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Pharmacology (SPRING 2024) > UNIT 4 Hypertension > Flashcards

UNIT 4 Hypertension Flashcards

1
Q

ThiaSystolic Blood Pressure

A

contraction phase; highest amount of pressure

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1
Q

Hypertension

A

increased pressure on arterial walls;
“silent killer”;
asymptomatic;
may lead to other complications: heart failure, cerebral hemorrhage - stroke, kidney failure, MI

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2
Q

Diastolic Pressure

A

relaxation phase; lowest amount of pressure

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3
Q

Normal Blood Pressure

A

Systolic: less than 120
Diastolic: less than 80

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4
Q

Two Types of Hypertension

A

Primary Hypertension/Essential Hypertension (most common)
Secondary Hypertension (a medical condition present)

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5
Q

Primary Hypertension/Essential Hypertension

A

most common;
cause is unknown;
risk factors: smoking, obesity, racial predisposition, family history, stress, sedentary lifestyle, high-fat diet

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6
Q

Seondary Hypertension

A

a medical condition present;
pregnancy, renal disease, drug-induces

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7
Q

Risk Factors for Hypertension

A

Stress, age: over 60, family history, gender: men and postmenopausal women, increased cholesterol, high sodium diet, sedentary lifestyles, smoking, diabetes

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8
Q

Baroreceptors

A

located in the internal walls of carotid arteries and the aortic arch and other vessels in the body sense the change in BP;
sensors that control BP

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9
Q

Blood Pressure Control

A

if BP decreases, baroreceptors sense the change; EPI and NE are released to constrict smooth muscle of the vessels; this increases BP

if BP increases, baroreceptors sense the change; vagus nerve is stimulated; HR, FOC, CO decrease; vasodilation occurs; this decreases BP

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10
Q

Renin-Angiotensin-Aldosterone System (RAAS)

A

maintains normal BP and blood volume
Angiotensin I is secreted by the kidney (is a vasoconstrictor; increases TPR and BP)
ACE is secreted by the liver
Angiotensin II is formed in the plasma; works on adrenal cortex and is a potent vasoconstrictor
Aldosterone is released by the adrenal cortex

Aldosterone works on the kidneys to conserve Na+ and H2O; this increases blood volume and BP

Angiotensin II stimulates the release of Antidiuretic hormone from the posterior lobe of the pituitary gland;
this stimulates the thirst center (higher fluid intake -> higher volume of blood)
this hormone also stimulates the kidney to pull water from the urine back into blood (higher blood volume); it is also a potent vasoconstrictor

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11
Q

Kidney

A

filter the blood, maintain water and electrolyte balance, maintains the acid-base balance, secretes urine, allows the blood to gain the necessary nutrients (water and electrolytes), is composed of nephrons

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12
Q

Nephron

A

a structure of the kidney;
consists of a glomerulus, a proximal collecting tubule, a loop of Henle, a distal convoluted tubule and a collecting duct

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13
Q

Rules with ions in kidneys

A

If Na+ goes out, so does H2O
If Na+ goes in, K+ comes out
If H+ goes in, Na+ goes out
If Cl- goes in, Na+ goes out

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14
Q

Urine Formation

A

Filtration - H2O, salts, sugars, acids, drugs, nitrogenous wastes leave the blood; large particles stay (proteins and blood cells)

Tubular Reabsorption - body retains H2O, salts, sugars

Tubular Secretion - substances from blood go back into the renal tubule (drugs, acids, nitrogenous wastes, salts and H2O) as wastes products to be excreted

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15
Q

Reabsorption

A

Glomerulus - filtration occurs

Tubular Reabsorption -
PCT & DCT - H+ is secreted; Na+ and H2O is reabsorbed
DCT - Aldosterone is secreted along with K+; Na+ and H2O are reabsorbed (increase in aldosterone may cause hyperkalemia)
Loop of Henle - CL- is reabsorbed along with Na+ and H2O
Collecting duct - ADH maintains the water balance, decrease in urine output, increase in blood volume
- No ADH: increase in urine output and decrease in blood volume

