Week 5 HTN Flashcards by Yuko Porter

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

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Modifiable causes leading to CVD death:

(#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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Associated Co-morbidities w/ HTN:

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

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If not properly treated, HTN will lead to?

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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HTN range
a) stage 1
b) stage 2

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

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Lifestyle Modifications
Weight reduction (#1 modification)

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Lifestyle Modifications
Alcohol Intake

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Lifestyle Modifications
Physical Activity

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Lifestyle Modifications
Limited Dietary Sodium

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What are the first line agents?

Thiazide diuretics
ACE inhibiter
ARBs
Calcium Channel Blockers

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Thiazide
drugs name
Action/ Short term and long term

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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Thiazide ADRs?

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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Thiazide
Contraindication?

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

Anuria/failure of the kidneys to produce urine

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ACE i
Name and action?

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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ACE i ADRs?

Hyperkalemia
Acute kidney failure
Angioedema
Persistent/dry cough
Orthostatic hypotension

(Angioedema Cough, Elevated potassium)

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ACE i
Specific Advantages contraindication

Heart failure
Chronic kidney disease
Ang I 🡪 blocking Ang II

Pregnancy

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ARBs Angiotensin 2 receptor blocker
Name and action?

ANYTHING ENDING IN “sartan”

Angiotensin II receptor antagonist
NO effects on bradykinin levels

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ARBs
ADRs?

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

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Calcium Chanel blocker
dihydropyridines
Name?

Dihydropyridines Ending in “dipin”
only works artery

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Calcium Chanel blocker
Non-dihydropyridines
Name?

Diltiazem
Verapamil
work on artery and heart

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Calcium Chanel blocker
ADRs/dihydropyridine?

Neg Inotropic effects
Dizziness
Flushing
Headache
Peripheral edema
Reflex tachycardia

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Calcium Chanel blocker
ADRs/Non-dihydropyridine?

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

Calcium Chanel blocker
action?

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

What are the 2nd line?

Direct renin inhibitors
Beta Blockers
Alpha Blockers

Direct renin inhibitors name and action?

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

Direct renin inhibitors ADRs

Pregnancy warning Orthostasis Angioedema

Beta Blockers Drug name/Cardio selective

Ending in ”olol” Nebivolol Betaxolol Metoprolol Atenolol Bisoprolol

Beta Blockers drug name Intrinsic Sympathomimetic

Acebutolol Penbutolol Pindolo

Beta Blockers drug name/Non-selective

Carvedilol Labetalol Nadolol Propranolol Timolol

Beta Blockers action/Cardio selective

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

Beta Blockers action/Intrinsic Sympathomimetic

Partial beta (B)-receptor agonist

Beta Blockers ADRs

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

Alpha Blockers Name and action

ANTHING ENDING IN “zosin” Selective a1 receptors antagonists in peripheral vascular Result: vasodilation, dec BP

Alpha Blockers ADRs

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

Central Alpha agonists Name and action

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

Central Alpha agonists ADRs

Na/H2O retention Depression Orthostatic hypertension Anticholinergic effects Rebound HTN

Angioedema?

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

Acute kidney failure?

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

Negative inotropic effects?

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

B receptors? Alpha receptors?

B1 and B2 when stimulated causes vasoconstriction

Rebound HTN?

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

Norepinephrine?

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

1st dose effect?

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

Lassitude?

physical/mental weariness

Priapism?

erection lasting for a long time

ACVD risk estimator?

used to determine risk for atherosclerosis cardiovascular disease (ASCHD)

Anticholinergic effects

sedation, dry mouth, urinary retention

1st line agents Characteristic

Lowers BP, REDUCE CV mortality CV mortality death where CVD was reported as the underlying cause of death on the death certificate.

2nd line agents Characteristic

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

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

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

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

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

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

Children & Adolescents HTN more common in a____children b______ HTN more common What drug should use?

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