antihypertensive drugs

Question 1

normal BP

Answer 1

1) 120/80

Question 2

hypertension

Answer 2

1) >= 130/80

Question 3

hypertensive crisis

Answer 3

> =180 / >=120

Question 4

primary essential hypertension

Answer 4

1) 90-95% of cases

Question 5

secondary hypertension

Answer 5

1) due to other diseases
2) ex. salt, alcohol, cushings, renal disease, etc

Question 6

transient elevation in BP

Answer 6

1) white coat hypertension, stress, anxiety

Question 7

symptoms and consequences

Answer 7

• Headache, fatigue, confusion, pounding in the chest, neck, or ears
• Heart failure
• Transient Ischemic Attack (TIA) and/or Cerebral Vascular Accident
  (CVA)
• Renal failure (RF)
• Visual impairment and blindness

Question 8

we measure

Answer 8

1) mean arterial BP

Question 9

baroreceptor reflex

Answer 9

1) balance bp with sympathetic and parasympathetic activity

Question 10

diuretics

Answer 10

Increase the excretion of salt and water
- Classified according to site of action:
1) Proximal tubule
o Carbonic anhydrase inhibitor (Acetazolamide): increase
HCO3- excretion, primarily used to treat metabolic
alkalosis, reduce intraocular pressure in glaucoma
o Osmotic diuretics: Mannitol
2) Thick ascending limb of loop of the Henle
3) Distal convoluted tubule

Question 11

proximal tubule

Answer 11

1) acetazolamide
2) mannitol

Question 12

loop diuretics

Answer 12

Thick ascending limb of loop of Henle
* Furosemide (LASIX)
* Inhibit co-transport of Na+/K+/2Cl- into the
tubular cell from the tubular lumen
* Large diuretic effect (up to 25% of filtrate)
* Elimination of water, Na+, K+, Cl- and Ca2+,
Mg2+ may produce electrolyte imbalance.
Possibly useful in treating hyperkalemia,
hypercalcemia
* Used for treatment of (acute) edema of
cardiac, hepatic or renal origin. First choice in
pulmonary edema (left heart failure)
* Side effects: hypokalemic, hyponatremia,
excessive depletion of Ca2+ and Mg2+,
hyperglycemia, hyperlipidemia

Question 13

thiazide

Answer 13

Effect on distal convoluted
tubule
* Hydrochlorothiazide,
chlorthalidone
* Inhibit Na+ and Cl- transport,
retention of H2O in the urine,
increase Ca2+ reabsorption
* Moderately effective, most
commonly prescribed for mild
hypertension
* Clinical use: hypertension,
congestive heart failure
* Side effects: loss of K+
(hypokalemia)

Question 14

K+ sparing diuretics

Answer 14

Effect on Cortical (early)
collecting tubules
* Amiloride, triamterene (direct
inhibitors):inhibit Na+
reabsorption
* Spironolactone (competitor of
aldosterone): inhibit Na+
reabsorption and K+ secretion
* Clinical use: in conjunction
with more potent diuretics to
prevent K+ loss
* Side effect: possible retention
of K+ (hyperkalemia)

Question 15

a1 blocker

Answer 15

a1 adrenergic receptors reside on
peripheral artery smooth muscle,
and their occupancy by
epinephrine or nor-epinephrine
causes contraction of smooth
muscle and increased peripheral
resistance
* a1 adrenergic blockers (Prazosin)
reduce TPR. Some times used in
combination with other agents to
lower blood pressure
1) a1 blocker
Brody’s, Fig. 11-1

Question 16

b blocker

Answer 16

Propranolol: non selective b blocker
* Reduce cardiac stroke volume and heart rate
* Decrease renin release from juxtaglomerular
apparatus in the kidney
* Centrally mediated reduction of sympathetic
drive
* Secondary effects: reduced cardiac output;
bronchial constriction (b2 receptor)
* Advantages:
* Good control of blood pressure when prescribed in
conjunction with a diuretic or alone
* Prevention of strokes and myocardial infarction
* Control of some alterations of cardiac rhythm
* Preferred b1 selective blocker (acebutolol) to
minimize secondary effects on bronchial constriction
* Side effect and clinic problems: abrupt cessation associated with tachycardia,
angina pectoris, and (rarely) myocardial infarction

Question 17

Centrally acting drugs

Answer 17

Centrally acting drugs (Clonidine)
act in the Central Nervous System
by reducing sympathetic nerve
firing frequency.
3) Centrally acting drugs
* This reduction is produced by activation of a2 receptors. Reduced
cardiac contractions account for hypotensive effect.
* Dry mouth is common. Furthermore, rebound hypertension produced
when clonidine is discontinued

Question 18

anti RAAS drugs

Answer 18

1) Renin Inhibitor: Aliskiren
Prevent angiotensinogen
to angiotensin I
2) ACE inhibitors: Lisinopril
Prevent angiotensin I to
angiotensin II
3) Angiotensin Receptor
Blockers (ARBs):
Losartan
4) Aldosterone antagonist:
spironolactone
Inhibit aldosterone
activity