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Pharmacology > Hypertension and AntiHypertensives > Flashcards

Hypertension and AntiHypertensives Flashcards

1
Q

Normal BP

A

<120mmHg/<80mmHg

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2
Q

Prehypertension

A

120-129/<80

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3
Q

stage 1 HTN

A

130-139/80-89

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4
Q

Stage 2 HTN

A

> 140/>90

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5
Q

White Coat Hypertension

A

Normal BP other than doctor’s office, Diagnosis is ambulatory BP, 24hr observation

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6
Q

Primary HTN Pathophysiology

A

Most common- Essential HTN, 95%

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7
Q

Hypersensitive SNS HTN

A

Increased SNS activity = Norepi on SM= Vasoconstriction= Inc. TPR= Inc. BP

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8
Q

SNS action on Kidneys HTN (Hyperactive RAA AXIS)

A

JGA= epi= Renin= AT1=AT2= Vasoconstriction (inc ADH and Aldosetrone)= TPR = high BP

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9
Q

SNS action on HEart

A

SA node= ic. HR= inc. BP

Ventricular Myocardium= inc. contractility= inc. CO and Inc BP

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10
Q

ELderly and Af-Am

A

Low renin HTN

DEcrease the excretion of Na+ = More Na in blood= Water moves towards Na= inc. BV= Inc. BP= inhibits RAAS= low Renin= Low AT2= and no effect.

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11
Q

Na Retention

A

Vasoconstriction= TPR inc = Inc BP

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12
Q

Risk Factors for primary HTN

A

Diabetes, Obesity, Obst. Sleep Apnea, neurosis, FH, Vitamins, Genetic, Ethnicity

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13
Q

Age range of primary HTN

A

(25-55)

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14
Q

Secondary HTN

A

5% (uncommon) younger ind. (<25)

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15
Q

Kidneys (parenchyma) in HTN

A

damage to the parenchyma of kidney= inc. Na, Water, and inc. BP

Glomerulonephritis
Diabetic nephropathy (most common)
Polycystic Kid. Disease

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16
Q

Kidney (blood vessels)

A 
Stenosis of Renal artery (no ACEinhib)
Atherosclerosis
Wegner's Granulomatosis
Polyarteritis Nedosa
Vasculitis
Fibro-muscular dysplasia (20-30 year old females)
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17
Q

Endocrine cause of HTN

A

Conn’s Disease (ZG)= Hyperaldosteronism= inc Na and h2o= inc. BV= Inc BP

Cushing’s (ZF)= inc Cortisol= Inc Nor/epi= Vasoconstriction= inc BP

Pheochromocytoma= Large Epi and NorEpi= inc. Contractility, inc SV, Inc RAAS= Inc.BP

Also, look for Electrolyte imbalances, BUN, creatinine, Low GFR

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18
Q

Thyroid HTN

A

Hyperthyroidism= inc. Nor/epi rec. sensititivity= Inc. Hr= Inc BP

Hypothyroidism cause= low T3 and T4= acts on kidneys= inc. Na retention= inc BV= Inc.BP

T3 and T4 inc. Diastolic BP

hyperparathyroidism= high levels of PTH= inc. Ca conc= osteoclast activty, SM cells= Vasoconstriction= BP

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19
Q

Turner’s Syndrome

A

Coarctation of aorta= constriction of a part of arota= inc. pressure

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20
Q

high ICP

A

Cushing’s Triad- Hypertension, Bradycardia and Slow respiration

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21
Q

Pregnancy HTN

A 
2nd Trimester (>20 wks)= High BP
risks= Pre-eclampsia- HTN and proteinuria
24 hr protein test, Protein/creatinine ratio

can lead to eclampsia- HTN, Proteinuria, Seizures (bad)

treat with Magnesium sulphate

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22
Q

drugs

A

Oral contraceptives- E2 inc= inc. Angiotensinogen= Inc.BP

Sympathomimetics- Aderall; Ritalin, cocaine

SSRI excess- serotonin syndrome too much antidepressants= SSRI, SNRI, St.John’s Wort

