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Chiro Y4 - Diagnosis & Management > Hypertension medication > Flashcards

Hypertension medication Flashcards

1
Q

Blood pressure formula?

A

Blood pressure = cardiac output x vascular resistance

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2
Q

What is systolic and what is diastolic?

A

systolic - when the heart contracts (120), diastolic - when the heart relaxes (80)

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3
Q

What is cardiac output?

A

the amount of blood leaving the heart per minute

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4
Q

How can cardiac output be altered?

A

heart rate (speed), the volume it ejects with each contraction

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5
Q

What is vascular resistance?

A

There is total, peripheral and central, and it is the resistance that the blood encounters as it travels through the blood stream

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6
Q

How can vascular resistance be altered?

A

size of vessels (dilate or constrict), thickness of blood (number of blood cells, severe dehydration), length of vessels

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7
Q

Factors causing elevated BP?

A

elevated cardiac output or increased resistance in the blood vessels?

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8
Q

What blood pressure medications are there?

A

AAAABCD
they can work by addressing the cardiac output or vascular resistance or both

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9
Q

What are the groups of blood pressure medications?

A

AAAABCD
Alpha-1-Blockers, ACE inhibitors, Angiotensin-2-Receptor Blockers, Aldosterone Blocker’s, Beta Blockers, Calcium Channel Blockers, Diuretics

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10
Q

Alpha-1 Antagonists / Blockers

A

the -Osins : Prazosin, Doxazosin, Terazosin
they BLOCK alpha-1 -> dilating effect on blood vessels with Alpha 1 receptors -> decreased resistance -> decreased BP
not commonly used

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11
Q

The Androgenic System - Adrenaline

A

fight/flight response, adrenaline
Alpha 1 and Beta 1 Receptors: when bind with noradrenaline they stimulate cells to DO their function; Alpha 2 and Beta 2 Receptors: triggers them to STOP their function
Adrenergic receptors, generally located on blood vessels, if noradrenaline binds it causes the vessels to constrict

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12
Q

The Androgenic System - Noradrenaline

A

Sympathetic response, noradrenaline
Alpha 1 receptors: stimulating smooth vessels on blood vessels -> constrict -> narrow diameter -> increased vascular resistance -> increased BP

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13
Q

Alpha 1 Blockers - Side effects

A

postural hypotension, stress incontinence (laughing, sneezing)

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14
Q

What group of hypertension medication ends in -osin (prazosin, doxazosin, terazosin)

A

Alpha 1 Blockers / Antagonists

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15
Q

ACE inhibitors

A

the -prils : ramipril, lisinopril, enalapril, perindopril
work on the kidneys, specifically the renin-angiotensin system (inhibiting ACE) -> no Angiotensin II is made -> no other processes occur to raise BP
also appear more effective at kidney, brain and heart, plus an effect of increased bradykinin release (vasodilator)

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16
Q

Importance and role of the Renin-Angiotensin-Aldosterone System

A

kidneys need to filter 1L of blood per minute to maintain GFR, if the volume drops, the kidneys won’t filter properly, renin-angiotensin system is activated when the volume drops

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17
Q

How does the RAAS work?

A

BP low, blood volume low -> triggers release of renin
renin activates angiotensinogen which is released from the liver and turns it into angiotensin I ; angiotensin I travels to the lungs which produce a lot of ACE, it is converted into angiotensin II

18
Q

What does ACE stand for?

A

Angiotensin Converting Enzyme

19
Q

Function of Angiotensin II

A

general vasoconstrictor (increased resistance -> increased BP)
travels to adrenal glands, triggers aldosterone
travels to hypothalamus, triggers release of anti-diuretic hormone which travels to the kidneys and causes resorption of water

20
Q

Function of aldosterone

A

travels back to the kidneys, increases resorption of Na+ back into the blood, which causes water to follow -> increased blood volume -> increased BP

21
Q

ACE inhibitors - Side effects

A

cough (significant side effect bc of bradykinin release)
proteinurea (bc of effect on kidneys)

22
Q

Angiotensin-2-Receptor blockers (ARBs)

A

the -sartan’s: candesartan, irbesartan, losartan, valsartan, olmesartan
angiotensin is still made but ARB blocks angiotensin’s ability to bind to its receptor -> can’t work, ARB bind to receptors on vasculature, parts of the nervous system and the kidneys

23
Q

What medication is used if an ACE inhibitor causes a cough?

