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MOHD3 Exam 2 > Hypertension Physiology and Drugs > Flashcards

Hypertension Physiology and Drugs Flashcards

1
Q

Prehypertension =

A

120-139 /(OR) 80-89

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2
Q

Stage 1 hypertension =

A

140-159/(OR) 90-99

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3
Q

Stage 2 hypertension =

A

> 160 /(OR) >100

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4
Q

Older people have rise in (systolic/diastolic) pressure

A

systolic

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5
Q

Younger people have rise in (systolic/diastolic) pressure

A

diastolic

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6
Q

It is (easier/harder) to lower systolic hypertension

A

harder

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7
Q

MAP =

A

CO x total peripheral resistance

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8
Q

CO =

A

Heart rate x stroke volume

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9
Q

AT1 receptor for angiotensin II causes

A

vasoconstriction

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10
Q

AT2 receptor for angiotensins II causes

A

vasodilation

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11
Q

ETA receptor for endothelin cause

A

vasoconstriction

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12
Q

ETB receptor for endothelin cause

A

vasodilation

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13
Q

Excess sodium increase causes (increase/decrease) release of NE or EPI

A

increase

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14
Q

Excess sodium increase causes (increase/decrease) response to nE and angiotensin II

A

increase

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15
Q

Excess sodium increase causes (increase/decrease) in intracellular Ca2+

A

increase

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16
Q

Diuretics mechanism:

Uses:

Adverse effects:

A
  1. Decrease extracellular fluid volume and CO
  2. Decrease vascular resistance
  3. Alone or in combo
  4. Heart failure

Deplete K+ –> need K+ supplements

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17
Q

Chlorothiazide, hydrocholorothiazide =

Mechanism:

Effect:

Adverse effects:

A

Thiazide diuretics

Block Na+/Cl- symporter in distal convoluted tubule

Moderate diuresis
Reduced by NSAIDs

Hypokalemia
Decreased uric acid and calcium excretion
Thiazide and sulfonamides cross reactivity

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18
Q

Furosemide =

Mechanism:

Effect:

Adverse effects:

A

high ceiling/loop diuretics

Block Na+, K+ 2Cl- cotransporter in thick ascending limb of Loop of Henle –> greater effect

Use with edema: most effective diuretics
Not as good for HTN

Hypokalemia
Decreased uric acid excretion
Deafness
Allergic reaction (sulfonamide derivative)

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19
Q

Bumetanide=

Mechanism:

Effect:

Adverse effects:

A

high ceiling/loop diuretics

Block Na+, K+ 2Cl- cotransporter in thick ascending limb of Loop of Henle –> greater effect

Use with edema: most effective diuretics
Not as good for HTN

Hypokalemia
Decreased uric acid excretion
Deafness
Allergic reaction (sulfonamide derivative)

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20
Q

Torsemide =

Mechanism:

Effect:

Adverse effects:

A

high ceiling/loop diuretics

Block Na+, K+ 2Cl- cotransporter in thick ascending limb of Loop of Henle –> greater effect

Use with edema: most effective diuretics
Not as good for HTN

Hypokalemia
Decreased uric acid excretion
Deafness
Allergic reaction (sulfonamide derivative)

21
Q

Spironolactone =

Mechanism:

Effect:

Adverse effects:

A

aldosterone receptor blockers
Used in combo

Collecting duct: block sodium and water reabsorption
Potassium SPARING

Mild diuresis
Resistant hypertension
CHF w/ HTN

Hyperkalemia

22
Q

Eplerenone =

Mechanism:

Effect:

Adverse effects:

A

aldosterone receptor blockers
Used in combo

Collecting duct: block sodium and water reabsorption
Potassium SPARING

Mild diuresis
Resistant hypertension
CHF w/ HTN

Hyperkalemia

23
Q

Triamterene =

Mechanism:

Effect in combo w/ ___:

Adverse effects:

A

Potassium sparing diuretics

Late distal tubule and collecting duct
Na+ channel blockers

Combo w/ thiazides –> mild diuresis, weak antihypertensive effect

Hyperkalemia

24
Q

Captorpil, enalapril, lisinopril, fosinopril =

Mechanism:

A

ACE inhibitor

  1. Blocks angiotensin I –> angiotensin II
  2. Elevated bradykinin levels –> vasodilation
  3. Decreased peripheral resistance
  4. Decreased aldosterone –> increase Na and H2O excretion
  5. Increase plasma renin and renin activity
25
Q

Captorpil, enalapril, lisinopril, fosinopril =

Use:

Adverse effects:

