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581 - Pharmacology I > Exam 7 - Antihypertensives & Renal Pharm > Flashcards

Exam 7 - Antihypertensives & Renal Pharm Flashcards

(95 cards)

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1
Q

Hypertension

A
  • Systolic > 140 mmHg
  • Diastolic > 90 mmHg
  • 30% incidence
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2
Q

Prehypertension

A

120-139 / 80-89

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3
Q

Stage I HTN

A

140-159 / 90-99

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4
Q

Stage II HTN

A

> 160 / >100

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5
Q

Primary HTN

A
  • Essential HTN
  • Idiopathic
  • Most common
  • 90%
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6
Q

Secondary HTN

A
  • caused by specific disease

- valve disease / coarcation of aorta / pregnancy

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7
Q

Diagnosis of HTN

A
  • Repeated and reproducible measurements

- at least 3 over several weeks / organ damage

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8
Q

HTN risk factors

A
  • Advanced age
  • DM
  • Obesity
  • Family history
  • Stress
  • Smoking
  • Poor diet
  • Lack of activity
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9
Q

HTN complications

A
  • Stroke/Ischemic heart heart disease (leading causes of death)
  • LV hypertrophy
  • Aortic aneurysm
  • Arrhythmias
  • End organ damage
    • especially kidneys / eyes
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10
Q

Blood Pressure

A

BP = CO x PVR

  • so antihypertensives either drop CO and/or PVR
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11
Q

Four ways of controlling BP

A
  • Arterioles resistance
  • Venule capacitance
  • Cardiac output
  • Volume via kidneys
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12
Q

CO and PVR control

A
  • Barroreceptor reflex

- Renin-Angiotensin-Aldosterone system

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13
Q

Barroreceptors

A
  • rapid, moment to moment changes

- in aortic arch and carotid sinuses

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14
Q

Renin-angiotensin-aldosterone system

A
  • baroreceptors release renin if BP drops
  • renin converts angiotensinogen to angiotensin I
  • Angiotensin I to Angio II via ACE
  • Angio II constricts..drops GFR…increases aldosterone
  • aldosterone increases Na absorption…more volume
  • BP goes up
    (Look at chart in slides)
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15
Q

Combo therapy

A
  • more than one drug used to treat HTN
  • minimize side effects
  • monotherapy can be used if mild HTN
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16
Q

Recommended HTN treatment strategy

A

Start with:

  • Thiazide diuretic
  • ACE inhibitor
  • Angiotensin receptor blocker (ARB)
  • Ca channel blocker
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17
Q

Diuretics

A
  • lower BP by reducing volume
  • safe
  • inexpensive
  • first line drug choice
  • used in combo therapy
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18
Q

Thiazide diuretic drugs

A
  • Hydrochlorothiazide
  • Chlorthalidone
  • Indapamide
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19
Q

Thiazide diuretic mechanism

A
  • inhibit Na/Cl cotransporter in distal tubule
  • increase Na/H2O excretion…drops volume
  • increase NaCl excretion
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20
Q

Thiazide diuretic uses

A
  • useful in combo therapy
  • Not effective in renal failure…metabolized by kidney
  • not recommended in pregnancy
    Can cause:
  • hypokalemia
  • hyperuricemia
  • hyperglycemia
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21
Q

Loop diuretic drugs

A
  • Furosemide (LASIX)

- Bumetanide (BUMEX)

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22
Q

Loop diuretic mechanism

A
  • inhibit Na/K/2Cl transporter in ascending limb
    • blocks reabsorption
  • decrease RVR
  • increase RBF
  • fast acting
  • increase Na excretion
  • increase K excretion
  • increase Cl excretion
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23
Q

Loop diuretic uses

A
  • Works well in renal failure
    Causes:
  • hypokalemia
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24
Q

