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Pharm I > test 6 > Flashcards

test 6 Flashcards

(46 cards)

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1
Q

What is Hypertension

A

•A sustained systolic blood pressure of greater than 140 mmHg or a sustained diastolic pressure of greater than 90 mmHg

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2
Q

Prehypertension

A

• 120-139/80-89 mmHg

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3
Q

Stage I hypertension

A

• 140-159/90-99 mmHg

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4
Q

Stage II hypertension

A

• ≥ 160/ ≥ 100 mmHg

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5
Q

Primary (Essential) HTN

A
  • No identifiable cause
  • Most common form
  • 90%
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6
Q

Secondary HTN

A
  • Caused by a specific disease process

* Valve disease, coarctation of aorta, pregnancy

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7
Q

Diagnosis of HTN

A
  • Repeated, reproducible measurements of elevated blood pressure
    * At least three pressure readings over several weeks
    * Evidence of organ damage
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8
Q

Risk Factors for HTN

A
  • Advance age
  • Diabetes
  • Obesity
  • Family history
  • Stress
  • Smoking
  • Poor diet (high fat and sodium)
  • Lack of physical activity
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9
Q

Complications of HTN

A
  • Stroke
  • Ischemic heart disease
  • LV hypertrophy
  • Aortic aneurysm
  • Arrhythmias
  • End organ damage
    * Kidneys, eyes
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10
Q

most antihypertensives work by

A
  1. Reducing cardiac output and/or (HR and contractility)
  2. Decreasing peripheral resistance (vascular tone)
    BP = CO X PVR
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11
Q

4 anitomical sites that control BP

A

1) arteries
2) veins
3) heart
4) kidneys
- all controlled by CNS (sympathetic nerves)

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12
Q

Cardiac output and peripheral vascular resistance are controlled by two overlapping control mechanism

A
  1. Baroreceptor reflexes

2. Renin-angiotensin-aldosterone system

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13
Q

Baroreceptors and the Sympathetic Nervous System

A

•Responsible for the rapid, moment to-moment
adjustments in blood pressure
•Located in the aortic arch and carotid sinuses

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14
Q

Renin-angiotensin-aldosterone System

A

• Baroreceptors respond to reduced arterial pressure by releasing renin
• Renin converts angiotensinogen -> angiotensin I
• Angiotensin I -> angiotensin II by Angiotensin-converting enzyme (ACE)
• Angiotensin II is a potent vasoconstrictor
• Angiotensin II decreases glomerular filtration and increases aldosterone secretion
• Aldosterone increases renal sodium and water reabsorption
-kidneys handle the long term control of BP by controlling the blood volume

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15
Q

More than likely to treat HTN

A

•Frequently more than one category of drug therapy is used to treat HTN to minimize side-effects (combination therapy)

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16
Q

Antihypertensive Drugs

A
  • Angiotensin II receptor blockers
  • Renin inhibitors
  • ACE inhibitors
  • Diuretics
  • β-blockers
  • Calcium channel blockers
  • α-blockers
  • Others
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17
Q

Current recommendations are to initiate

therapy with

A
  • Thiazide diuretic
  • ACE inhibitor
  • Angiotensin receptor blocker (ARB)
  • Calcium channel blocker
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18
Q

Diuretics

A
  • Lower BP by depleting the body of sodium and water, therefore, reducing blood volume
  • Safe
  • Inexpensive
  • Often the first-line drug of choice
  • Often used in combination therapy
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19
Q

how does Thiazide Diuretics work

Study These Flashcards
A

•Inhibit the Na+/Cl cotransporter in the distal tubule
•Increase sodium and water excretion causing a decrease in extracellular volume
-decrease cardiac output => decreasing BP
-decrease in PVR

20
Q

Thiazide Diuretics

Study These Flashcards
A
  • Useful in combination therapy with:
    * β-blockers, ACE inhibitors, ARBs, potassium sparing diuretics
  • Not effective in patients with inadequate kidney function because drug needs to be excreted in the tubular lumen where the transporter exists
  • Can induce hypokalemia, hyperuricemia, hyperglycemia
  • Not recommended during pregnancy
21
Q

How do Loop Diuretics work

Study These Flashcards
A

•Inhibit the Na+/K+/2Cl- cotransporter in the ascending limb
•Blocks Na+, K+, and 2Cl reabsorption in the kidneys
•Cause decreased renal vascular resistance
•Cause increased renal blood flow
-increases excretion of Na, K, and Cl

22
Q

Loop Diuretics

Study These Flashcards
A
  • Acts promptly
  • Works well in patients with poor renal function
  • Can cause hypokalemia
23
Q

Potassium-sparing Diuretics

Study These Flashcards
A
  • Aldosterone receptor antagonist
    * Causes more sodium and water to pass into the collecting duct
  • Reduces potassium loss in the urine
  • Used in combination with loop and thiazide diuretics to reduce potassium loss
24
Q

