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Pharmacology > Week 5 HTN > Flashcards

Week 5 HTN Flashcards

1
Q

HTN is?
Most common a________ in world
Most frequent reason for b_______
Leading indication for prescription drugs
Increase BP greatly increase risk of dying from c________

A

a) chronic med problem
b) Dr. visit
c) Stroke, heart disease
CVD/Cardiovascular disease

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2
Q

Modifiable causes leading to CVD death:

A

(#1) Smoking
(#2) Hypertension
-causes 25% of CV events
50+ age: SBP is bigger risk factor for CVD than DBP
55+ age w/ normotensive BP: 90%

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3
Q

Associated Co-morbidities w/ HTN:

A

Hypercholesterolemia (#1)
Obesity (#2)
Diabetes (#3)

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4
Q

If not properly treated, HTN will lead to?

A

Stroke
Hemorrhagic: d/t bleeding in the brain
Ischemic: d/t lack of blood supply

Coronary heart disease
Angina: heart pain
MI & CHF

Retinopathy – retinal infarcts then hemorrhages
Nephropathy – chronic kidney disease

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5
Q

HTN range
a) stage 1
b) stage 2

A

a) 130-139 or 80-89
b) >140 or >90

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6
Q

Lifestyle Modifications
Weight reduction (#1 modification)

A
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7
Q

Lifestyle Modifications
Alcohol Intake

A
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8
Q

Lifestyle Modifications
Physical Activity

A
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9
Q

Lifestyle Modifications
Limited Dietary Sodium

A
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10
Q

What are the first line agents?

A

Thiazide diuretics
ACE inhibiter
ARBs
Calcium Channel Blockers

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11
Q

Thiazide
drugs name
Action/ Short term and long term

A

Hydrochlorothiazide
Chlorthalidone
Metolazone
indapamide

Short term: dec BP, inc urination
Long term: dec peripheral vascular resistance
Often used in combination with other anti-hypertensives

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12
Q

Thiazide ADRs?

A

Any dose: sun sensitivity
High doses: N/V, diarrhea, erectile dysfunction, hypokalemia, hyperglycemia, hyperlipidemia
(limit dose to limit ADRs)

-Most ADRs are limited related
limit dose 25mg/day

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13
Q

Thiazide
Contraindication?

A

Pregnant women (fetal hypoperfusion)
Diabetics (ADR: hyperglycemia)
Gout
Renal failure

Anuria/failure of the kidneys to produce urine

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14
Q

ACE i
Name and action?

A

ANYTHING ENDING IN “pril”

Blocks conversion of ANG I 🡪 ANG II, blocking vasoconstriction and dec aldosterone secretion
Blocks degradation of bradykinin
Result: vasodilation

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15
Q

ACE i ADRs?

A

Hyperkalemia
Acute kidney failure
Angioedema
Persistent/dry cough
Orthostatic hypotension

(Angioedema Cough, Elevated potassium)

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16
Q

ACE i
Specific Advantages contraindication

A

Heart failure
Chronic kidney disease
Ang I 🡪 blocking Ang II

Pregnancy

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17
Q

ARBs Angiotensin 2 receptor blocker
Name and action?

A

ANYTHING ENDING IN “sartan”

Angiotensin II receptor antagonist
NO effects on bradykinin levels

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18
Q

ARBs
ADRs?

A

NO cough
Much less angioedema than ACEi (maybe none…)
Orthostasis

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19
Q

Calcium Chanel blocker
dihydropyridines
Name?

A

Dihydropyridines Ending in “dipin”
only works artery

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20
Q

Calcium Chanel blocker
Non-dihydropyridines
Name?

A

Diltiazem
Verapamil
work on artery and heart

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21
Q

Calcium Chanel blocker
ADRs/dihydropyridine?

A

Neg Inotropic effects
Dizziness
Flushing
Headache
Peripheral edema
Reflex tachycardia

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22
Q

Calcium Chanel blocker
ADRs/Non-dihydropyridine?

A

Neg Inotropic effects
Anorexia, nausea
Constipation
Peripheral edema (not as much as DHP CCBs)

23
Q

Calcium Chanel blocker
action?

A

Blocks Ca influx across cell membrane 🡪 coronary/peripheral vasodilation
Result: vasodilation

24
Q

What are the 2nd line?

A

Direct renin inhibitors
Beta Blockers
Alpha Blockers

25
Q

Direct renin inhibitors
name and action?

