Antihypertensives Flashcards by Stephanie Wordes

What are normal blood pressure values?

<120/80

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What is prehypertension?

120-139/80-89

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What are hypertensive blood values?

> 140/90

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T/F Hypertension can include only high values on systolic and diastolic pressures.

FALSE; if you have systolic or diastolic high, then it is considered hypertension.

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What are some “classes” that differ in BP values?

Gender (post-menopausal women have higher BP than men, pre-menopausal women have lower BP than men)
Race (AA have higher BP than white counterparts)
Age (elderly individuals have higher BP than younger counterparts)

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What percentage of patients get adequate treatment in HTN?

50%

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What is essential to diagnose HTN?

Screening programs

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What diseases or drugs contribute to Secondary HTN? (6)

(1) Renal disease
(2) Endocrine disease
(3) Hyperthyroidism (increased CO)
(4) Narrowing of aorta (coarctation)
(5) Toxemia of pregnancy
(6) Oral contraceptives (2-3x more than the others- especially in obese and older women)

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What are the factors for Essential HTN? (5)

(1) Alterations in cardiovascular control
(2) Humoral factors: R-A-A, catecholamines
(3) Genetic factors (30%)
(4) Life-style: SALT, diet, weight, working conditions
(5) Psychogenic factors (STRESS)

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What are the multi-target complications of HTN? (5)

(1) Brain: Hemorrhage, stroke
(2) Eye: Retinopathy
(3) Vasculature: Peripheral vascular disease (atherosclerosis)
(4) Kidney: renal failure (nephrosclerosis)
(5) Heart: heart disease

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In the presence of this disease, all complications of HTN become worse in what situation?

Diabetes

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What are the increased work loads on the heart during HTN?

(1) L.V. hypertrophy (enlargement)
(2) Ischemic Heart disease –> M.I.
(3) Heart Failure (10-20% of all deaths)

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What are the 4 anatomic sites of blood pressure control?

(1) Resistance- arterioles
(2) Capacitance- venules
(3) Pump Output- heart
(4) Volume- KIDNEYS

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What are the 2 BP control mechanism in HTN patients?

(1) Baroreceptors

(2) Renal blood volume- pressure control systems

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What happens to these BP control mechanisms in HTN patients?

The baroreceptors and renal blood volume systems are at a higher value (therefore, HTN remains)

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What is the short-term BP mechanism?

Baroreflexes (moment-to-moment adjustments)

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What is the long-term BP mechanism?

Kidneys (intravascular blood volume)

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How many classes of drugs are there to treat HTN?

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What are the major sites of action of Antihypertensive drugs?

(1) SNS (CNS also)
(2) Renal loop
(3) Vascular smooth muscle

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What are some aspects of non-pharmalogical therapy of HTN? (8)

(1) Low sodium chloride diet
(2) Weight reduction
(3) Exercise
(4) Cessation of smoking
(5) Decrease in excessive alcohol consumption
(6) Psychological methods (e.g. relaxation)
(7) Dietary increase in polyunsaturated fat intake
(8) Dietary increase in fruits, vegetables

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What are the Non-selective and Beta-1 selective Beta-Blockers?

(1) Propranol: Nonselective

(2) Metoprolol: B-1 selective

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What are the responses to Beta-blockers (Propranolol, Metoprolol)? Which one is predominant?

*(1) Decrease contractility, HR, CO, BP**

(2) Decrease renin release, prevents ANG-II formation, decrease BP

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What are the precautions for Beta-blockers?

(1) Heart failure
(2) Diabetes- interferes with glucose metabolism
(3) Asthma

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What are the adverse effects of Beta-blockers?

(1) Fatigue, disturbing dreams, nausea
(2) GI discomfort
(3) Insomnia
(4) Occasional impotence

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What Beta-blocker are the asthmatics prescribed? Why?

Metoprolol; because the non-selective beta-blockers will antagonise B-2 as well and cause bronchial constriction

What are the Thiazide Diuretics?

Hydrochlorothiazide

What does Hydrochlorothiazide do?

(1) Inhibits Na transport by depleting Na stores (decreases the constrictor response) (2) Decreases blood volume, CO, BP (3) Chronic use: decrease PR, BP

What are the adverse effects of Hydrochlorothiazide?

(1) Hypokalemia (2) Drowsiness (3) Increase LDL cholesterol (4) Apathy

What happens when you use Hydrochlorothiazide over 6-8 weeks?

The CO goes back to normal, yet you have a decrease in peripheral resistance that in turn keep the decrease in BP

What are the ACE inhibitors? What does ACE stand for?

(1) Captopril (2) Enalapril; Angiotensin Converting Enzyme

| What are the responses of ACE inhibitors? Which one is most important?

**(1) Decrease formation of ANG II: decreases PR** (2) Blocks release of aldosterone (slight decrease in blood volume) (3) Increases bradykinin release- increased vasodilation

Which ACE inhibitor has a longer duration?

Enalapril

T/F There is a CNS effect in ACE inhibitors.

FALSE

Which drugs are used to also treat congestive heart failure?

(1) ACE inhibitors | (2) Angiotension II Receptor Antagonists

What are the limitations of ACE inhibitors?

Cannot give to pregnant/nursing mothers (fetal/neonatal morbidity and mortality)

What are the adverse effects of ACE inhibitors?

