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DMD 5247 > Antihypertensive Drugs > Flashcards

Antihypertensive Drugs Flashcards

1
Q

Preload

A

tension exerted by blood on the chamber wall before systole
determined by the volume of blood in the chamber at the end of diastole
end of diastolic volume (EDV)

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2
Q

Afterload

A

tension developed in the chamber to pump blood out

Left ventricle afterload is determined by peripheral resistance/Blood Pressure

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3
Q

End of Systolic Volume

A

volume of blood remaining in the ventricle after systole

indicator of cardiac emptying and left ventricle function

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4
Q

End diastolic volume

A

volumtole
determines the preload
larger EDV = higher contractility during systole
dependent on venous return

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5
Q

Stroke volume

A

EDV-ESV

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6
Q

ventricular ejection fraction

A

Fraction of blood ejected from the ventricle after systole

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7
Q

4 stages of hypertension

A

Normal
Prehypertension
Stage 1 Hypertension
Stage 2 Hypertension

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8
Q

Compelling Indications of hypertension

A 
POST MY
high cardiovascular risk
heart failure
diabetes mellitus
chronic kidney disease
previous stroke
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9
Q

Classification of BP

A

-Hypertension can be defined by its cause
essential, idiopathic, or primary hypertension is unknown
secondary hypertension is a known cause

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10
Q

Primary(Essential) Hypertension causes

A 
most prevalent type
more prevalent in african americans
less prevalent in mexican americans
heredity 
high salt intake
tobacco
diet
age
males
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11
Q

secondary hypertension causes

A 
less prevalent
secondary
kidney disease
renal artery disease
aldosteronism
phenochromocytoma
thyroid disorders
obesity
drugs
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12
Q

drugs that may cause hypertension

A 
NSAIDs
Corticosteroids
Licorice
Sympathomimetics
Oral contraceptives
Excess alcohol
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13
Q

thiazide-type diuretics

A

should be the initial drug therapy for most patients with hypertension(alone or with other drug classes)

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14
Q

antihypertensive drugs

A 
adrenergic drugs
angiotensin converting enzyme inhibitors (ACE)
Angiotensin 2 receptor blockers
calcium channel blockers
diuretics
vasodilators
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15
Q

centrally and peripherally acting neuron blockers

A
  • reserpine is the only drug in this class
  • rarely used, but still available
  • peripherally it depletes epinephrine from postganglionic sympathetic nerve terminals
  • reduces sympathetic stimulation of the heart and blood vessels
  • this results in a drop in cardiac output and blood pressure
  • centrally reserpine depletes serotonin and catecholamines from neurons in the central nervous system, causing deep emotional depression
  • absolutely contraindicated in patients with a history of depression
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16
Q

centrally acting alpha2 receptor agonists

A

stimulate alpha2 adrenergic reseptors 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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17
Q

centrally acting alpha2 receptor agonists drugs

A

clonidine

methyldopa: can be used for hypertension in pregnancy

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18
Q

indications for using centrally acting alpha receptor agonists

A
  • treatment of hypertension, either alone or with other drugs: usually a diuretic
  • usually used after other drugs have failed because of adverse effects(orthostatic hypertension, fatigue, dizziness)
  • may be used for severe dysmenorrhea, menopausal flushing, and glaucoma
  • clonidine is useful in the management of withdrawal symptoms in opioid or nicotine-dependent persons
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19
Q

peripheral alpha1 blockers

A 
block alpha1 adrenergic receptors
alpha 1 adrenergic receptors
dilates both arteries and veins
might increase urinary flow rates 
decrease outflow obstruction by preventing smooth muscle contractions in the bladder, neck, and urethra
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20
Q

examples of peripherally acting alpha 1 receptor blockers

A

doxazosin
terazosin
prazosin

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21
Q

indications for use of peripheral alpha 1 blockers

A
  • treatment of hypertension
  • some used to relieve symptoms of BPH(tamsulosin)
  • management of severe heart failure when used with cardiac glycosides and diuretics
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22
Q

