27: Antihypertensives Flashcards Preview

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Flashcards in 27: Antihypertensives Deck (69):
1

hypertension is defined as either:

-sustained systolic BP > 140
-sustained diastolic BP > 90

2

why is it dangerous that patients with chronic hypertension are often asymptomatic?

because chronic elevated blood pressure can lead to heart disease and stroke

3

hypertension is also an important risk factor in what 2 disease developments?

-chronic kidney disease (CKD)
-heart failure (CH or CHF)

4

what specific heart complication is closely associated with HTN

left ventricular hypertrophy (LVH)

5

what is left ventricular hypertrophy (LVH)

enlargement and thickening (hypertrophy) of the walls of the heart's main pumping chamber (left ventricle) which causes the left ventricle to work harder

6

why is left ventricular hypertrophy (LVH) bad?

the enlarged heart muscle loses elasticity and eventually may fail to pump with as much force as needed

7

ocular complications of HTN

retinopathy including retinal hemorrhages, exudates, or papilledema

8

some key risk factors associated with HTN

-obesity and weight gain
-diabetes and dyslipidemia
-high-sodium diet
-excessive alcohol consumption
-physical inactivity

9

define hypertensive emergency

severe hypertension with evidence of acute end-organ damage

10

define hypertensive urgency

severe hypertension in asymptomatic patients

11

define white coat hypertension

BP that is consistently elevated by office readings, but does not meet diagnostic criteria for hypertension based upon out-of-office readings

12

6 main categories of antihypertensives

-angiotensin II receptor blockers
-ace inhibitors
-diuretics
-B-blockers
-calcium-channel blockers
-A-blockers

13

arterial blood pressure is directly proportional to:

cardiac output and peripheral vascular resistance

14

how do most hypertensive drugs lower blood pressure?

by reducing cardiac output and/or decreasing peripheral resistance

15

inotropes affect the:

force of contractility

16

chronotropes affect the:

heart rate

17

dromotropes affect

conduction velocity

18

baroreflexes act by:

changing the activity of the sympathetic nervous systems

19

what are responsible for rapid regulation of blood pressure

baroreflexes

20

how do baroreflexes act to a fall in BP?

pressure-sensitive neurons (baroreceptors) send fewer impulses to cardiovascular centers in the spinal cord and this signals for a reflex response of increased symp. and decreases parasymp. output to heart/vasculature, resulting in vasoconstriction and increased cardiac output

21

how does the kidney control BP

provides long term control of BP by altering the blood volume

22

baroreceptors in the kidney respond to arterial pressure by releasing:

the enzyme renin

23

what other 2 things can increase renin release?

-low sodium intake
-greater sodium loss

24

what converts angiotensin I to II

angiotensin-converting enzyme (ACE)

25

angiotensin II is a potent ____ ____

circulating vasoconstrictor

26

how does angiotensin II change BP

increases BP by constricting both arterioles and veins and stimulating aldosterone secretion

27

(review) 5 main classes of diuretics

-thiazide
-loop
-potassium-sparing
-carbonic anhydrase
-osmotic

28

angiotensin converting enzyme inhibitors (ACEIs) end in ___

pril

29

ACEIs are recommended 1st line therapy for what conditions?

-hypertension
-heart failure and/or myocardial infarction
-history of diabetes
-chronic kidney disease

30

mechanism of action for ACEIs

-inhibits ACE
-prevents conversion of angiotensin I to II
-increase in plasma renin/ reduction in aldosterone secretion
-also increases bradykinin levels -> enhanced vasodilation

31

common side effects of ACEIs

-dry cough (due to increase bradykinin levels)
-rash
-hyperkalemia
-fever, altered taste, hypotension

32

pregnancy risk factor of ACEIs

D

33

BBW for ACEIs

fetal toxicity
(discontinue asap once pregnancy detected)

34

ophthalmic side effects of ACEIs

-blurred vision (rare, lisinopril >= 1%, capopril (>), enalapril (<1%) ), diplopia, vision loss

35

how can ACEIs and ARBs help with history of diabetes

slow the progression of diabetic nephropathy and decrease albuminuria

36

indictions for ARBs

-similar to ACEIs but less broad

37

mechanism of action for ARBs

-direct antagonism of angiotensin II receptors (AT2)
-more efficient blockade of the cardiovascular effects of angiotensin II and fewer side effects than ACEIs

38

cautions for ARBs

should not be combined with an ACEI for the tx of HTN due to similar mechanisms and adverse effects

