Hypertension Drugs Flashcards
what do loop diuretics act on?
the sodium reabsorbing protein in the loop of henle
by not absorbing Na what do we inherently block reabsoroption of?
Water
name the loop diuretic
furosemide
what is the adverse effect of loop diuretics?
alkalosis…high serum pH
3 things affecting the BP
cardiac output
vasculature resistance
blood volume
what is the mechanism of thiazide diuretics?
block the sodium and chloride symporter in the distal convuluted tubule…so less Na and less H2O
adverse effects of thaizide diuretics?
alkalosis and hypokalemia
name the two thiazide diuretics
hydrochlorothiazide
chlortalidone
mechanism of K+ sparing diuretics
inhibit the ENaC or epithelial sodium channel in the collecting duct
or it blocks the effects of aldosterone on the collecting duct
what is the ENaC diuretic?
traimterene
what are the two aldosterone inhibiting diuretics?
spironolactone and eplerenone
spironolactone toxicity
gynecomastia
explain how loop and thiazide diuretics cause hypokalemia
leads to increased sodium downstream and in collecting duct there is a Na and K antiporter so you get more Na flowing into blood since high conc down stream and more K leaving blood into the collecting duct
what is the mechanism of hydralizine?
somehow increases concentration of cyclic GMP which leads to vasodilation through NO pathway
what is the mechanism of diazoxide?
makes K+ channels stay open longer causing hyperpolarization and not letting contraction of SMC to occur
what is the mechanism of calcium channel blockers (hydropyridines/non)
block calcium channels and lower smooth muscle contraction strength
name the two hydropyridines
amlodipine
nifedipine
nimodipine
name the two non hydropyridines
verapimil
diltiazem
toxicity of calcium channel blockers
gingival enlargement…big gums
of the calcium channel blockers, which do you give during pregnancy?
nifedipine
name the two ACE inhibitors
captopril
lisinopril
name the two ARB inhibitors
Losartan
Valsartan
what is the mechanism of ARB drugs
they block the angiotensis receptors where it would lead to alodsterone and vasoconstriction
name the three toxicities of ARB and ACE inhibitors
dry cough
angioedema
hyperkalemia
how do ACE inhibs lead to angioedema
by blocking the ACE, the secondary role of ACE to breakdown bradykinin does not occur so you get leaky capillaries that cause angioedema
should ACE inhibitors be given during pregnancy?
eh…its debatable
how does clonidine affect blood pressure?
it is an A2 agonist that actually decreases the sympathetic effects..
what do beta antagonist disrupt?
blood sugar…so be careful giving to diabetics
how do beta antagonists affect folks with asthma?
why is this problem moot now?
beta blockers block B2 in the lungs and lead to vasoconstriction…can worsen asthma
most beta blockers are specific to B1 and the heart now
3 types of sympathetic drugs to give for HBP
beta blockers- metoprolol atenolol esmolol
a1 antagonist- prazosin
a2 agonist-clonidine
of the sympathetic drugs for hypertension, which are riskiest with pregnancy?
beta blockers
what group has highest risk of angioedema with ACE and ARB?
african americans have three times the risk…so not a first line drug
what is the threshold of BP for initiating treatment?
140/90
in what circumstances does the threshold for BP treatment change and what does the threshold move to?
if patient has CVD, CKD, diabetes, or high risk of CVD
130/80
what is most dominating risk factor is developing ASCVD?
AGE
if patient has BP of 135/85 and has greater then 10% chance of having ASCVD in next ten years…do we treat HBP?
Yes
name the four preferred first line HBP medication classes
thiazide diuretics
ACE inhibitors
ARBs
calcium antagonists
it is common to combine any of these to dual treat…except ACE and ARB since they sorta do same thing
