Antihypertensive Flashcards
(111 cards)
1
Q
• Hypertension is the most common
A
CV disease
2
Q
Management of hypertension
Non-pharmacologic management; includes
4 things
A
- -Diet(increase consumption of potassium and calcium with moderate decrease in sodium intake).
- -Exercise.
- -Weight reduction.
- -Stop smoking & alcohol intake
3
Q
Management of hypertension
Pharmacologic:
5 things
A
- Diuretics.
- Sympatholytics.
- Calcium channel blockers (CCBs)
- Inhibitors of angiotensin (ACEI &ARAs/ARBs).
- Direct vasodilators
4
Q
Hypertension cause ———- like ——-4things
A
Target organ damage cerebrovascular accidents congestive heart failure MI renal damage
5
Q
Inc. CO affect ————more
A
Systolic pressure
6
Q
Inc. PR affect ——–more
A
Diastolic pressure
7
Q
• Normal regulation of BP:
BP=—————-
A
COXPR
8
Q
Hypertension : 5-10% is secondary to ————
9 things
A
renal disease pheochromocytoma Cushing hyperaldosteronism or drugs (either VC as phenylephrine in flu medication volume expanders as glucocorticoids NSAlDs and oral contraceptives
9
Q
Essential or primary where no———–
A
where no specific cause can be found.
10
Q
chronic use of Morphine cause ———-
A
Salt and Water retention which cause hypertension
11
Q
- Normal regulation of BP:
* CO= ————-
A
HR X stroke volume
12
Q
• BP is regulated by:———————,
long term control ——————-
A
- Baroreceptors: rapid, responsible for moment to moment control.
- Renin angiotensin aldosterone system (RAAS): kidney is responsible for long term control of BP through this system.
13
Q
Antihypertensive drugs act by —————–
A
interfering with these normal mechanisms.
14
Q
Potassium is considered as ——–
A
Vasorelaxent
15
Q
Smoking cause hypertension due to——
A
Nicotine which is vasoconstrictive
16
Q
————-Act primarily by depleting body sodium stores thus reducing blood volume & CO.Peripheral resistance(PR) may ——————-
A
Diuretics - increase
17
Q
Diuretic:Long term treatment causes CO to return to ———-while PR—–
A
normal - decrease
18
Q
Diuretics: Thiazides are used in ————-to———– hypertension
A
mild to moderate
19
Q
while loop diuretics are used in———— and in patients with———- or those ———–.
A
severe type- renal affection(not renal failure )-not responding to other diuretics
20
Q
In more severe hypertension they are combined with —————–or———- to control tendency towards Na retention caused by these drugs—————
A
vasodilators (VDs) or sympatholytic agents- vasodilator and sympatholytic
21
Q
The least expensive ———-
A
diuretics
22
Q
Sympathoplegic or sympatholytic drugs :Centrally acting sympathoplegic drugs (—————):
A
alpha methyl dopa & clonidine
23
Q
centrally acting Sympathoplegic or sympatholytic have mechanism :2 things
A
- decerese sympathetic outflow from vasopressor centers in the brain stem
- Bind to central alpha2 adrenoceptors(dec. norepinephrine) ( decreasing central sympathetic outflow)
24
Q
1st choice in hypertensive pregnant patients is ————–
A
alpha methyl dopa
25
Side effects of Alpha methyl dopa :9 things
CNS adverse effects: night mares, depression, sedation, extra pyramidal symptoms.
Hemolytic anemia, hepatitis, systemic Lupus Erythematosis (SLE) & positive Coomb's test. Lactation (hyperprolactinemia).
26
drug use in hypertension with renal failure
clonidine
27
ß-adrenoceptor blockers like ------
propanolol
28
• Mechanism of action of beta adreno receptor blocker
| 4 things
- dec HR, contractility and CO primarily.
- dec central sympathetic outflow.
- dec Renin release.
- decPR
29
Advantages of Betadrenoreceptor blocker
* dec morbidity & mortality & protect against heart disease.
* Relatively not expensive.
