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CV > Hypertension > Flashcards

Hypertension Flashcards

1
Q

ACE-I side effects

A
  • cough (bradykinin sensitizes bronchial epithelium to irritants)
  • increase creatinine (2 months)
  • decrease renal fxn (GFR)
  • sulfhydryl effects (neutropenia, rash)
  • Hyperkalemia (1 week)
  • Angioedema ( potentiation of bradykinin; hives, tongue/throat swelling)
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2
Q

ACE inhibitors

A
  • bind to angiotensin converting enzyme-increase renin and Ang1, decrease Ang2
  • decrease aldosterone
  • decrease peripheral arterial resistance and intravascular volume
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3
Q

ARB

A
  • selectively block AT1 receptor -> block vasoconstriction, sympathetic activation, cell growth, Na and fluid retention
  • also block pathways independent of RAS
  • decreased kinin SE, otherwise similar to ACE-I
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4
Q

Renin Inhibitors

A
  • block rate limiting step of RAAS
  • do not use w/ ACE-I or ARB
  • SE overlap w/ ACE-I or ARB
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5
Q

Diuretics

A

-Increase urinary excretion of Na -> venodilation , decrease intravascular volume, decrease BP

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6
Q

Diuretic Side Effects

A
  • volume depletion
  • hypotension, orthostasis
  • electrolye changes- hypokalemia, hypomagnesemia, hyponatremia, hypercalcemia
  • ototoxicity
  • metabolic side effects-hyperglycemia, hypercholesterolemia, hyperuricemia
  • erectile dysfunction
  • sulfa allergy
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7
Q

Aldosterone Antagonist

A

aldosterone-> increased fluid retention by increased NaCl absorption, direct peripheral vasoconstriction, endothelial dysfunction

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8
Q

Spironolactone

A

-non-selective aldosterone antagonist
-good for tx in heart failure
-binds to progesterone and androgen receptors
Side effects:
-men-erectile dysfunction, gynecomastia
-women-menstrual abnormalities

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9
Q

Eplerenone

A
  • selective aldosterone antagonist

- similar actions as spironolactone but better SE

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10
Q

Calcium channel blockers

A
  • L type Ca channels-> Ca influx and smooth muscle contraction
  • CCB bind receptors -> vasodilation, decrease peripheral vascular resistance
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11
Q

Dihydropyridines (amlodipine)

A
  • CCB
  • vascular smooth muscle only (arteriolar dilation)
  • SE: edema, HA, flushing, dizziness, palpitation, reflex tachycardia, gingival hyperplasia, aggravate GI reflux
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12
Q

Non-dihydropyridine (diltiazem, verapamil)

A
  • CCB
  • vascular smooth muscle and myocardium
  • SE: bradycardia, AV block, constipation, gingival hyperplasia, aggravate GI reflux
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13
Q

B-adrenoreceptor blockers

A
  • decrease cardiac output
  • inhibit renin secretion
  • inhibit NE and Epi release
  • decrease HR (decreased automaticity in sinus node)
  • decrease myocardial contractility
  • reduce ventricular hypertrophy, stroke, heart failure, coronary events, and mortality
  • lipid soluble or hydrophilic
  • 1st line if CAD, heart failure
  • some partial agonists- weak sympathomimetic activity
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14
Q

Selective B-blockers

A
  • B1 only
  • myocardium, less effect on airways
  • atenolol, metoprolol
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15
Q

Non-Selective B-blockers

A
  • B1 and B2
  • myocardium, vascular, and bronchial cells
  • may exacerbate asthma, COPD
  • carvedilol, propanolol
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16
Q

B-blocker side effects

A
  • bradycardia, heart block, dizziness
  • bronchospasm, cold extremities
  • CNS-fatigue, depression, mental slowness, vivid dreams, dry mouth
  • erectile dysfunction
  • hyperglycemia
  • lipid abnormalities (triglyceride elevation, decrease HDL)
17
Q

Hydralazine

A
  • Direct vasodilator
  • directly relax smooth muscle
  • decrease peripheral resistance
  • usually given w/ a diuretic and B-blocker to prevent “pseudotolerance” (tachycardia and volume retention)
18
Q

Minoxidil

A
  • Direct vasodilator
  • opens K+ channels in vascular smooth muscle
  • most useful in severe HTN
  • SE-pericardial effusion, tachycardia, facial hirsutism
  • Use w/ BB and diuretic-prevent pseudotolerance
19
Q

a-adrenergic receptor blockers

A
  • selective a1 antagonists-block NE
  • decrease arteriolar resistance
  • beneficial in pts w/ prostate sx
  • SE-postural hypotension, dizziness, syncope, reflex tachycardia, nasal congestion, volume expansion
20
Q

Central sympatholytics

A
  • a2 agonists (clonidine, methyldopa)
  • decrease sympathetic outflow to heart and BV
  • SE- sedation, xerostomia, erectile dysfxn
  • Clonidine SE-rebound HTN, skin hypersensitivity
  • Methyldopa SE- Coombs and hemolytic anemia, elevated liver function tests

CV (4 decks)

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