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23
Q

MAO inhib

A

Tyramine (cheese), Selegiline (treat resistant depression)= hypertensive crisis

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24
Q

HYPERTENSIVE CRISIS

A 
Retinopathy (flame haemorrages)
LVH
Arrythmia
A. Dissection
Abdominal aor. Aneyrysm
Atherosclerosis
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25
Q

. TREATMENT STRATEGIES BP goal

A

> 130/>80

THiazide, ACE inhib, ARB or Ca blocker

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26
Q

General nonelderly

A

Non Black :Thiazide. ACE Inhibitor, ARB, CCB

Black: thiazide diuretic or CCB

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27
Q

Elderly >65 yean old

A

Use clinical judgment on blood pressure goal and

drug choice if serious comorbidities

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28
Q

Diabetes

A

ACE inhib and ARB

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29
Q

CKD without proteinuria (140/90) and with proteinuria= (130/80)

A

ACE inhib or ARB

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30
Q

Stable ischemic HD

A

B blockers, ACE in, ARB and CCB

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31
Q

Diabetic HTN

A

Diuretics, ACe inhib, ARb and CCB

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32
Q

Recurrent stroke

A

Diuretcs, ACE inhib and ARB

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33
Q

HEART FAILURE

A

Diuretics, b blocker, ACe inhib, ARB and Aldosterone antagosist

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34
Q

Prev. MI

A

b blockers, ACE inhib, Ald. inhib

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35
Q

CCD

A

Ace inhib and ARBs

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36
Q

Thiazide diuretics

A

Hydrochlorothiazide, Chlorthalidone

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37
Q

Thiazide diuretics MOA

A

Lower Na and water retention, Dec.\BV, CO, TPR= Dec. BP

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38
Q

Therapeutic use

A

Thiazides are useful in combination therapy with a variety of
other antihypertensive agents, including p-blockers, ACE inhibitors,
ARBs, and potassium-sparing diuretics. With the exception of metolazone

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39
Q

TD are not effective in patients

A

low GFR, use Loop diuretics instead

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40
Q

Side effects of TD

A

hypokalemia, hyperuricemia,

and, to a lesser extent, hyperglycemia in some patients

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41
Q

Loop diuretics

A

furosemide, torsemide, bumetanide, and ethacrynic acid

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42
Q

LD, MOA

A

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 cause decreased renal vascular resistance and increased
renal blood flow

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43
Q

Difference in MOa of TD and LD

A

Thiazides, they can cause hypokalemia. However,
unlike thiazides, loop diuretics increase the calcium content of urine,
whereas thiazide diuretics decrease it. These agents are rarely used
alone to treat hypertension, but they are commonly used to manage
symptoms of heart failure and edema

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44
Q

Potassium-sparing diuretics

A

Amiloride, Triamterene ( inhibitors of epithelial sodium transport at the late distal and collecting
ducts)

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45
Q

spironolactone and eplerenone

A

aldosterone receptor antagonists

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46
Q

Beta·ADRENOCEPTOR-BLOCKING AGENTS

A

b-Blockers are a treatment option for hypertensive patients with concomitant heart disease or heart failure

47
Q

MOA of Beta-blockers

A

The p-blockers reduce blood pressure primarily by decreasing
cardiac output (Figure 16.8). They may also decrease sympathetic
outflow from the central nervous system (CNS) and inhibit the release
of renin from the kidneys, thus decreasing the formation of angiotensin II and the secretion of aldosterone

48
Q

propranolol

A

which acts at both B1 and B2

49
Q

Selective blockers of b1

A

metoprolol, atenelol

50
Q

Nebivolol

A

selective blocker
of receptors, which also increases the production of nitric oxide,
leading to vasodilation. The selective may be administered
cautiously to hypertensive patients who also have asthma. The nonselective p-blockers are contraindicated in patients with asthma due
to their blockade of bronchodilation.

51
Q

Therapeutic uses of B-bLocker

A

The primary therapeutic benefits of are seen in hypertensive patients with concomitant heart disease, such as supraventricular
tachyarrhythmia {for example, atrial fibrillation), previous myocardial
infarction, stable ischemic heart disease, and chronic heart failure.

52
Q

Adverse effects of BEta blocker

A

decrease libido and
cause erectile dysfunction, which can severely reduce patient
compliance.

decreasing high-density
lipoprotein cholesterol and increased triglycerides.

