Week 2 Pharmacology Flashcards
What type of drugs are ACE inhibitors?
Drugs affecting vascular tone
What do AT₁ receptor antagonists (ARBs) primarily affect?
Vascular tone
What is the function of β-blockers?
Drugs affecting the heart
What do calcium channel blockers (CCBs) primarily affect?
The heart
What is the role of thiazide diuretics?
Drugs affecting fluid balance
What is the difference between hypertensive emergency and hypertensive urgency?
Hypertensive emergency involves acute end-organ damage while hypertensive urgency does not
Fill in the blank: ACE inhibitors are drugs affecting _______.
vascular tone
Fill in the blank: β-blockers are classified as drugs affecting the _______.
heart
True or False: Calcium channel blockers are used to manage fluid balance.
False
What do thiazide diuretics primarily manage?
Fluid balance
What drug class do Enalapril, Lisinopril, and Ramipril belong to?
ACE Inhibitors
ACE Inhibitors inhibit angiotensin-converting enzyme (ACE), preventing the conversion of angiotensin I to II.
What is the mechanism of action of ACE Inhibitors?
Inhibit angiotensin-converting enzyme (ACE), preventing angiotensin I → II conversion, resulting in vasodilation and decreased aldosterone-mediated volume expansion.
List the indications for ACE Inhibitors.
- Hypertension (especially in younger patients, diabetics)
- Congestive heart failure
- Post-myocardial infarction (improves survival)
- Diabetic nephropathy (delays progression)
- Left ventricular dysfunction
What are the contraindications for ACE Inhibitors?
- Pregnancy (teratogenic)
- Bilateral renal artery stenosis
- History of angioedema associated with ACE inhibitors
- Hyperkalemia
What drug class do Losartan, Valsartan, and Irbesartan belong to?
Angiotensin II Receptor Blockers (ARBs)
ARBs block AT₁ receptors, preventing angiotensin II-mediated vasoconstriction and aldosterone secretion.
What is the mechanism of action of Angiotensin II Receptor Blockers (ARBs)?
Block AT₁ receptors, preventing angiotensin II-mediated vasoconstriction and aldosterone secretion.
List the indications for Angiotensin II Receptor Blockers (ARBs).
- Hypertension
- Heart failure
- Diabetic nephropathy (especially in those intolerant to ACE inhibitors)
- Post-MI with left ventricular dysfunction
What are the contraindications for Angiotensin II Receptor Blockers (ARBs)?
- Pregnancy
- Bilateral renal artery stenosis
- Hyperkalemia
- Co-administration with ACE inhibitors in certain populations
What drug class do Metoprolol, Atenolol, and Propranolol belong to?
Beta Blockers
Beta Blockers block β₁ (cardioselective) and/or β₂ (nonselective) receptors.
What is the mechanism of action of Beta Blockers?
Block β₁ (cardioselective) and/or β₂ (nonselective) receptors; decrease heart rate, contractility, and renin secretion.
List the indications for Beta Blockers.
- Hypertension (especially with coexisting CAD or heart failure)
- Angina pectoris
- Post-MI (secondary prevention)
- Arrhythmias (e.g., atrial fibrillation, SVT)
- Heart failure (only specific β-blockers like carvedilol, metoprolol succinate, bisoprolol)
What are the contraindications for Beta Blockers?
- Severe bradycardia
- Heart block (second or third degree without pacemaker)
- Acute decompensated heart failure
- Asthma or severe COPD (nonselective agents like propranolol)
- Cardiogenic shock
What drug class do Amlodipine and Nifedipine belong to?
Calcium Channel Blockers (CCBs)
CCBs are divided into dihydropyridines and non-dihydropyridines.
What are the subclasses of Calcium Channel Blockers (CCBs)?
- Dihydropyridines: Amlodipine, Nifedipine (vascular selective)
- Non-dihydropyridines: Verapamil, Diltiazem (cardiac + vascular effects)
What is the mechanism of action of Calcium Channel Blockers (CCBs)?
Block L-type calcium channels; reduce intracellular calcium → vasodilation and decreased cardiac workload.
List the indications for Calcium Channel Blockers (CCBs).
- Hypertension (especially in elderly, African Americans)
- Angina (both effort and vasospastic)
- Supraventricular tachyarrhythmias (non-DHPs only)
- Raynaud’s phenomenon (DHPs)
What are the contraindications for Calcium Channel Blockers (CCBs)?
- Severe hypotension
- Heart failure with reduced ejection fraction (non-DHPs)
- AV block or bradycardia (non-DHPs)
- Concomitant β-blockers with non-DHPs (↑ risk of heart block)
What drug class do Hydrochlorothiazide and Chlorthalidone belong to?
