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MOHD3 Exam 2 > Hypertension Physiology and Drugs > Flashcards

Hypertension Physiology and Drugs Flashcards

(49 cards)

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1
Q

Prehypertension =

A

120-139 /(OR) 80-89

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2
Q

Stage 1 hypertension =

A

140-159/(OR) 90-99

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3
Q

Stage 2 hypertension =

A

> 160 /(OR) >100

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4
Q

Older people have rise in (systolic/diastolic) pressure

A

systolic

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5
Q

Younger people have rise in (systolic/diastolic) pressure

A

diastolic

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6
Q

It is (easier/harder) to lower systolic hypertension

A

harder

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7
Q

MAP =

A

CO x total peripheral resistance

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8
Q

CO =

A

Heart rate x stroke volume

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9
Q

AT1 receptor for angiotensin II causes

A

vasoconstriction

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10
Q

AT2 receptor for angiotensins II causes

A

vasodilation

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11
Q

ETA receptor for endothelin cause

A

vasoconstriction

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12
Q

ETB receptor for endothelin cause

A

vasodilation

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13
Q

Excess sodium increase causes (increase/decrease) release of NE or EPI

A

increase

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14
Q

Excess sodium increase causes (increase/decrease) response to nE and angiotensin II

A

increase

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15
Q

Excess sodium increase causes (increase/decrease) in intracellular Ca2+

A

increase

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16
Q

Diuretics mechanism:

Uses:

Adverse effects:

A
  1. Decrease extracellular fluid volume and CO
  2. Decrease vascular resistance
  3. Alone or in combo
  4. Heart failure

Deplete K+ –> need K+ supplements

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17
Q

Chlorothiazide, hydrocholorothiazide =

Mechanism:

Effect:

Adverse effects:

A

Thiazide diuretics

Block Na+/Cl- symporter in distal convoluted tubule

Moderate diuresis
Reduced by NSAIDs

Hypokalemia
Decreased uric acid and calcium excretion
Thiazide and sulfonamides cross reactivity

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18
Q

Furosemide =

Mechanism:

Effect:

Adverse effects:

A

high ceiling/loop diuretics

Block Na+, K+ 2Cl- cotransporter in thick ascending limb of Loop of Henle –> greater effect

Use with edema: most effective diuretics
Not as good for HTN

Hypokalemia
Decreased uric acid excretion
Deafness
Allergic reaction (sulfonamide derivative)

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19
Q

Bumetanide=

Mechanism:

Effect:

Adverse effects:

A

high ceiling/loop diuretics

Block Na+, K+ 2Cl- cotransporter in thick ascending limb of Loop of Henle –> greater effect

Use with edema: most effective diuretics
Not as good for HTN

Hypokalemia
Decreased uric acid excretion
Deafness
Allergic reaction (sulfonamide derivative)

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20
Q

Torsemide =

Mechanism:

Effect:

Adverse effects:

Study These Flashcards
A

high ceiling/loop diuretics

Block Na+, K+ 2Cl- cotransporter in thick ascending limb of Loop of Henle –> greater effect

Use with edema: most effective diuretics
Not as good for HTN

Hypokalemia
Decreased uric acid excretion
Deafness
Allergic reaction (sulfonamide derivative)

21
Q

Spironolactone =

Mechanism:

Effect:

Adverse effects:

Study These Flashcards
A

aldosterone receptor blockers
Used in combo

Collecting duct: block sodium and water reabsorption
Potassium SPARING

Mild diuresis
Resistant hypertension
CHF w/ HTN

Hyperkalemia

22
Q

Eplerenone =

Mechanism:

Effect:

Adverse effects:

Study These Flashcards
A

aldosterone receptor blockers
Used in combo

Collecting duct: block sodium and water reabsorption
Potassium SPARING

Mild diuresis
Resistant hypertension
CHF w/ HTN

Hyperkalemia

23
Q

Triamterene =

Mechanism:

Effect in combo w/ ___:

Adverse effects:

Study These Flashcards
A

Potassium sparing diuretics

Late distal tubule and collecting duct
Na+ channel blockers

Combo w/ thiazides –> mild diuresis, weak antihypertensive effect

Hyperkalemia

24
Q

Captorpil, enalapril, lisinopril, fosinopril =

Mechanism:

