Flashcards in Hypertension Deck (22):
Which loop diuretic is used in management of HTN?
What transporter does it block?
It blocks absorption of which ions?
Competitively inhibit Na/K/Cl cotransporter @ TAL --> inhibit Na, Ca reabsorption --> inhibit H20 reabsorption
What type of diuretic is Furosemide?
It is used to treat what type of HTN in what 3 settings?
Describe Furosemide in terms of potency and onset of action, relative to other types of diuretics.
Severe HTN in setting of CHF, cirrhosis, or renal insufficiency
Most potent, Fast acting
Name the 4 medium potency, Thiazide diuretics that are used in the treatment of mild to moderate HTN?
What is their mechanism?
Thiazide Diuretics inhibit the Na/Cl cotransporter @ the early DT luminal membrane
Name the 3 low potency, Potassium-sparing diuretics that are combined with loop/thiazide diuretics to prevent diuresis-induced hypokalemia.
What is their general mechanism?
Inhibit Na reabsorption in the distal tubule
What are some side effects of loop & thiazide diuretics?
Impaired glucose tolerance, Increased lipids
ED, Volume depletion (if sick)
What are some side effects of the potassium-sparing diuretics?
Menstrual irregularities, Menorrhagia
There are 6 examples of ACE Inhibitors (they all end in -pril) that are used in treatment of HTN.
The 1 short-acting ACE-I is...
The 4 long-acting ACE-I are...
The ACE-I that is converted to an active metabolite...
Converted to active metabolite
What is the mechanism of action of the ACE-Is?
inhibit ACE --> prevent formation of Ang2 + inhibit breakdown of bradykinin --> vasodilation
Besides lowering BP, ACE-I and ARBs have can be beneficial in the following conditons:
1. chronic kidney disease & proteinuria
1. chronic kidney disease and proteinuria
3. LV remodeling post-MI
4. Reducing risk of diabetes
Name the 3 Angiotensin Receptor Blockers (ARBs) used in treatment of HTN. (they end in -sartan)
What is their mechanism of action?
Competitive inhibition of Ang2 Receptors @ vascular endothelium --> vasodilation
((Ang2 = potent vasoconstrictor))
What are the 4 common side effects of ACE-Is and ARBs? (one of them is not present in ARBs...)
What are 4 contraindications for ACE-I/ARB use?
1. cough (ACE-Is only)
3. Decreased renal function
1. Renal artery stenosis
4. Cautious use in renal failure
For calcium channel blockers...
Which two are Dihydropyridines?
Which two are Non-Dihydropyridines?
What is their common mechanism?
block Ca entry --> inhibit vasc sm muscle contraction --> reduced systemic vasc resistance
What 3 therapeutic effects do all Calcium Channel Blockers share?
What extra therapeutic use is associated with Non-Dihydropyridines?
All Ca Chnl Blockers:
1. lower BP
3. Raynaud's syndrome
1. decrease HR --> lower myocardial O2 demand
All Calcium Channel Blockers share what three side effects?
Dihydropyridines have what unique side effect?
Common Side Effects
--constipation, leg edema, AV nodal block
--bradycardia & heart failure
There are 8 Beta Blockers used in the treatment of HTN.
The non-selective Beta Blocker that is rarely used?
What are the 7 Beta1 selective BBs?
(Hint: ABC - E - LMN)
How do Beta-1 Receptor blockers affect the following:
Block B1 Rs -->
1. lower contractility --> reduce CO
2. inhibit renin release
3. reduce NE release from neurons
4. lessen sympathetic tone
There are 4 BBs that are used for treatment of plain old HTN, CHF, and CAD.
Name them. Which two are long-acting?
There are two really potent BBs...
--Which one is used for BP control in a hypertensive emergency?
--Which one can be used for BP control in Acute Coronary Syndrome or CHF?
What BB is unique because it is given by IV and is used for AV nodal blocking?
Acute Coronary Syndrome/CHF
AV nodal blocking
7 Side Effects of BBs are listed below. Of these side effects, which 3 are the moderately selective BBs less likely to cause?
1. decreased exercise capacity
5. masking of diabetes
6. crossing BBB to cause depression
7. worsened symptoms of peripheral vascular diease
Moderately selective BBs (ie, all BBs not named Propranolol) are less likely to cause...
masking of diabetes
What are the alpha1 antagonists that are useful in treatment of BPH, and 2nd tier for treating HTN?
Side effects of these drugs include orthostatic hypotension, fluid retention, and worsening angina...which is secondary to what process?
1. orthostatic hypotension
2. fluid retention
3. worsening angina, due to reflex tachycardia
There are 2 vasodilators that act by relaxing sm mm at peripheral arterioles.
Which one is used for hypertensive emergencies, and patients with chronic/advanced CHF & HTN?
Which one is used in refractory HTN and hair loss?
--patients with advanced CHF/HTN