30
• Indications of using beta-adrenoreceptor blocker
| 5 things
• Hypertension complicated with myocardial infarction, angina, supraventricular dysrhythmia, migraine, essential tremors
31
we dont give diuretic at night, we give it early in the morning, why ?
to make pateint sleep عشان لا يحشر
32
pateint has hypertension and renal failure , what would you get him to have ?
clonidine
33
adverse effects of clonidine ?
| 4 things
* Dry mouth, sedation, depression.
| * Sudden withdrawal *hypenensive crisis (treated by alpha & beta blockers).
34
Sudden withdrawal of Clonidine treated by --------- and -------
alpha and beta blokers
35
ß-adrenoceptor blockers for hypertension act on which receptor -----
beta 1
36
• Adverse effects of beta-adrenoceptor blockers :
| 6 things
1- CNS: depression, fatigue, insomnia.
2-Bradycardia & hypotension.
3-dec libido & impotence in males (dec compliance)
4-Glucose intolerance (mask signs and symptoms of hypoglycemia and delay recovery from hypoglycemia in IDD) & dyslipidemia
5-Brochospasm, cold extremities, heart block (less with ßl selective).
6-Abrupt(sudden) withdrawal —rebound hypertension, nervousness, myocardial infarction may occur(must be withdrawn over 2-3weeks)
37
betadrenorecetpor blocker must be withdrawn over -----to--------weeks
2-3 weeks
38
any thing affect libido means it affect on --------------receptor
alpha and beta receptor
39
Someone has hypertension and prostatic hyperplasia, what drug can he use ?
prazosin & doxazosin
40
• Selective alpha1 blockers as ----------and----------
prazosin & doxazosin
41
--------------------------cause less reflex tachycardia (as they allow norepinephrine to exert feed back inhibition on its own release through unblocked a2) than non-selective a blockers like ---------- that use for hypertension cause by --------
- Selective alpha 1 blockers as prazosin & doxazosin
| - phenoxybenzamine - pheochromocytoma
42
alpha-adrenoceptor blocker act by blocking alpha1 receptors----------- in------------------ and —-------PR
arterioles -venules- decrease
43
adverse effects of alpha-adrenoceptor?
| 3 things
* Postural hypotension occurs with these drugs.
* Also salt & water retention headache and nasal congestion may occur.
* Sexual dysfunction in males may occur
44
alpha-adrenoceptors may be combined with ---------------------or----------------
with diuretic or beta blocker (for tachycardia).
45
alpha-adrenoceptor blocker Indicated in patients with prostatic hypertrophy ( --------------but has a ------antihypertensive activity).
tamsulosin-weak
46
Labetalol and-----------block both al and ß adrenoceptors
carvedilol
47
What is the type of alpha receptor that found in base of bladder and prostatic gland ?
alpha1 a
48
-----------------producing peripheral vasodilatation, thereby reducing blood pressure
a and ß adrenoceptor blockers like
| • Labetalol and carvedilol
49
----------is the drug of choice in athletic hypertensive patients
Labetalol
50
--------------decreases lipid peroxidation and endothelial dysfunction thus having benefits in patients with heart failure.
• Carvedilol
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• They do not alter blood glucose or serum lipids
a and ß adrenoceptor blockers like
| • Labetalol and carvedilol
52
------------- is used treatment of hypertensive emergencies
Labetalol
53
----------an alternative to methyl dopa in pregnant hypertensive patients.
Labetalol
54
• Adverse effects of a and ß adrenoceptor blockers like
• Labetalol and carvedilol ?
2 things
postural hypotension and dizziness.
55
-------------Block al subunit of L-tvpe channel located in conductive tissues (SAN, AVN), cardiac myocytes & vascular smooth muscles including coronaries lead to smooth muscle------ &---------- of arterioles.
CaIcium channel blockers (CCBs)-relaxation-dilatation
56
Dihydropyridines (DHP): ---------- (short acting), ------,------and------ (long acting).