A

ACE inhibitor

mild-moderate hypertension
heart failure

  1. DRY COUGH
  2. Hyperkalemia: inhibition of aldosterone secretion
  3. Angioedema: sweling of airway, lips, glottis
  4. Hypotension
  5. Rash
  6. Pregnancy problems
26
Q

Losartan, valsartan, candesartan, irbesartan =

Mechanism:

A

Angiotensin receptor antagonists (ARBs)

  1. AT1 receptor antagonists: prevents constriction
  2. Vasodilation
  3. Increase Na+ and H2O excretion
  4. Reduce plasma volume
  5. Decrease cellular hypertrophy
  6. Increase plasma renin and renin activity
27
Q

Losartan, valsartan, candesartan, irbesartan =

Use:

Adverse effects:

A

Angiotensin receptor antagonists (ARBs)

Hypertension
Heart failure

Hypotension
Cough or angioedema: less than ACEI
Hyperkalemia
Fetal renal toxicity

28
Q

Aliskiren =

Mechanism:

Use:

Adverse effects:

A

renin inhibitor

Direct, competitive inhibitor of renin
Increase plasma renin but NOT renin activity

Hypertension

Diabetic or renal impairment
Hypotension
Dry cough: less than ACEI
Hyperkalemia: inhibition of aldosterone

29
Q

Verapamil =

Mechanism:

Use:

Adverse effects:

A

Cardioselective calcium channel blockers

Block L-type Ca2+ channels
Relax VSM and decrease peripheral resistance
Decrease MAP
Negative chronotropic (reduce heart rate)

Hypertension
Black and old people w/ systolic hypertension

Contraindicated in heart failure
Depress AV conduction and contractility
Headache
Gingival inflammation/hyperplasia

30
Q

Diltiazem =

Mechanism:

Use:

Adverse effects:

A

Cardioselective calcium channel blockers

Block L-type Ca2+ channels
Relax VSM and decrease peripheral resistance
Decrease MAP
Negative chronotropic (reduce heart rate)

Hypertension
Black and old people w/ systolic hypertension

Contraindicated in heart failure
Depress AV conduction and contractility
Headache
Gingival inflammation/hyperplasia

31
Q

Nifedipine, nicardipine, amlodipine =

Mechanism:

Use:

Adverse effects:

A

Vascular smooth muscle selective calcium channel blockers

Block L-type Ca2+ channels
Relax VSM and decrease peripheral resistance
Decrease MAP

Hypertension
Black and old people w/ systolic hypertension

Contraindicated in heart failure
Depress AV conduction and contractility
Headache
Gingival inflammation/hyperplasia

32
Q

Propranolol =

Action:

Use:

Adverse effects:

A

Non selective beta-adrenergic receptor antagonist

Decreased CO
Renin secretion
Central sympathetic outflow
Resetting of baroreceptors

Hypertension

Nausea, vomiting, confusion, dizziness, fatigue, sleep disorders
Avoid w/ pt:
1. asthmatic (block B2 action of bronchodilation)
2. peripheral vascular disease (sensitive to cold, unopposed B1 effect)
3. Diabetics: inability to elevate glucose
*rebound hypertension

33
Q

Metoprolol =

Action:

Use:

Adverse effects:

A

Beta 1 selective receptor antagonist

Decreased CO
Renin secretion
Central sympathetic outflow
Resetting of baroreceptors

Hypertension

Nausea, vomiting, confusion, dizziness, fatigue, sleep disorders
Avoid w/ pt:
1. asthmatic (block B2 action of bronchodilation)
2. peripheral vascular disease (sensitive to cold, unopposed B1 effect)
3. Diabetics: inability to elevate glucose
*rebound hypertension

34
Q

Prazosin, doxazosin =

Mechanism:

Use:

Adverse effects:

A

Alpha-1 adrenergic receptor antagonist

Blockade of alpha-1 receptors on vascular smooth muscle
Dilation of arterioles and capacitance veins

Alone or combo for hypertension
Pheochromocytoma: increased epinephrine release

Reflex tachycarida, orthostatic hypotension, fluid retention
GI upset, palpitation, tinnitus, headache, dizziness, urinary incontinence
Water retention –> use with diuretic or beta-antagonist

35
Q

Labetalol =

Use:

A

non-selectie beta and alpha-1 receptor antagonist

Chronic hypertension
Hypertensive emergencies

36
Q

Carvedilol =

Use:

A

non-selectie beta and alpha-1 receptor antagonist

Antioxidant, antiproliferative
Hypertension
HEART FAILURE

37
Q

Reserpine =

Mechanism:

