Exam 1; Antihypertensive Agents Flashcards by Courtney Kast

What is the definition of hypertension

any prolonged elevation in blood pressure
most common cardiovascular disease
most are untreated

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What is the desirable blood pressure

115/75

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What category of blood pressure is pre-hypertensive

120/80-139/89

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What category of blood pressure is stage 1 hypertension

140/90

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What category of blood pressure is stage 2 hypertension

180/110

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What category of blood pressure is hypertensive urgency

220/120

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Every increase in blood pressure of what increases likelihood of cardiovascular incident by two fold

20/10

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What is the result if 220/120 blood pressure is untreated for the long term

60% die within 6 months

80% dies within the year

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What is it about hypertension that makes it so dangerous

it is generally asymptomatic until its final stages; can cause stroke, heart attack, aneurysms, and renal failure

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True or False

There is a clear treatment option for hypertension

True

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What is secondary hypertension (5-10%)

Know exactly what the problem/cause is (renal, tumor, etc.)

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What is primary or essential hypertension

the cause is unknown

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What is malignant hypertension

220/120+

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A baroreceptor on the blood vessel stimulates what center of the brain

vasomotor center

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In the vasomotor center of the brain, what occurs upon receiving a signal from the baroreceptor

NE is released to an α1 receptor which increases sympathetic flow
NE also autostimulates an α2 receptor which decreases sympathetic flow

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The synapse from the vasomotor center relays to what

a paravertebral ganglia

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From the paravertebral ganglia, what two places does the signal from the vasomotor center go

β1 receptors on the heart to increase cardiovascular output

α1 receptors on the blood vessel to stimulate vasoconstriction

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A calcium influx into the blood vessel causes what to occur

constriction

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A potassium efflux out of the blood vessel causes what to occur

relaxation

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An increase cyclicGMP activity in the blood vessel causes what to occur

relaxation

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Stimulation of an endothelium receptor on a blood vessel causes what to occur

constriction

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Stimulation of a DA (dopamine) receptor on a blood vessel causes what to occur

relaxation

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Stimulation of the angiotension II receptor by angiotension II on a blood vessel causes what to occur

constriction

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The neuronal-vascular control loop is what kind of response to blood pressure changes

extremely rapid response (sudden dizziness upon sitting up quickly)
reflex blood pressure control

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The kidney control loop system is what kind of response to blood pressure changes

long term regulation of blood pressure | renin-angiotension-aldesterone system

A decrease in renal blood pressure or decrease in Na in the kidney stimulates what

increases renin secretion by the kidney

Renin from the kidney is a precursor to what, via angiotensionogen

angiotension I

Angiotension 1 is converted to what via angiotension converting enzyme

angiotension II

Angiotension II has what three effects

vasoconstriction Na retention in the kidney secretion of aldesterone

This is converted to an inactive product by angiotension converting enzyme

bradykinin

What three effects does bradykinin have

dilates arteries - decreasing blood pressure causes capillary leakage (edema) activates sensory nerves (pain/itching)

What is the main treatment for hypertension

behavorial modification; stress, diet, weight management, smoking

Drugs like diuretics (thiazides) or a low Na diet cause this to occur, which can treat hypertension

decrease fluid volume

What are three characteristics of hypertension drugs

interrupt "normal" BP control do not "cure" hypertension must be taken for life

What is the one side effect that is common for all anti-hypertensives

risk of hypotension

Any drug that can enter the CNS can have what kind of effects

behavioral effects

This is a pro-drug metabolized to α-methyl NE which activates/stimulates α2 receptors

