Pharm Test 7 Flashcards
Hypertension
(>140/>90)
normal= <120/<80, preHTN= 120-139/80-89, stage 1 =140-159/90-99, stage 2= >160/>100
-primary(essential)= unknown cause- 90%, secondary= caused by disease
Risk factors= diabetes, obesity, smoke, stress, history
Complications= stroke, ischemia, LV hypertrophy, aneurysm, arrhythmia
Blood Pressure control
BP= CO x PVR, reduced CO (beta 1-heart and renin), decrease PVR (alpha 1 on vessels)
1) Baroreceptor reflex/SNS= when low BP- releases renin
2) Renin-angiotensin-aldosterone= vasoconstrictor (incase SVR), increase aldosterone (increases Na reab- increase CBV)
so if we inhibit/block these, we can lower BP
Treatment Sequence (which drugs tried first)
1st- thiazide, 2nd- ACE inhibitor, 3rd- ARB, 4th- Ca blocker
3 Types of Diuretics
work by decreasing water/Na reab= lower CBV
Thiazide, Loop, Potassium sparing
Thiazide Diuretics
inhibits Na-Cl reab channels in early distal, increase Na and water excretion
- needs functional kidney
- can cause: hypokalemia, hyperuricemia, hyperglycemia
Loop Diuretics
inhibits Na-2Cl-K reab in thick ascending limb of loop= decreased renal vascular resistance, increase RBF
- works better with non functional kidney
- can cause: hypokalemia
Potassium Sparing Diuretics
blocks Na/K atpase on principal cell in distal, and also blocks the Na from coming in and K from leaving
- used with others to spare K
- aldosterone receptor antagonist (prevents Na reab)
Beta Blockers
block increase CO and renin release
(nonselective beta blockers bad for patients with asthma because of b2 vasoconstriction when blocked)
-can cause: hypotension, bradycardia, fatigues, insomnia
-don’t withdraw fast= angina, MI, death
ACE Inhibitors
decreases AngII (vasodilates), increase bradykinin/increase NO (vasodilates), lowers aldosterone (less Na reab)
- good for: diabetic nephropathy, MI, decreasing LV hypertrophy
- can cause: dry mouth, rash, hyperkalemia, weird poop/taste
ARB
AngiotensinII Receptor Blockers
- decrease AngII, decrease aldosterone, no effect on bradykinin
- good for: patients with DM, HF, kidney disease
- can cause: less dry mouth, teratogenic (fetal malformation)
- dont use with ACE
Renin Inhibitor
directly lowers renin- reduces Na/water reab
- not used with ARB, ACE, or thiazides
- can cause cough, diarrhea
Calcium Channel Blockers
prevents Ca from coming into heart and smooth muscles around vessels so they can’t contract
Alpha 1 Blocking Agents
block a1 on arterials= dilates, lowers BP and PVR
- reflex tachycardia, orthostatic hypotension
- use with diuretic because Na/water still reab
Alpha and Beta Blockers
blocks alpha 1, beta 1 and 2
lowers BP and PVR
Other 2 Antihypertensives
both are alpha 2 agonists= decrease SNS and lowers BP and PVR
-clonidine and methyldopa
What to do if HTN on CBP
1) flow down 2) ask anesthesiologists depth 3) drugs
Carbonic Anhydrase Inhibitors
increase urine pH, cuz inhibits reab of bicarb
Mannitol dose
during .5-1 g/kg
prime 12.5 g/50 ml
Loop Diuretic dose
20-40 mg bolus to pump?