• All have a much greater affinity for vascular calcium channels than for calcium channels in the heart
nifedipine-amlodipine, nicardipine, felodipine
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in marked tachycardia & acute myocardial ischemia in coronary disease (------------)bad side effect of short acting .which drug ?
nifedipine
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CCBs -----heart rate , ------ contractility , vaso------
dec-dec-vasodilation
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Dihydropyridines (DHP): works more on
Vascular smooth muscle
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------------ never use with hypertension because it cause marked tachycardia & acute myocardial ischemia in coronary disease
Nifedipine
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• Amlodipine(2nd generation) Adverse effects
| 5 things
hypotension, headache, flushing, lower limb edema and fewer interactions.
62
Non-DHP include 2 classes------------and------------
verapamil and Diltiazm
63
Verapamil is ---------------depressor act mainly on ---------
myocardium
64
--------------Used in angina, prophylaxis in supraventricular tachycardia and migraine
Verapamil
65
---------with digoxin —it inc. level of digoxin(Toxcitiy) as a result of decreased tissue binding binding and dec. excretion
• Verapamil
66
• Verapamil adverse effects ? 3 things
• Causes constipation(impo), bradycardia & heart block
67
-------------------contraindicated in any one have AV conduction abnormalties
Diltiazm
68
-----------------contraindicated in patient has brnochial asthma and hypertension but can has CCBs ---------------we don't give them verabmil and diltiazem because they are ---------------
Beta blocker- Amlodipine- cardiac depressent
69
we dont give CCBs with ------------because they both myocardial depressent except the 1st grop of CCBs because it act mainly on------------
Beta blocker-blood vessels
70
Diltiazem Affects both -------------and---------
vascular & cardiac tissues
71
• Diltiazem has-------- negative inotropic effect than verapamil
less
72
Side effects of Diltiazem ? 3 things
• Causes CHF, bradycardia & heart block
73
Angiotensin converting enzyme inhibitors (ACEls):
| • e.g. 5 things
Captopril(not a prodrug) ,EnalapriI, perindopril, and fosinopril& Lisinopril
74
•--------------mechanism of action :Vasodilatation due to inhibition of ACE and decreased conversion of angiotensin I to Il, also by increasing vasodilator bradykinin,•Inhibition of aldosterone lead to Na+ loss
ACEIs
75
Adverse effects of ACEIs ?
| 6 things
1-Initial hypotension (start with a small dose at bed time).
2-Acute angioedema & chronic dry cough (t BK).
3-Hyperkalemia (potassium supplement or spironolactone are Cl).
4-Renal impairment (in renal artery stenosis, high renin states as CHF).
5-Metallic taste (captopril), neutropenia in some
cases.
6-Fetotoxic (Cl in pregnancy) (Teratogenic)
76
Patient has hypertension and nephropathy, what drug should he has ?
ACEIs
77
Angiotensin Il receptor blockers (ARBs) :
| • ----------- is the prototype
Losartan
78
block angiotensin Il receptor I (ATI) responsible for most damaging effects of -----------—VD & block secretion.
angiotensinIl-aldosterone
79
ACEIs contraindicated in ----------------
Asthma
80
in ARBs there is -----------------bradykinin production that lead to -------- angeioedema or cough but other adverse effects as ACEIs and contraindicated in ---------------
no -no - pegnancy
81
-------------Relax vascular smooth muscle lead to ------- resistance lead to ----------BP
Vasodilators- dec - dec
82
chronic use of Vasodilators lead to ---------------due to
| ----------------------------------lead to
tolerance-reflex activation of sympathetic and RAAS -reflex tachycardia , salt & water retention
83
Vasodilators must be combined with --------- to dec. Tachycardia and ------ for edema
Beta blocker and Diuretic
84
Vasodilator
| --------------Arteriolar VD, used in moderately sever hypertension.
Hydralazine
85
Vasodilator
| headache, flushing, sweating, angina, Lupus syndrome (high dose) are Adverse effect of --------------
Hydralazine
86
Vasodilator
| •---------Used as monotherapy (1st choice) in sever hypertension with pregnancy
Hydralazine
87
Vasodilator
| ------- Arteriolar VD , used in sever hypertension.Causes hirsutism (used in treat of baldness).
MinoxidiI
88
Vasodilator
| -----------Potent arteriolar and veinular VD lead to dec. preload and after load.
