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Hypertension Flashcards

1
Q

Methyldopa

A

centrally acting sympathoplegic - A2 agonist

  • Considered last line treatment because of significant CNS adverse effects (especially in elderly)
  • Act in CNS on presynaptic a2 receptors = inhibition of SYMP
  • Most are oral, clonidine also come in transdermal patch
  • AE: sedation, dry mouth (clonidine) - dose at bed time
  • Sudden withdrawl of clinidine = hypertensive crisis , headache, tremor, abdominal pain, sweating and tachycardia -> all SYMP hyperactivation stuff
  • Methyldopa - limited to hypertension in pregnant women
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2
Q

clonidine

A

centrally acting sympathoplegic drug - A2 agonist

  • Considered last line treatment because of significant CNS adverse effects (especially in elderly)
  • Act in CNS on presynaptic a2 receptors = inhibition of SYMP
  • Most are oral, clonidine also come in transdermal patch
  • AE: sedation, dry mouth (clonidine) - dose at bed time
  • Sudden withdrawl of clinidine = hypertensive crisis , headache, tremor, abdominal pain, sweating and tachycardia -> all SYMP hyperactivation stuff
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3
Q

propranolol

A

non selective beta blocker

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4
Q

nadolol

A

non selective beta blocker

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5
Q

penbutolol

A

non selective beta blocker

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6
Q

pindolol

A

non selective beta blocker

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7
Q

timolol

A

non selective beta blocker

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8
Q

acebutolol

A

beta 1 blocker

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9
Q

atenolol

A

beta 1 blocker

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10
Q

bisprolol

A

beta 1 blocker

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11
Q

esmolol

A

beta 1 blocker

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12
Q

metoprolol

A

beta 1 blocker

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13
Q

carteolol

A

beta blocker with aditional action

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14
Q

cavedilol

A

beta blocker with aditional action (a1 antagoinst and block Ca entery)

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15
Q

labetolol

A

beta blocker with aditional action (A1 antagonist)

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16
Q

betazolol

A

beta blocker with aditional action

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17
Q

prazosin

A

A1 blocker

Reduces NE induced vasoconstriction = dilate both arteries and veins

May be considered second line treatement in pateinst with BPH - because it antagonizes the alpha receptors on the bladder = less SYM (more para) = relaxation and more easily voiding

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18
Q

terazosin

A

A1 blocker

Reduces NE induced vasoconstriction = dilate both arteries and veins

May be considered second line treatement in pateinst with BPH - because it antagonizes the alpha receptors on the bladder = less SYM (more para) = relaxation and more easily voiding

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19
Q

doxazosin

A

A1 blocker

Reduces NE induced vasoconstriction = dilate both arteries and veins

May be considered second line treatement in pateinst with BPH - because it antagonizes the alpha receptors on the bladder = less SYM (more para) = relaxation and more easily voiding

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20
Q

hydralazine

A

oral vasodilator

not used anymore

  • Act directly on VSM to cause relaxation = less vascular resistance
  • Hydralazine, minoxidil, diazoxide dilate arteries selectively (don’t change venous SM)
  • AE: hypotension (headaches, flushing etc)
    • Hydralazine may cuase lupus like syndrome
    • Minoxidil cuases hypertrichosis - used in Rogaine to treat male baldness
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21
Q

minoxidil

A

oral vasodilator

  • Act directly on VSM to cause relaxation = less vascular resistance
  • Hydralazine, minoxidil, diazoxide dilate arteries selectively (don’t change venous SM)
  • AE: hypotension (headaches, flushing etc)
    • Hydralazine may cuase lupus like syndrome
    • Minoxidil cuases hypertrichosis - used in Rogaine to treat male baldness
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22
Q

Nitroprusside

A

IV vasodilator - basically all IV vasodilators are for emergencies

  • Act directly on VSM to cause relaxation = less vascular resistance
  • Sodium nitroprusside: non selective or balanced vasodilator (dilates both arteries and veins)
  • AE: hypotension (headaches, flushing etc)
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23
Q

