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Flashcards in Hypertensives Deck (71)
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1

prehypertensive BP

120-139/80-89

2

hypertension BP

greater than 140/90

3

What is required for the diagnosis of hypertension?

repeated and reproducible measurements of elevated BP

4

What are the causes of essential hypertension?

alterations in CV control, humoral factors, genetic factors, lifestyle, psychogenic factors

5

What are some complications of hypertension? (target organ damage)

hemorrhage, stroke, retinopathy, peripheral vascular disease (atherosclerosis) heart disease (increase work load), renal failure

6

What are the anatomic sites od BP resistance?

arterioles (decrease resistance), venules (decrease capacitance), heart (decrease cardiac output), kidneys (decrease volume).

7

What is the short term mechanism of the body for control of BP?

baroreceptors provide moment to moment adjustments

8

What is the long term mechanism of the body for control of BP?

Kidneys control intravascular blood volume.

9

What are the three major sites of action for antihypertensive drugs?

SNS (CNS also), renal loop and vascular smooth muscle.

10

What are some non pharmacological therapy or htn?

Low NaCl diet, weight reduction, exercise, smoking cessation, decrease alcohol, relaxation, increase polyunsaturated fat intake, increase fruits/veggies

11

What are the general drug classes for antihypertensives? (10)

beta blockers, thiazide diuretics, ace inhibitors, angiotensin II antagonists, Ca channel blockers, alpha blockers, CNS acting drugs, vasodilators, hypertensive emergencies and adrenergic neuron blocking agents

12

What is the nonselective beta blocker?

propranolol

13

What is the beta 1 selective beta blocker?

Metoprolol

14

mechanism for beta blockers?

1. decrease contractility, HR, CO and BP.
2. decreases renin release, prevents AII formation and decreasing BP

15

Precautions for beta blockers

heart failure, diabetes, asthma

16

Adverse effects of beta blockers

fatigue, disturbing dreams, nausea, GI discomfort, insomnia and occasional impotence

17

What is the Thiazide diuretic you need to know?

hydrochlorothiazide

18

What is the mechanism of hydrochlorothiazide?

1. inhibits Na transport by depleting Na stores (decreases constrictor responses)
2. decrease blood volume, CO and BP.
3. Chronic use decreases PR and BP.

19

What effect does thiazide diuretics have on other drugs?

Potentiates the action of other anti-hypertensive drugs

20

Adverse effects of thiazide diuretics?

hypokalemia, drowsiness, increases LDL and apathy.

21

What does ACE in ACE inhibitors stand for?

Angiotensin Converting Enzyme

22

What two ACE inhibitors do we need to know?

Captopril and Enalapril

23

mechanism for ACE inhibitors

decreases the formation of angiotensin II (blocks AI conversion to AII), decreases PR. Little to no change in CO and HR. Blocks release of aldosterone. No CNS effect. Blocks bradykinin to metabolite rxn.

24

Which ACE inhibitor is more potent and long lasting?

Enalapril

25

Which drugs are used for the tx of congestive heart failure?

ACE inhibitors (captopril and enalapril), Angiotensin II receptor antagonists (losartan), verapamil, diltiazem

26

What are the limitations of ACE inhibitors?

pregnant women and nursing mothers

27

adverse effects of ACE inhibitors?

coughing, reversible rash, taste alteration, hyperkalemia

28

What is the drug we need to know for Angiotensin II receptor antagonists?

Losartan

29

What is losartan's mechanism?

1. selective angiotensin II receptor blocking agent, decreases PR and BP.
2. Decreases aldosterone release (slight decrease in blood volume).
3. No change in bradykinin levels

30

What are the limitations for Losartan?

pregnant and nursing women

31

What are the adverse effects of Losartan?

GI complaints, postural hypotension and hyperkalemia potential

32

What are the three calcium entry blockers?

verapamil, diltiazem and nifedipine

33

What is the mechanism for Ca entry blockers?

blocks entry of Ca into cells (L type channels) in the heart and some smooth muscles.