Thiazide Diuretics
Thiazide Diuretics inhibit Na⁺/Cl⁻ cotransport in the distal convoluted tubule.
What is the mechanism of action of Thiazide Diuretics?
Inhibit Na⁺/Cl⁻ cotransport in the distal convoluted tubule; increase sodium and water excretion; long-term BP lowering via vasodilation.
List the indications for Thiazide Diuretics.
- Hypertension (first-line, especially in African Americans and elderly)
- Mild edema due to heart, liver, or kidney disease
- Nephrolithiasis due to idiopathic hypercalciuria
- Osteoporosis (modestly increases calcium reabsorption)
What are the contraindications for Thiazide Diuretics?
- Hypokalemia
- Hyponatremia
- Hypercalcemia
- Gout (may increase uric acid)
- Sulfa allergy (caution)
What drug class do Nitroprusside, Labetalol, and Nicardipine belong to?
Emergency Antihypertensives
Emergency Antihypertensives are used in hypertensive emergencies.
What is the mechanism of action of Nitroprusside?
NO donor → direct vasodilation of arteries and veins.
What is the mechanism of action of Labetalol?
α₁ and β blocker → reduces SVR and CO.
What is the mechanism of action of Nicardipine?
Dihydropyridine CCB → arterial vasodilation.
List the indications for Emergency Antihypertensives.
- Hypertensive emergency (BP >180/120 mmHg with organ damage)
- Acute aortic dissection (labetalol preferred)
- Acute ischemic stroke with elevated BP
- Eclampsia or preeclampsia (labetalol, hydralazine)
What are the contraindications for Nitroprusside?
- Renal/hepatic impairment (risk of cyanide toxicity)
- Pregnancy
What are the contraindications for Labetalol?
- Bradycardia
- Heart block
- Asthma/COPD
What are the contraindications for Nicardipine?
- Advanced aortic stenosis
- Caution in acute heart failure
What is the optimal blood pressure range?
Systolic pressure < 120 mm Hg and diastolic pressure < 80 mm Hg
What characterizes normal blood pressure?
Systolic 120-129 mm Hg or diastolic 80-84 mm Hg
What is high-normal blood pressure?
Systolic 130-139 mm Hg or diastolic 85-89 mm Hg
What are common clinical manifestations of hypertension?
- Asymptomatic in most individuals
- Ischemic heart disease
- Heart failure
- Stroke
- Renal failure
- Peripheral vascular disease
Hypertension is often referred to as a ‘silent killer’ due to its asymptomatic nature.
What is crucial for the diagnosis of hypertension?
Accurate measurement of blood pressure and assessment of global cardiovascular risk
What factors are considered in the ASCVD risk calculator?
- Age
- Sex
- Race
- Total cholesterol
- HDL cholesterol
- Systolic blood pressure
- Blood pressure lowering medication use
- Diabetes status
- Smoking status
What is the significance of a 10-year cardiovascular event risk greater than 10%?
Treatment is more aggressive
What is the least accurate method for measuring blood pressure?
Conventional Auscultatory Office Blood Pressure
What is required for accurate blood pressure measurement in the office?
Measure at least twice after 5 minutes of rest, with proper positioning and cuff size
How is Automated Office Blood Pressure measured?
3 readings at 1-minute intervals with the patient unattended
What is the procedure for Home Blood Pressure Monitoring?
3 readings in the morning and 3 in the evening for at least 4 consecutive days
What is the gold standard for blood pressure monitoring?
Ambulatory Blood Pressure Monitoring
What is White Coat Hypertension?
High office blood pressures that are normal at home due to transient adrenergic response
What increases the prevalence and severity of White Coat Hypertension?
Age
What is Masked Hypertension?
Office readings that underestimate ambulatory blood pressures
What conditions are commonly associated with Masked Hypertension?
- Elderly persons
- Patients with diabetes
- Patients with chronic kidney disease
What does nocturnal hypertension predict?
Future cardiovascular disease better than daytime measurements
What is the implication of relying solely on office blood pressure measurements?
Leads to overtreatment or undertreatment in three out of four patients
When should secondary hypertension be evaluated?
- Drug-resistant or induced hypertension
- Abrupt onset of hypertension
- Onset of hypertension at < 30 years
- Exacerbation of previously controlled hypertension
- Disproportionate target organ damage
- Accelerated or malignant hypertension
- Onset of diastolic hypertension in older adults (>65 years)
- Unprovoked or excessive hypokalemia
What is Hypertension?