Tubular Secretion - occurs when ions from blood go into the tubules

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16
Q

Non-pharmacological Treatment of HTN

A

decrease sodium input, reduce fat intake, decrease stress, increase physical activity, rest, moderate alcohol intake, weight loss

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17
Q

Antihypertensive Pharmacological Treatment

A

Vasodilators, CCB, BB, diuretics, ACE inhibitors, ARB, renin inhibitors, combo therapy

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18
Q

Diuretics

A

USES: CHF, HTN, edema, anuria, renal disease

Types: Osmotic Diuretics, Thiazide/Thiazide-like Diuretics, Loop Diuretics (Organic Acid Diuretics)

19
Q

Osmotic Diuretic

A

decreased ICP; pulls water from tissues (changes plasma osmolality)
mannitol (Osmitrol)

20
Q

Thiazide/Thiazide-like Diuretics

A

do not spare K+;
block reabsorption of Na+, diuresis, Na+ and H2O loss
- sulfa derivative, if allergic to sulfonamides, these are contradicted

Thiazide Diuretic:
hydrochlorothiazide (HCTZ) (Hydrodiuril)

Thiazide-like Diuretic:
chlorthalidone (Hygroton)
indapamide (Lozol)
metolazone (Zaroxolyn)

21
Q

Loop Diuretics (Organic Acid Diuretics)

A

do not spare K+ (secreted through urine)

USES: edema, HTN, pulmonary congestion, liver and kidney disease

MOA: inhibit Na+ and Cl- transport in Loop of Henle -> this increases Na+, Cl- and H2O secretion

DRUGS:
furosemide (Lasix)
torsemide (Demadex)

22
Q

Potassium Sparing Diuretics (Aldosterone Receptor Antagonists)

A

control K+ depletion through urine

DRUGS:
amiloride (Midamor)
sprinolactane (Aldactone)
triamterene (Dyrenium)

(possible hyperkalemia and gynecomastia)

23
Q

Diuretics (Common Side Effects)

A

Hypotension,
orthostatic hypotension,
reflex tachycardia,
thirsty/dry mouth,
nausea

24
Q

Diuretics Patient Teaching

A

Take medication exactly as prescribed;
taking medication as prescribed helps control high BP and prevent complications;
syncope may be experienced (fainting may occur due to blood volume depletion, low BP, and low blood flow and O2 level)
Due to taking a diuretic, an increase in HR should be reported; a reflex tachycardia may occur due to lowering of BP);
if taking a diuretic and a cardiac glycoside, monitor pulse;
orthostatic hypotension may occur - be careful with changing positions;
patients should monitor and journal their daily weight; monitor for fluid gain;
monitor input and output for patients in hospitals

25
Q

Thiazide Diuretics: Patient Teaching

A

Side Effects:
hypercalcemia, hyperglycemia, hyperlipidemia, hyperuricemia, hypokalemia ( may need to supplement with (dietary): bananas, papayas, mangos, lima beans, artichoke, cantaloupe, watermelon, apricots, nuts, oranges, dates and fish)

Symptoms Include: leg cramps, muscle weakness, less alert, lethargy, constipation, arrhythmias

26
Q

Sympatholytics (lower HTN)

A

Beta Adrenergic Blockers, Peripheral Alpha-1 Blockers, Alpha-2 Central Agonists

27
Q

Beta Adrenergic Blockers (Sympatholytics; lower HTN)

A

MOA: block beta-1 receptors - decrease BP and CO
block release of renin by kidneys - interferes with the RAAS

USES: HTN, CHF, angina, migraines, glaucoma, tachyarrhythmias

DRUGS: metoprolol (Lopressor)
propranolol (Inderal)

PATIENT TEACHING/SIDE EFFECTS: drowsiness, GI upset, bradycardia, CNS depression, monitor serum lipid levels, mental depression, monitor blood glucose levels in diabetics

27
Q

Peripheral Alpha-1 Antagonists/Blockers (azosin)

A

USES: HTN, angina, BPH

MOA: block NE from binding to adrenergic alpha-1 receptors -> vasodilation

DRUGS: prazosin (Minipress)
doxazosin (Cardura)
terazosin (Hytrin)

