Hypertension TEST 2 Flashcards
What are the major classes of antihypertensives?
- Diuretics
- Sympathoplegics
- Direct Vasodilators
- Anti-Angiotensin Agents
Where do diuretics act?
-Kidney Tubules
What do diuretics do?
- Deplete sodium
- Reduce blood volume
What do sympathoplegics do?
-Reduce peripheral vascular resistance
How many different classes of diuretics do you have?
- Acetazolamide
- Osmotic agents
- Loop agents
- Thiazides
- Aldosterone antagonists
- ADH antagonists
- Adenosine
What is Mannitol?
-An osmotic diuretic agent
Where is mannitol used at?
-Thin descending limb
What are Carbonic anhydrase inhibitors?
-Acetazolamide diuretics
Where do Carbonic anhydrase inhibitors work?
-Proximal tubules
What does Acetazolamide do?
-Shut down reabsorption of H2CO3 into the interstitial space and thus less Na+ reabsorption thus more Na+ in lumen and thus diuresis
What are two loop diuretics?
- Furosemide (Lasix)
- Bumetanide (Bumex)
What do loop diuretics do?
-Inhibit the luminal Na+/K+/2Cl- transporter in the thick ascending limb of the loop of Henle thus reducing NaCl reabsorption
What is a side effect of Loop diuretics?
-Hypokalemia (should eat bananas)
What can keep loop diuretics from working?
-NSAIDs
Where do Thiazides work?
-Distal convoluted tubule
What are examples of Thiazide diuretics?
- Hydrochlorothiazide
- CHlorthalindone
What do thiazides do?
-Inhibit NaCl reabsorption from the luminal side of epithelial cells in the DCT by clocking the NA+/Cl- transporter
What can keep thiazides from working?
-NSAIDs
What is a side effect from Thiazides?
-Hypokalemia
What can Hypokalemia can lead to decreased insulin secretion and thus hyperglycemia?
- Thiazides
- Loop diuretics
What are potassium-sparing diuretics?
-Aldosterone antagonists
What are some examples of Aldosterone antagonists/K+ sparing diuretics?
- Spironolactone (Aldactone)
- Amiloride
What should you watch for when giving aldosterone antagonists?
- Headache
- Diarrhea
- Hyperkalemia
- Electrolyte imbalance
- Fatigue
- GI disturbance
What do you use in combination with loop diuretics to offset hypokalemia?
-Potassium-sparing
What do you not use potassium sparing drugs with and why?
ACE-I because you can worsen hyperkalemia
What does spironolactone do?
-Prevent K+ secretion by antagonizing effects of aldosterone in collecting tubules
What does angiotension lead to?
- Vasoconstriction
- Aldosterone secretion
What occurs if you use an angiotensin inhibitors?
-You won’t get vasoconstriction or aldosterone secretion
What are ACE inhibitors?
-Captopril (Capoten)
What do ACE inhibitors do?
- Inhibit the converting enzyme (peptidyl dipeptidase) that hydrolyzes angiotensin I to angiotensin II
- Increase bradykinin levels (potent vasodilator)
What are some side effects from ACE inhibitors?
- Dry cough from increased bradykinin
- Hyperkalemia because little aldosterone
What are Angiotensin II inhibitors?
-Losartan (Cozaar)
What does Angiotensin II inhibitors do?
- Decrease peripheral vascular resistance
- No effect on bradykinin
What are some side effects of Angiotensin II inhibitors?
-Hyperkalemia
What direct vasodilators release of nitric oxide from drug or endothelium?
- Nitroprusside
- Hydralazine (Apresoline)
- Nitroglycerin (Nitrostat)
What direct vasodilators cause a reduction of calcium influx?
- Verapamil
- Diltiazem
- Nifedipine
What direct vasodilators cause hyperpolarization of smooth muscle membrane through opening of potassium channels?
- Minoxidil
- Diazoxide
What direct vasodilators cause activation of dopamine receptors (D1)?
-Fenoldopam
What do all the vasodilators that are useful in hypertension do?
-Relax muscle of arterioles that decreases systemic vascular resistance
What does Sodium nitroprusside do?
-Relax vein
What is Clonidine?
-Alpha 2 agonist (centrally mediated)
What does Clonidine do?
-Reduce sympathetic tone resulting in decreased blood pressure
What are side effects of Clonidine?
- Dry mouth
- Sedation
What is mecamylamine?
-Ganglionic blocker
What are side effects of ganglionic blockers such as mecamylamine?
- Orthostatic hypotension
- parasympathoplegia
- constipation
- urinary retention
- Precipitation of glaucoma
- dry mouth
- blurred vision
What are some adrenergic blocking agents?
-Guanethidine (Ismelin)
What does Guanethidine do?
-Inhibit the release of norepinephrine from sympathetic nerve endings
What is a side effect of Guanethidine?
- Orthostatic hypotension
- Diarrhea
What are cardioselective beta blockers (B1 in the heart)?
- Atenolol (Tenormin)
- Metoprolol (Lopressor)
What are non-cardioselective (B1 and B2 ) beta blockers?
- Propranolol
- Nadolol
What drugs are Beta and Alpha 1 blockers?
- Labetalol (Trandate)
- Carvedilol (Coreg)
What are the effects of Beta blockers in the cardiac area?
-Decreased HR and contractility
What are the effects of Beta blocker on the vasculature?
-Increased TPR
What are the effects of Beta blockers on the renal system?
-Decreased Renin release
What are the effects of Beta blockers on the respiratory system?
-Bronchial constriction
What are the effects of Beta blockers on the metabolic system?
-Decreased Glycogenolysis in response to hypoglycemia
What are the effects of Beta blockers on aqueous humor production?
-Decreases it
What are cardioselective Alpha 1 blockers?
- Prazosin (Minipress)
- Terazosin (Hytrin)
- Doxazosin (Cardura)
what are non-cardioselective (alpha1 and alpha 2 blockers)?
- Phentolamine (Regitine)
- Phenoxybenzamine (Dibenzyline)
What are the side effects of alpha 1 blockers?
- orthostatic hypotension
- Nasal congestion