A

Angiotensin-2-Receptor Blockers

24
Q

When are ARBs used?

A

after an ACE inhibitor if it causes a cough
may be used in adolescents with hypertension
may be used in those with diabetes & hypertension

25
Q

Angiotensin-2-Receptor Blockers - side effects

A

hypotension, teratogenic

26
Q

What is teratogenic?

A

substances that cause congenital disorders to the developing foetus
aka.: don’t take when pregnant

27
Q

Aldosterone blockers

A

example: eplenerone, spirinolectone, spirolacin
technically a diuretic
aldosterone travels to the distal convoluted tubule and increases the resorption of sodium (Na) and water back into the blood -> increases BP, therefore: stop aldosterone -> stop rise in BP
can be called potassium sparing diuretics as other diuretics expel potassium

28
Q

Aldosterone blocker - side effects

A

impotence, gynecomastea
- runs similar to the androgens (male sex hormones) since both released by adrenal gland

29
Q

Beta blockers

A

the -olols : atenolol, bisoprolol, propranolol
work by blocking beta receptors
beta 1 + noradrenaline -> stimulate receptors / tissues to do their job; beta 2 + noradrenaline -> inhibits tissue from doing its job
two types: selective and non-selective
not used much (not very effective, especially in pts 60+)

30
Q

Non-selective beta blockers

A

example: propranolol
inhibit both Beta 1 and Beta 2
Usually:
Beta 1 receptors (on heart) + noradrenaline -> HR increase
Beta 2 receptors (on airways) + noradrenaline -> inhibit (dilate)
With beta blocker:
Beta 1 -> heart will relax (blocks stimulation)
Beta 2 -> blocks inhibitory effect -> activation -> airway constriction

31
Q

Side effect of non-selective beta blockers

A

airway restriction -> NOT advised for patients with asthma or COPD

32
Q

Selective Beta Blockers

A

block only Beta-1 -> no bronchoconstriction effects
used less for hypertension and more for anxiety now (“off label use”)

33
Q

Side effects of selective beta blockers

A

some will also block alpha-1 -> cardiac side effects
some increase nitrogen oxide -> vasodilation effects
airway constriction (non-selective)
bradycardia
general fatigue
cold extremities

34
Q

Calcium Channel Blockers

A

the -pine’s : Amlodipine, Felodipine, Nicardipine
block calcium from entering contractile cells -> reduce contractile force
Two types:
- Dihydropyridines -> work on heart
- Non-dihydropyridines -> work on vessels

35
Q

Nifedipine

A

specific to blood vessels (CCB)

36
Q

Felodipine

A

heart and vessels
more likely to have a side effect of constipation and tingling of hands and feet
(CCB)

37
Q

Calcium Channel Blocker - side effects

A

tingling in hands and feet
constipation
ankle swelling (edema)
dizziness
fatigue
headache
nausea
rash

38
Q

Diuretics

A

Thiazide (Chlorothiazide, Indamapide, Chlorthalidone) and Thiazide-like diuretics (Chlortalidine, Xipamide, Metolazone)
increase urine output -> decrease blood volume -> decrease BP
increase output of water directly and output of ions (Na, K, Mg)
work at the distal convoluted tubule

39
Q

Diuretics - Side effects

A

reabsorption of calcium
increased frequency of urination

40
Q

Loop Diuretics

A

work on the ascending part of the Loop of Henle: Channels which reabsorb 2 Cl, 1 Na and 1K by absorbing lots of ions -> absorb lots of water
with loop diuretic: block these channels, ions and water remain in tubule, are excreted out
powerful diuretics
not used in isolation due to risk of hypocalcaemia

Chiro Y4 - Diagnosis & Management (5 decks)

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