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Dental Pharmacology Exam 4 > Hypertension > Flashcards

Hypertension Flashcards

1
Q

Distal Tubule Diuretic Drugs

A

Thiazides:
Hydrochlorothiazide
Chlorhilidone

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2
Q

Loop of Henle Diuretic Drugs

A

Furosemide

Ethacrynic Acid

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3
Q

Collecting Duct Drugs

A

Spironalactone
Amiloride
Triamterine

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4
Q

What diseases do thiazides and loop diuretics promote?

A

Gout and Hypokalemia

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5
Q

What potential side effects do all diuretics have?

A

Dehydration

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6
Q

Loop diuretic features (3)

A
  1. 35% of filtered Na is reabsorbed in loop of henle
  2. Furosemide/Ethacrynic acid blok Na, K, and Cl transportation from Lumen to thick ascending limb
  3. Increased Na in collecting duct results in increased exchanged in K = hypokalemia
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7
Q

Thiazide diuretic features (3)

A
  1. 10% of filtered Na is reabsorbed in distal convoluted tubule
  2. Hydrochlorothiazide and Chlorthalidone block Na and Cl transportation into distal tubule
  3. Increased Na in collecting duct increases exchange of K to urine = hypokalemia
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8
Q

Which thiazide diuretic is longer lasting?

A

Chlorthalidone

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9
Q

Potassium Sparing Diuretic Features (3)

A
  1. Collecting duct absorbs 2-5% filtered Na but determines final urine Na concentration
  2. Aldosterone binds to intracellular Mineralcorticoid receptor - MR maintinas the transcription gene for Na-K-ATPase on basolateral membrane
  3. Potassium Sparing
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10
Q

Where does spironalactone have its effects? (2)

A
  1. Collecting Duct

2. Blocks MR - reduced expression of basolateral Na-K-ATPase

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11
Q

Where do Triamterine/Amiloride have their effects?

A
  1. Collecting Duct

2. Block Na channel on Apical membrane

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12
Q

What drugs are Beta-blockers?

A

Propranolol (non-selective)
Atenolol (cardioselective)
Nadolol (long-acting)

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13
Q

Features of beta blockers? (4)

A
  1. Antagonist at B1 adrenergic receptors
  2. Block sympathetic increases in heart rate and contractile force
  3. Decrease CO
  4. Reduce renin production in the kidneys
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14
Q

Alpha1 Adrenergic Receptor Antagonists (2)

A
  1. Prazosin

2. Terzosin

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15
Q

Features of alpha 1 adrenergic receptor antagonists (3)

A
  1. Block Sympathetic contraction of arterial Smooth Muscle
  2. Vasodilators
  3. Decrease TPR
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16
Q

Indirect acting types (2)

A

Alpha 2 Antagonists

Catecholamine Release Inhibitors

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17
Q

What drug is an alpha2 agonist?

A

Clonidine

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18
Q

What drug is an catecholamine release inhibitor?

A

Reserpine

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19
Q

Where does Clonidine have its effects?

A
  1. Vasomotor control center inhibition

2. effects the pre-synaptic a2 receptor on its way to the heart

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20
Q

Are arterial vessels capacitance or resistance vessels?

A

Resistance

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21
Q

Action of sympatholytic drugs

A

Block sympathetic NS induced contraction of arterial smooth muscle
A1 adrenergic receptor antagonists

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22
Q

Oral Direct Vasodilators include which 3 drugs?

A
  1. Hydralazine
  2. Calicium Channel Blockers
  3. Minoxidil
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23
Q

Selective arterial dilator that can be taken orally to treat HTN?

A

Hydralazine

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24
Q

Highly effect direct vasodilator with lots of side effects

A

Minoxidil

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25
Q

When are parenteral drugs used?

A

Emergency situations, hypertensive crisis

26
Q

2 Parenteral direct vasodilator drugs

A
  1. Sodium Nitroprusside

2. Diazoxide

27
Q

What are the 2 types of CCBs and what drugs are they?

A

Non-Cardioactive: Amlodipine, Nifedipine

Cardioactive: Verapamil, Diltiazem

28
Q

Whats makes a drug cardioactive vs noncardioactive?

A

The selectivity for calicum channels on vascular smooth muscle, instead of the channels in the heart

29
Q

What do cardioactive CCBs do to the heart?

A

Relax VSM and reduce CO (lower HR, AV conduction, and force of contraction)

30
Q

When treating HTN on angina pectoris, always use ____ - acting drugs like _____. or Special extended release formulations like _____.

