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Pharmacology > Chp 22 Antihypertensive Drugs > Flashcards

Chp 22 Antihypertensive Drugs Flashcards

1
Q

Hypertension

A

A common, often asymptomatic disorder in which systolic blood pressure persistently exceeds 150 mm Hg and/or diastolic pressure exceeds 90 mm HG in patients over 60 years of age and 140/90 for patients younger than 60 and those who have chronic kidney disease or diabetes. (High blood pressure)

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2
Q

Blood Pressure =

A

CO x SVR

Cardiac output x systemic vascular resistance

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3
Q

What are the four stages based on BP measurements according to the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure?

A
  1. Normal
  2. Prehypertension
  3. Stage 1 hypertension
  4. Stage 2 hypertension
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4
Q

Essential hypertension

A

elevated systemic arterial pressure for which no cause can be found; also called primary or idiopathic hypertension. (90% of all cases)

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5
Q

Secondary hypertension

A

high blood pressure caused by another disease such as renal, pulmonary, endocrine, or vascular disease. (10% of all cases)

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6
Q

About how many people in the United States have hypertension?

A

approx 70 million

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7
Q

What does the parasympathetic nervous system stimulate?

A

smooth muscle, cardiac muscle, glands

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8
Q

What does the sympathetic nervous system stimulate?

A

heart, blood vessels, skeletal muscle

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9
Q

What are the two divisions of the autonomic nervous system?

A

parasympathetic

sympathetic

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10
Q

What are the 7 categories of antihypertenisve drugs? (AAACDVD)

A
  1. Adrenergic Drugs
  2. Angiotensin-Converting Enzyme Inhibitor
  3. Angiotensin II Receptor Blockers
  4. Calcium Channel Blockers
  5. Diuretics
  6. Vasodilators
  7. Direct Renin Inhibitors
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11
Q

What are the 5 subcategories of adrenergic antihypertensive drugs?

A
  1. Centrally and peripherally acting adrenergic neuron blockers
  2. Centrally acting alpha2 receptor agonists
  3. Peripherally acting alpha1 receptor blockers
  4. Peripherally acting beta receptor blockers (beta blockers) - Cardioselective, Nonselective
  5. Peripherally acting dual alpha1 and beta receptor blockers
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12
Q

What do the centrally acting alpha2 receptor agonists do?

A
  • Stimulate alpha2-adrenergic receptors in the brain
  • Decrease sympathetic outflow from the CNS
  • Decrease norepinephrine production
  • Stimulate alpha2-adrenergic receptors, thus reducing renin activity in the kidneys
  • Results in decreased blood pressure
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13
Q

What are two centrally acting adrenergic drugs?

A

clonidine and methyldopa which can be used for hypertension in pregnancy

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14
Q

What do peripheral alpha1 blockers/antagonists do?

A

block alpha1-adrenergic receptors

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15
Q

What are three alpha1 blockers?

A

doxazosin (Cardura)
terazosin (Hytrin)
prazosin (Minipress)

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16
Q

What do beta blockers do?

A
  • Reduce BP by reducing heart rate through beta1 blockade
  • Cause reduced secretion of renin
  • Long-term use causes reduced peripheral vascular resistance
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17
Q

What are some examples of beta blockers?

A

nebivolol (Bystolic)
propranolol (Inderal)
atenolol (Tenormin)

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18
Q

What do dual-action alpha1 and beta receptor blockers do?

A
  • Reduce heart rate (beta1 receptor blockade)
  • Cause vasodilation (alph1 receptor blockade)
  • Result in decreased blood pressure
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19
Q

What are some examples of dual-action alpha1 and beta receptor blockers?

A

carvedilol (Coreg)

labetalol

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20
Q

What is the centrally acting alpha2 receptor agonist Clonidine ueful in?

A

the management of withdrawal symptoms in opioid-dependent persons

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21
Q

Why are centrally acting alpha2 receptor agonists usually used only after other drugs have failed?

A

because of adverse effects

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22
Q

What are peripherally acting alpha1 receptor agonists used to treat other than hypertension?

A
  • Tamsulosin (Flomax) is used to relieve symptoms of BPH (Benign Prostatic Hyperplasia: Age-associated prostate gland enlargement that can cause urination difficulty.)
  • Management of severe heart failure when used with cardiac glycosides and diuretics
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23
Q

What are the adverse effects of adrenergic antihypertensive drugs?

A 
High incidence of orthostatic hypotension
Bradycardia with reflex tachycardia
Dry mouth
Drowsiness, sedation
Constipation
Depression
Edema
Sexual dysfunction
Headaches
Sleep disturbances
Nausea
Rash
Cardiac disturbances
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24
Q

Hypotension

A

abnormally low BP

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25
Q

Which category of antihypertensive drugs are often used as first-line drugs for heart failure and hypertension?

A

Angiotensin-Converting Enzyme (ACE) Inhibitors

26
Q

What may ACE Inhibitors be combined with?

A

a thiazide diuretic or calcium channel blocker

27
Q

What are some examples of ACE Inhibitors?

A 
captopril (Capoten)
benazepril (Lotensin)
enalapril (Vasotec)
fosinopril (Monopril)
lisinopril (Prinivil)
moexipril (Univasc)
quinapril (Accupril)
28
Q

How do ACE Inhibitors work?

A
  • they inhibit angiotensin-converting enzyme, which is responsible for converting angiotensin I (through the action of renin) to angiotensin II
  • prevents the breakdown of the vasodilating substance bradykinin
  • results in decreased systemic vascular resistance (afterload), vasodilation, and therefore decreased blood pressure.
29
Q

What is angiotensin II?