34

What effect does Ca entry blockers have on vascular smooth muscle?

decreases PR and BP.
Nifedipine > Verapamil >/= Diltiazem

35

What effect does Ca entry blockers have on cardiac muscle?

decrease contractility and CO
Verapamil > Nifedipine

36

What side effect does Nifedipine have?

mild reflex tachycardia

37

What effect does Verapamil and Diltiazem have on HR and what is it's effect?

decreases HR and blunts reflex tachycardia.`

38

What are the (tx) limitations to Ca entry blockers?

SA/AV nodal abnormalities, CHF (verapamil and diltiazem).

39

What is the adverse effect of Verapamil?

constipation

40

What are the adverse effects of nifedipine?

HA, flushing and dizziness

41

what is an adverse effect of diltiazem and verapamil?

bradycardia

42

What alpha blocker do we need to know?

Prazosin

43

What is Prazosin's mechanism?

It is a selective alpha 1 antagonist, decrease PR and BP. Has minimal reflex tachycardia, may increase blood V, LDL and HDL

44

What is the adverse effects of prazosin?

first dose hypotension, dizziness and fatigue

45

What are the two CNS acting drugs?

alpha-methyldopa and clonidine

46

What is the mechanism of alpha-methyldopa and clonidine?

selective alpha 2-agonists, decrease symph activity from CNS

47

What is alpha-methyldopa's mechanism?

decreases peripheral resistance and BP

48

What is clonidine's mechanism?

decreases sympathetic drive to the heart, decreases contractility, HR and CO

49

What are the adverse effects of CNS acting drugs?

sedation, vertigo, nightmares, drug fever, dry mouth, positive Coomb's test, increase in water retention. Occasional postural hypotension and impotence.

50

What drug combo does alpha-methyldopa and clonidine need?

Diuretics

51

What vasodilator drug do we need to know?

Hydralazine (minoxidil)

52

What is hydralazine used for?

moderate to severe hypertension

53

What is Hydralazine's mechanism?

dilates arteries, arterioles > veins
Increases NO, activates cGMP which leads to dilation (decrease in PR and BP)

54

What is the reflex reactivity of hydralazine?

increases HR, contractility and thus CO
Increases renin, ANG II, aldosterone and water retension.

55

What drug combo des hydralazine need?

Beta blocker and diuretic

56

What are the adverse effects of vasodilators?

hypotension related: HA, sweating, dizziness, flushing nausea, tachycardia, lupus like syndrome (fever, joint pain)

57

What adverse effect does Minoxidil have?

Hair growth

58

Conditions that require rapid BP reduction

"malignant" htn, pheochromocytoma, hypertensive encephalopathy, refractory htn of pregnancy, acute L Vent failure, aortic dissection, coronary insufficiency and intracranial hemorrhage.

59

What two drugs are used in hypertensive emergencies?

Na nitroprusside and labetolol

60

What is the mechanism of Na Nitroprusside?

It is a nonselective vasodilator which dilates arterioles and veins equally, decreases PR and BP. Reflex tachycardia, lil bit CO. RAPID decrease in BP (IV)

61

Adverse effects of Na Nitroprusside?

hypotension (N&V, nervousness). Chronic use: psychosis

62

What are the receptors of labetolol?

Combination alpha, beta-blocker. Non selective beta blocker and a selective alpha-1 blocker

63

What is the mechanism of labetolol?

decreases PR: decreases BP (alpha) and Renin (beta)
HR, CO: slight decrease (not consistent)

64

adverse effects of labetlol

hypotension, GI disturbances, fatigue and nervousness

65

What kind of drug is reserpine?

adrenergic neuron blocking agent

66

What is the mechanism of reserpine?

depletes nerve ending stores of catecholamines. Slow decrease in BP: decrease in CO, bradycardia. Small decrease in reflex tachycardia.

67

What are the adverse effects of Reseprine on the CNS?

sedation, depression and nightmares

68

What are the adverse effects of reserpine on the peripheral?

cramps, diarrhea and increased water retention.

69

Which drugs are and are not suggested for elderly pts?

suggested: ACE inhibitors, diuretics
not: beta blockers, alpha blocker and some Ca channel blockers

70

Which drugs are recommended for black pts? not?

suggested: diuretics and Ca channel blockers
not: beta blockers or ace inhibitors

71

What are some causes of secondary hypertension?

Renal disease, endocrine disease, hyperthyroidism, narrowing of aorta, toxemia of pregnancy, OC