PATIENT TEACHING/ SIDE EFFECTS: orthostatic hypotension - caution with changing positions, reflex tachycardia, GI upset, increased urination

27
Q

Alpha-2 Central Agonists

A

USES: HTN, angina

MOA: inhibits CNS activity, lowers BP, acts on alpha-2 receptors -> vasodilation

DRUGS: clonidine (Catapres)
methyldopa (Aldomet)

PATIENT TEACHING/SIDE EFFECTS: hypotension, dry mouth, drowsiness

27
Q

Vasodilators (lower HTN)

A

MOA: relaxes smooth muscle of the vessels

USES: HTN, CHF, CAD

DRUGS: hydralazine
minoxidil (Loniten, Rogaine)
nitroprusside (Nipride, Nitropress)

PATIENT TEACHING/SIDE EFFECTS: flushing, HA, hypotension, N/V, rapid heartbeat, cannot be used with ED meds

28
Q

Hypotension (Symptoms)

A

dizziness, lightheadedness, syncope, nausea

29
Q

Hypotension (Treatment)

A

rest - lay down, elevate legs, give O2, force fluids

30
Q

Renin-Angiotensin II-Aldosterone System

A

Renin is secreted by the kidneys;
Angiotensin I is secreted by the liver (is a vasoconstrictor);
ACE is released by the lungs;
Angiotensin II is formed in the plasma;
Angiotensin II stimulates adrenal cortex to release aldosterone;
Angiotensin II stimulates posterior pituitary to release ADH,
Angiotensin II is a potent vasoconstrictor;
Angiotensin II stimulates the thirst center (more fluid intake, higher blood volume, higher BP)
Aldosterone works on the kidneys; they reabsorb Na+ and water back into blood (higher blood volume, higher BP)
AntiDiuretic Hormone works on the kidneys to take fluid from urine back into blood; is a vasoconstrictor

31
Q

ACE Inhibitors (work against HTN)

A

Normal Process: ACE -> Angiotensin II

MOA: inhibits the ACE;
decrease of release of aldosterone; decreased reabsorption of Na+ and H2O; vasodilation

USES: HTN

DRUGS:
captoprin (Capoten)
enalapril (Vasotec)
lisinopril (Zesttril)
benazepril (Lotensin)
quinapril (Accupril)
ramipril (Altace)

PATIENT TEACHING/SIDE EFFECTS: Where does K+ go? -> K+ levels rise -> causing hyperkalemia, hypotension, angioedema, dizziness, HA, GI upset, rash, arrhythmias, coughing

32
Q

Angiotensin II Receptor Blockers/Antagonists (ARBs) (work against HTN)

A

MOA: block effects of Angiotensin II; blocks the release of aldosterone, vasodilation
- No significant effects on K+, no angioedema

USES: HTN

DRUGS:
olmesartan (Belicar)

PATIENT TEACHING/SIDE EFFECTS: hypotension, dizziness, HA, drowsiness, cough, N, monitor K+ levels

33
Q

Renin Inhibitors (work against HTN)

A

MOA: inhibit actions of renin

USES: HTN

DRUGS: aliskiren (Tekturna)

PATIENT TEACHING/SIDE EFFECTS: hypotension, dizziness, upset stomach, HA, cough, lightheadedness

34
Q

Calcium Channel Blockers (CCBs) (work against HTN)

A

MOA: interfere with Ca2+ entry into the cardiac muscle cells and smooth muscle cells of the vessels; this results in a decrease of a venous return, decrease of BP, increase of blood flow in the coronary arteries, slower conduction; vasodilation

USES: HTN, tachyarrhythmias, angina

DRUGS:
nifedipine (Procardia), nisoldipine (Sular), amlodipine (Norvasc), verapamil (Calan), diltiazem (Cardizem)

PATIENT TEACHING/SIDE EFFECTS: hypotension, dizziness, HA, facial flushing, constipation, reflex tachycardia, xerostomia

35
Q

BP Thresholds

A

1) Normal BP: less than 120/80 mm Hg
2) Elevated BP: 120-129/less than 80 mmHg
3) Stage 1 HTN: 130-139/80-89 mm Hg
4) Stage 2 HTN: equal or greater than 140/90 MM Hg

