Hypertension Flashcards
What is the goal when treating hypertension?
<140/90
What is the goal blood pressure of an individual with diabetes?
<140/80
What is the goal blood pressure of an individual with chronic kidney disease and proteinuria?
<130/80
What is used as initial drug therapy for hypertension by increasing sodium and water retention?
Thiazide diuretics
What conditions can Thiazide diuretics induce?
hypokalemia and hyperuricemia
What kind of diuretics act by blocking sodium and chloride reabsorption in the kidneys, even in patients with poor renal function or those who have not responded to thiazide diuretics?
Loop diuretics
What mineral increases in the urine with loop diuretics?
Calcium
Who would typically use a beta blocker?
Hypertensive patients with heart disease
What drug is a nonselective beta-blocker, reduces chronotropic, inotropic and vasodilator responses by competing for the receptor site, and B1 blockade of juxtaglomerular apparatus lead to decrease in renin release?
Propranolol
What are the adverse effects of Propranolol?
- bronchoconstriction
- hypotension
- bradycardia
- sexual dysfunction
What is the first line treatment of hypertension in patients with a variety of compelling indications, including high coronary disease risk or history of diabetes, stroke, heart failure, myocardial infarction, or chronic kidney disease?
ACE Inhibitors
What do ACE inhibitors decrease and what do they increase?
decrease angiotensin II
increase bradykinin
What condition do ACE inhibitors slow the progression of?
Diabetic nephropathy
What kind of patients are ACE inhibitors a first-line treatment with?
systolic dysfunction and following a myocardial infarction
What are the adverse effects of ACE Inhibitors?
Dry cough
rash
hypotension
hyperkalemia
What is the key ACE inhibitor decreases BP by inhibiting the enzyme responsible for production of angiotensin II, a potent vasoconstrictor and prevents breakdown of bradykinin, a vasodilator?
Captopril
What class of drugs are alternatives to ACE Inhibitors and are drugs that block the AT1 receptors, decreasing the activation of AT1 receptors by angiotensin II?
Angiotensin Receptor Blockers (ARBs)
What is the key difference in ARBs versus ACE Inhibitors?
ARBs do not increase bradykinin levels
What are the adverse effects of ARBS?
same as ACE Inhibitors
T/F: ARBs should not be combined with an ACE inhibitor for the treatment of hypertension due to similar mechanisms and adverse effects
True
What is an example of an ARB?
Losartan
Do Selective Renin Inhibitors act earlier or later in the renin–angiotensin–aldosterone system than ACE inhibitors or ARBs ?
Earlier
What is the contradiction with Selective Renin Inhibitors?
Pregnancy
What is the adverse effects of Selective Renin Inhibitors?
Diarrhea, cough, and angioedema
What is the recommended treatment option in hypertensive patients with diabetes or angina?
Calcium Channel Blockers
What is the only member of Diphenylalkylamines class and is the least selective of any calcium channel blocker and has significant effects on both cardiac and vascular smooth muscle cells?
Verapamil
What is Verapamil used to prevent?
migraine and cluster headaches
What is the only member of Benzothiazepines class and affects both cardiac and vascular smooth muscle cells?
Diltiazem
What do dihydropyridines have a much greater affinity for?
vascular calcium channels
what is the main MOA of Calcium Channel Blockers?
causes vascular smooth muscle to relax, dilating arterioles
What 2 drugs are used in the treatment of atrial fibrillation?
Diltiazem and verapamil
What are 2 key adverse effects for Verapamil?
atrioventricular block and constipation
What class of drugs produce a competitive block of α1-adrenoceptors and decrease peripheral vascular resistance and lower arterial blood pressure by causing relaxation of both arterial and venous smooth muscle?
Alpha-Blockers
What can Alpha-blockers also treat in males?
Benign prostatic hyperplasia
What alpha blocker is mainly used in the treatment of heart failure?
Carvedilol
What alpha-blocker is used in the management of gestational hypertension and hypertensive emergencies?
Labetalol
What centrally acting adrenergic drug stimulates alpha 2 adrenergic receptors in the brain reducing sympathetic outflow from the CNS and decrease peripheral resistance, renal vascular resistance, heart rate, and blood pressure?
Clonidine
What are the adverse effects of Clonidine?
- vasoconstriction and increased BP
- Drowsiness, dizziness, and headache
- Mild bradycardia
- Xerostomia
- Constipation
What centrally acting adrenergic drug Acts as alpha 2 receptor agonist and acts centrally to stimulate alpha receptors decreasing sympathetic outflow and decreasing blood pressure?
Methyldopa
What are the adverse effects of Methyldopa?
- edema
- sedation, dizziness, and headache
- bradycardia
- Lupus like syndrome
- Positive Coomb’s test
What act by producing relaxation of vascular smooth muscle, primarily in arteries and arterioles which results in decreased peripheral resistance and blood pressure?
Vasodilators
What concentrations can vasodilators increase?
plasma renin concentrations
What vasodilator is almost always administered in combination with a β-blocker and diuretic?
Hydralazine
What do the three above drugs decrease?
cardiac output, plasma volume, and peripheral vascular resistance
What drug is used for controlling blood pressure in pregnancy induced hypertension?
Hydralazine
What vasodilator causes hypertrichosis (the growth of body hair) and is used topically to treat male pattern baldness?
Minoxidil