K sparing diuretic drugs

A
  • Spironolactone

- Eplerenone

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25
K sparing diuretics mechanism
- Aldosterone receptor antagonist - more Na/H2O into collecting duct - reduces K loss in urine - used in combo therapy w/ thiazides to reduce K loss - increase Na excretion - increase K retention
26
B blockers
- block B1/B2 receptors - decrease sympathetic outflow - drop CO / HR / contractility - inhibit renin release from kidney
27
B1 selective drugs
- Acebutolol - Atenolol...for HTN - Bisoprolol - Esmolol (BREVIBLOCK)....use in OR....short acting - Metoprolol...for HTN
28
Nonselective B blockers
- Propanolol - Nadolol - don't use w/ COPD - ALL B blockers Nonselective at high doses
29
A/B blockers
- Carvedilol... for heart failure | - Labetalol....OK for pregnancy HTN
30
B blocker adverse effects
- Bradycardia - Hypotension - Fatigue - Insomnia - Sexual dysfunction - Altered lipid panel...high LDL...low LDL...high triglycerides
31
B blocker cautions
- do not stop abruptly ....angina / MI / death | - tapered off over weeks
32
B blockers in IV form
- Esmolol - Metropolol - Propanolol
33
ACE inhibitor drugs
- Benazepril - Captopril - Enalpril - Lisinopril
34
ACE inhibitor mechanism
- blocks ACE - No Angio I to Angio II - drops Angio II levels - causes vasodilation - increases bradykinin - reduces aldosterone...decrease in Na/H2O retention
35
ACE and bradykinin
- ACE breaks down bradykinin - bradykinin increase NO / prostacyclin - both vasoconstrictors
36
ACE inhibitor uses
- good for patients with diabetic nephropathy - decrease progression and albuminuria - common following MI Chronic use can: - drop in BP - LV hypertrophy regression - better LV healing after MI
37
ACE inhibitor adverse effects
- dry cough...main reason to get off - rash - fever - altered taste - hypotension - hyperkalemia - fetal malformations
38
Angiotensin II Recepter Blockers (ARBs)
- Candesartan - Eprosartan - Irbesartan - Losartan - Telmisartan - Valsartan
39
ARB mechanism
- Block angio II receptors - produce vasodilation - block aldosterone secretion...lowers BP and Na/H2O retention - DOES NOT increase bradykinin
40
ARB uses
- good for DM / HF / Chronic kidney disease - adverse effects like ACE inhibitors...but less cough - put on ARB if ACE inhibitors don't work - DO NOT combine with ACE inhibitors - Teratogenic...fetal malformations
41
Renin inhibitors
- Aliskiren
42
Renin inhibitor mechanism
- directly inhibits renin - drops Na/H2O retention - as effective as other methods - NO NOT combine worth ACEi or ARB
43
Renin inhibitor adverse effects
- diarrhea - cough - DO NOT use in pregnancy
44
Ca channel blockers
- blocks Ca into heart cells / smooth muscle cells - smooth muscle relaxation - dilates MAINLY arterioles - initial or add on therapy
45
Alpha 1 blocker drugs
- Doxazosin - Prazosin - Terazosin
46
Alpha 1 blocker mechanism
- decrease PVR - decrease BP - relaxes venous and smooth muscle - causes reflex tachycardia / orthopedic hypotension - Na/H2O retention increases....so used with diuretic - NOT used as initial treatment
47
Clonidine
- Alpha 2 agonist - drops sympathetic outflow...drops PVR and BP - relaxation of venules
48
Clonidine adverse effects
- dry mouth - sedation - constipation - rebound HTN if stopped abruptly
49
Methydopa
- Alpha 2 agonist - similar to clonidine - HTN during pregnancy - also Labetol OK for pregnancy
50
Vasodilator drugs
- Hydralazine - Minoxidil - Nitroprusside - Nitroglycerin
51
Hydralazine