(1) Coughing (5-20% pts) (2) Reversible rash (3) Taste alteration (4) Hyperkalemia

What are the Angiotensin II Receptor Antagonists? Is it selective or non-selective?

Losartan; selective

What responses does Losartan have?

(1) Decrease PR and BP | 2) Decrease aldosterone release (slight decrease in blood volume

What is the different between ACE inhibitors and Ang-II receptor antagonists in reference to response?

Losartan (Ang-II receptor antagonist) has NO change in bradykinin levels

What are the limitations of Losartan?

Cannot give to pregnant/nursing mother

What are the calcium entry blockers?

(1) Verapamil (2) Diltiazem (3) Nifedipine

What do calcium channel blockers do?

Blocks Ca entry into the cells (L-type channels in the heart and some in smooth muscle)

What are the responses of calcium channel blockers?

(1) Vascular smooth muscle: Decrease PR, BP (N>V>D) | 2) Cardiac muscle: Decrease contractility, decrease CO (V>N

Which calcium channel blocker has a mild reflex tachycardia?

Nifedipine

What population should not be given calcium entry blockers (Verap/Dil)? Why?

Elderly; because the blunt in reflex tachycardia can lead to heart disease

What are the limitations of calcium channel blockers?

(1) SA or AV nodal abnormalities | 2) Congestive heart failure (Verapamil, Diltiazem

What are the adverse effects for Verapamil, Nifedipind, Diltiazem?

V- Constipation N- Headache, flushing, dizziness D and V- Bradycardia

What are the selective alpha-blockers?

Prazosin

What are the responses for Prazosin?

(1) Decrease PR, BP (2) Minimal reflex tachycardia (3) May increase blood volume

What are the adverse effects of Prazosin?

(1) First dose hypotension | (2) Dizziness, fatigue

What is the lipid profile for Prazosin?

High LDL and high HDL

What are the 2 CNS acting drugs? Which one acts on both the CNS and heart?

(1) Alpha-methyldopa | * *(2) Clonidine**

What are the responses to CNS acting drugs? Are they selective?

They are selective alpha-2 agonists (1) A-methyldopa: Decrease PR --> decrease BP (2) Clonidine: decrease sympathetic drive to the heart- decrease contractility, HR -->CO

What are the adverse effects of CNS acting drugs?

(1) Sedation, vertigo, nightmares, drug fever, dry mouth | (2) Increased water retention

What is commonly given with CNS acting drugs?

Diuretics

T/F Alpha-methyldopa is not safe for pregnant/nursing mothers.

FALSE

Which drug potentiates anti-hypertension action of other drugs?

Thiazide diuretics (Hydrochlorothiazide)

What do you occasionally see in CNS acting drugs?

Postural hypotension, impotence

What are the Vasodilators?

Hydralazine and Minoxidil

What are the vasodilators used for?

moderate, severe hypertension

What do Hydralazine and Minoxidil do?

- Dilates arteries, arterioles > veins - Increases NO which activates guanylyl cyclase in smooth muscles - Increases cGMP --> dilation (decreased PR and BP)

What are the responses of Hydralazine and Minoxidil?

- Reflex activity: increase HR, contractility --> increases CO - Increases renin, angil, and aldosterone - increases water retention

What do you need to use in combination with Hydralazine and Minoxidil?

Beta-blockers and diuretics

What are the adverse effects of Vasodilators (Hydralazine and Minoxidil)

(1) Headache (2) Sweating (3 Dizziness (4) Flushing (5) Nausea (6) Tachycardia (7) lupus like syndrome (fever, joint pain)

What is associated as another effect of Minoxidil? (that does not have to do with the heart)

It causes hair growth

What are the conditions that require rapid blood pressure reduction? (8)

(1) "Malignant" hypertension (2) Pheochromocytoma (3) Hypertensive encephalopathy (4) Refractory hypertension of pregnancy (5) Acute left ventricular failure (6) Aortic dissection (7) Coronary insufficiency (8) Intracranial hemorrhage

What are the two drugs that you use for hypertensive emergencies?

(1) Na Nitroprusside | (2) Labetolol

What type of drug is Na Nitroprusside?

Nonselective vasodilator

How is Na Nitroprusside given? When is it given?

IV; for emergency use only because it as a rapid decrease in BP

What responses does Na Nitroprusside do?

Dilates arterioles and veins equally | - decreases PR and BP

T/F Reflex tachycardia in Na Nitroprusside is significant.

FALSE

What are the adverse reactions of Na Nitroprusside? What does chronic use cause?

Hypotension (Nausea, vomiting, nervousness); psychosis

What type of drug is Labetolol?

Combo - non-selective beta blocker - selective alpha-1 blocker

What are the responses of Labetolol?

- decrease PR: decreases BP (alpha) and Renin (beta) | - not consistent decrease in HP and CO

How is Labetolol taken?

Oral or IV

What are the adverse effects of Labetolol?

(1) Hypotension (2) GI disturbances (3) Fatigue (4) Nervousness

What is the Adrenergic Neuron Blocking Agent?

Reserpine

What does Reserpine do?

Depletes nerve ending stores of catecholamines that blocks NE/Epi release and uptake

What are the responses of Reserpine?

- Slow decrease in BP: decrease CO, bradycardia | - Small decrease in reflex response

What are the adverse effects of Reserpine?

CNS- Sedation, depression, nightmares | Peripheral- cramps, diarrhea, increased water retention (use with diuretic)

Antihypertensives Flashcards

(80 cards)