Study These Flashcards
A

ACE inhibitor

  1. Blocks angiotensin I –> angiotensin II
  2. Elevated bradykinin levels –> vasodilation
  3. Decreased peripheral resistance
  4. Decreased aldosterone –> increase Na and H2O excretion
  5. Increase plasma renin and renin activity
25
Captorpil, enalapril, lisinopril, fosinopril = Use: Adverse effects:
ACE inhibitor mild-moderate hypertension heart failure 1. DRY COUGH 2. Hyperkalemia: inhibition of aldosterone secretion 3. Angioedema: sweling of airway, lips, glottis 4. Hypotension 5. Rash 6. Pregnancy problems
26
Losartan, valsartan, candesartan, irbesartan = Mechanism:
Angiotensin receptor antagonists (ARBs) 1. AT1 receptor antagonists: prevents constriction 2. Vasodilation 3. Increase Na+ and H2O excretion 4. Reduce plasma volume 5. Decrease cellular hypertrophy 6. Increase plasma renin and renin activity
27
Losartan, valsartan, candesartan, irbesartan = Use: Adverse effects:
Angiotensin receptor antagonists (ARBs) Hypertension Heart failure Hypotension Cough or angioedema: less than ACEI Hyperkalemia Fetal renal toxicity
28
Aliskiren = Mechanism: Use: Adverse effects:
renin inhibitor Direct, competitive inhibitor of renin Increase plasma renin but NOT renin activity Hypertension Diabetic or renal impairment Hypotension Dry cough: less than ACEI Hyperkalemia: inhibition of aldosterone
29
Verapamil = Mechanism: Use: Adverse effects:
Cardioselective calcium channel blockers Block L-type Ca2+ channels Relax VSM and decrease peripheral resistance Decrease MAP Negative chronotropic (reduce heart rate) Hypertension Black and old people w/ systolic hypertension Contraindicated in heart failure Depress AV conduction and contractility Headache Gingival inflammation/hyperplasia
30
Diltiazem = Mechanism: Use: Adverse effects:
Cardioselective calcium channel blockers Block L-type Ca2+ channels Relax VSM and decrease peripheral resistance Decrease MAP Negative chronotropic (reduce heart rate) Hypertension Black and old people w/ systolic hypertension Contraindicated in heart failure Depress AV conduction and contractility Headache Gingival inflammation/hyperplasia
31
Nifedipine, nicardipine, amlodipine = Mechanism: Use: Adverse effects:
Vascular smooth muscle selective calcium channel blockers Block L-type Ca2+ channels Relax VSM and decrease peripheral resistance Decrease MAP Hypertension Black and old people w/ systolic hypertension Contraindicated in heart failure Depress AV conduction and contractility Headache Gingival inflammation/hyperplasia
32
Propranolol = Action: Use: Adverse effects:
Non selective beta-adrenergic receptor antagonist Decreased CO Renin secretion Central sympathetic outflow Resetting of baroreceptors Hypertension Nausea, vomiting, confusion, dizziness, fatigue, sleep disorders Avoid w/ pt: 1. asthmatic (block B2 action of bronchodilation) 2. peripheral vascular disease (sensitive to cold, unopposed B1 effect) 3. Diabetics: inability to elevate glucose *rebound hypertension
33
Metoprolol = Action: Use: Adverse effects:
Beta 1 selective receptor antagonist Decreased CO Renin secretion Central sympathetic outflow Resetting of baroreceptors Hypertension Nausea, vomiting, confusion, dizziness, fatigue, sleep disorders Avoid w/ pt: 1. asthmatic (block B2 action of bronchodilation) 2. peripheral vascular disease (sensitive to cold, unopposed B1 effect) 3. Diabetics: inability to elevate glucose *rebound hypertension
34
Prazosin, doxazosin = Mechanism: Use: Adverse effects:
Alpha-1 adrenergic receptor antagonist Blockade of alpha-1 receptors on vascular smooth muscle Dilation of arterioles and capacitance veins Alone or combo for hypertension Pheochromocytoma: increased epinephrine release Reflex tachycarida, orthostatic hypotension, fluid retention GI upset, palpitation, tinnitus, headache, dizziness, urinary incontinence Water retention --> use with diuretic or beta-antagonist
35
Labetalol = Use:
non-selectie beta and alpha-1 receptor antagonist Chronic hypertension Hypertensive emergencies
36
