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Flashcards in 101414 HTN pharm Deck (65):
1

what is the JNC 8 recommendation for target BPs for pts over 60?

below 150 systolic and 90 diastolic (thought that higher BP was necessary for elderly to keep blood flow to vital organs)

2

anti hypertensive drugs classification

vasodilators

agents affecting adrenergic fxn

agents affecting renin angiotensin system

diuretics

3

effect of vasodilators

decreases peripheral arterial resistance, decreasing BP

baroreceptor activation can cause compensatory increase in sympathetic outflow. increases HR. reflex release of renin.

4

direct arterial vasodilators ex

hydralazine
minoxidil
diazoxide
nitroprusside
fenoldopam

5

how do you counteract the compensatory reflexes created by direct arterial vasodilators?

give concurrent beta blocker

6

hypertensive crisis is

BP over 180/120 mmHg

you will want to reduce the BP gradually

7

hypertensive urgency

elevated BP
no acute or progressing target-organ injury

8

hypertensive emergency

acute or progressing target organ damage (encephalopathy, intracrnial hemorrhage, acute left ventricular failure with pumonary edema, dissecting aortic aneurysm, unstable angina, eclampsia)

9

how should you approach hypertensive emergency?

treat quickly but not too quickly b/c if lower BP too fast, will get low perfusion to organs

10

MOA of nitric oxide donors

they form NO, which results in formation of cGMP, which activates protein kinase G to affect calcium and promote relaxation

11

what part of the vasculaure do nitric oxide donors work on?

primarily arterial but has venous component

12

ex of nitric oxide donor

nitroprusside

13

what is a side effect of nitroprusside

cyanide toxicity, so don't want to use this for a long time

14

adverse effects of direct arterial vasodilators

sodium/water retention
tachycardia/angina

hydralazine-lupus like syndrome
minoxidil-hair growth

15

how do you prevent some of the side effects of direct arterial vasodilators?

use with diuretic (preferably thiazide) and beta blocker to reduce fluid retention and reflex tachycardia

16

effect of calcium ch blocker

decreases vascular tone to decrease BP

will see small increase in HR

17

ex of calcium channel blockers

nifedipine
diltiazem
verapamil
amlodipine

18

effects of dihydropyridines

baroreceptor mediated reflex tachycardia due to potent vasodilating effects

do NOT alter conduction through AV node

19

effects of non-dihydropyridines

decrease HR and slow AV node conduction

20

side effects of calcium ch blockers

flushing
headaches
negative ionotropic effect (greatest in verapamil)
constipation (greater in verapamil)
decreased AV conduction (greater in verapamil and diltiazem)
edema (greatest in nifedipine)
refractoriness (nifedipine)

21

vasoconstriction of arterioles in skin and viscera is mediated by which adrenergic receptor

alpha 1

22

vasodilation of skeletal muscle and liver arterioles is mediated by which adrenergic receptor

beta 2

23

bronchodilation is mediated by which adrenergic receptor

beta 2

24

increased renin secretion is mediated by which adrenergic receptor

alpha 1, beta 1

25

effect of alpha1/alpha2 combined blockers

decreases vascular tone
alpha 2 blocking- causes decreased venous tone

increases HR

26

effect of alpha1 blockers

decreases peripheral resistance
increases HR

27

ex of alpha 1 blockers

prazosin

28

alpha1 or alpha1/alpha2 blockers are more effective for anti-HTN?

alpha1 because of the lack of inhibition of alpha2 to inhibit NE release

29

what is the effect of alpha1 blockers on HR and renin release?

increase, but smaller increase than for alpha1/alpha2 blocker

don't stimulate renin release

30

what is the first dose effect?

with alpha1 blockers-

the first dose--can get orthostatic hypotension. transient dizziness, palpitations, syncope within 1-3 hrs. reflex tachycardia.

31

how do you minimize the first dose effect?

use alpha1 blocker at bedtime

32

compare alpha1 blocker and mixed alpha1/beta blocker in terms of side effects

prazosin-orthostatic hypotension. headaches/dizziness.

labetalol/carvedilol-are alpha1 and beta1/beta2 blockers. mild orthostatic hypotension and headaches.