peripherally acting beta receptor blockers

A
  • reduce blood pressure by reducing heart rate through beta blockade
  • cause reduced secretion of renin resulting in reduction of angiotensin 2 mediated vasoconstriction and aldosterone mediated volume expansion
  • long-term use causes reduced peripheral vascular resistance
  • result is decreased blood pressure
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23
Q

non-selective beta vlockers

A

propanolol
nadolol
timolol

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24
Q

cardioselective beta blockers

A

atenolol
metoprolol
penbutolol

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25
Q

peripherally acting dual alpha 1 and beta receptor blockers

A
  • block alpha 1 adrenergic receptors
  • reduction of heart rate through a beta 1 receptor blockade
  • vasodilation through an alpha 1 receptor blockade
  • result in decreased blood pressure
26
Q

peripherally acting dual alpha1 and beta receptor blockers

A
  • labetalol

- carvedilol

27
Q

adverse effects of adrenergic drugs

A 
high incidence of orthostatic hypertension
bradycardia with reflex tachycardia
dry mouth
drowsiness
dizziness
depression
edema
constipation
impotence
28
Q

contraindications for adrenergic drugs

A

known drug allergy
acute heart failure
concurrent use of monoamine oxidase inhibitor
severe mental depression
peptic ulcer disease
severe liver or kidney disease
asthma if the patient is taking a nonselective beta blocker

29
Q

interactions of adrenergic drugs

A

additive CNS depression when taken with alcohol, benzodiazepines, and opioids

30
Q

ACE inhibitors

A

large group of safe and effective drugs
often used as first line drugs for heart failure and hyper tension
may be combined with a thiazide diuretic or calcium channel blocker

31
Q

renin-angiotensin aldosterone system

A

inhibit angiotensin converting enzyme(this enzyme converts angiotensin 1 to angiotensin 2 throguh the action of renin)
angiotensin 2 is a potent vasoconstrictor and causes aldosterone secretion from the adrenal glands
aldosterone stimulates water and sodium resorption
Result: increased blood volume, increased preload, increased blood pressure

32
Q

ACE inhibitors mechanism

A

ACE mediates the production of angiotensin 2
angiotensin 2 is a vasoconstrictor
angiotensin 2 mediates hypertrophy
angiotensin 2 also causes sodium and fluid retention
ACE inhibitors prevent the production of angiotensin 2

33
Q

ACEIs mechanism

A

dilate blood vessels and reduce peripheral resistance
reduction in blood pressure
ACEIs reduce blood volume by preventing sodium and water retention
reduces preload and cardiac output

34
Q

Indications for ACE inhibitors

A
  • hypertension
  • heart failure
  • slow progression of left ventricular hypertrophy after MI
  • renal protective effects in patients with diabetes
  • drugs of choice in hypertensive patients with heart failure
  • drugs of choice for diabetic patients
35
Q

ACE inhibitors end in:

A

-pril

36
Q

Adverse effects of ACE inhibitors

A
  • fatigue
  • dizziness
  • headache
  • mood changes
  • impaired taste
  • possible hyperkalemia
  • dry cough
  • angioedema
37
Q

ACEIs inhibit the degradation of what?

A

bradykinin and substance P
bradykini is a vasodilator
but bradykinin and supstance P are responsible for the dry cough

38
Q

contraindications of ACE inhibitors

A 
known allergy
high baseline potassium 
lactating women
children
bilateral renal artery stenosis
can cause injury and death to the developing fetus
39
Q

interactions of ACE inhibitors

A

NSAIDs can reduce the antihypertensive effects of the ACE inhibitors
may also predispose the patient to renal failure
concurrent use with lithium can cause lithium toxicity
potassium supplements can result in hyperkalemia