Use:

Adverse effects:

A

Inhibitor of adrenergic transmission

Deplete NE from adrenergic nerve endings
Inhibit reuptake of NE into storage terminal
Decrease peripheral resistance and CO

Mild to moderate hypertension
Combo w/ thiazide diuretic in resistant hypertension patients

Postural hypotension
Sedation, dry mouth, nightmares
Sodium and water retention –> use diuretics

38
Q

Clonidine =

Mechanism:

Use:

Adverse effects:

A

Central-mediated antihypertensives
AGONIST

  1. Stimulate brainstem alpha2 adrenergic receptors –> decrease sympathetic outflow
  2. Vagal activity to heart increased
  3. Decreased peripheral vascular resistance and CO

Resistance hypertension

Rebound hypertension
Sedation, dry mouth, depression, drowsiness
Sodium and water retention –> use diuretic
Postural hypotension in elderly

39
Q

Alpha-methyldopa =

Mechanism:

Use:

Adverse effects:

A

Central-mediated antihypertensives
AGONIST

  1. Stimulate brainstem alpha2 adrenergic receptors –> decrease sympathetic outflow
  2. Vagal activity to heart increased
  3. Decreased peripheral vascular resistance and CO

Pregnancy -induced hypertension

Rebound hypertension
Sedation, dry mouth, depression, drowsiness
Sodium and water retention –> use diuretic
Postural hypotension in elderly

40
Q

Hydralazine =

Mechanism:

Use:

Adverse effects:

A

Vasodilators

Reduce intracellular calcium
Preferential effect on arterioles (vs. arteries and veins)
Decreased PVR, MAP
Reflex increase in HR, contractility, CO

Mild to moderate hypertension + diuretic and beta blocker

Headache, anorexia, nausea, dizziness, sweating
Reflex tachycardia –> Angina or ischemic arrhythmias w/ ischemic heart disease
Increase renin and fluid retention
Immune response (Lupus)

41
Q

Minoxidil =

Mechanism:

Use:

Adverse effects:

A

Vasodilators

Preferential effect on arterioles
Decreased PVR
Activates K+ channels –> VSM relaxation
Reflex increase in HR, contractility, CO, renin secretion and fluid retention

Resistant hypertension + diuretic and beta blocker

Fluid retention: contraindicated in heart failure
Pericardial effusion and cardiac tamponade
Reflex tachycardia
Abnormal hair growth (Rogain)

42
Q

Nitroprusside =

Mechanism:

Use:

Toxic effects:

A

Direct vasodilator

Generates NO –> activate guanylyl cyclase –> increase cGMP
Effect on veins (reduce preload) and arteries (reduce afterload)

Produce hypotension in surgery
Hypertensive emergencies

Rapid MAP decrease
Cyanide accumulation

43
Q

Nitroglycerin =

Mechanism:

Use:

Side effects:

Pharmacokinetics:

A

Vasodilator

Preferential effect on VEINS
Generates NO –> activate guanylyl cyclase –> increase cGMP

Produce hypotension in surgery
Hypertensive emergencies

Headache

Short duration

44
Q

Epoprostenol =

Mechanism:

Use:

A

prostacyclin = vasodilator

Direct vasodilator via cAMP
Counteracts thromboxane A2

Potent antihypertensive
Primary pulmonary hypertension
Administered continuously

45
Q

Bosentan =

Use:

Adverse effect:

A

Non-selective endothelin receptor blocker

Primary pulmonary hypertension

Edema, headache
Spermatogenesis inhibition
Respiratory tract infection
Decreased hematocrit
Decrease bile salt secretion --> accumulate --> liver damage 
Birth defect
46
Q

Ambrisentan =

Use:

Adverse effects:

A

ETA receptor blocker

Primary pulmonary hypertension

Edema, headache
Spermatogenesis inhibition
Respiratory tract infection
Decreased hematocrit
Decrease bile salt secretion --> accumulate --> liver damage 
Birth defect
47
Q

Riociguat
Mechanism:

Use:

Adverse effects:

A

Directly stimulates guanylyl cyclase –> increase cGMP

Primary pulmonary hypertension
Thromboembolic pulmonary hypertension
Combined w/ ET receptor blockers

Headache, dizziness, nausea, diarrhea
Hypotension
Birth defects

48
Q

ACE inhibitor or ARB w/ thiazide diuretic treats:

A

stage 2 hypertension

49
Q

ACE inhibitor or ARB w/ CCB

A

stage 2 hypertension

MOHD3 Exam 2 (13 decks)

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