36
Q

Normal BP recommendations

A

promote optimal lifestyle habits: healthy diet, weigh loss if needed, tobacco use cessation, alcohol moderation, physical activity;
reassess in a year

37
Q

Elevated BP recommendations

A

Nonpharmacological treatment (Class I);
reassess in 3 to 6 months;
weight loss for overweight or obese patients;
healthy diet (DASH);
Sodium restriction;
potassium supplementation;
increased physical activity with structured exercise program;
limited alcohol: 1 per day (in women) and 2 per day (in men)

38
Q

Stage 1 HTN
(ASCVD or estimated 10-y CVD risk greater than or equals to 10%)

A

BP: 130-139/80-89 mm Hg;

Nonpharmacological treatment and BP lowering medication (Class I);
reassess in 1 month (Class I);

if BP goal is met, reassess in 3 to 6 months (Class I);

if BP goal is not met, assess and optimize adherence to therapy (consider intensification of therapy)

39
Q

Stage 1 HTN (130-139/80-89)
(no ASCVD or risk of CV of or greater than 10 %)

A

Nonpharmacologic therapy (Class I);

reassess in 3 to 6 months (Class I)

40
Q

Stage 2 HTN

A

BP equals or is greater than 140/90;

nonpharmacologic treatment and BP lowering medication (Class I)

41
Q

Stepped Care Approach to HTN

A

First-line options (single or in combination):
-ACE Inhibitors, ARBs, CCBs, and thiazide diuretics
-beta-blockers can be used in patients who have any of the following: CAD, dysrhythmia, post-myocardial infarction, and heart failure
(those older than 60 yrs old should not take beta blockers as initial agents; have not shown effective at preventing CV events
-for moderate HTN of >20 mm Hg:
take an ARBs or ACE Inhibitors with a diuretic or a dihydropyridine (DHP) calcium channel blocker (such as amlodipine, nifedipine, or felodipine) combination
-start with a low dose and titrate upwards
-if hypertension has not been controlled, the following may be added in the stepwise order:
*CCB or a thiazide diuretic (chlorthalidone is more potent than hydrochlorothiazide (HCTE); add whichever one has not been used); can use a combination low dose amiloride/HCTZ in appropriate patients;
-a vasodilating beta-blocker (such as carvedilol or nebivolol) and/or aldosterone blocker
-alpha-blockers, direct vasodilators; consider referral

42
Q

Treatment Recommendations for Specific Patient Populations

A

-African-Americans should be prescribed CCB 1first
-those with chronic kidney disease, should be prescribe ACE Inhibitors or ARBs
-differences in ARBs agents and diuretics
*Losartan (Cozaar): weakest ARB; may require twice a day dosing;
*Valsartan (Diovan), telmisartan (Micardis), irbesartan (Avapro), candesartan (Attacand), olmesartan (Benicar) are all generic (except Edarbi) and can be used everyday
*more potent ARBs include olmesartan and azilsartan (which is the most potent)
*chlorthalidone is more potent than HCTZ

-for hypertension that is difficult to control:
*make sure that the patient is on sodium restricted diet of 1500-2000 mg per day and not taking OTC nonsteroidal or anti-inflammatory medication or drinking excess alcohol
*if a patient is on ACE Inhibitor/ARB with a thiazide diuretic and systolic pressure remains uncontrolled, change ACE inhibitor to ARBs, if a patient is on losartan, change to a more daily, once-daily ARB
*if the patient is on a beta-blocker for some other reason, the drug cab be changes to a vasodilating beta-blocker
*clinicians may use a dihydropyridine CCB; do not use nifedipine with LV systolic dysfunction
*may add an aldosterone blocker if BP remains unchanged
*clinicians may change HCTZ to chlorthalidone (more potent patient thiazide diuretic)

-for elevated isolated systolic pressure:
the Canadian guidelines recommend using an ARB, a thiazide diuretic, and/or dihydropyridine CCBs

Pharmacology (SPRING 2024) (7 decks)

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