Intro to Antihypertensive Agents I Flashcards Preview

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Flashcards in Intro to Antihypertensive Agents I Deck (44):
1

prehypertension

SBP 120-139
DBP 80-89

recommend lifestyle changes

2

stage 1 HTN

SBP 140-159
DBP 90-99

begin treating HTN

3

stage 2 HTN

SBP >160
DBP >100

4

mean arterial pressure

MAP = CO x TPR

5

cardiac output

CO = HR x SV

6

drug strategy with HTN

reduce CO
reduce TPR

7

compensation for HTN meds**

reflex tachycardia - increased symapthetics

edema - increased renin activity

**so can add different drug to counteract

8

weight reduction

5-20 decreased SBP

9

DASH diet

8-14 decreased SBP

10

dietary sodium reduction

2-8 decreased SBP

11

physical activity

4-9 decreased SBP

12

moderation of alcohol

2-4 decreased SBP

13

antihypertensive sites of action

arterioles
venules
heart
kidneys

14

major classes of antihypertensive meds

-diuretics
-agents blocking ANG action
-direct vasodilators
-sympathoplegic agents

15

diuretics

act at kidney tubules

16

agents that block ANG action

- angiotensin receptors of vessels
-beta-receptors of JG cells
-ACE inhibitors
-renin inhibitors

17

direct vasodilators

on vascular smooth m.

18

sympatholytics

-vasomotor center of brain
-beta-receptors of heart
-alpha receptor of vessels
-beta receptors of JG cells

19

patients with CKD

ACE inhibitors
ARB (angiotensin receptor blocker)

20

black patients without CKD

thiazide diuretic
calcium channel blockers

21

nonblack patient without CKD

thiazide diuretic**
ACE inhibitor
ARB
CCB

22

kidney blood flow

20-25% of CO

23

carbonic anhydrase

formation/dehydration of carbonic acid in proximal tubule

24

proximal tubule activity

-active reabsorption of HCO3, NaCl, K, glucose, AAs
-passive reabsorption of water

-Na/K pump maintains Na concentration in cell low

-carbonic anhydrase

**site of action of carbonic anhydrase inhibitors

25

thin descending loop of henle

water reabsorption

26

thin ascending loop of henle

impermeable to water, other ions/solutes

27

thick ascending loop of henle

Na/H/2Cl cotransport
-established concentration gradient

28

K leak in thick ascending limb

high K in cells - K diffuses back to lumen

-creates positive charge- drives the paracellular reabsorption of Mg, Ca

29

tubular fluid

concentrated in descending limb and diluted in ascending limb

30

distal convoluted tubule

-10% NaCl reabsorbed
-impermeable to water

Na/Cl cotransporter - active NaCl out of lumen

-Ca is reabsorbed by calcium channels

31

thiazide diuretics

blocks Na/Cl cotransporter in the distal convoluted tubule

32

Ca reabsorption

distal convoluted tubules
-has Ca channels
-regulated by PTH

-increased PTH/increased reabsorption

33

most important site of K secretion**

collecting tubule
-site where all diuretic induced K balance changes occur

**most diuretics - hypokalemia - bc more sodium to CT lumen > more Na pulled out at ENaC > causes more K secretion**

**also hypokalemia with metabolic alkalosis > lumen negative favors retention of H+ in lumen > urine pH goes down > body pH goes up**

more Na to CT - more K secretion

34

collecting tubule

-proton pump - increased urine acidity
-ENaC - 2-5% Na reabsorption

creates electrical gradient that facilitates K secretion down concentration gradient

35

aldosterone

increased ENaC and basolateral Na/K ATPase in collecting tubule

water retention - increase in blood volume and BP

36

ENaC

in collecting tubule
-increased Na reabsorption
-2-5% of total
-does create gradient to facilitate K secretion

37

ADH

aka vasopression
-released from pituitary
-increases aquaporin 2 on collecting tubules
-via V2 receptor

-increased water reabsorption

38

ADH level control

serum osmolality and volume status

39

diuretics

-carbonic anhydrase inhibitors
-loop diuretics
-thiazide diuretics
-potassium-sparing diuretics

40

diuretic use

increase rate of urine flow

edematous and nonedematous states

41

site of loop diuretics

Na/K/2Cl cotransporter in thick ascending limb

42

site of thiazide diuretics

Na/Cl cotransporter

43

site of potassium sparing diuretics

sodium channels

44

site of potassium sparing diuretics

mineralocorticoid receptors

and sodium channels