Hypertension & Heart Failure Drugs Flashcards
abbr. for enzyme that generates biologically active angiotensin II from the inactive angiotensin I generated by renin
ACE
abbr. for class of drugs known to attenuate/partially correct the adverse consequence of chronic hypertension on blood vessels and proven to preserve/improve failing heart function and prolong life
ACEI
group at greatest risk for hypertension development in US
African Americans
increases prevalence of hypertension
age
mineralocorticoid secreted by blood vessels adjacent to myocardial infracts, promotes myocardial fibrosis, effects blocked by spironolactone
aldosterone
newest RAS drug, directly blocks renin, has no obvious clinical advantages over ACEI or ARB
aliskiren
adrenergic receptors located on blood vessels (and prostate) to cause constriction
alpha1
classically the presynaptic autoinhibitory populations of adrenergic receptors that decrease NE neuronal release, but also located postsynaptically in both CNS and periphery
alpha2
potentially deadly adverse effect associated with the use of ACEI
angioedema
potent vasoconstrictor, causes renal retention of salt and water via direct effects and by promoting aldosterone secretion, also a very important mitogen for the cardiovascular remodeling that causes a progressive deterioration of cardiovascular function in heart failure patients
angiotensin II
renin substrate supplied by the liver
angiotensinogen
abbrev. for class of drugs with similar beneficial effects on heart and vasculature as ACEI, but theoretically better since >1 way to generate Ang II, potentially allows for beneficial effects of AT2 stimulation, and has much lower incidence of cough and angioedema
ARB
develop a thicker media during hypertensive remodeling and an increase in collagen in larger ones makes them stiff
arteries
group for whom non-selective beta blockers are contraindicated for hypertension
asthmatics
typical characteristic of hypertension
asymptomatic
sense blood pressure, modulate firing of sympathetic nerves on blood vessels to maintain venous return during changes in body posture
baroreceptors
drug combination that emerged as antihypertensive combination of choice in recent ACCOMPLISH clinical trial, among reasons many physicians are now choosing either of these agents as initial therapy since other can be added as necessary
benazepril amlodipine
population of adrenergic receptors that increases heart rate and contractility, and renin secretion by the kidneys
beta1
adrenergic receptor population responsible for dilation of skeletal muscle vasculature and bronchodilation
beta2
class of drugs used for decades to lower blood pressure, but indications in the absence of angina or prior MI were decreased by the finding that other drug classes provide better protection against cardiovascular morbidity and mortality (especially stroke); once contraindicated in heart failure, now some (but definitely not all) can be used routinely/judiciously in clinically stable patients to protect against arrhythmias and keep the heart from becoming desensitized to sympathetic stimulation
beta blockers
a vasodilator combination containing organic nitrate vasodilator isosorbide dinitrate to dilate veins and hydralazine to dilate arteries; especially useful in African Americans and others whom my not be able to use ACEI or ARB
BiDil
ectopic beat alternating with normal beat, seen in digoxin toxicity
bigeminy
increase in this increases blood pressure, it is decreased by diuretics
blood volume
alpha-1 blockers are now seldom used to lower blood pressure but would also help treat this as a result of an adverse effect that manifests in healthy males as “reverse ejaculation” (abbr)
BPH
normally broken down by ACE, its accumulation with use of ACEI is thought to contribute to the adverse effects of this drug class
bradykinin
inward current that makes a major contribution to the plateau phase of fast cardiac action potentials, drugs blocking this decrease myocardial contractility
calcium
ARB noteworth for relatively irreversible binding to the AT1 receptors
candesartan
prototypical ACE inhibitor (and supposedly first drug developed via rational drug design technology)
captopril
aka digitalis, widely used to treat heart failure until epidemiologists showed they may have reduced office visits but did not prolong life (e.g., felt better until moment of death due to fatal arrhythmia)
cardiac glycosides
refers to the vicious cycle that progressively worsens cardiac function once triggered by an index event
cardiac remodeling
while metoprolol and bisoprolol can be used, this is the beta blocker that appears to work best in heart failure, perhaps because it actually functions as an inverse agonist at these receptors; shown to reduce mortality in patients with systolic dysfunction due to MI, should be given to all CLINICALLY STABLE patients with symptomatic CHF and ejection fraction < 40%
carvedilol
class of drugs with utility in angina therapy, also widely used for treatment of primary hypertension; some evidence for improvement in vascular structure and function similar to ACEI and ARB
CCB
group more likely to have secondary hypertension
children
more potent and longer-acting than hydrochlorothiazide with benefits actually proven in ALLHAT clinical trial, this is now the preferred thiazide diuretic of hypertension specialists
chlorthalidone
prototypical alpha2 agonist, acts in the brainstem to decrease sympathetic outflow, which lowers blood pressure; little orthostatic hypotension, but dry mouth and sedation limit its utility
clonidine
microdeposits here are a near universal finding in patients receiving amiodarone
cornea
the primary reason patients stop taking ACEI to control their blood pressure, a sign of congestive heart failure
cough
action potential triggered by calcium oscillations in sarcoplasmic reticulum
