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ASDOH Pharm II > E1 Anti-Hypertensive > Flashcards

E1 Anti-Hypertensive Flashcards

All things E1 (63 cards)

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1
Q

__% of patients with known

hypertension are treated

A

Only 50%

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2
Q

Complications of Sustained Hypertension

A

 Kidney disease
 Heart disease
 Cardiovascular problems (MI, stroke) – Problems increased if also smoking

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3
Q

Essential hypertension

A

– Also known as idiopathic or primary HTN

– 85-90% of cases

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4
Q

– Associated with disease process of endocrine or renal system
– Drugs: NSAIDS, birth control pills, decongestants, tricyclic
antidepressants

A

Secondary hypertension

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5
Q

– Develops in 5% of patients with primary or secondary HTN

– BP very high or rapidly rises; evidence of retinal and renal damage

A

Malignant hypertension

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6
Q

3 basic methods used to obtain the overall goal

of decreasing blood pressure:

A
  1. Reduce peripheral resistance
     SNS can affect peripheral resistance: agents used to
    block SNS reduce BP by decreasing peripheral resistance
  2. Reduce cardiac output
  3. Decrease blood volume
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7
Q

Family of Antihypertensive drugs acting at CNS:

A

Alpha-2 agonist

Beta Blockers

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8
Q

Family of Antihypertensive drugs acting at Heart:

A

Beta Blockers

Calcium channel blockers

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9
Q

Family of Antihypertensive drugs acting at Kidney:

A 
ACE inhibitors
Aliskiren
AT-1 Receptor antagonists
Beta Blockers
Diuretics
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10
Q

Family of Antihypertensive drugs acting at Blood vessels:

A

Ace inhibitors
Alpha-1 receptors antagonist
Calcium channel blockers
Vasodilators

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11
Q

Diuretics work by?

A

increasing the rate of ruin formation

Block kidney tubular reabsorption of Na+

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12
Q

Where is aldosterone made?

A

Adrenals

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13
Q

Classes of diuretics:

A 
– Mercurials
– Thiazides
– Loop (high ceiling)
– Carbonic anhydrase inhibitors
– Potassium-sparing diuretics
– Osmotics
– Acidifying agents
– Xanthines
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14
Q

Diuretics help secrete?

A

Sodium into the urine

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15
Q

Potassium-sparing diuretics also known as?

A

Aldosterone Blockers

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16
Q

Not used anymore but the first diuretics made

A

Mercurials

mercaptomerin (Thiomerin); meralluride
Mercuhydrun

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17
Q

First choice agents for hypertension and

congestive heart failure**

A

Thiazides (Benzothiazides)

Or HCTZ

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18
Q

Thiazides (Benzothiazides) ACTION:

A

 Inhibition of active Na+ reabsorption in the
proximal and distal tubules

 Inhibition of carbonic anhydrase = decreased
availability for H+ exchange with Na+

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19
Q

Starling’s Law =

A

if decrease amount of blood

returning to the heart (preload), heart doesn’t have to work as hard to eject blood back into the systemic circulation

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20
Q

Desired Effects of Thiazide Diuretics

A 
 Lower blood pressure:
– Decreased plasma volume
– Decreased extracellular fluid
 Decreased peripheral resistance
 Normalization of cardiac output after several days
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21
Q

“HCTZ” (MICROZIDE) is

A

hydrochlorothiazide

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22
Q

HCTZ USE

A

hypertension, edema from congestive heart failure

and nephrotic syndrome

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23
Q

HCTZ Therapeutic Category:

A

thiazide diuretic

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24
Q

HCTZ Oral complications:

