objective 2.2 (pt.2) (1)

Question 1

(idiopathic, primary)
90 to 95% of cases

Answer 1

essential hypertension

Question 2

5 to 10% of cases
Most commonly result of pheochromocytoma, pre-eclampsia, renal artery disease, sleep apnea, thyroid disease, or parathyroid disease

Answer 2

secondary hypertension

Question 3

BP above 180/120; a medical emergency

Answer 3

malignant hyertension

Question 4

what are the categories of antihypertensive drugs?

Answer 4

Adrenergic drugs
Angiotensin-converting enzyme (ACE) inhibitors
Angiotensin II receptor blockers (ARBs)
Calcium channel blockers
Diuretics
Vasodilators
Direct renin inhibitors

Question 5

what are the 5 subcategories of adrenergic drugs?

Answer 5

Adrenergic neuron blockers (central and peripheral)
α2-receptor agonists (central)
α1-receptor blockers (peripheral)
β-receptor blockers (peripheral)
Combo α1 and β receptor blockers (peripheral)

Question 6

Examples: clonidine and methyldopa
Not typically prescribed as first-line antihypertensive drugs
High incidence of unwanted adverse effects: orthostatic hypotension, fatigue, and dizziness
Adjunct drugs to treat hypertension after other drugs have failed
Used in conjunction with other antihypertensives such as diuretics

Answer 6

Α2 adrenergic receptor stimulators (agonists)

Question 7

such as doxazosin, prazosin, and terazosin:
Lowering of BP occurs through dilation of arteries (in the periphery)

Answer 7

Peripherally acting α1 blockers

Question 8

Commonly used α1 blocker
Reduces peripheral vascular resistance and BP by dilating both arteries and veins

Answer 8

Doxazosin mesylate (cardura)

Question 9

Lowers BP through vasodilation

Answer 9

Prazosin hydrochloride (minipress)

Question 10

Stimulate α2 adrenergic receptors in the brain and reduces SNS stimulation from the CNS
By decreasing SNS output, HR is slowed, and fource of contraction is lessened which lowers BP
Also affects the kidneys by reducing renin activity and the vasoconstriction associated with it

Answer 10

Centrally acting α2 adrenergic stimulators (agonists)

Question 11

such as propranolol, metoprolol, and atenolol also work in the heart and vessels
These drugs decrease BP through reduction of HR
Reduction of the heart rate through β receptor blockade
Cause reduced secretion of renin
Long-term use causes reduce peripheral vascular resistance

Answer 11

βeta blockers

Question 12

what are the indications of adrenergic drugs?

Answer 12

All used to treat hypertension
Glaucoma
BPH: doxazosin, prazosin, and terazosin
Management of severe HF when used with cardiac glycosides and diuretics
Clonidine is also used for menopausal flushing

Question 13

what are the AE of adrenergic drugs?

Answer 13

High incidence or orthostatic hypotension
Most common: bradycardia with reflex tachycardia, dry mouth, drowsiness, sedation, constipation, depression, edema, sexual dysfunction, headaches, sleep disturbances, nausea, rash, cardiac disturbances, others

Question 14

Lrg group of safe and effective drugs ie. enalapril and ramipril
Often used as first-line drugs for HF and hypertension
May be combined with thiazide diuretic or calcium channel blocker

Answer 14

angiotensin-converting enzyme (ACE) inhibitors

Question 15

what are the MAO of ACE inhibitors?

Answer 15

Inhibits ACE, which is responsible for converting angiotensin I to angiotensin II
Angiotensin II is a potent vasoconstrictor
So by blocking angiotensin converting enzyme (ACE):
They prevent the formation of angiotensin II, this decreases the vascular constriction therefore causing BV dilation
This dilation of BV lowers BP

Question 16

what are the indications of ACE inhibitors?

Answer 16

Hypertension: Bp: reduces BP by decreasing SVR
HF (drug used either alone or in combo with diuretics or other drugs)
Slow progression of left ventricular hypertrophy after MI
Renal protective effect in pts with diabetes
HTN and HF: prevent sodium and wtr reabsorption. Increases diuresis, decreases blood volume and HTN
Decreases preload therefore decreases work required of the heart
Cardioprotective:
Decreases SVR and preload, therefore decreases the work of the heart
Protects the heart from enlargement after an MI by decreasing the workload of the muscle
Drug of choice for hypertensive pts with HF

Question 17

Reduce glomerular filtration pressure which protects the delicate structures of the kidneys
Cardiovascular drugs of choice for pts with diabetes bcuz of the renal protective effects
Standard therapy for diebetic pts to prevent the progression of diabetic nephropathy

Answer 17

renal protective effects

Question 18

what are the AE of ACE inhibitors

Answer 18

Dry, nonproductive cough (ACE cough), which reverses when therapy is stopped
Fatigue, dizziness, headache, impaired taste
Mood changes
First-dose hypotensive effect
Possible hyperkalemia as ACE inhibitors can cause potassium to be retained

Question 19

what are examples of ACE inhibitors?