A
  1. Long-acting
  2. Amlodipine
  3. Nifedipine
31
Q

Side effects of all vasodilators (3)

A
  1. Postural (orthostatic) Hypotension
  2. Flushing/Sweating
  3. Headache
32
Q

What are the 2 reflex responses and what is co-administered w/ vasodilators to treat this?

A
  1. Reflex tachycardia - admin beta-blockers

2. Reflex fluid retention - admin diuretics

33
Q

Indirect effects of vasodilators

A

Reflex increase in HR and Fluid Retention

34
Q

What beta blockers are also vasodilators?

A

Carvedilol

Nebivolol

35
Q

What receptors does carvedilol bind?

A

Mixed B1
B2
A1 antagonist
-decrease CO and TPR

36
Q

What receptors does nebivolol bind?

A

Beta-1, promotes NO production

37
Q

Why are angiotensin II inhibitors used when prescribing vasodilators?

A

To keep the body from having a fluid retention reflex

38
Q

What are the effects of blocking renin-angiotensin systems?

A
  1. Vasoconstriction
  2. Increase aldosterone production
  3. Increase vasopressin release
  4. NO REFLEX SYMPATEHTIC ACTIVTION
39
Q

What are the angiotensin related agents (3)

A
  1. ACE inhibitors
  2. Angiotensin Receptor Blockers (ARBs)
  3. Renin Inhibitors
40
Q

How do ACE inhibitors work and what drugs are they?

A

Inhibit conversion of angiontensin to angiotensin II by Angiotensin Converting Enzyme

  1. Ramipril
  2. Enalapril
  3. Captopril
41
Q

How do ARBs work and what drugs are they?

A

Inhibit angiotensin II to AT1 receptor

  1. Losartan
  2. Valsartan
42
Q

How do renin inhibitors work and what drug is it?

A

Inhibit conversion of angiotensinogen to angiotensin I by the enzyme Renin
1. Aliskiren

43
Q

Side effects of ACE inhibitors (3)

A
  1. Dry cough (bradykinin effect due to ACE inhibition)
  2. Angioedema (rapid, non-allergic swelling of skin and mucosa, also bradykinin)
  3. Hyperkalemia (reduced sodium potassium exchange in kidney)
  4. TERATOGENIC
44
Q

Captopril facts (4)

A
  1. First approved
  2. No metabolism necessary
  3. Higher risk of SE
  4. Shorter half-life = reiquires BID admin
    * *TERATOGENIC
45
Q

Enalapril fact

A

Pro-drug metabolized into active ACE inhibitor

46
Q

Ramipril facts (2)

A
  1. Prodrug

2. More cardioprotective than others

47
Q

How are ARBs different than ACE inhibitors?

A

ARBs block receptor for Angiotensin II, avoiding SE mediated by interactions w/ other receptors
ARBs are competitive antagonists at AT1 Angiotensin Receptors

48
Q

How are ARBs and ACE inhibitors similar?

A

Produce hyperkalemia and are teratogenic

49
Q

What receptors do ARBs effect?

A

Complete blockade of AT1 mediated angtiotensin II, less AT2 receptor antagonism

50
Q

2 ARB drugs, how do they differ

A
  1. Losartan
  2. Valsartan
    Differ in efficacy, AT1 vs AT2 Selectivity, half life
51
Q

Renin Inhibitor rationale

A

ACE and ARbs produce compensatory increases in renin synth and activity
SE are similar to ARBs

52
Q

SE of ARBs

A
  1. Less bradykinin SE (cough/angioedema) but also possibly less therapeutic effects
53
Q

First choice drugs for most individuals

A

Thiazide Diuretics

54
Q

1st choice HTN drugs for diabetics

A

ACE inhibitors

55
Q

1st choice HTN drugs for Coronary Artery Disease

A

Beta Blockers

56
Q

Phase I HTN vs Phase II HTN threshold and drug amounts

A

Phase I = 1 drug = 140-159/90-99

Phase II = 2 drugs = 160+/100+

57
Q

What drugs are first choice for African American HTN?

A
  1. CCBs or Thiazides
58
Q

Efficacy of Thiazides vs ACE inhibitors?

A

Equal in most populations (except AAs), but thiazides are less expensive

59
Q

Current Guidlines for HTN?

A
  1. 60 - tx at 150/90
60
Q

Sprint Study

A

At risk adults 50yrs and older should maintain systolic BP

Dental Pharmacology Exam 4 (5 decks)

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