A

xerostomia, lichenoid drug reaction, photosensitivity

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25
Drugs of choice for serious edema*
Loop (High Ceiling) Diuretics
26
Loop Diuretics Drugs are toxic due to such rapid loss of
electrolytes* | – All loop diuretics are ototoxic to some degree cause hearing loss/deafness
27
Common Loop Diuretics
 *ethacrynic acid (Edecrin) |  *furosemide (Lasix)
28
False autoimmune response **observed with thiazide and loop diuretics
Lichenoid Drug Reaction
29
Potassium-sparing diuretics (also called potassium retaining diuretics or aldosterone blockers) ACTION
Competes with aldosterone for receptor sites in the distal renal tubules, increasing Na+, Cl- and water excretion while conserving K+ and H+  Blocks the effect of aldosterone  Prevents the usual loss of K+
30
Xanthines in general
 Respiratory drugs (theopylline) for asthma and COPD  Xanthines are also stimulants (think caffeine which is also a xanthine)  What happens when you drink caffeine or other stimulants? PEE
31
xanthines inhibit
ADH = increases bloodflow and decreases reabsorption of water in collecting duct
32
Rank diuretics from most potent to least potent:
– Loop – Thiazides – Carbonic anhydrase inhibitors (very mild) – Potassium-sparing
33
Beta Receptors Blockers two classes of families
cardioselective and non-cardioselective Cardioselective (block beta-1) Noncardioselective (Beta-1 Beta-2)
34
Beta Receptors Blockers Mechanism of action:
– Decrease cardiac output (even though constrict vessels via beta-2) ```  Decrease the work of the heart – Decrease renin secretion – Reduce plasma volume and venous return – Decrease sympathetic outflow from CNS – Reduce peripheral resistance ```
35
Beta blockers Side effects
consistent with over activity of the parasympathetic nervoussystem: ``` – GI upset – Xerostomia – Weakness and fatigue – Orthostatic hypotension – Sedation – Depressed mood – Sexual dysfunction (Impotence in men = #1 reason for poor compliance) ```
36
Contraindications to Beta Blockers
 Congestive heart failure** (already have decreased cardiac output)  Asthma** (don’t want to block B bronchoconstriction = want to be able to use B agonist to open the airway) ***– Use cardioselective beta blocker  Heart block** (these drugs decrease heart rate and force of contraction)  Diabetes** (beta blockers decrease glycogenolysis and glucagon secretion, so pronounced hypoglycemia may occur after insulin injection) ***– Use cardioselective beta blocker –***
37
Alpha-1 Blockers location
Postsynaptic receptor
38
Blockers produce peripheral vasodilation in arterioles and venules, decreasing peripheral vascular resistance
Alpha-1 Blockers
39
More effective when used with diuretics and/or | beta blockers
Alpha-1 Blockers
40
 Used to improve urination in men with enlarged prostate and those with bladder problems – benign prostatic hypertrophy = BPH
Alpha-1 Blockers
41
``` Prevents conversion of angiotensin I to angiotensin II (a potent vasoconstrictor) – “inhibit” vasoconstriction = vasodilation ```
ACE Inhibitors
42
ACE Drugs end in...
-pril
43
– Drugs of choice for hypertension in patients | with diabetes
PRINIVIL, ZESTRIL  Generic Name: lisinopril  Therapeutic Category: ACE inhibitor
44
Side Effects of ACE Inhibitors (B/C ARB)
Chronic dry cough – Patients use cough syrups, lozenges to suppress cough – no effect ***Cough mediated by increased bradykinin release in bronchial tree*** Angioneurotic edema with first dose
45
Blocks vasoconstrictor and aldosterone-secreting effects of angiotensin II THEN increase in plasma renin level causing vasodilation, decreased sodium and water retention
Angiotensin Receptor Blockers (ARBs)
46
Angiotensin Receptor Blockers (ARBs) preferred over ACE inhibitors because...
– More specific in site of action, fewer side effects – Better tolerated by patients
47
Common ARBs
 losartan (Cozaar)  valsartan (Diovan) And more... **study tip: these drugs end in “-sartan”
48
aliskiren (Tekturna) =
``` Renin Inhibitor .....first in class drug ```
49
Renin Inhibitor Action
Binds to renin which then reduces levels of | angiotensin I, angiotensin II and aldosterone
50
Calcium Channel Blockers Uses
– Hypertension – Angina – Arrhythmias
51
Calcium Channel Blockers Mechanism
Inhibits calcium ion from entering the “slow channels” or select voltage-sensitive areas of vascular smooth muscle and myocardium during depolarization Produces relaxation of coronary vascular smooth muscle and coronary vasodilation
52
Calcium Channel Blockers Effects
Increases myocardial oxygen delivery (good for | angina too)
53
Common Calcium Channel Blockers
 amlodipine (Norvasc) - #1 in US sales (newest) less gingival hyperplasia  nifedipine (Adalat, Procardia) – one of original drugs in this class  verapamil (Calan) – one of original drugs in this class
54
verapamil effects
(Calan) has its major effects on the heart – Lowers heart rate by decreasing AV conduction in addition to lowering blood pressure
55
nifedipine effects
(Procardia) has more of an effect on blood vessels – Associated with the greatest number of cases of ***gingival hyperplasia*** for all drugs in this class
56
clonidine (Catapres) is a... and does...
Alpha-2 Agonist Decreases sympathetic outflow from CNS
57
Block granular uptake and storage (depletion) of norepinephrine = decrease sympathetic activity due to lack of neurotransmitter supply
Catecholamine Release Blockers
58
 reserpine**  guanethidine** (no longer used in U.S.) Type?
Catecholamine Release Blockers
59
Dental Drug Interactions with Antihypertensive Medications
 Enhanced hypotension with general anesthetics and | CNS depressants
60
– Remember safe cardiac dose of epinephrine =
0.04 mg Two cartridges
61
These common drugs for longer than 3 weeks may decrease effectiveness of some diuretics, beta blockers and ACE inhibitors
Use of NSAIDS
62
Most potent vasoconstrictor in all medicine
Nicotine second cocaine
63
 Diuretics make you_____ potassium |  ACEI and ARBs______ potassium
lose increase

ASDOH Pharm II (9 decks)

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