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IC > Hypertension > Flashcards

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
Q

benazepril

A

inhibitor of angiotensin - ACE inhibitor

26
Q

captopril

A

inhibitor of angiotensin - ACE inhibitor

only active drug (ace inhibitor) - doesnt need to be metabolized

27
Q

enalapirl

A

inhibitor of angiotensin - ACE inhibitor

28
Q

fosinopril

A

inhibitor of angiotensin - ACE inhibitor

29
Q

lisinopril

A

inhibitor of angiotensin - ACE inhibitor

30
Q

moexipirl

A

inhibitor of angiotensin - ACE inhibitor

31
Q

perindopril

A

inhibitor of angiotensin - ACE inhibitor

32
Q

quinapril

A

inhibitor of angiotensin - ACE inhibitor

33
Q

amipril

A

inhibitor of angiotensin - ACE inhibitor

34
Q

trandolapirl

A

inhibitor of angiotensin - ACE inhibitor

35
Q

candesartan

A

inhibitor of agniotensin - angiotensin receptro blocker

36
Q

losartan

A

inhibitor of agniotensin - angiotensin receptro blocker

37
Q

eprosartan

A

inhibitor of agniotensin - angiotensin receptro blocker

38
Q

irbesartan

A

inhibitor of agniotensin - angiotensin receptro blocker

39
Q

olmesartan

A

inhibitor of agniotensin - angiotensin receptro blocker

40
Q

telmisartan

A

inhibitor of agniotensin - angiotensin receptro blocker

41
Q

valsartan

A

inhibitor of agniotensin - angiotensin receptro blocker

42
Q

aliskiren

A

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
Q

clorthalidone

A

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
Q

ACE inhibitors

A
  • 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
Q

ARBs

A
  • 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
Q

CCBs

A
  • 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
Q

verapamil

A

CCB - vasodilator

myocardial depression

48
Q

diltiazem

A

CCB - vasodilator

myocardial depression

49
Q

amlodipine

A

CCB - vasodilator (dihydropuridine)

reflex tach - for all dihydropuridines

50
Q

felodipine

A

CCB - vasodilator (dihydropuridine)

51
Q

isradipine

A

CCB - vasodilator (dihydropuridine)

52
Q

nicardipine

A

CCB - vasodilator (dihydropuridine)

53
Q

nifedipine

A

CCB - vasodilator (dihydropuridine)

54
Q

nisoldipine

A

CCB - vasodilator (dihydropuridine)

55
Q

symaptholytic drugs

A
  • 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
Q

hypertension treatment in pregnant women

A
  • 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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