53
Q

ACE INHIBITORS

A

captopril [KAP-toe-pril], enalapril [e-NAL-ah-pril],
and lisinopril [lye-SIN-oh-pril] are recommended as 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 (

54
Q

MOA of ACE inhib

A

lower TPR without inc. CO
breakdown bradykinin- NO, prostacyclin and vasodilaton
Dec. Preload and Afterload

55
Q

Therapeutic uses of Ace inhib.

A

slow diabetic nephropathy
dec. albuminuria
MI
systolic HF

56
Q

Do ace inhib need adjustment in Renal impaired patients

A

All of the ACE inhibitors are orally bioavailable as a drug or prodrug.
All but captopril and lisinopril undergo hepatic conversion to active
metabolites, so these agents may be preferred in patients with severe
hepatic impairment

57
Q

only IV ace inhib

A

Enalaprilat

58
Q

only ACE ihnib not ecreted by kidneys

A

Fosinopril- No need to adjust in REnal Failure

59
Q

Adverse effects of ACE

A

Dry cough
angioedema
K+ diuretics should be used

Contraindicated in Pregnant

60
Q

ANGIOTENSIN II RECEPTOR BLOCKERS

A

Lorsartan

61
Q

MOA of AT2 Blockers

A

block AT1 levels= block AT2= Low BP

62
Q

RENIN INHIBITOR

A

aliskiren

63
Q

MOA

A

acts on RAAS by blocking Renin

64
Q

CCBs

A

Calcium channel blockers are a recommended first-line treatment option
in black patients. They may also be useful in hypertensive patients with
diabetes or stable ischemic heart disease

65
Q

Diphenylalkylamines

A

Verapamil

Angina, SVT

66
Q

Benzothiazepines

A

Diltiazem

Relax cardiac and smooth muscle

more favorable than Verapamil

67
Q

Dihydropyridines

A

nifedipine, amlodipine, felodipine, isradipine, nicardipine, nisoldipine

68
Q

MOA of DHPY

A

dihydropyridines have a much greater affinity for vascular
calcium channels than for calcium channels in the heart. They are,
therefore, particularly beneficial in treating hypertension. The dihydropyridines have the advantage in that they show little interaction
with other cardiovascular drugs, such as digoxin or warfarin, which
are often used concomitantly with calcium channel blockers

69
Q

Adverse effects of CCBs

A

Flushing, Dizziness, Headache, hypotension, per. edema

70
Q

a-ADRENOCEPTOR-BLOCKING AGENTS

A

Prazosin, Doxazosin, Terazosin

71
Q

MOA of a-adrenoreceptor

A

They decrease peripheral vascular resistance and lower arterial blood
pressure by causing relaxation of both arterial and venous smooth muscle. These drugs cause only minimal changes in cardiac output, renal
blood flow, and glomerular filtration rate

72
Q

Side-eff. of a-ARB

A

. Reflex tachycardia
and postural hypotension often occur at the onset of treatment and with
dose increases, requiring slow titration of the drug in divided doses

73
Q

a-/p-ADRENOCEPTOR-BLOCKING AGENTS

A

Labetalol, carvedilol

74
Q

uses of a,b ARB

A

Carvedilol is indicated in the treatment of heart failure and
hypertension. It has been shown to reduce morbidity and mortality associated with heart failure. Labetalol is used in the and hypertensive emergencies

75
Q

management of

gestational hypertension

A

Labetalol

76
Q

CENTRALLY ACTING ADRENERGIC DRUGS

A

Clonidine, Methyldopa

77
Q

Clonidine

A

a2 agonist- inhibition of sympathetic vasomotor centers, decreasing sympathetic
outflow to the periphery. This leads to reduced total peripheral resistance and decreased blood pressure

78
Q

e treatment of hypertension that has not responded adequately to
treatment with two or more drugs.

A

Clonidine

79
Q

useful in the treatment of hypertension complicated by renal disease.

