lecture 8 Flashcards
major modifiable risk factor for CV disease is ?
hypertension
HYPER TENSION increases the risk of CV diseases as?
(myocardial infarction,
heart failure)and stroke
Sustained arterial hypertension damages blood vessels of which organs ?
brain, kidney, heart.
Secondary hypertension percentage and examples ?
5-10%
- Renal artery stenosis
- Pheochromocytoma
- Drugs
how Glucocorticoids may lead to hypertension ?
they have the ability to cause sodium and water retention
this will increase the blood volume that will increase BP
Drug- Induced hypertension
• Oral contraceptives. • NSAIDs. • Sympathomimetic OTC cold medication • excessive doses of caffeine. • Glucocorticoids • Liquorice عرق سوس
curable / non :
essential HTN
non-essential HTN
non curable
may be curable by either surgery or remove the drug -stop it
stroke time depends on
Heart Rate
Contractility
Filling Pressure- preload
main drugs that reduces HTN
beta &alpha blockers RAAS CCD (Ca) diuretics direct VD
If primary HTN , initiate lifestyle changes how ?
smoking cessation, weight loss, diet,
stress reduction , less alcohol
Diuretics adv [3]
safe
inexpensive
effective in preventing stroke, myocardial infarction, and heart failure.
Type of diuretics:
name -efficacy-example-act on
1) Loop Diuretics (high efficacy ): furosemide (Lasix)- loop of henle
2) Thiazides Diuretics ( moderate efficacy): Hydrochlorothiazide-DCT
3) Potassium-sparing Diuretics (low efficacy) : spironolactone-collecting duct
the diuretic drug that it is use in initial therapy or hypertension is ?
thiazides diuretics
Indicated in mild to moderate HT
just thiazides
in severe HTN combination drug of ?
sympathoplegic , Angiotensin antagonist & vasodilator drugs
respond to thiazide diuretics reduce the blood pressure within about
4–6 weeks
case of using loop Diuretics
when fluid overload in the body such as pulmonary
edema→ the cause it heart failure
Favorable indication for thiazide:
❑ HTN with osteoporosis.
❑ HTN with recurrent renal stones.
Thiazides are sometimes useful in the prevention of calcium-containing kidney stones
Favorable indication for loop:
Fluid overload: heart failure ,renal disease -pulmonary edema
Hypokalemia needs to be avoided
how ?
combining a thiazide with inhibitors of the RAS or with a K+-sparing diuretic
Hypokalemia (cause by loop and thiazide) increases the risk of
drug-induced ventricular tachycardia
the risk for ischemic ventricular fibrillation
the leading cause of sudden cardiac death
major contributor to cardiovascular mortality in treated hypertensive patients.
S.E of loop diuretics :[3]
Hypocalcaemia. (inhibit Ca2+ reabsorption)
Hypokalemia.
Ototoxicity: transient and occur with rapid IV infusion
case of using loop Diuretics
when fluid overload in the body such as pulmonary edema→ the cause it heart failure
______diuretics are commonly used in HTN
thiazide
Spironolactone :
is_____ _/agonist
benefit
S.E
~aldosterone antagonist
~diminishing the cardiac remodeling that occurs in heart failure
~Hyperkalemia-gynecomastia in males and menstrual irregularities in females-nasea
gynecomastia in males and menstrual irregularities in females is a side effect of _____ drug
Spironolactone
Some ___ blockers have been shown to reduce mortality after MI, in
patients with heart failure
beta
In severe HTN _blockers are especially useful in preventing the reflex
tachycardia that often results from treatment with direct vasodilators
β
______ is recommended therapy for hypertension when concomitant heart disease is present ( stable angina, SVT, post MI)
β blockers
contraindications of beta blockers?
asthma patient
Cardio-selective beta blockers are used for asthma patient
metoporolol
atelol
nebivolol
patients with hypertension and heart failure we use
metoprolol
example of single-pill combination
Tenoretic
Tenoretic is combination of
Tenormin + diuretic Thiazide
the management of heart failure as[ have both β-blocking and vasodilating effects]
1- cardio-selective blocker(beta1blocker) :
2-Non-selective (beta and alpha1) :
3-
1-Nebivolol,
2-Labetalol & Carvedilol
beta blocker Favorable indication:
- Hyperthyroidism.
- Essential tremor
- Migraine
Verapamil+ B-Blocker causes ? may lead to ?
-ve inotropic and chronotropic effects.
This canlead to cardiac arrest
DM patients shouldn’t be given____ , because it will increase the hypoglycemia.
beta blocker
bronchial asthma patients shouldn’t be given ______ because it leads to bronchoconstriction
beta blocker spc 2
some patients bradykinin can lead to angioedema that can be treated by ?
Ep
first-line in hypertensive diabetic patients is ?
ACEi /ARB
Indications of ACE inhibitors
1-Chronic Heart Failure (DOC)
2-Hypertension.
3-Drug of choice in progressive renal insufficiency, diabetic nephropathy.(nephroprotective
effect of ACEI).
• Slow the progression of diabetic nephropathy and decrease albuminuria
Contraindications of ACEi
1- Pregnant women (they are fetotoxic drugs, lead to renal toxicity in fetus).
2- Bilateral renal stenosis
for hypertension and angina
CCD DRUGS
to treat angina and supraventricular tachyarrhythmia and prophylaxis of migraine and cluster headaches
Verapamil (Non-dihydropyridine)
The most common tocolytic agents used for the treatment of preterm labor
- Nifedipine(Dihydropyridine)
Therapeutic uses of CCB
Hypertension
Angina
Arrhythmias
drug may cause gingival hyperplasia
(Nifedipine )
Verapamil and diltiazem should be avoided in patients with
congestive heart failure or
with AV block
treatment of mild-moderate hypertension in pregnancy
methyldopa
Clonidine is used in case of
resistance hypertension
Treatment of hypertension complicated by ___disease
renal
_____is similar to clonidine, but with reduced adverse effects
Moxonidine
Topical _____ is used as a stimulant to hair growth for correction of baldness
minoxidil