delayed after-depolarization
unavoidable risk for hypertension development, reason to avoid non-selective beta blockers due to risk of hypoglycemia, reason for trying to keep blood pressure < 130/80 mm Hg
diabetes
heart failure in which ejection fraction is preserved, problem is that heart doesn’t fill enough; usually has concentric remodeling/hypertrophy; increasingly common diagnosis, especially in elderly women
diastolic
should contain < 3 g of salt per day in heart failure patients
diet
aka cardiac glycosides such as digoxin, once first-line therapy in heart failure, now generally only used in systolic heart failure with very low ejection fraction
digitalis
a critical component of heart failure therapy; eliminate the fluid causing congestion in acute decompensated heart failure, prevent the accumulation of this fluid in stable heart failure, and, by decreasing blood volume, keep the heart from becoming overfilled and therefore unable to perform at its now optimal level
diuretics
synthetic catecholamine that selectively activates beta1 receptors; preferred drug to administer if symptomatic hypotension/hypoperfusion despite optimization of cardiac filling pressure due to low cardiac output
dobutamine
catecholamine that activates beta receptors at low dose and alpha receptors at higher doses, used to increase cardiac output in patients with acute heart failure; notion that it had a beneficial “renal sparing” effect has been discredited
dopamine
left-sided heart failure leads to this in lungs, right-sided heart failure leads to this in legs and ankles/periphery (aka “dropsy” in history); reason loop diuretics are used in heart failure
edema
renal arterioles preferentially constricted by Ang II, reason ARB and ACEI can attenuate the detrimental glomerular hypertension seen in diabetes
efferent
term now used for 120 < SAP < 129 mmHg and DAP < 80 mmHg
elevated
old term for primary hypertension when high blood pressure was deemed necessary to get adequate flow through blood vessels with smaller lumens
essential
loop/high ceiling diuretic that works when GFR is low (unlike thiazides), especially important for mobilizing the large volumes of fluid that accumulate in patients with heart failure and are responsible for the “congestion”
furosemide
early antihypertensive drug intended to improve upon reserpine, works by displacing NE from synaptic vesicle and blocking receptors; now seldom used because a “sledgehammer” with adverse effects including severe orthostatic hypotension
guanethidine
increasing this is why later generation antihypertensive drugs such as benazepril, amlodipine and telmisartan can be administered orally once per day
half-life
anorexia, nausea, vomiting and salivation may be the more common signs of digoxin toxicity, but the yellowish/greenish tinge of these make for a better test question
halos
potential adverse effect of beta blockers
heart-block
common consequence of coronary artery disease, chronic hypertension and diabetes, stage A evidence for it is reason to initiate treatment with ACEI or ARB
heart failure
should be greater than 60 before digoxin is administered
heartrate
classic ganglionic blocker among the first agents employed as antihypertensive therapy, raised resting HR and BP and had numerous intolerable side effects (google ____ man for classic description)
hexamethonium
heart failure with causes including hyperthyroidism, pregnancy, anemia, arteriovenous fistula, wet beriberi (thiamine deficiency), Paget’s disease
high-output
extrinsic modulators of renal function that shift the intrinsic relationship in kidneys between urinary output of salt and water sideways along the arterial pressure (x) axis in such a way that increases or decreases in Na+ intake normally have minimal effect on blood pressure
hormones
a direct acting vasodilator that preferentially acts on arterioles; the principal use for this drug is to control blood pressure in pregnant women with pre-ecclampsia
hydralazine
predominant thiazide diuretic, widely used as monotherapy and in drug combinations
hydrochlorothiazide
currently defined as SAP >180 mmHg or DAP > 120 mmHg
hypertensive crisis
because of the abundance of this in amiodarone, it can cause either hypo- or hyperthyroid disturbances
iodine
e.g., blood pressure of 170/80, type of hypertension common in elderly due to loss of elasticity in aorta and large distribution vessels
isolated systolic
“funny” current blocker used in heart failure if sinus rhythm but ejection fraction <35% and HR >70 bpm when beta blockers are either contraindicated or on board at maximally tolerated doses
ivabradine
theoretically the ultimate regulators of blood pressure because of their “infinite gain”
kidneys
a combination alpha/beta blockers useful in hypertensive emergencies
labetalol
changes from a V-shape to a U-shape during cardiac remodeling of systolic heart failure
left ventricle
digoxin and amiodarone are among the drugs for which this is required due to their long half-life
loading dose
prototype of angiotensin receptor blocker (ARB) drug class, now available as a generic
losartan
characteristic of ~25% of hypertension cases, more common in blacks & elderly, reason ARBs, ACEI and beta-blockers are less effective as monotherapy in these people
low-renin
syndrome associated with prolonged use of, among other drugs, hydralazine and procainamide (w/o hyphen)
lupus-like
early drug now known to be converted to a centrally acting alpha2 agonist that decreases sympathetic outflow, remains a drug of choice for pregnancy-induced hypertension
methyldopa
a phosphodiesterase inhibitor that increases cAMP levels in heart and blood vessels to cause increases in contractility and vasodilatation, respectively; can be used together with sympathomimetic drugs, but drug has been shown to decrease survival in some studies