A

Clonidine does not decrease renal

blood flow or glomerular filtration

80
Q

Adverse effects Clonidine

A

y. It is
also available in a transdermal patch. Adverse effects include sedation, dry mouth, and constipation (Figure 16.14}. Rebound hypertension occurs following abrupt withdrawal of clonidine. The drug should,
therefore, be withdrawn slowly if discontinuation is required

81
Q

Methyldopa

A

a2 agonist- methylepinephrine, dec. adreneric outflow

82
Q

common side effects of methyldopa

A

sedation
and drowsiness. Its use is limited due to adverse effects and the need
for multiple daily doses. It is mainly used for management of hypertension in pregnancy, where it has a record of safety

83
Q

VASODILATORS

A

The direct-acting smooth muscle relaxants, such as hydralazine [hyeDRAL-a-zeen] and minoxidil/[min-OX-i-dill], are not used as primary drugs
to treat hypertension.

84
Q

VD mOA

A

relaxation of
vascular smooth muscle, primarily in arteries and arterioles. This results
in decreased peripheral resistance and, therefore, blood pressure

inc Contractility, HR and O2 consump.

85
Q

adv. eff of vasodialtion

A 
inc. MI and AP
Na and H2O retention
Headache
Tachycardia
nausea
sweating
arrhythmia
high dose- lupus-like syndrome can occur with high dosages, but it
is reversible upon discontinuation of the drug
86
Q

Indicated in

A

Hydralazine

is an accepted medication for controlling blood pressure in pregnancy-induced hypertension.

87
Q

HYPERTENSIVE EMERGENCY

A

severe elevations in blood pressure (systolic greater than
180 mm Hg or diastolic greater than 120 mm Hg)

A severe elevation in blood pressure without
evidence of target organ damage is considered a hypertensive urgency

88
Q

managemetn of HTN emer

A

Hypertensive emergencies require timely blood pressure reduction with
treatment administered intravenously to prevent or limit target organ
damage. A variety of medications are used, including calcium channel
blockers (nicardipine and clevidipine), nitric oxide vasodilators (nitroprusside and nitroglycerin), adrenergic receptor antagonists (phentolamine,
esmolol, and the vasodilator hydralazine, and the dopamine
agonist fenoldopam. Treatment is directed by the type of target organ
damage and/or comorbidities present.

89
Q

Diuretics (Thiazides, Loop

agents)

A

Minimal

90
Q

Centrally acting

A

Salt & water

retention

91
Q

Ganglion blocker

A

Salt & water retention

92
Q

Alpha1-selective

blockers

A

Salt & water
retention, slight
tachycardia

93
Q

Beta blockers

A

Minimal

94
Q

Vasodilator, CCB amd Nitroprissude

A 
tention, moderate
tachycardia
Marked salt & water
retention, moderate
tachycardia
Minor salt & water
retention
Salt & water
retention
95
Q

Left ventricular

hypertrophy

A

ACEI, ARB, CCB

96
Q

Asymptomatic

atherosclerosis

A

CCB

97
Q

Microalbuminemia

A

ACEI, ARB

98
Q

Renal dysfunction

A

ACEI, ARB

99
Q

Previous stroke

A

ACEI, ARB, Diuretics

100
Q

Previous MI

A

ACEI, ARB, BB

101
Q

Coronary artery

disease

A

ACEI, ARB, BB

102
Q

Angina pectoris

A

BB, CCB

103
Q

Heart failure

A

ACEI, ARB, Diuretic, MRA

BB

104
Q

Aortic aneurysm

A

BB

105
Q

Atrial fibrillation

A

ACEI, ARB, BB

106
Q

prevention
Atrial fibrillation, rate
control

A

BB, CCB
(nondihydropyridines)
ESRD, proteinuria ACEI

107
Q

Peripheral artery

disease

A

ACEI, CCB

108
Q

isolated systolic HTN

A

ACEI, ARB, CCB,

Diuretic

109
Q

Metabolic syndrome

A

ACEI, ARB, CCB

110
Q

Diabetes mellitus

A

ACEI, ARB, CCB,

Diuretic

111
Q

DM with proteinuria

A

ACEI, ARB

112
Q

Hyperaldosteronism

A

MRA

113
Q

Pregnancy

A

BB, CCB, Methyldopa

114
Q

Black ethnicity

A

CCB, Diuretics

Pharmacology (19 decks)

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