40
Q

Angiotensin receptor blockers

A 
newer class
well tolerated
have no effect on bradykinin metabolism so does not cause a dry cough
41
Q

angiotensin 2 receptor blockers mechnism of action

A

primarily affect vascular smooth muscle and the adrenal gland
allows angiotensin 1 to be converted to angiotensin 2, but block the receptors that receive angiotensin 2
blocks vasoconstriction and the release of aldosterone
ARBs are better tolerated than ACE inhibitors in treating heart failure or in protecting the kidneys : as in diabetes

42
Q

angiotensin 2 receptor blockers end in

A

-sartan

43
Q

angiotensin 2 receptor blockers indications

A

hypertension
adjunctive drugs for the treatment of heart failure
may be used alone or with other drugs auch as diuretics
used primarily in patients who cannot tolerate ACE inhibitors

44
Q

adverse effects of angiotensin 2 receptor blockers

A
  • upper respiratory infections
  • headache
  • may cause occasional dizziness, inability to sleep, diahrrhea, dyspnea, heartburn, nasal congestion, back pain, fatigue,
  • hyperkalemia is much less likely to occur
45
Q

angiotensin 2 receptor blockers: contraindications

A
  • known allergy
  • pregnancy
  • lactation
  • use caution in the elderly with renal dysfunction
46
Q

angiotensin 2 receptor blockers: interactions

A
  • may promote hyperkalemia
  • NSAIDs decrease ARB effects
  • Lithium concurrent use with ARBs causes toxicity
  • Rifampin decreased ARB effects
47
Q

calcium channel blockers mechanism of action

A

smooth muscle relaxation by blocking the binding of calcium to its receptors

  • decreased peripheral smooth muscle tone
  • decreased systemic vascular resistance
  • decreased blood pressure
48
Q

calcium channel blockers end in

A

-ipine

49
Q

calcium channel blockers indicators

A

-angina
-hypertension
-dysrhythmias
-migraine
-raynauds disease
carebral artery vasospasm

50
Q

adverse effects of calcium channel blockers

A

cardiovascular: hypotension, palpitations, tachycardia, bradycardia
gastrointestinal: constipation and nausea
other: rash, flushing, peripheral edema, dermatitis, fatigue, headache, dizziness, dyspnea
rare: gingival hyperplasia

51
Q

calcium channel blockers contraindications

A

known allergy
acute MI
second or hird degree block
hypotension

52
Q

diuretics

A

act on the nephron in different ways to increase urine output
decrease plasma and extracellular fluid volumes
decrease preload
decrease cardiac output
decreased total peripheral resistance
overall effect: decreased workload of the heart, decreased blood pressure

53
Q

diuretics end in

A

-azide

54
Q

adverse drug reactions to diuretics

A 
known allergy
fluid and electrolyte disturbance
nausea
skin rashes
photosensitivity
thrombocytopenia
pancreatitis
cholecystitis
55
Q

contraindications to diuretics

A

known allergy
hepatic coma
anuria
severe renal failure

56
Q

vasodilators mechanism

A 
directly relax smooth muscle
do not work through adrenergic receptors
results in: decreased systemic vascular response
decreased afterload
peripheral vasodilation
57
Q

examples of vasodilators

A

diazoxide
hydralazine
minoxidil
sodium nitroprusside

58
Q

vasodilators: indications

A

treatment of hypertension
may be used in combination with other drugs
sodium nitroprusside and intravenous diazoxide are reserved for the management of hypertensive emergencies

59
Q

adverse effects of vasodilators

A

hydralazine: dizziness, headache, anxiety, tachycardia, nausea and vomiting, diarrhea, anemia, dyspnea, edema, nasal congestion, others
sodium nitroprusside: bradycardia, hypotension, possible cyanide toxicity
diazoxide: dizziness

60
Q

contraindications of vasodilators

A 
known allergy
hypotension
cerbral edema
head injury
acute MI
CAD
HF secondary to diastolic dysfunction

DMD 5247 (13 decks)

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