Anti-Hypertensives Flashcards
(38 cards)
What blood pressure figure is considered hypertension?
What blood pressure figure is considered hypertension stage 1?
What blood pressure figure is considered hypertension stage 2?
140/90
140-159/90-99
160/100 or more
the actual increase in arterial blood pressure in hypertension is caused by what? what equation should come to mind?
an increase in peripheral vascular resistance (PVR) or an increase in cardiac output
BP = CO x PVR
what determines the peripheral vascular resistance?
what determines the cardiac output?
the vascular tone
heart rate and stroke volume
- what is an effective and inexpensive way of reducing venous pressure and CO?
- what do diuretics do?
- Reducing blood volume not only reduces central venous pressure, also reduces what?
- CO is reduced as what other thing is reduced?
- by using drugs that reduce blood volume
- act on the kidney to enhance sodium and water excretion
- cardiac output
- preload
What group of diuretics are preferred for Hypertension?
For thiazides, maximum antihypertensive action is at what dose?
what is an added benefit of these drugs?
What will Toxicity of Thiazides cause?
thiazides
lower dose than the diuretic dose
they reduce systemic vascular resistance with long-term use.
- hypokalemia
- ↓ glucose tolerance and may unmask latent diabetes mellitus
- ↑ plasma LDL, cholesterol, and triglycerides
- ↑ increased levels of plasma uric acid and precipitate acute gout
Why can beta adrenergic blockers be considered antihypertensives?
- Decrease CO (block cardiac beta 1 receptors)
- inhibit renin release (block beta 1 receptors in JG cells)
what is the Hemodynamic effects of beta blockers in hypertension?
- Heart rate: decreased
- Cardiac output: decreased
- Venous tone: unchanged
- Peripheral vascular resistance: decreased
- Postural hypotension: negligible
in severe hypertension, how well do beta blockers work?
What is an example of a nonselective compound beta blocker? What are its principal symptoms of toxicity?
what happens when propranolol is discontinued abruptly after prolonged regular use?
are useful in preventing the reflex tachycardia that often results from treatment with direct vasodilators
propranolol
toxicity: bradycardia, asthma, peripheral vascular insufficiency, diabetes
result in reflex tachycardia
what is an example of a beta blocker that is cardio-selective beta 1?
what is different of these when compared with propranolol?
atenolol and metropolol
they cause less bronchoconstriction
Calcium Channel Blockers (CCBs)act on what receptor?
What Calcium channel blocker drugs are effective in lowering blood pressure?
L type Ca++ Channels
Dihydropyridines, Verapamil, diltiazem
Dihydropyridines drugs for lowering blood pressure through calcium channel blocker, are more effective at what?
what may they lead to?
What calcium channel blocker has the most depressant effect?
are more selective as vasodilators
may lead to reflex tachycardia
Verapamil
What are the Inhibitors of Renin Angiotensin Aldosterone system (RAAS)?
- ACE Inhibitors (ACEI)
- Angiotensin Receptor blockers (ARBs)
- Renin antagonist
- Aldosterone receptor inhibitor
what are the ACE Inhibitor drugs?
Captopril
Enalapril
Ramipril
Benazepril
Fosinopril
Lisinopril
Quinapril
What are the Angiotensin Receptor blockers (ARBs) drugs?
Losartan
Valsartan
Candesartan
eprosartan
irbesartan
telmisartan
olmesartan
what is an example drug of renin antagonist?
Aliskiren
what is an example drug of Aldosterone receptor inhibitor?
spironolactone
elprenone
What is the effect of Angiotensin 2 in the myocardium and kidney?
there is remodeling:
- Increased wall-to-lumen ratio in blood vessels
- Concentric & eccentric hypertrophy
- Fibrosis
- Stenosis of intimal surface of blood vessel
- Due to increased migration and hyperplasia of vascular smooth muscle cells, myocytes, and fibroblasts.
What do ACE inhibitors do?
ACE inhibitors are mainly used for what? (drug of choice) Why?
- inhibit the ACE converting enzyme
- lower BP through vasoconstriction
- diabetic neuropathy: they diminish proteinuria and stabilize renal function
(they improve intrarenal hemodynamics, with decreased glomerular efferent arteriolar resistance and a resulting reduction of intraglomerular capillary pressure. )
What are the adverse effects of ACE inhibitors?
- Severe hypotension: in patients who are hypovolemic
- Dry cough: due to ↑ levels of bradykinin
- Acute renal failure: in patients with bilateral renal artery stenosis
- Angioedema
- Pregnancy category D: cause severe renal pathology in fetus
- Drug interactions: Hyperkalemia- if K+ sparing diuretics and ACE inhibitors used at the same time
What do Angiotensin receptor blockers do?
what effect do they have on bradykinin metabolism?
Who has more affinity, ACE inhibitors or Angiotensin receptor blockers?
To what patients are angiotensin receptor blockers more benefitial?
- block the angiotensin II type 1 (AT1) receptor
- none
- Angiotensin receptor blockers
- patients with heart failure and chronic kidney disease.
What are the adverse effects angiotensin receptor blocker may cause?
- Noticeably lower incidence of cough
- Hyperkalemia
- Renal effects
- Pregnancy category D
what are the 2 types of alpha adrenergic blockers?
- α1-selective drugs
- Nonselective α-blockers
What drugs are alpha-1 selective?
What drugs are non-selective alpha blockers?
- Prazosin, terazosin, doxazosin
- phentolamine, phenoxybenzamine
where do we find alpha 1 receptors?
what side effects can be seen in selective alpha 1 drugs?
In what patients are alpha 1 receptors used mainly?
venules and arterioles
postural hypotension
in men with concurrent HTN and benign prostatic hyperplasia (BPH)