β-blockers

Study These Flashcards
A

•Block β1 and/or β2 receptors
•Decrease sympathetic outflow from CNS
•Decease CO
• HR and contractility
•Inhibit release of renin from kidneys -> decreases anigotensin II => decrease in PVR => decreased BP
-decrease in angiotensin II => decrease in adosterone => decrease in Na and water reabsorption => decreased CBV => decreased CO => decreased BP
-decrease in BP

25
β-blockers Adverse Effects
* Bradycardia * Hypotension * Fatigue * Insomnia * Sexual dysfunction * Altered lipid pane * Decrease HDL * Increase triglycerides
26
β-blockers that can be given through IV
• Esmolol, metoprolol, and propranolol
27
Stop using β-blockers?
* Abrupt withdrawal may induce * Angina * MI * Death * Must be tapered over a few weeks
28
how do ACE Inhibitors work
* Block the angiotensin converting enzyme (ACE) * Prevents pulmonary and renal endothelium from converting angiotensin I into angiotensin II (potent vasoconstrictor) * Decrease angiotensin II levels in the blood * Vasodilation of arterioles and veins * Increase bradykinin levels * Reduce secretion of aldosterone * Resulting in decrease sodium and water retention
29
angiotensin converting enzyme (ACE) and bradykinin
* ACE is responsible for the breakdown of bradykinin * Bradykinin Increases production of nitric oxide and prostacyclin by blood vessels * Potent vasodilators
30
ACE Inhibitors: Therapeutic Uses
* Course of action in patients with diabetic nephropathy (diabetic kidney disease) * Slows progression * Decreases albuminuria * Standard of care following MI
31
Chronic treatment of ACE Inhibitors achieves
* Sustained blood pressure reduction * Regression of LV hypertrophy * Prevention of ventricular remodeling after MI
32
ACE Inhibitors: Adverse Effects
* Dry cough (number one cause of being taken off drug) * Rash * Fever * Altered taste * Hypotension * Hyperkalemia * Fetal malformations
33
how do angiotensin II receptor blockers (ARBs) work
* Block angiotensin II receptors * Decreasing activation by angiotensin II * Produce arteriolar and venous dilation * Block aldosterone secretion * Lowering BP and decreasing sodium and water retention * Does not increase bradykinin levels
34
angiotensin II receptor blockers (ARBs) course of action in patients with
* Diabetes Mellitus (DM) * Heart failure (HF) * Chronic kidney disease
35
angiotensin II receptor blockers (ARBs) Adverse effects
* Similar to ACE inhibitors * Less risk of cough * Should not be combined with ACE inhibitors * Similar mechanism and adverse effects * Teratogenic (Don't take while pregnant)
36
How do Renin Inhibitors work
* Directly inhibits renin * Decreases sodium and water retention * As effective as ARBs, ACE inhibitors, and thiazides * Should not be combined with ACE inhibitor or ARB * Can cause diarrhea and cough * Contraindicated during pregnancy
37
how do Calcium Channel Blockers work
* Prevents inward movement of calcium into heart cells and smooth muscle of the coronary and peripheral arteriolar vasculature * Causes smooth muscle relaxation * Dilates mainly arterioles * Can be used as initial therapy or add-on therapy
38
what do α1-blockers do
* Selectively block the α1 -receptors in arterioles and venules * Decrease PVR and BP by causing relaxation of both arterial and venous smooth muscle * Cause reflex tachycardia and postural hypotension * Cause salt and water retention * Used with diuretic * Not used as initial treatment for HTN
39
α/β-blockers
•Labetalol and carvedilol •Block α1, β1, and β2 receptors • PVR and BP (block α1) •Carvedilol is mainly used to treat heart failure •Labetalol used to treat gestational hypertension
40
Clonidine (CATAPRESS)
* α2 agonist * Decreases sympathetic outflow from CNS * PVR and BP * Causes relaxation of venules
41
Clonidine: Side Effects
* Dry mouth * Sedation * Constipation * Rebound HTN following abrupt withdrawal
42
Methyldopa (ALDOMET)
* α2 agonist * Similar to clonidine * Decreases sympathetic outflow from CNS * Used to treat HTN during pregnancy
43
how does hydralazine work
* Causes reflex stimulation of heart * Increased contractility, HR, and oxygen consumption * Causes angina, MI, or heart failure * Increases renin causing sodium and water retention * Used in conjunction with a β-blocker and diuretic to reduce side effects * Can be used during pregnancy * Can cause lupus-like syndrome at high doses
44
Minoxidil: Side Effects (vasodilator)
* Severe tachycardia * Dose-dependent * Palpitations * Angina * Headache * Sweating * Hypertrichosis * Excessive hair growth * Co-administered with β-blocker and diuretic
45
Nitroprusside: Side Effects
* Accumulation of cyanide (cyanide poisoning) * Use is limited to 3 days or less * Arrhythmias * Excessive hypotension
46
Treatment of HTN on Pump
* Flow * Anesthetic depth * Drugs

Pharm I (15 decks)

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