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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
When are parenteral drugs used?
Emergency situations, hypertensive crisis
26
2 Parenteral direct vasodilator drugs
1. Sodium Nitroprusside | 2. Diazoxide
27
What are the 2 types of CCBs and what drugs are they?
Non-Cardioactive: Amlodipine, Nifedipine | Cardioactive: Verapamil, Diltiazem
28
Whats makes a drug cardioactive vs noncardioactive?
The selectivity for calicum channels on vascular smooth muscle, instead of the channels in the heart
29
What do cardioactive CCBs do to the heart?
Relax VSM and reduce CO (lower HR, AV conduction, and force of contraction)
30
When treating HTN on angina pectoris, always use ____ - acting drugs like _____. or Special extended release formulations like _____.
1. Long-acting 2. Amlodipine 3. Nifedipine
31
Side effects of all vasodilators (3)
1. Postural (orthostatic) Hypotension 2. Flushing/Sweating 3. Headache
32
What are the 2 reflex responses and what is co-administered w/ vasodilators to treat this?
1. Reflex tachycardia - admin beta-blockers | 2. Reflex fluid retention - admin diuretics
33
Indirect effects of vasodilators
Reflex increase in HR and Fluid Retention
34
What beta blockers are also vasodilators?
Carvedilol | Nebivolol
35
What receptors does carvedilol bind?
Mixed B1 B2 A1 antagonist -decrease CO and TPR
36
What receptors does nebivolol bind?
Beta-1, promotes NO production
37
Why are angiotensin II inhibitors used when prescribing vasodilators?
To keep the body from having a fluid retention reflex
38
What are the effects of blocking renin-angiotensin systems?
1. Vasoconstriction 2. Increase aldosterone production 3. Increase vasopressin release 4. NO REFLEX SYMPATEHTIC ACTIVTION
39
What are the angiotensin related agents (3)
1. ACE inhibitors 2. Angiotensin Receptor Blockers (ARBs) 3. Renin Inhibitors
40
How do ACE inhibitors work and what drugs are they?
Inhibit conversion of angiontensin to angiotensin II by Angiotensin Converting Enzyme 1. Ramipril 2. Enalapril 3. Captopril
41
How do ARBs work and what drugs are they?
Inhibit angiotensin II to AT1 receptor 1. Losartan 2. Valsartan
42
How do renin inhibitors work and what drug is it?
Inhibit conversion of angiotensinogen to angiotensin I by the enzyme Renin 1. Aliskiren
43
Side effects of ACE inhibitors (3)
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
Captopril facts (4)
1. First approved 2. No metabolism necessary 3. Higher risk of SE 4. Shorter half-life = reiquires BID admin * *TERATOGENIC
45
Enalapril fact
Pro-drug metabolized into active ACE inhibitor
46
Ramipril facts (2)
1. Prodrug | 2. More cardioprotective than others
47
How are ARBs different than ACE inhibitors?
ARBs block receptor for Angiotensin II, avoiding SE mediated by interactions w/ other receptors ARBs are competitive antagonists at AT1 Angiotensin Receptors
48
How are ARBs and ACE inhibitors similar?
Produce hyperkalemia and are teratogenic
49
What receptors do ARBs effect?
Complete blockade of AT1 mediated angtiotensin II, less AT2 receptor antagonism
50
2 ARB drugs, how do they differ
1. Losartan 2. Valsartan Differ in efficacy, AT1 vs AT2 Selectivity, half life
51
Renin Inhibitor rationale
ACE and ARbs produce compensatory increases in renin synth and activity SE are similar to ARBs
52
SE of ARBs
1. Less bradykinin SE (cough/angioedema) but also possibly less therapeutic effects
53
First choice drugs for most individuals
Thiazide Diuretics
54
1st choice HTN drugs for diabetics
ACE inhibitors
55
1st choice HTN drugs for Coronary Artery Disease
Beta Blockers
56
Phase I HTN vs Phase II HTN threshold and drug amounts
Phase I = 1 drug = 140-159/90-99 | Phase II = 2 drugs = 160+/100+
57
What drugs are first choice for African American HTN?
1. CCBs or Thiazides
58
Efficacy of Thiazides vs ACE inhibitors?
Equal in most populations (except AAs), but thiazides are less expensive
59
Current Guidlines for HTN?
1. 60 - tx at 150/90
60
Sprint Study
At risk adults 50yrs and older should maintain systolic BP

Dental Pharmacology Exam 4 (5 decks)

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