Pharmacology - Antihypertensive Drugs (Exam 3) Flashcards
What are the antihypertensive drug classes?
- Diuretics
- ACE Inhibitors
- Angiotensin antagonists
- Calcium channel blockers
- Beta blockers
- a1 blockers
- Renin inhibitors
What is the mechanism of diuretics?
Lose salt
Lose water
What is the effect of diuretics?
Decrease BP and blood volume
What do ACE inhibitors target?
Renin-Angiotensin-Alodersterone (RAA) system
What is the mechanism of ACE inhibitors?
Inhibit angiotensin converting enzyme (ACE) from converting angiotensin I into angiotensin II
What does angiotensin II do?
- Increase aldosterone (leads to increased Na+ reabsorption, water retention, and blood volume)
- Increase vasoconstriction and thirst (leads to increased resistance and water intake)
What suffix do ACE inhibitors have?
“-pril”
(think: April)
What is the other mechanism of ACE inhibitors?
Increase level of bradykinin, which makes ACE inactive
What does increasing the level of bradykinin cause?
Vasodilation
Cough
What are the main benefits of ACE inhibitors?
- Decreased angiotensin II and aldosterone levels
- Increased bradykinin levels
- Increased vasodilation
- Decreased BP and blood volume
ACE inhibitors have ____________ effect even in patients without _________ activities
antihypertensive; high-renin
T/F ACE inhibitors have little effect on cardiac output
True
T/F ACE inhibitors cause orthostatic hypotension and tachycardia
FALSE
T/F ACE inhibitors do not induce salt and water retention
True
ACE inhibitors cause _________ mortality in patients following acute myocardial infarction and chronic systolic heart failure
decreased
ACE inhibitors cause ________ chronic hypertension-induced ________ damage
decreased; renal
ACE inhibitors have protective effects in __________ patients
diabetic
T/F ACE inhibitors cause increased deterioration of renal function in diabetic nephropathy
FALSE, they cause decreased deterioration
What are the adverse effects of ACE inhibitors? (VERY IMPORTANT FOR EXAM)
- Dry cough
- Reduced taste
- Angioedema
- Hyperkalemia
ACE inhibitors are contraindicated in which patients?
Pregnant women
What is the mechanism of Angiotensin Receptor Blockers/Antagonists (ARBs)?
Inhibit angiotensin II
What suffix do Angiotensin Receptor Blockers/Antagonists (ARBs) have?
“-sartan”
(think: art = Angiotensin Receptor anTagonist)
Angiotensin Receptor Blockers/Antagonists (ARBs) are selective for what receptor?
AT1 receptor
(angiotensin II receptor type 1)
What do AT1 receptors do when activated?
Vasoconstriction (increase BP)
What do AT2 receptors do when activated?
Vasodilation
What drug is a renin inhibitor?
Aliskiren
What is the mechanism of renin inhibitors? What does renin do?
Inhibits renin, which is the rate-limiting enzyme in the RAA system
What are the 3 RAA system inhibitors?
- ACE inhibitors
- Angiotensin receptor blockers/antagonists
- Renin inhibitor
What can the RAA system inhibitors cause?
Hyperkalemia
Hypotension
What are the contraindications of RAA system inhibitors?
Bilateral renal artery stenosis
Pregnancy
What is the mechanism of calcium channel blockers (CCBs)?
Block calcium channels; causes relaxation and vasodilation
What are the 2 main groups of calcium channel blockers (CCBs)?
- Non-dihydropyridines
- Dihydropyridines
What drugs are non-dihydropyridines?
- Verapamil
- Diltiazem
What suffix do dihydropyridines have?
“-dipine”
(think: 2 pine trees on their side looks like a B, so they are CCBs)
What do non-dihydropyridines do?
Decrease contractility
What do dihydropyridines do?
Increase vasodilation
What do CCBs cause in membrane potential?
Slow depolarization
Increase length of phase 0
(causes decreased automaticity, conduction speed, HR)
Which drugs are sympatholytic?
- B blockers (“-lol”)
- Selective a1 blockers (“-osin”)
- Centrally acting a2 agonists (ex: clonidine)
What do B blockers cause in membrane potential?
Block sympathetic stimulation; inhibits the steep sympathetic “slope”
What drugs are direct acting vasodilators?
- Hydralazine
- Minoxidil
T/F Controlling hypertension often requires multiple drug therapies
True
What are the compensatory mechanisms your body has when taking direct acting vasodilators to decrease BP?
What drug can be added to resist the compensatory mechanism?
- Baroreceptor reflex and increased sympathetic discharge -> reflex tachycardia (increases HR); B blockers can resist this
- Decreased renal artery perfusion pressure -> increased renin and fluid retention; ACEI and ARBs can resist this
What is a non-pharmacological approach for hypertension?
Decreased Na+ intake
Sudden and severe increase in BP
Hypertensive emergency
Blood pressure drugs can cause __________ ___________
Orthostatic hypotension
What is the formula for blood pressure?
BP = Flow x TPR
(flow = cardiac output)
Stress + __________ = hypertensive crisis (in uncontrolled hypertension)
Epinephrine
What is hypertension defined as?
> than or = to 140/90
What increases risk of cardiovascular disease, stroke, renal, and retinal damage?
Hypertension