- releases NO from endothelium - mainly on arteries - reflex stimulation of heart... causes angina / MI / HF - increases renin...Na/H2O retention - must be used w/ beta blocker AND diuretic - OK for pregnancy - Can cause Lupus at high doses...autoimmune disease
52
Minoxidil
- Hyper-polarization of smooth muscle...contraction less likely - Mainly in arteries
53
Minoxidil side effects
- severe tachycardia...dose dependent - palpitations - angina - headache - sweating - hypertrichosis...hair growth - used w/ beta blocker and diuretic
54
Nitroprusside
- dilates arteries/veins by releaseing NO - drops PVR and venous return - rapid onset/offset...IV infusion...used in emergencies - lasts 5 min
55
Nitroprusside side effects
- Accumulation of cyanide - only use 3 days - arrhythmias - excessive hypotension
56
Nitroglycerin
- common in OR / on CPB / after CPB - bolus or IV drip - decreases BP and SVR - dilates coronary vasculature - good for coronary spasm / air in coronaries
57
HTN on pump
- adjust flow - check anesthetic depth - increase isofluorene - drugs
58
Proximal convoluted tubule
Reabsorbed: - 100% of glucose, proteins, metabolites - 65% Na, H2O, Cl, K, bicarb Secreted: - H - organic acids/bases - catecholamines - drugs/toxins
59
Descending loop
Reabsorbed: | - 20% H2O
60
Ascending loop
- impermeable to H2O Reabsorbed: - 25% Na, Cl, K - Ca, bicarb, Mg Secreted: - H
61
Early distal
- impermeable to H2O Reabsorb: - 5% Na, Cl, K
62
Late distal / Collecting tubule
Reabsorb: - H2O if there is ADH Principal cells: - reabsorb Na - secrete K Intercalated cells: - reabsorb/secrete K, bicarb, H
63
Collecting duct
Reabsorb: - 10% Na, H2O (if ADH) - urea Secrete: - H
64
Common uses for diuretics
- HTN - Edema from: - CHF / liver cirrhosis / corticosteroid therapy / bad renal
65
Ascites
Swelling in abdomen
66
Thiazide diuretics characteristics
- most widely used - acts on distal tubule - all have same Emax....but different potencies - low ceiling diuretics - effective orally - 1-3 weeks for BP drop
67
Thiazide diuretics mechanism
- blocks Na/Cl transporter - enter lumen via proximal tubule...act on distal - compete with organic acids to enter proximal
68
Thiazide diuretics actions
- Increased excretion of Na and Cl - hyperosmolar urine...UNIQUE to thiazides...don't change pH - Loss of K - high Na = more K secretion later in tubule...continual loss - Loss of Mg - supplementation required - Ca retention - due to increased PTH in distal...good for bones - Reduced PVR - less volume = less CO...overtime volume comes up but PVR stays low
69
Thiazide therapeutic uses
- HTN: drug of choice / minor diuretic effect / PVR low - HF: loops are drug of choice / thiazide is supplement - Hypercalciuria: idiopathic / good for kidney stones - Diabetes Insipidus: substitute for ADH
70
Thiazide diuretics adverse effects
- K depletion - Hyponatremia - Hyperuricemia...caution with gout - Volume depletion...orthostatic hypotension - Hypercalcemia - Hyperglycemia...impaired release of insulin/tissue glucose uptake
71
Thiazide diuretic drugs
- Hydrochlorothiazide (HCTZ) (Microzide) | - Chlorothiazide (Diuril)...not oral...ok for pregnancy
72
Thiazide-like diuretics
- Chlorothalidone (Thalitone) - Metolazone (Zaroxolyn)....more potent than others - Indapamide - different structure / same functions / same effects
73
Loop diuretics characteristics
- act on ascending loop - high ceiling diuretics...higher doses...higher urine output - Oral or IV - Rapid onset, short duration...2-4 HOURS - Limiting step: how much gets into lumen via proximal tubule - good at removing Na and Cl from body
74
Loop diuretics mechanism