Answer 19

Captopril, benazepril, enalapril, fosinopril sodium, lisinopril, cilazapril, perindopril, quinapril, ramipril, trandolapril

Question 20

are inactive in their administered form and must be metabolized in their liver to an active form so as to be effective

Answer 20

prodrugs

Question 21

what is the MOA of angiotensin II receptor blockers?

Answer 21

Also referred to as angiotensin II blockers
Affect primarily vascular smooth muscle and the adrenal glands
Selectively block the binding of angiotensin II to the receptors
Block vasoconstriction and the secretion of aldosterone

Question 22

what are the indications of angiotensin II receptor blockers?

Answer 22

Hypertension
Adjunctive drugs for the treatment of HF
May be used alone or with other drugs such and diuretics

Question 23

what are the AE of angiotensin II receptor blockers?

Answer 23

Upper respiratory infections and headaches most common
Dizziness, inability to sleep, diarrhea, dyspnea, heartburn, nasal congestion, back pain, fatigue, hyperkalemia is less likely to occur than with the ACE inhibitors

Question 24

what are examples of angiotensin II receptor blockers?

Answer 24

Losartan, eprosartan mesylate, valsartan, candesartan cilexetil, aomesartan, telmisartan, azilsartan medonomil potassium

Question 25

Beneficial in pts with hypertension and HF
Used with caution in pts with renal or hepatic dysfunction and in pts with renal artery stenosis
Not to be taken by breastfeeding women

Answer 25

losartan

Question 26

treatment of hypertension and angina

Answer 26

calcium channel blockers

Question 27

cause smooth muscle relaxation by blocking the binding of calcium to its receptors, thereby precenting contraction

Answer 27

hypertension

Question 28

what is the MOA for calcium channel blockers?

Answer 28

results in decreased peripheral smooth muscle tone, decreased SVR; decreased BP

Question 29

what are the indications of calcium channel blockers?

Answer 29

Angina
Hypertension
Antidysrhythmias
Migraine headaches
Raynauds disease
Cerebral artery spasms after subarachnoid hemorrhage

Question 30

First-line antihypertensives in the Canadian Hypertension Edu Program guidelines
They decrease plasma and extracellular fluid volumes through diuresis (increased urination)
Results…
Decreased preload and cardiac output
Decreased total peripheral resistance
Overall effect
Decreased workload of the heart decreased BP

Answer 30

diuretics

Question 31

used in the treatment of HTN as they OPEN ARTERIES BY RELAXING SMOOTH MUSCLE, ALLOWING MORE BLOOD TO REACH THE VESSELS
Results in decreased SVR
Also used to treat PERIPHERAL VASCULAR DISEASE (AS THEY OPEN ARTERIES ALLOWING MORE BLOOD)

Answer 31

vasodilators

Question 32

what are the indications of vasodilators?

Answer 32

Treatment of hypertension
May be used in combo with other drugs
Sodiul nitroprusside and IV diazoxide are reserved for the management of hypertensive emergencies

Question 33

what are examples of vasodilators?

Answer 33

Hydralazine
Sodium nitroprusside
Minoxidil
Nitroglycerin

Question 34

Orally: routine cases of essential hypertension
Injectable: hypertensive emergencies

Answer 34

hydralazine

Question 35

Used in critical care setting for severe hypertensive emergencies; titrated to effect by IV infusion
Contraindications: known hypersensitivity to the drug, severe HF, and known inadequate cerebral perfusion

Answer 35

sodium nitroprusside

Question 36

what are the AE of sodium nitroprusside?

Answer 36

bradycardia, decreased platelet aggregation, rash, hypothyroidism, hypotension,methemoglobinemia, and cyanide toxicity

Question 37

what are the AE of hydralazine?

Answer 37

dizziness, headache, anxiety, tachycardia, edema, dyspnea, N/V, diarrhea, hepatitis, and rash

Question 38

what are the AE of minoxidil?

Answer 38

T-wave electrocardiographic changes, pericardial effusion or tamponade, angina, breast tenderness, rash, thrombocytipenia