Elevated pressure within the blood vessels
Hypertension can affect both arteries and veins.
Define Arterial Hypertension.
Hypertension within arteries (Systemic or Pulmonary)
It specifically refers to elevated blood pressure in the arterial system.
What is Venous Hypertension?
Hypertension within veins (Portal Hypertension)
This type often pertains to the pressure in the portal vein.
What is Essential (Primary) Hypertension?
Hypertension without an identifiable secondary cause
It accounts for the majority of hypertension cases.
What is Secondary Hypertension?
Hypertension with an identifiable secondary cause
Examples include renal artery stenosis and endocrine disorders.
Define Systolic Hypertension.
Elevated blood pressure during systole
This condition reflects high pressure in arteries when the heart beats.
Define Diastolic Hypertension.
Elevated blood pressure during diastole
This indicates high pressure in arteries when the heart is at rest.
What is Hypertension with Widened Pulse Pressure?
Hypertension with an abnormally large gap between systolic and diastolic pressures
This can indicate specific cardiovascular issues.
What does Pulse Pressure indicate?
Varies relative to the compliance of the major arteries
Compliance affects how arteries respond to blood flow.
What is the global prevalence of Systemic Arterial Hypertension?
30% of the global population
It is a leading cause of death worldwide.
What are hereditary factors in hypertension?
Approximately 70% of cases
Genetics play a significant role in the development of hypertension.
How does hypertension prevalence vary by age and gender?
More common in men under age 50; more common in women over age 50
The loss of protective estrogen in women contributes to this trend.
What is the relationship between Body Mass Index (BMI) and hypertension?
Prevalence of hypertension increases linearly with average BMI
Obesity impacts sympathetic nervous system activity, contributing to hypertension.
Define Metabolic Syndrome.
Clustering of hypertension with abdominal adiposity, insulin resistance, and dyslipidemia
Typically involves elevated triglycerides and low HDL cholesterol.
What is the relationship between sodium intake and hypertension?
Hypertension is linearly related to dietary sodium intake
Salt sensitivity varies among individuals due to genetic factors.
What are the primary pathogenesis mechanisms of Essential Hypertension before age 50?
Excess vasoconstriction
This leads to both systolic and diastolic hypertension.
What are the primary pathogenesis mechanisms of Essential Hypertension after age 50?
Decreased arterial compliance
This often results in isolated systolic hypertension.
What is Hypertensive Urgency?
Acute severe elevation of blood pressure not associated with end-organ damage
It requires prompt management but not immediate hospitalization.
Define Hypertensive Emergency.
Acute, severe elevation of blood pressure (>220/130) associated with end-organ damage
Commonly affects the heart, kidneys, or brain.
What is Malignant Hypertension?
Hypertensive emergency associated with retinal damage
Includes findings like hemorrhages and cotton wool spots.
What is Hypertensive Encephalopathy?
Hypertensive emergency associated with mental status changes and seizures
It can lead to reduced consciousness and cortical blindness.
What are common causes of Acute Hypertension?
Uncontrolled chronic hypertension, secondary causes, reversible hypertension, medication use, illicit substances, alcohol withdrawal, uncontrolled pain
Each cause requires different management approaches.
List common clinical scenarios associated with Acute Hypertension.
- Acute aortic dissection
- Ischemia (acute myocardial infarction, unstable angina)
- Cocaine-induced sympathetic crisis
- Eclampsia
- Head trauma
- Severe body burns
- Postoperative bleeding
- Uncontrolled epistaxis
- Neurologic emergencies
Hypertensive encephalopathy can complicate these scenarios.
What characterizes Hypertensive Encephalopathy?
Severe hypertensive retinopathy
It is crucial to distinguish from other neurologic emergencies.
What are the complications of Hypertension?
Atherosclerosis, aortic dissection, left ventricular hypertrophy (LVH), heart failure (HF), stroke, nephropathy, retinopathy
Define Atherosclerosis in the context of hypertension.
Pathophysiology related to hypertension leading to vascular pathology
What is aortic dissection?
Pathophysiology related to hypertension leading to serious vascular complications
What is Left Ventricular Hypertrophy (LVH)?
Pathophysiology associated with hypertension, often leading to heart failure
What does HF stand for?
Heart Failure
What is the pathophysiology of stroke related to hypertension?
Pathophysiological changes in the vascular system due to hypertension leading to stroke
What is nephropathy?
Pathophysiology related to kidney damage caused by hypertension
What is retinopathy?
Pathophysiology related to eye damage due to hypertension
Fill in the blank: _______ is a proven nonpharmacologic intervention for hypertension.
[life style modification]