- blocks Na/K/2Cl transporter on luminal membrane - downstream sites can't compensate for increase in Na - greatest diuretic effect - increase RBF via prostaglandin synthesis - this effect blocked by NSAIDS...they block loop diuretics - increase secretion of Na / K / Ca
75
Loops diuretic uses
- Peripheral/pulmonary edema - Emergency...acute pulmonary edema - Hypercalcemia (1.2-1.4 is normal) - Hyperkalemia (3.5-5 is normal) - Diuretic of choice in renal failure
76
Loop diuretic perfusion uses
- remove extra fluid on pump - treat hyperkalemia - maintain urine production / renal function
77
Loop diuretic dose
20-40 mg bolus...lasts 2 hours in pump
78
Loop diuretic adverse effects
- Ototoxicity...hearing loss - Hyperuricemia...compete with uric acid for secretion - Acute hypovolemia - K depletion...more exchange of Na for K in tubule - Hypomagnesemia....on chronic use
79
Loop diuretic drugs
- Furosemide (Lasix) - Bumetanide (Bumex) - Ethacrinic acid
80
K sparing diuretic characteristics
- act in collecting tubule - aldosterone antagonists... stops Na reabsorption/K secretion - Na channel blockers
81
Aldosterone
- from adrenal cortex...zone glomerulosa cells - principal cells of collecting tubule - increase Na/K ATPase activity AND permeability of membrane Na - increase Na reabsorption and K secretion - important regulator of K
82
K sparing diuretic uses (aldosterone antagonists)
- Diuresis...given with loops or thiazides - Secondary hyperaldosteronism - like hepatic cirrhosis or nephrotic syndrome - HF...prevent remodeling / decrease mortality / UNIQUE effect - Resistant HTN...use of 3+ medications w/o BP drop - Ascites...like with hepatic cirrhosis - Polycystic ovary syndrome...high androgen levels - off label use...stop steroid synthesis
83
K sparing adverse effects (aldosterone antagonists)
- Gynecomastia in males - Menstrual irregularities - Hyperkalemia...careful if on high K diet - confusion
84
K sparing drugs (aldosterone antagonists)
- Sprinolactone (aldactone) | - Eplerenone (Inspra)...less endocrine effects
85
K sparing diuretics (Na channel blockers)
- not very effective - in combo w/ other diuretics for k sparing effects - increase Na secretion - increase K reabsorption
86
K sparing diuretics (Na channel blockers) adverse effects
- Increase uric acid - renal stones - K retention
87
K sparing diuretics (Na channel blockers) drugs
- Triamterene (dyrenium) | - Amiloride
88
Carbonic anhydrase inhibitors
- much less effective than loops and thiazides | - 1st diuretic developed
89
Carbonic anhydrase inhibitors mechanism
- acts in proximal tubule - drops Na uptake by dropping H levels in tubule cells - less effective Na/H exchange - urine pH increase - metabolic acidosis after several days - increase excretion of Na / K / bicarb
90
Carbonic anhydrase inhibitors uses
- glaucoma: less aqueous humor / pressure - correction of metabolic alkalosis (gets rid of bicarb) - mountain sickness - prophylaxis...counters respiratory alkalosis - drops pulmonary edema
91
Carbonic anhydrase inhibitors drug
- Acetazolamide (Diamox)
92
Osmotic diuretics drug
- Mannitol (osmitrol) | - IV only
93
Osmotic diuretics mechanism
- elevates blood osmolality...pulls in water - elevates tubular filtrate osmolality - filtered but not reabsorbed - causes water excretion - inhibits reabsorption of Na / Cl / solute
94
Osmotic diuretic uses
- reduce intracranial pressure - acute renal failure...shock/drug toxicity/trauma - will give on bypass
95
Mannitol dose
CPB: 0.5-1.0 g/kg In prime: 12.5g/50ml vials in prime - check for crystals - use filtered needle - may cause transient hypotension if given too fast

581 - Pharmacology I (6 decks)

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