39

pregnancy risk factor/ BBW for ARBs

D
BBW: fetal toxicity

40

ophthalmic side effects of ARBs

rare blurred vision (Valsartan >1%, Irbesrtan <1%) and conjunctivitis

41

mechanism of action for B-blockers

-competitively blocks response to beta adrenergic stimulation
-decreases in heart rate, myocardial contractility, BP, and myocardial oxygen demand
-may also decrease sympathetic outflow to CNS and inhibit release of renin

42

primary mechanism for B-blockers is

decreasing cardiac output

43

difference between prototype B-blocker (propranolol) and cardio-selective B-blockers

prototype is non-selective (blocks B1 and B2)
cardio-selective blocks B1

44

cautions with B-blockers

exacerbate bronchospasm in asthma or COPD patients

45

3 examples of non-cardioselective B-blockers

-propranolol (Inderal)
-timolol
-nadolol (Corgard)

46

3 examples of cardio-selective B-blockers

-metoprolol (Lopressor)
-atenolol (Tenormin)
-bisoprolol (Zebeta)

47

Carvedilol (Coreg) is indicated for both:

hypertension and heart failure
(has some alpha blocking activity, so acts on B1, B2, and Alpha sites)

48

how can B-blockers be used ophthalmically?

treatment of elevated IOP in chronic open angle glaucoma by reducing aqueous production

49

ophthalmic non-cardioselective B-blockers

-timolol (Timoptic)
-levobunolol (Betagan)
-Metipranolol
-Carteolol

50

ophthalmic cardioselective B-blocker

-Betaxolol (Betoptic-S)

51

some ophthalmic side effects of B-blockers

visual disturbances, blurred vision, dry eyes, xerophthalmia

52

3 classes of calcium channel blockers (CCBs)

1. amlodipine and nifedipine
2. diltiazem
3. verapamil

53

indications for CCBs

-HTN
-angina
-in general black population without chronic kidney disease instead of an ACEI or ARB

54

mechanism of action for CCBs

-inhibits calcium from entering the "slow channels"
-produces relaxation of coronary vascular smooth muscle and coronary vasodilation

55

3 classes of CCBS

1. diphenylalkylamines (Verapamil-Calan)
2. Benzothiazepenes (Diltiazem- Cardizem)
3. Dihydropyridines (Nifedipine- Procardia/ Adalat or Amlodipine- Norvasc)

56

ophthalmic side effects of CCBs

-visual disturbances, blurred vision

57

alpha blockers for HTN end in

azosin

58

alpha blockers for BPH end in

osin except for Prazosin

59

a-blocker indications

-HTN only (Prazosin-minipress)
-HTN and BPH (Terazosin- Hytrin, Doxazosin-Cardura)
not first line tx for HTN

60

mechanism of action for a-blockers for HTN

competitively blocks alpha1 adrenergic receptors, leads to vasodilation of veins/arterioles and decrease in total peripheral resistance and BP

61

mechanism of action for a-blockers for BPH

competitively blocks alpha1 adrenergic receptors in prostatic stromal and bladder neck tissue which relaxes the smooth muscle of the bladder neck and reduces bladder outlet obstruction

62

a-blockers for BPH

-tamsulosin (Flomax)
-alfuzosin (Uroxatral)
-Silodosin (Rapaflo)

-Terazosin (Hytrin)- also for HTN
-Doxazosin (Cardura)- also for HTN

63

ophthalmic adverse effects of a1-adrenergic antagonists

-intraoperative floppy iris syndrome (IFIS) in cataract and glaucoma surgery patients

64

example of an "other" antihypertensive:
Clonidine (Catapres or Duraclon)

centrally acting adrenergic agonist (a2)
-not front line agent

65

mechanism of action for Clonidine (Catapres or Duraclon)

stimulates a2 receptors in brain stem resulting in reduced sympathetic outflow from CNS, producing decreased vascular resistance

66

ophthalmic side effects of Clonidine (Catapres or Duraclon)

-accommodation disturbance, blurred vision, burning sensation in eyes, lacrimination changes, dry eye

67

example of an "other" antihypertensive:
Hydralazine-Apresoline

vasodilator

68

mechanism of action for Hydralazine-Apresoline

direct vasodilation of arterioles, with little effect on veins, resulting in decreased systemic resistance

69

ophthalmic side effect of Hydralazine-Apresoline

conjunctivitis, lacrimination