diazoxide

A

IV vasodilator

24
Q

fenoldapam

A

IV vasodilator

  • Act directly on VSM to cause relaxation = less vascular resistance
  • Fenoldapam also dilates arteries by acting as a dopamine D1 agonist
  • AE: hypotension (headaches, flushing etc)
25
benazepril
inhibitor of angiotensin - ACE inhibitor
26
captopril
inhibitor of angiotensin - ACE inhibitor only active drug (ace inhibitor) - doesnt need to be metabolized
27
enalapirl
inhibitor of angiotensin - ACE inhibitor
28
fosinopril
inhibitor of angiotensin - ACE inhibitor
29
lisinopril
inhibitor of angiotensin - ACE inhibitor
30
moexipirl
inhibitor of angiotensin - ACE inhibitor
31
perindopril
inhibitor of angiotensin - ACE inhibitor
32
quinapril
inhibitor of angiotensin - ACE inhibitor
33
amipril
inhibitor of angiotensin - ACE inhibitor
34
trandolapirl
inhibitor of angiotensin - ACE inhibitor
35
candesartan
inhibitor of agniotensin - angiotensin receptro blocker
36
losartan
inhibitor of agniotensin - angiotensin receptro blocker
37
eprosartan
inhibitor of agniotensin - angiotensin receptro blocker
38
irbesartan
inhibitor of agniotensin - angiotensin receptro blocker
39
olmesartan
inhibitor of agniotensin - angiotensin receptro blocker
40
telmisartan
inhibitor of agniotensin - angiotensin receptro blocker
41
valsartan
inhibitor of agniotensin - angiotensin receptro blocker
42
aliskiren
inhibitor of angiotensin - renin inhibitor * Basics * Orally active * Dose dependent reduction of plasma renin and BP * Safety and tolerability similar to ACEi * Avoid in pregnancy * Don’t combine with ACE or ARBs
43
clorthalidone
thiazide like drug prefered for treatment of hypertension becuase of long HL * More effective in AA and elderly * Use * Low dose for hypertension, high dose for congestive heart failure * Nephrolithiasis due to idiopathic hypercalciuria - reduce urinary calcium concentration * Nephrogenic diabetes insipidus - reduce polyrira and polydipsia - paradoxical effect due to plasma volume reduction (people don’t really know why this happens) * AE * Hypokalemic metabolic alkalosis * Hyponatremia * Hyperglycemia * Hyperlipidemia * Hyperuricemia * hypercalcemia
44
ACE inhibitors
* Captopril is the only active drug - the rest are given as pro drugs * Inhibit ACE - angiotensin2 and aldosterone release, also there is more bradykinin * BP lowering mostly due to decreased peripheral vascular resistance * Do not typically cause reflex tach- concurrent baroreceptor resseting or vagal activation * Use in * Young and middle aged cuacasians, less effective in: AA and elderly * First choice of treatment with hypertensive patienst with * Diabetes * chronic renal disease * Left vent hypertrophy * AE * Cough - bradykinin levels * Hyperkalemia - due to inhibited aldosterone secretion * Angioedema and anaphylaxis * Do not use in combination with ARBs - they cause kidney damage together * Avoid in pregnancy - contraindicated in second and third trimester
45
ARBs
* Two main differences from ACEi * More specific than ACEi: they don’t hit bradykinin (no cough) * More complete inhibition of angiotensin action (there are other enzymes that also generate angiotensin 2) * AE: same as ACEi (except cough)
46
CCBs
* Two main groups * Dihydropyridines (amlodipine, feldipine, isradipine, nicardipine, nifedipine, minodipine, nisoldipine) - all end in dipine * Non dyhydropyridines (verapamil, diltiazem) * Block slow Ca channels = reduce intracellular Ca -\> relax arterilar SM -\> vasodilation and lower BP (dihydropyridines have the most vasodilatory capacity - espeically nifedipine, verapamil has cardiac depressent effects and diltiazem is inbetween the two ) * Verapamil and diltiazem don’t cause reflex tach (because they directly depress the SA and AV nodes = slow HR) * The dihydros have reflex tach usually * ![]() * Very good in AA and elderly * AE * Verapamil and diltiazem may cuase bradycardia * Contraindicated in patienst with SA or AV node abnormalities * Dihydros - reflex tach and vascular side effects (headache, flushing, dizziness, peripheral edema) * Constipation is the most common side effect of verapamil
47
verapamil
CCB - vasodilator myocardial depression
48
diltiazem
CCB - vasodilator myocardial depression
49
amlodipine
CCB - vasodilator (dihydropuridine) reflex tach - for all dihydropuridines
50
felodipine
CCB - vasodilator (dihydropuridine)
51
isradipine
CCB - vasodilator (dihydropuridine)
52
nicardipine
CCB - vasodilator (dihydropuridine)
53
nifedipine
CCB - vasodilator (dihydropuridine)
54
nisoldipine
CCB - vasodilator (dihydropuridine)
55
symaptholytic drugs
* Basics * More effective in Caucasian and young people * Combined with other antihypertensive drugs to counteract * Reflex tach cuased by vasodilators * Increased renin secretion cuased by thiazide and loop diuretics * AE - * they can all cause postural hypotension (reduce SYM compensation when you stand up) * May worsen symptoms in patients with * Reduced myocardial reserve * Asthma (b2 cross over) * Peripheral vascular insufficiency * Diabetes - delays recovery of normoglycemia * Inhibits hyperglycemic response medaited by epinephrine (epi causes insulin release - cuases glucose to go into tissues) * Can also cuase diabetes - if they are prediabetic * May predispose to atherogenesis by * Increaseing plasma triglycerides * Decreasing HDL * Abrupt cessation can lead to tachycardia, hypertension, angina, myocardial ischemia or infarction - because of the supersensitivity - as soon as SYMP kicks in it really stresses the heart
56
hypertension treatment in pregnant women
* Situations: * Newly preg mother with existing hypertension * Incident hypertension (developed at preg) * Preeclampsia * Severe hypertension * Use B-blocker (labetalol) or CCB (nifedipine); methyldopa and hydralazine may also be used

IC (32 decks)

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