33

effect of beta blockers

decrease renin, decreasing peripheral resistance
decrease HR

34

ex of beta1 blockers

metoprolol
atenolol

35

where are beta2 receptors found

lungs
liver
pancreas
arteriolar smooth muscle

stimulation causes bronchodilation and vasodilation
mediate insulin secretion and glycogenolysis

36

why do beta blockers work better in young adults

because CO has a greater contribution to BP in younger adults

37

potential adverse effects of beta blockers

glucose intolerance, masked hypoglycemia
bradycardia, dizziness
bronchospasm
increased TGs and decreased HDL

CNS-depression, fatigue, sleep disturbance
reduced CO, exacerbation of heart failure
impotence
exercise intolerance

38

central alpha2 agonists' effect

work on CNS to decrease sympathetic nervous sys
increases vagal tone

decreases vascular tone
decreases renin
DECREASES HR

39

ex of central alpha2 agonists

clonidine
guanabenz
alpha-methyldopa

40

adverse effects of central alpha2 agonists

sodium/water retention
abrupt discontinuation may cause rebound HTN
depression
orthostatic hypotension
dizziness

41

effects of neuronal and ganglionic blocking agents

decreases sympathetic nerv sys activity-decrease renin, decreases HR

42

ex of neuronal and ganglionic blockers

guanethidine
guanadrel
reserpine
trimethaphan

43

side effects of reserpine and guanethidine

sedation (reserpine)
depression (reserpine)
decreased CO
sodium and water retention
increased gastric acid secretion (reserpine)
diarrhea
bradycardia

use with diuretic (preferably thiazinde) to avoid fluid retention

44

effect of diuretics

decrease vascular volume, decreasing venous retruen and CO

cause compensatory increase in peripheral vascular resistance

45

side effects of diuretics

electrolyte disturbances
hyperglycemia
hypotension, orthostasis
lipid abnormalities
photosensitiity
ototoxicity
hyperuricemia, gout

46

aldosterone antagonists MOA

inhibit renal action of aldosterone (Na and water retention)

inhibit extrarenal action of aldosterone (fibrosis, inflammation)

47

ACE inhibitors, AT1 blockers, renin inhibitors effects

decrease vascular tone
decrease aldosterone to decrease venous return

48

what should yoo monitor with ACE inhibitors?

serum K and creatinine within 4 wks of initation or dose increase

49

adverse effects of ACE inhibitors

cough
angioedema
hyperkalemia
acute renal failure

50

AT1 receptor effects

vasoconstriction
vascular proliferation
aldosterone secretion
cardiac myocyte proliferation
increased sympath tone

51

AT2 receptor effects

vasodilation
antoproliferation
apoptosis

52

when do you see the maximal effect with losartan?

after 6 wks
note-renin angitensin system agents take time to see effects!

53

what are side effects for all renin angiotensin system inhibitors?

orthostatic hypotension
hyperkalemia

54

precautions for ACE inhibitors/ARB

can cause acute kidney failure in certain pts (bilateral renal artery stenosis)

pregnancy

55

what is a benefit of combo therapy?

diuretic decreases Na and will increase renin. so if you give an ARB, can counteract

can reduce BP further than with solo agents

56

what are some mixed vasodilators

nitroprusside
ACE inhibitors and ARBs
alpha adrenergic blockers
alpha2 central agonists
nesiritide ( no longer recommmended)

57

graded recommendations are used in JNC8 or 7?

8

58

race, CKD, and diabetic subgroups are addressed in JNC 8or 7?

8

59

what is recommended for the general population for treating HTN in JNC8

thiazide, CCB, ACEi, ARB

60

recommendation for black population in JNC8 in treating HTN?

CCB or thiazide

61

if goal of BP isn't met after 1 month of treatment, according to JNC8, what should you do

increase dose of initial drug or
add second drug

62

what do African Am have increased risk of as side effect?

angioedema

63

what should be avoided in pregnancy?

ACEi and ARBs

64

in combo therapy, what should one of the agents be?

thiazide unless contraindicated

a diuretic (preferably thiazide)

65

in a hypertensive emergency, what is given?

sodium nitroprusside (adverse effect is cyanide toxicity)
fenoldopam

esmolol, labetalol