Sodium nitroprosside
89
Vasodilator
------------Immediate effect and very --------action so given by IV infusion ( ------ min)must be freshly prepared & protected from light by foil
Sodium nitroprosside - short -1
90
Vasodilator
----------Causes sever hypotension (overdose) , and cyanide toxicity(treated by ---------- less toxic thiocyanate excreted by the kidney). toxic if given -----------------
dium nitroprosside-Na thiosulfate-orally
91
Vasodilator
| -------------------: causes hyperglycemia
Diazoxide
92
• Hypertensive emergency:
• - If SBP is >---------- mmHg or DBP is -------- combined with a complication as ----------------------------
---- --- but not------- reduction in blood pressure is required.
210-130-encephalopathy, nephropathy, heart failure, retinal hemorrhage-Rapid -vigorous
93
• All drugs must be given------------ , as soon as reasonable blood pressure control is achieved, oral antihypertensive therapy should be substituted, because this allows smoother long-term management of hypertension
parenterally
94
• The goal of treatment in the first few hours or days is not complete--------- of blood pressure because chronic hypertension is associated with ----------- in cerebral blood flow. Thus, rapid normalization of blood pressure may lead to cerebral--------- and brain injury. Rather, blood pressure should be lowered by about----- , maintaining diastolic blood pressure at no less than ------------ Hg. Subsequently, blood pressure can be reduced to normal levels using oral medications over several weeks
normalization- autoregulatory changes-hypoperfusion-25% -100-1 10 mm
95
treatment of Hypertensive emergency ---------------
Sodium nitroprosside
96
treatment of Hypertensive emergency:
a dopamine receptor 1 agonist —increase renal blood flow, especially effective in renal---------- . Contraindicated in --------------
insufficiency-glaucoma
97
treatment of Hypertensive emergency
| Labetalol: a and ß------------ .
blocker
98
treatment of Hypertensive emergency
1-Nicardipine: a---------------- .The major limitation of this drug in hypertensive emergency is its ------------ half life which prevents rapid --------------of the dose
2-Nitroglycerine.
3- Diazoxide and hydralazine.
4-Diuretics to overcome volume expansion which occurs with powerful
CCB-long-titration- VDs
99
pregnant women can use --------------for hypertension
Atenolol
100
pregnant women can use during labor ( Preeclampsia) ------------------
Labetalolo and Hydralazine
101
Patient with DM can use low dose of ---------
and ----------------because that will ---------------and---------------
they can also use --------------------
Thiazides
ACEIs / ARBs
Rilmenidine
102
Diabetic patients sholudnt use full dose of -------------- because that will lead to inc --------------------
Thiazides
| glucose
103
Asthma (COPD) pateints can use ----------------(relax bronchi) and -------------and they should not use ------- special -------- because will cause-------------
CCBs - Thiazides diuretics- BETA Blocker - non selective - Bronchospasm
104
Angina patient should use -----------------(of choice ) and -----
Beta Blockers - CCBs
105
Angina patient shouldnot use --------------in vasoppspastic angina
Beta blocker
106
CHF patient can use ------------------- , --------------------- ,-------------
and should not use ---------------------,--------------
ACEIs or ARBs - Diuretics , Spronolactone
| Verapamil -Diltiazem
107
Chronic kidney disease pateint should use -------------------------- , ---------------- in renal failure and should not use
-----------,-------------in renal hypoperfusion states
ACEIs and/or ARBs
Furosemide
not use : ACEIs and /or ARBs in renal hypoperfusion states
108
preipheral vascular disease pateints can use -------------- and they shouldn't use -----------------
CCBs
| Beta blocker
109
Isolated systolic hypertension can use -----------,------------
Thiazide diuretics
| CCBs
110
Diabeteic or non diabetic pateint has nephropathy and hypertension can use ?
ACEIs
111
```
Most expensive class because it ----incidence of stroke by 25%
after blocking receptor----------it will work on --------------- and cause vaso--------------and has antithrombotic and antiplatelet effect
```
Angiotension 2 type 1 receptor blocker- Dec-1 -2-dilation
