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CV Final Material > Hypertension Drugs 2 > Flashcards

Hypertension Drugs 2 Flashcards

1
Q

In general, how do central alpha-2 agonists lower blood pressure?

A

by decreasing SNS outflow which reduces vascular tone & decreases HR

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2
Q

What are some central alpha-2 agonists?

A
  • Clonidine
  • Guanabenz
  • α-Methyldopa
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3
Q

What is the MOA of central alpha-2 agonists?

A

Stimulate α2-adrenergic receptors in the brain
– reduces sympathetic outflow from the brains vasomotor center
– increases vagal tone

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4
Q

General adverse effects of central alpha-2 agonists?

A 
– sodium/water retention
– abrupt discontinuation may cause rebound hypertension
– depression
– orthostatic hypotension
– dizziness
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5
Q

Adverse effect specific to cloonidine?

A

anticholinergic side effects

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6
Q

Adverse effects specific to methyldopa?

A

can cause hepatitis & hemolytic anemia (rare)

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7
Q

In general, how do neuronal & ganglionic blocking agents lower BP?

A

decrease SNS outflow

  • decreases renin and inhibits alpha-1 both which reduce vascular tone
  • blocks beta-1 on heart decreasing HR
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8
Q

What are some neuronal & ganglionic blocking agents?

A
  • Guanethidine
  • Guanadrel
  • Reserpine
  • Trimethaphan ganglionic
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9
Q

Adverse effects of neuronal & ganglionic blocking agents?

A 
– Sedation (reserpine)
– Depression (reserpine)
– decreased CO
– sodium/water retention
– increased gastric acid secretion (reserpine)
– diarrhea
– bradycardia
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10
Q

In general, how do diuretics help lower BP?

A

decrease vascular volume causes decreased venous return therefore decreased CO
-however, causes reflex increased SNS

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11
Q

What are some diuretic drugs?

A
  • Hydrochlorothiazide
  • Furosemide
  • Amiloride
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12
Q

MOA of diuretics?

A
  • Exact hypotensive mechanism unknown
  • Initial BP drop caused by diuresis
  • Extracellular & plasma volume return to near pretreatment levels with chronic use but anti-hypertensive effects continue
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13
Q

Potential adverse effects of diuretics?

A 
– Electrolyte disturbances • potassium, magnesium, sodium, calcium
– Hyperglycemia
– Hypotension, orthostasis
– Lipid abnormalities
– Photosensitivity
– Ototoxicity
– Hyperuricemia, gout flare
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14
Q

What are some aldosterone antagonists?

A

Spironolactone & Eplerenone

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15
Q

What is the MOA of aldosterone antagonists?

A

Inhibit the renal (Na and H2O retention) and extra-renal (fibrosis, inflammation, etc.) actions of aldosterone

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16
Q

What are the general classes of RAS inhibitors?

A

ACE inhibitors
AT1 blockers
renin inhibitor

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17
Q

How do RAS inhibitors decreased BP?

A

block the effects of kidney mediated vasoconstriction which decreases vascular tone decreasing peripheral resistance

18
Q

What are the ACE inhibitors?

A
  • Captopril
  • Enalapril
  • Lisinopril
19
Q

What is the AT1 blocker?

A

Losartan

20
Q

What is the renin inhibitor?

A

Aliskiren

21
Q

MOA of ACE inhibitors?

A

Block angiotensin I to angiotensin II conversion by ACE (Angiotensin Converting
Enzyme) distributed in many
tissues

22
Q

Secondary effects of ACE inhibitors?

A
  • Block bradykinin degradation; stimulate synthesis of other vasodilating substances such as prostaglandin E2 & prostacyclin
  • Prevent or regress left ventricular hypertrophy
23
Q

What should we monitor in people with ACE inhibitors?

A

Monitor serum K+ & SCr within 4 weeks of initiation or dose increase

24
Q

Adverse effects of ACE inhibitors?

A

– cough: up to 20% of patients due to increased bradykinin
– angioedema
– hyperkalemia: particularly in patients with CKD or DM
– neutropenia, agranulocytosis, proteinuria, glomerulonephritis, acute renal failure

25
Q

MOA of ARB like losartan?

A

block AT1r which causes vasoconstriction and allows ATII to work on ATIIr causing vasodilation

26
Q

Why do you get less cough with ARBs?

A

Do not block bradykinin breakdown

27
Q

Adverse effects of ARB?

A

– orthostatic hypotension
– renal insufficiency
– hyperkalemia

28
Q

Do ACE inhibitors and ARB work right away?

A

No, takes 4 to 6 weeks to see full effect

29
Q

What is the MOA of renin inhibitor?

A

Inhibits angiotensinogen to angiotensin I conversion and Does not block bradykinin breakdown

30
Q

What are the adverse effects of renin inhibitors?

A

orthostatic hypotension & hyperkalemia

31
Q

What are ACE Inhibitor/ARB Precautions?

A

• Can cause acute kidney failure in certain patients
– severe bilateral renal artery stenosis
– severe stenosis in artery to solitary kidney
• Pregnancy

32
Q

ACE inhibitors and ARB’s Potential Drug Interactions?

A

– Medications which promote hyperkalemia
– Medications that have activity which is sensitive to changes in serum K+
– Medications that may cause additive antihypertensive effects
– NSAIDs

33
Q

RAS inhibitors combo well with what?

A

diuretics

34
Q

What are some lifestyle modifications that can help with hypertension?

A
  • Reduce weight to normal BMI (<25kg/m2): 5-20 mmHg/10kg loss
  • DASH eating plan: 8-14 mmHg
  • Dietary sodium reduction: 2-8 mmHg
  • Increase physical activity: 4-9 mmHg
  • Reduce alcohol consumption: 2- 4 mmHg
35
Q

What are JNC8 Recommendations for General Non-black Population?

A
  • General population– Thiazide, CCB, ACEi, ARB (Grade B)
  • Black population – CCB or Thiazide (Grade B) Grade C for black patients with DM
  • DM– Thiazide, CCB, ACEi, ARB (Grade B)
  • CKD– ACEi or ARB (Grade B)
36
Q

Guidelines for JNC8 combo therapy?

A
  • Most patients require > 2 agents to control BP
  • A thiazide-type diuretic should be one of these agents unless contraindicated
  • Combination regimens should include a diuretic (preferably a thiazide)
  • Resistant hypertension: failure to achieve BP goal on full doses of 3 drug regimen including a diuretic
37
Q

Special populations guideline: african americans?

A

response to diuretics & CCB greater than ACEI, ARB and beta-blockers
angioedema is 2-4 fold higher

38
Q

Special populations guideline: left ventricular hypertrophy?

A

Aggressive BP control regresses LVH…but hydralazine & minoxidil DO NOT!

39
Q

Special populations guideline: elderly usually systolic HTN?

A

– Thiazide or CCB may be better tolerated

40
Q

Special populations guideline: pregnancy?

A

– Methyldopa, beta-blockers, vasodilators (hydralazine)

– Avoid ACEI & ARBs

41
Q

Special populations guideline: children/adolescents?

A

Avoid ACEI & ARBs in pregnant or sexually active girls

CV Final Material (16 decks)

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