Carvedilol = Use:
non-selectie beta and alpha-1 receptor antagonist Antioxidant, antiproliferative Hypertension HEART FAILURE
37
Reserpine = Mechanism: Use: Adverse effects:
Inhibitor of adrenergic transmission Deplete NE from adrenergic nerve endings Inhibit reuptake of NE into storage terminal Decrease peripheral resistance and CO Mild to moderate hypertension Combo w/ thiazide diuretic in resistant hypertension patients Postural hypotension Sedation, dry mouth, nightmares Sodium and water retention --> use diuretics
38
Clonidine = Mechanism: Use: Adverse effects:
Central-mediated antihypertensives AGONIST 1. Stimulate brainstem alpha2 adrenergic receptors --> decrease sympathetic outflow 2. Vagal activity to heart increased 3. Decreased peripheral vascular resistance and CO Resistance hypertension Rebound hypertension Sedation, dry mouth, depression, drowsiness Sodium and water retention --> use diuretic Postural hypotension in elderly
39
Alpha-methyldopa = Mechanism: Use: Adverse effects:
Central-mediated antihypertensives AGONIST 1. Stimulate brainstem alpha2 adrenergic receptors --> decrease sympathetic outflow 2. Vagal activity to heart increased 3. Decreased peripheral vascular resistance and CO Pregnancy -induced hypertension Rebound hypertension Sedation, dry mouth, depression, drowsiness Sodium and water retention --> use diuretic Postural hypotension in elderly
40
Hydralazine = Mechanism: Use: Adverse effects:
Vasodilators Reduce intracellular calcium Preferential effect on arterioles (vs. arteries and veins) Decreased PVR, MAP Reflex increase in HR, contractility, CO Mild to moderate hypertension + diuretic and beta blocker Headache, anorexia, nausea, dizziness, sweating Reflex tachycardia --> Angina or ischemic arrhythmias w/ ischemic heart disease Increase renin and fluid retention Immune response (Lupus)
41
Minoxidil = Mechanism: Use: Adverse effects:
Vasodilators Preferential effect on arterioles Decreased PVR Activates K+ channels --> VSM relaxation Reflex increase in HR, contractility, CO, renin secretion and fluid retention Resistant hypertension + diuretic and beta blocker Fluid retention: contraindicated in heart failure Pericardial effusion and cardiac tamponade Reflex tachycardia Abnormal hair growth (Rogain)
42
Nitroprusside = Mechanism: Use: Toxic effects:
Direct vasodilator Generates NO --> activate guanylyl cyclase --> increase cGMP Effect on veins (reduce preload) and arteries (reduce afterload) Produce hypotension in surgery Hypertensive emergencies Rapid MAP decrease Cyanide accumulation
43
Nitroglycerin = Mechanism: Use: Side effects: Pharmacokinetics:
Vasodilator Preferential effect on VEINS Generates NO --> activate guanylyl cyclase --> increase cGMP Produce hypotension in surgery Hypertensive emergencies Headache Short duration
44
Epoprostenol = Mechanism: Use:
prostacyclin = vasodilator Direct vasodilator via cAMP Counteracts thromboxane A2 Potent antihypertensive Primary pulmonary hypertension Administered continuously
45
Bosentan = Use: Adverse effect:
Non-selective endothelin receptor blocker Primary pulmonary hypertension ``` Edema, headache Spermatogenesis inhibition Respiratory tract infection Decreased hematocrit Decrease bile salt secretion --> accumulate --> liver damage Birth defect ```
46
Ambrisentan = Use: Adverse effects:
ETA receptor blocker Primary pulmonary hypertension ``` Edema, headache Spermatogenesis inhibition Respiratory tract infection Decreased hematocrit Decrease bile salt secretion --> accumulate --> liver damage Birth defect ```
47
Riociguat Mechanism: Use: Adverse effects:
Directly stimulates guanylyl cyclase --> increase cGMP Primary pulmonary hypertension Thromboembolic pulmonary hypertension Combined w/ ET receptor blockers Headache, dizziness, nausea, diarrhea Hypotension Birth defects
48
ACE inhibitor or ARB w/ thiazide diuretic treats:
stage 2 hypertension
49
ACE inhibitor or ARB w/ CCB
stage 2 hypertension

MOHD3 Exam 2 (13 decks)

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