A

Aliskiren

Blocks renin’s activity to convert angiotensinogen 🡪angiotensin I
Similar to ACE i

26
Q

Direct renin inhibitors
ADRs

A

Pregnancy warning
Orthostasis
Angioedema

27
Q

Beta Blockers
Drug name/Cardio selective

A

Ending in ”olol”
Nebivolol
Betaxolol
Metoprolol
Atenolol
Bisoprolol

28
Q

Beta Blockers
drug name
Intrinsic Sympathomimetic

A

Acebutolol
Penbutolol
Pindolo

29
Q

Beta Blockers
drug name/Non-selective

A

Carvedilol
Labetalol
Nadolol
Propranolol
Timolol

30
Q

Beta Blockers
action/Cardio selective

A

Possesses greater affinity親和性　 for B1 receptors (heart and kidney) than B2 receptors (lungs, liver, pancreas)

31
Q

Beta Blockers
action/Intrinsic Sympathomimetic

A

Partial beta (B)-receptor agonist

32
Q

Beta Blockers
ADRs

A

Bradycardia
CNS depression
Bronchoconstriction in COPD/asthma
Rebound HTN if abruptly discontinued

33
Q

Alpha Blockers
Name and action

A

ANTHING ENDING IN “zosin”

Selective a1 receptors antagonists in peripheral vascular
Result: vasodilation, dec BP

34
Q

Alpha Blockers
ADRs

A

1st dose effect
Dizziness
Sustained orthostatic hypotension
(elderly)
Lassitude, vivid dreams, depression
Priapism

35
Q

Central Alpha agonists
Name and action

A

Clonidine
Methyldopa

Reduces sympathetic outflow from brain 🡪 once all peripheral NE receptors are bound, drug binds to NE receptor in brain to dec NE release
Result: dec HR, CO, BP

36
Q

Central Alpha agonists
ADRs

A

Na/H2O retention
Depression
Orthostatic hypertension
Anticholinergic effects
Rebound HTN

37
Q

Angioedema?

A

Swelling of face and airways, more likely in black pts and smokers

38
Q

Acute kidney failure?

A

stop/dec dose of ACEi if Scr (serum creatine) rises above baseline by 35% 🡪 kidneys are being hypoperfused

39
Q

Negative inotropic effects?

A

Keeps the heart from beating as strong as it normally would 🡪 lowers contractability of heart and the vasculature

40
Q

B receptors?
Alpha receptors?

A

B1 and B2
when stimulated causes vasoconstriction

41
Q

Rebound HTN?

A

The medication blocks the receptors for norepinephrine, so in response, body produces excess norepinephrine and excess NE receptors 🡪 if med is abruptly discontinued, all of the excess
NE binds to receptors and causes a HUGE inc in HR

42
Q

Norepinephrine?

A

hormone that functions to inc heart rate during fight/flight response

43
Q

1st dose effect?

A

med drastically dec BP immediately causing dizziness/fainting/syncope w/in 1-3 hrs of 1st dose 🡪 take 1st dose before bed 🡪 effects will go away after continuous doses but will return if dose amount is changed or non-adherence occurs

44
Q

Lassitude?

A

physical/mental weariness

45
Q

Priapism?

A

erection lasting for a long time

46
Q

ACVD risk estimator?

A

used to determine risk for atherosclerosis cardiovascular disease (ASCHD)

47
Q

Anticholinergic effects

A

sedation, dry mouth, urinary retention

48
Q

1st line agents
Characteristic

A

Lowers BP, REDUCE CV mortality

CV mortality
death where CVD was reported as the underlying cause of death on the death certificate.

49
Q

2nd line agents
Characteristic

A

Lowers BP the same amount or more than 1st line agents, Not proven to reduce CV mortality

50
Q
A
51
Q

Black patients
HTN occurs a______ & b_______ (greater risk for HTN complications)

Most effective treatment is c______and d_________ (since they don’t target the RAAS system)

Most black pt w/ HTN don’t have a malfunctioning e________🡪 HTN is due to another issue

A

a) younger age
b) higher absolute pressures
c) thiazides
d) calcium channel blockers
e) RAAS system

52
Q

Pregnant women
a) HTN causes?
b) Preferred drugs?
c) Alternatives
d) Contraindicated:

A

a) Chronic or gestational HTN
b) labetalol, long acting nifedipine, methyldopa
c) : other beta blockers & calcium channel blockers
d) ACEi, ARBs, direct renin inhibitors

53
Q

Elderly >65
a) causes HTN
b) which drugs should avoid?

A

a) Isolated systolic HTN
b) central alpha agonists, peripheral alpha blockers

54
Q

Children & Adolescents
HTN more common in a____children
b______ HTN more common

What drug should use?

A

a) obese
b) Secondary
c) 1st line agents and beta blockers

Pharmacology (34 decks)

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