A

it’s a potent vasoconstrictor and causes aldosterone secretion from the adrenal glands.

30
Q

What are ACE Inhibitors used for in addition to hypertension?

A
  • Heart failure (either alone or in combination with diuretics or other drugs)
  • Slow progression of left ventricular hypertrophy after myocarial infarction (heart attack)
  • Renal protective effects in patients with diabetes
  • Drug of choice in hypertensive patients with HF and for diabetic patients
31
Q

Why would captopril most likely be ordered to treat a patient for hypertension who also has a history of pancreatitis and cirrhosis?

A

Captopril is not a prodrug; therefore it does not need to be metabolized by the liver to be effective. This is an advantage in patients with liver disease.

32
Q

Prodrugs

A

inactive in their administered form and must be metabolized in the liver to an active form so as to be effective

33
Q

What are the adverse effects of ACE Inhibitors?

A
  • Fatigue
  • Dizziness
  • Headache
  • Mood changes
  • Impaired taste
  • Possible hyperkalemia
  • Dry, nonproductive cough, which reverses when therapy is stopped
  • Angioedema (rare but potentially fatal)
  • First dose hypotensive effect may occur
34
Q

What is primarily affected by Angiotensin II Receptor Blockers (ARBs)?

A

vascular smooth muscle and the adrenal gland

35
Q

What functions do ARBs block by blocking the binding of AII to the type 1 AII receptors?

A

vasoconstriction and the secretion of aldosterone

36
Q

What adverse effect do ACE Inhibitors cause that ARBs do not?

A

dry cough

37
Q

What are some examples of Angiotensin II Receptor Blockers (ARBs)?

A 
losartan (Cozaar)
eprosartan (Teveten)
valsartan (Diovan)
irbesartan (Avapro)
candesartan (Atacand)
olmesartan (Benicar)
telmisartan (Micardis)
azilsartan (Edarbi)
38
Q

How do Angiotensin II Receptor Blockers (ARBs) work?

A

They allow angiotensin I to be converted to angiotensin II but block the receptors that receive angiotensin II.

39
Q

What are ARBs used to treat?

A
  • Hypertension

- Adjunctive drugs for the treatment of heart failure

40
Q

What are the adverse effects of Angiotensin II Receptor Blockers (ARBs)?

A
  • Upper respiratory infections
  • Headache
  • may cause occasional dizziness, inability to sleep, diarrhea, syspnea, heartburn, nasal congestion, back pain, fatigue
  • Hyperkalemia much less likely to occur
41
Q

What is an overdose of angiotensin II receptor blockers manifested by?

A

hyptoension and tachycardia

42
Q

What is the primary use for calcium channel blockers? What else do they treat?

A

Primary: treatment of hypertension and angina

Also used for dysrhythmias, migraine headaches, Raynaud’s disease.

43
Q

How do calcium channel blockers work?

A

they cause smooth muscle relaxation by blocking the binding of calcium to its receptors which prevents contraction.

44
Q

What does the use of calcium channel blockers result in?

A
  • Decreased peripheral smooth muscle tone
  • Decreased systemic vascular resistance
  • Decreased blood pressure
45
Q

What is the primary therapeutic effect of diuretics?

A

decreasing the plasma and extracellular fluid volumes.

46
Q

What is the result of the use of diuretics?

A
  • Decreased preload (the initial stretching of the cardiac myocytes prior to contraction)
  • Decreased cardiac output
  • Decreased total peripheral resistance
  • Overall decreased workload of the heart and decreased blood pressure
47
Q

What are the most commonly used diuretics for hypertension?

A

Thiazide diuretics

48
Q

What are diuretics listed as in the JNC-8 guidelines?

A

first-line antihypertensives

49
Q

What do vasodilators act directly on?

A

arteriolar and/or venous smooth muscle to cause relaxation

50
Q

What are some common vasodilators?

A

diazoxide (Hyperstat)
hydralazine HCI (Apresoline)
minoxidil (Loniten)
sodium nitroprusside (Nipride, Nitropress)

51
Q

What does the use of vasodilators result in?

A
  • Decreased systemic vascular response
  • Decrased afterload (the initial stretching of the cardiac myocytes prior to contraction)
  • Peripheral vasodilation
52
Q

What are vasodilators used to treat?

A

Hyptertension (may be used in combination with other drugs)

53
Q

Which two vasodilators are reserved for the management of hypterensive emergencies?

A

sodium nitroprusside and intravenous diazoxide

54
Q

What should be monitored during the use of antihypertensive drugs?

A

BP

55
Q

What can happen if a patient abruptly stops using antihypertensive drugs?

A

rebound hypertensive crisis and possibly stroke

56
Q

Why should oral forms of antihypertensive drugs be taken with food?

A

so that absorption is more gradual and effective

57
Q

What else should patients who are taking antihypertensive drugs be sure to watch?

A
  • diet, stress level, weight, and alcohol intake

- avoid smoking and high sodium foods

58
Q

Why should patients taking antihypertensive drugs change positions slowly?

A

to avoid syncope (temporary loss of consciousness caused by a fall in blood pressure) from postural hypotension

59
Q

What adverse effects should patients taking antihypertensive drugs report?

A
  • unusual shortness of breath
  • difficulty breathing
  • swelling of the feet, ankles, face, or around the eyes
  • weight gain or loss
  • chest pain
  • palpitations
  • excessive fatigue
60
Q

What adverse reaction could affect male patients taking antihypertensive drugs?

A

impotence

Pharmacology (12 decks)

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