α-methyl DOPA

What are the 5 side effects of α-methyl DOPA

``` depression drowsiness dry mouth impaired ejaculation hepatic dysfunction ```

This drug is an α2 agonist which has unlabeled uses

clonidine

What are the four unlabeled uses of clonidine

fibromyalgia insomnia Tourette's opiate withdrawal

What are the 4 side effects of clonidine

depression drowsiness dry mouth impaired ejaculate

This is a β blocker drug that has central and peripheral effects

propranolol

This is a drug that inhibits the enzyme tyrosine hydroxyls which prevents the synthesis of E and NE; used to treat tumor of adrenal gland (pheochromoctyoma)

α-methyl tyrosine

This drug causes depletion of post-ganglionic neuron neurotransmitter

reserpine

What are the side effects of reserpine

depression drowsiness diarrhea

Which family of drugs block the α1 receptor on vascular smooth muscle

-osin's | prazosin, terazosin, etc.

These three drugs are α1 blockers and used only to treat benign prostatic hypertrophy (BPH)

tamsulosin alfuzosin silodosin

What is the main side effect of the α1 site inhibitors (-osin's)

first dose effect; rapid dose in BP | orthostatic or postural hypotension

This drug blocks all β blockers (β1 and β2)

propranolol

Propranolol blocks β1 receptors on the heart and cause what

prevents any increase in heart rate and contraction force; decreases renin secretion

What are the four "lesser" side effects of propranolol

gets into the CNS; depression bradycardia; fatigue impotence decreases HDL and increases triglycerides

What is the main side effect of propranolol

worsens asthma (β2 = bronchodilators)

How many specific β1 blockers are there on the market

13 | the -olol's

What are the side effects of the β1 blockers, the -olol's

fewer CNS effects bradycardia fatigue (with exercise)

Labetalol and carvedilol block which receptors

α1, β1, β2

What are the side effects of labetalol andcarvedilol

postural hypotension | dry mouth

Which family of drugs are angiotension receptor blockers (ARBs)

-artans | Angiotension RecepTor ANtagonists

What effect does the antiogention receptor blockers induce (-artans)

block the angiotension II receptor | decreasing secretion of aldosterone

*What is the main side effect of ARBs

``` can cause fetal abnormalities; like all agents that alter the angiotension system class X pregnancy drugs ```

Which family of drugs are the endothelian blockers

-entan's

What are -entan's the treatment for specifically

pulmonary artery hypertension

What are the three side effects of endothelin blockers

fetal damage hepatic toxicity testicular atrophy

This drug is a prodrug which is involved with opening potassium channels in arterial smooth muscle; efflux leads to hyper polarization for very refractory patients

minoxidil

What are two side effects of minoxidil

hypertichosis (hair growth); discontinuation = hair loss | edema - pericardial effusion; leads to cardiac tamponade

This is a vasodilator which increases cGMP which causes smooth muscle relaxation

hydralazine

What is the side effect of hydralazine

in slow acetylators - lupus like syndrome

This drug acts by opening potassium channels decreasing insulin secretion from β cells

diazoxide

This is the drug of choice in hypertensive emergencies

nitroprusside

Nitroprusside acts within seconds via an IV to do what

dilate both arteries and veins equaling a rapid drop in blood pressure

Why must nitroprusside be stored in powder form

because it degrades in solution (saline) into other molecules including cyanide

What is the meaning behind "Minnie Hid the Diamonds in the Nitro" because she was KG KG

``` Minoxidil = potassium hydralazine = cGMP diazoxide = potassium mitroprusside = cGMP ```

What family of drugs are calcium channel blockers

-ipine's

The calcium channel blockers have what effect

inhibit Ca++ influx into vascular smooth muscle; prevents vasoconstriction

What are two side effects of calcium channel blockers

can cause heart burn | may worsen heart failure

This family of drugs are angiotension converting enzyme inhibitors (ACE)

-pril's

ACE inhibiting drugs have what three effects

inhibits ACE that is required for conversion of angiotension I to II prevents breakdown of bradykinin (vasodilation) decreases aldosterone secretion

What are the five side effects of ACE inhibitors

``` rash dry cough angioneurotic edema (swelling of URT) taste alteration fetal damage ```

This is a renin inhibitor (directly inhibits renin)

aliskiren

What are the four side effects of aliskerin

fetal damage cough angioedema diarrhea

This agent activates D1 receptors; given in IV for hypertensive emergencies

fenoldpam

Exam 1; Antihypertensive Agents Flashcards

(80 cards)