milrinone
direct-acting vasodilator also applied directly to scalp to promote hair growth, must use with a diuretic since it can cause profound vasodilation with fluid retention sufficient to cause congestive heart failure and cardiac tamponade
minoxidil
digoxin binds/competes for the K+ binding site on this membrane transporter
Na-K-ATPase
hyped “3rd generation beta blocker” was widely expected to be better than existing beta-blockers due to vasodilatory effects, but has failed at least one major clinical trial attempting to prove this
nebivolol
synthetic B-natriuretic peptide; expensive drug once widely used for its ability to treat dyspnea in acute heart failure until other studies suggested it caused kidney failure; clinical trials later showed the drug to be safe with no additional benefit for dyspnea…
nesiritide
venous vasodilator often administered as initial therapy for treatment of acute decompensated heart failure; heart is being overfilled and venous pooling of blood helps alleviate that problem until diuretics can coax the kidneys to excrete that excess volume
nitroglycerin
mixed arterial and venous dilator with short half-life infused during hypertensive emergencies
nitroprusside
blood pressure with SAP < 120 mmHg and DAP < 80 mmHg
normal
can be the cause of hypertension in women
oral contraceptives
may need to administered this to patients presenting with acute decompensated heart failure
oxygen
early non-selective alpha blocker used for hypertension treatment with poorly tolerated adverse effects, a drug you should know as a classic non-competitive/irreversible receptor blocker
phenoxybenzamine
non-selective alpha-blocker and classic drug you should know; short half-life coupled with profound hypotension and reflex tachycardia made it poor antihypertensive therapy
phentolamine
contraindication for aliskiren, ACEI and ARB
pregnancy
occurs in heart due to conditions such as aortic stenosis or chronic hypertension; tends to cause concentric hypertrophy due to the parallel addition of new myofibrils
pressure overload
ending in generic drug name that tells you it is an ACE inhibitor
pril
prolonged in ECG by digoxin, manifests as heart block during digoxin toxicity, can be useful in atrial fibrillation to prevent ventricular tachycardia
PR interval
developed to treat angina by slowing heart rate, found to cause a slow onset but sustained decrease in blood pressure that elevated its drug class to the ranks of first-choice antihypertensive therapy for decades
propranolol
major side effect of amiodarone
pulmonary fibrosis
refers to the large and potentially lethal increases in blood pressure seen when patients taking beta blockers or alpha2 agonists as antihypertensive therapy abruptly stop taking their medication
rebound hypertension
among the earliest effective antihypertensive agents, blocks incorporation of NE into synaptic vesicles; modest effect –> increased dose –> severe depression/suicide –> realization that doing opposite might treat depression
reserpine
refers to people with hypertension in whom increases in sodium intake cause large increases in blood pressure
salt-sensitive
neutral endopeptidase inhibitor (prolongs half-life of endogenous natriuretic peptide) marketed in combination with valsartan for the treatment of heart failure
sacubitril
ending in generic drug name that tells you it is a blocker of AT1 receptors
sartan
body position utilized for patients presenting with acute decompensated heart failure
seated
refers to hypertension with an identifiable cause such as renal artery stenosis or chronic kidney disease
secondary
a bluish discoloration of this is among the adverse effects of amiodarone
skin
even though many have salt-resistant hypertension, all will see some benefit by decreasing this, and antihypertensive medications will work better
sodium intake
aldosterone antagonist and K+-sparing diuretic, can be added to K+-losing diuretics to increase Na+ elimination while minimizing concurrent K+ changes; has proven antifibrotic effects in post-MI heart leading to reductions in morbidity and mortality in clinical trials, but remains underutilized in heart failure due to a risk of hyperkalemia
spironolactone
current hypertension category with 130 < SAP < 139 mmHg or 80 < DAP < 89 mmHg
stage 1
current hypertension category for SAP > 140 mmHg or DAP > 90 mmHg, typically requires > 1 drug for therapy
stage 2
depressed in ECG by therapeutic levels of digoxin (–> “Salvadore Dali mustache”)
ST segment
decreases with digoxin use since cardiac output is increased
sympathetic tone
another term for heart failure with reduced ejection fraction (i.e.< 50%); typically manifests as progressive chamber dilation with eccentric remodeling
systolic
class of diuretics discovered in 1958, and among drugs of first choice for hypertension treatment ever since
thiazides
a major concern with digoxin; KCl, lidocaine and antidigitalis antibodies are among the treatments
toxicity
abbr. for something that is always increase in chronic hypertension, either as an initiating feature or secondary to excessive blood flow through tissues because of excessive blood volume
TPR
increases with digoxin use since cardiac output is increased
urine production
ARB noteworthy for not being a prodrug requiring activation
valsartan
occurs in heart due to conditions such as valvular regurgitation, tends to cause eccentric hypertrophy due to the addition of sarcomeres in series
volume overload
law of Laplace dictates that this must increase much for smaller increases in lumen radius to generate and/or contain the same pressure
wall tension
ending of generic names for drugs selectively blocking alpha-1 adrenergic receptors; use discontinued dramatically in hypertension therapy when ALLHAT clinical trial linked these drugs to an increased risk for developing heart failure
zosin
