Hypertension Flashcards
maximum blood pressure during contraction of ventricles is called _______
systolic pressure
minimum pressure recorded just prior to next contraction is called _________
diastolic pressure
define stage 1 HTN
systolic BP from 140-159
diastolic BP in 90s
define stage 2 HTN
systolic BP from 160-179
diastolic BP in 100-109 range
define stage 3 HTN
systolic BP >180
diastolic BP >110
aka malignant HTN
what outcomes can you expect to improve by treating elevated BP
atherosclerosis –> MI & stroke
HF
renal damage
non-pharmacologic tx to HTN
sodium restriction
weight loss
smoking cessation
stress management
four categories of antihypertensive drugs
Diuretics
Beta blockers
CCB
ACE/ARB
2014 BP guidelines, which 3 or 4 are recommended in general non-black population?
Diuretic, ACE/ARB, CCB
at which site do loop diuretics act?
thick ascending loop of henle
at which site to thiazides act?
distal convoluted tubule
name the 4 common thiazide diruetics
Chlorothiazide (prototype)
Hydrochlorothiazide
Chlorthalidone
Metolazone
what is the MOA of thiazide diuretics
inhibit Na and Cl transportere in distal convoluted tubule
increase NA and Cl excretion
increase K/Mg excretion
decrease Ca excretion
natriuretic effect on Na reduces circulating blood vol. and relaxes vascular SM in wall of arteries
Side effects of thiazide diuretics
*****hypokalemia (order CMP after 6 mo use)
hyponatremia
name the 4 loop diuretics
Furosemide (prototype)
Bumetanide
Torsemide
Ethacrynic acid
MOA loop diuretics
inhibits apical Na-K-Cl transporter in thick ascending loop of henle (these drugs really make you pee)
competes with Cl binding sites
enhances passive Mg and Ca excretion
inhibits reabsorption of 25% of glomerular filtrate
which diuretic is preferred in patients with moderate-severe chronic kidney dz
loop
side effect of loop diuretics
increase lithium toxicity
hypokalemia**
hyponatremia
what are the best tolerated antihypertensives?
RAS: ACE/ARB*****
T/F: dual RAS blockade either with an ACE-Iplus an ARB or with aliskiren plush ACE-I or ARB is contraindicated
true
how do ACE-I, ARBs and aliskiren work?
blocking conversion of angiotensin I into angiotensin II and thus reducing effects of angiotensin II on blood vessels
they are basically vasodilators
name the 4 ACE-I’s
Lisinopril
Enalapril
Catopril
Ramipril
name the 4 ARBs
Losartan
Irbesartan
Valsartan
Candesartan
what are the side effects of RAS
contraindicated in pregnancy --> birth defects mc is dry cough angioedema (mc in ACE-I) hyperkalemia small reductions in kidney function
Three classes of CCB
Phenylalkylamines (Verapamil)
Benzothiazepines (Diltiazem)
1, 4-Dihydropyridines (nifedipine)
which CCBs work thru decreasing CO
Phenylalkylamines and Benzothiazepines
which CCB is a vasodilator
1,4-Dihydropyridines
what is the principal side effect of dihydropyridines
ankle edema
can also cause gingival hyperplasia
side effect of verapamil and diltiazem
impairment of cardiac conduction (esp. in older pts)
Beta-1
tachycardia
increased lipolysis
increased myocardial contractility = increased cardiac output
Beta-2
vasodilation
slightly decreased peripheral resistance
bronchodilation
MOA beta blockers
all are competitive antagonists
antagonize effects of catecholamines on heart
cardioselective BBs
metoprolol esmolol acebutolol atenolol (markedly hydrophilic --> can penetrate tissue less well, making it preferred in practice) betaxolol
non-cardioselective BBs
carvedilol
what BB is contraindicated in pts with lung dz
carvedilol
adverse side effects Beta blockers
CNS effects (sedation, depression, hallucinations)
precipitation or worsening of HF
hypoglycemia unawareness in diabetes
worsening of impotence
