Hypertension Flashcards
Alpha-2 receptors inhibit….
Norepinephrine release
Stimulation of alpha-1 receptors located on arterioles and venules causes….
Vasoconstriction
Activation of beta-2 receptors causes….
Vasodilation
Beta-1 receptors are located on
The heart and kidneys
Beta-1 receptors regulate…
HR and contractility impacting cardiac output
Blocking beta-1 receptors….
Decreases CO, peripheral resistance and BP
BP rises as a result of
Sodium and water elimination by kidney,
In turn plasma volume, CO and BP decrease
Dysfunction of this raises BP and plasma volume
Renin is released in response to….
Changes in BP, caused by reduced renal perfusion, decreased intravascular volume or increased circulation of catecholamines
Angiotensin I is converted into
The vasoconstrictor angiotensin II by angiotensin-converting enzyme (ACE)
Angiotensin II causes
Vasoconstriction and stimulation of the sympathetic nervous system and the release of aldosterone from the adrenal gland resulting in water and salt retention
Thiazides
Mechanism of action
Increasing urinary excretion of sodium and chloride in equal amounts and inhibit reabsorption
Thiazides
Contraindications
Not recommended in pts with creatinine clearance of <30mL/min
Renal decompensation
Hypersensitive to thiazides or Sulfonamides
Thiazides
Adverse events
Hypokalemia Hypomagnesemia Hypercalcemia Hyperuricemia Hyperglycemia GI upset Tinnitus Paresthesia
K+ sparing diuretics have the potential for causing ….
Hyperkalemia and hyponatremia, especially in pts with renal insufficiency or diabetes. Pts with concurrent tx with an acei, nsaids, or k+ supplements
Beta-1 receptors (heart and kidneys) regulate….
Heart rate
Renin release
Cardiac contractility
Beta-2 receptors (lungs, liver, pancreas, and arteriolar smooth muscle) regulate ….
Bronchodilation and vasodilation
Beta-blockers reduce BP by….
Blocking central and peripheral beta receptors, resulting in decreased CO and sympathetic outflow
Beta-1 receptors are referred to as..,,,
Cardioselective because they do not significantly block beta-2 receptors
Better for asthmatics, CPOD, and peripheral vascular disease
BB that possess sympathomimetic activity (ISA)
Partial beta-receptor agonist that reduce HR and contractility during excessive sympathetic outflow
In diabetics, BB ….
Can mask all symptoms of hypoglycemia with the exception of sweating
ACE
Mechanism of action
Inhibiting ACE enzyme, converting angiotensin I to angiotensin II a potent vasoconstrictor
CHF, post MI, systolic dysfunction
ACE
Contraindications
Avoid with renal issues
Don’t use with ARBs
Past angioedema during pregnancy
ACE
Adverse Events
Chronic dry cough Rashes Dizziness Angioedema is rare most frequently in blacks, reversible with discontinuation Laryngeal edema Hyperkalemia
ARBs mechanism of action
Block vasoconstriction and aldosterone-secreting effects
Indicated for HTN, nephropathy in type II diabetes, HF and those that can’t tolerate ACE
ARBs more effective
Losartan more effective than atenolol in reducing cardiovascular morbidity and mortality in DM with HTN and LVH
ARBs and cough and hyperkalemia….
Lower than with ACEs
Angioedema with ARBS vs ACEs
ARBs less common
CCB
Mechanism of action
Inhibit the movement of Ca+ ions across the cell membranes
Relaxing and vasodilation, decreases HR and slows cardiac conduction at the AV node
Effective with black pts
Tx HTN associated with ischemic heart disease
Recommended for Prinzmetal angina
CCB
Contraindications
Not first line for HF
Dilt and verapamil should be avoided in HB and with EF <45%
Causes reflex tachycardia
CCB
Adverse Events
Produce symptoms of vasodilation, such as headaches, flushing, palpitations, and peripheral edema Dizziness Gingival hyperplasia Mood changes GI upset Peripheral edema Bradycardia AV block CHF Verapimil causes constipation in elderly
Peripheral Alpha-1 receptor blockers
Cadura or minipress
Effective in pts with benign prostatic hypertrophy
Dilate both arterioles and veins, causing relaxation of smooth muscle
Diuretics work by…..
Increasing urine output therefore decreasing fluid volume
Beta blockers work by…..
Blocking the SNS and inhibit HR
CCB work by….
Causing vasodilation, affect preload and afterload
ACE inhibitors work by….
Stopping conversion of angiotensin I to angiotensin II in RAAS
ARBs work by…..
Blocking the action of angiotensin II in RAAS
Adrenergic inhibitors….
Cause vasodilation, centrally acting
Vasodilators work by….
Causing vasodilation
JNC 8 algorithm
All ages CKD present with or without DM
Initiate ACEI or ARB alone or in combo with another drug class
JNC 8 algorithms
All ages
DM present no CKD
Black
Initiate thiazide type diuretic or CCB, alone or in combination
JNC 8 algorithms
All ages
DM present no CKD
Nonblack
Initiate thiazide type diuretic or ACEI or ARB or CCB, alone or in combination
