Hypertension Flashcards
What are the BP ranges for the three stages of hypertension?
Stage 1: 140-159/90’s
Stage 2: 160-179/100-109
Stage 3: =>180/110
What is the JNC 8 recommendation for those aged over 60?
Treat if over 150/90 (either sys or dia) with a goal to be below those numbers.
What is the JNC 8 recommendation for those aged below 60?
Treat a systolic above 140. (expert opinion)
What are the four major types of antihypertensives?
Diuretics
Beta-blockers
ACE-I/ARB
CCBs
Which of the four major types of antihypertensives is slightly less effective than the rest?
Beta-blocker
What describes a substance that promotes the excretion of urine?
Diuretic
What describes a substance that promotes the renal excretion of Na+?
Natriuretic
What is the site of action for osmotic diuretics?
Proximal tubule and thin descending limb of Henle
What is the site of action for Carbonic anhydrase inhibitors?
Proximal tubule
What is the site of action for Thiazides?
Distal convoluted tubule
What is the site of action for loop diuretics?
Thick ascending limb of Henle
What is the site of action for Na+ channel blockers and spironolactone?
Cortical collecting duct
What is the MOA for Thiazide diuretics?
Inhibits Na+ and Cl- transporter in distal convoluted tubules.
Increases excretion of Na+, Cl-, K+, Mg2+
Decrease Ca2+ excretion
How are thiazides administered and absorbed?
Orally, poorly absorbed
How long is the onset of action for thiazides and what is their t1/2?
1-2 hours (BP effects take several days)
Wide range of t1/2 for different thiazides (generally longer than diuretics)
What the two major side effects to worry about with thiazides?
Hypokalemia and hyponatremia
What are four commonly used thiazides?
Chlorothiazide
Hydrochlorothiazide
Chlorthalidone
Metolazone
What are four common loop diuretics?
Furosemide
Bumetanide
Torsemide
Ethacrynic acid
What is the MOA of loop diuretics?
Inhibit apical Na-K-2Cl transporter in thick ascending loop of henle
Competes with Cl- binding site
Enhanced excretion of Mg2+, Ca2+, K+, and H+
Inhibits reabsorption of glomerular filtrate
How are loop diuretics administered and absorbed?
Orally, rapid absorption
What is the onset of action for loop diuretics?
Rapid for both diuresis and BP effects
What are the toxicity concerns with loop diuretics?
They cause retention of lithium, also has additive toxicity with ototoxic drugs at IV doses
What decreases the potency of loop diuretics?
Inhibitors of organic acid ion transport (NSAIDs)
What are the two main side effects to worry about with loop diuretics?
Hypokalemia and hyponatremia
What antihypertensive drugs are the best tolerated?
Renin-Angiotensin Inhibitors (RAS) and ARBs.
What are four common Angiotensin Converting Enzyme Inhibitors (ACE-Is)?
Lisinopril
Enalapril
Captopril
Ramipril
What are four common Angiotensin Receptor Blockers (ARB)?
Losartan
Irbesartan
Valsartan
Candesartan
What is the most common side effect of ACE-I’s?
A dry cough (more common in black and asian patients)(can replace with ARB)
What are the side effects of ACE-I’s?
Dry cough
Angioedema
Hyperkalemia
Kidney function reduction
What are the three types of CCBs?
Phenylalkylamines
Benzothiazepines
1, 4-dihydropryidines
Two of the three CCB types work mostly through decreased cardiac output. Which one works by causing vasodilation?
Dihydropyradines
What is the principal side effect of dihydropyridines?
Ankle edema
What is the MOA of beta-blockers?
Competitive antagonism (non-selective for both beta 1 and 2 receptors) Antagonize effects of catecholamines on the heart.
What is the difference between cardioselective and non-cardioselective beta-blockers?
Cardioselective prefer B1 receptors (except at high doses. Theoretically cause less bronchoconstriction and peripheral vasodilation
What are some of the important adverse effects of beta blockers?
CNS effects (sedation, depression, hallucinations)
Worsening of heart failure when initiated (start low dose)
Bronchospasm
Hypoglycemia unawareness in diabetes
Impotence
