reactions –drug fever, hepatitis, haemolytic anaemia

17
Q

what are the two oral directly acting vasodilators?

A

Hydralazine

Minoxidil

18
Q

what is the parental directly acting vasodilators ?

A

Na nitroprusside

19
Q

what directly acting vasodilator can be used for both oral and parenteral?

A

hydralazine

20
Q

how do directly acting vasodilators produce their effect?

A

relaxation of blood vessels/dilation

decrease in TPR and cO

21
Q

How does Na nitroprusside produce this antihypertensive effect?

A

increase intracellular cGMP - increase in relaxation

22
Q

how does relaxation Minoxidil produce its antihypertensive effect?

A

open K+channels > hyperpolarization

23
Q

what are the clinical uses for minoxidil and Hydralazine?

A

reserved for severe/refractory HPT

must be used in combination with diuretics & BBs

24
Q

what are the clinical uses for Na nitroprusside?

A

reserved for severe hypertensive crisis/emergencies

25
what are the 3 adverse effects of directly acting vasodilators?
postural hypotension & fluid retention reflex sympathetic stimulation- risk of angina headaches, dizziness
26
when do you treat adults with hypertension?
Adults of any age with persistent Stage 2 HPT (BP >160/100 mmHg)
27
when do you treat adults under 80 with stage 1 hypertension?
``` when they also have one of the following: target organ damage existing / established CVD renal disease diabetes an estimated 10-year CVD risk >10% ```
28
when do you treat adults under 60 with stage one hpt?
when they have an estimated 10-year CVD risk <10%
29
when do you treat adults over 80 for hpt?
a clinic blood pressure of over 150/90
30
what are the clinical BP targets?
aim for target BP <140/90 mmHg in under 80 year olds | aim for target BP <150/90 mmHg in over 80 year olds
31
what are the BP targets for BPM or HBPM in addition in patients with ‘white coat effect’
aim for target BP <135/85 mmHg in under80 year olds | aim for target BP <145/85 mmHg in over80 year olds
32
what are the 3 types of drug therapy associated with hypertension treatment?
Initial Monotherapy with 'Stepped-Care’ Approach Initial Monotherapy with ‘Sequential Monotherapy’ Approach Initial Combination Therapy (with SPC therapy)
33
what is initial monotherapy with stepped care approach?
start with lowest recommended dose of 1st-line drug(s) titrate up .... till BP control achieved, treatment not tolerated or maximum dose reached (except some diuretics)add next recommended drug ....... allow >4 weeks to observe full response at each
34
what is combination therapy?
control of BP with two or more drugs | needed to achieve target BP levels in >60% of patients indicated for lower target BP levels & in high risk groups
35
what is a disadvantage of combination therapy?
one drug may inhibit activation of compensatory mechanisms by another drug e.g. b-blocker & diuretic with vasodilator ACEI with diuretic additive /synergistic effect achieved with drugs acting on different mechanisms e.g. diuretic with b-blocker/ACEI/a-blocker