Topic 7 Antihypertensive Flashcards by Rachel ramella

“Staged” HTN:

Pre-HTN (mmHg)

120-130/80-90 mm Hg

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“Staged” HTN

Stage 1 HTN (mmHg)

140-160/90-100 mm Hg

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“Staged” HTN

Stage 2 HTN (mmHg)

> 160/100 mm Hg

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Hypertension pressures?

Sustained systolic BP > 140 (120)mmHg or a sustained diastolic BP > 90 mm Hg

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Primary (Essential)

HTN is caused by a blend of nurture and nature, is generally idiopathic (what’s this?) and is the most common form (~90%)

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Secondary HTN

caused by a specific etiology and is less common (~10%)

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BP =

CO x SVR

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most antihypertensives work to alter

blood pressure by what two things

1)Decreasing cardiac output
or
2)Decreasing peripheral resistance

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CO and SVR are generally controlled by what two things?

1) The SNS and baroreceptotor feedback.
and/or
2) The Renin/Angiotensin System

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Frequently HTN is treated with what type of therapy ?

“combination therapy”

more than one category of drug therapy is used to treat HTN to minimize side-effects

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In critters with “stiff” arteries, having 110%

of normal blood volume can cause

profound HTN

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In critters with “stiff” arteries having 95% of normal blood volume can mean

the critter’s normotensive

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First line of defense against HTN

Diuretics

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Why are Diuretics the first line of defense against HTN?

fairly safe (wide therapeutic margin) and inexpensive

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Recent evidence indicates diuretics are

superior for treatment of HTN in what population?

In the elderly

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Second line of defense against HTN

β-Blockers

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β-Blockers decrease what?

Decrease C.O.
Decrease SNS “tone”
Decrease renal renin release

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Nadolol

Nonselective β-Blockers

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Atenolol and Lorpressor, Toprol-XL are what type of drug?

Beta 1 Selective Blockers

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“Bystolic” is what type of drug?

β₁-selective and a potent vasodilator

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β-Blockers are best on what demographic

Evidence suggests these are best in young &

white patients

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β-Blockers are NOT best with what demographic?

NOT well suited for patients with CHF, asthma,
&/or COPD. Black patients respond relatively
poorly

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Third line of defense against HTN

ACE-Inhibitors

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“ACE” = stands for what?

“Angiotensin Converting Enzyme”

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ACE-Inhibitors prevent what conversion?

Prevents pulmonary and renal endothelium | from converting Angiotensin I into Angiotensin II (the active form)

Commonly used as a first line drug post-MI for HTN

ACE Inhibitors

Can be used in patients with systolic dysfunction to treat HTN

ACE Inhibitors

Biggest use-limiting side-effect of ACE Inhibitors

dry cough

Captopril

Capoten ACE Inhibitors

Enalapril

Vasotec ACE Inhibitors

Lisinopril

Prinivil, Zestril ACE Inhibitors

Benazepril

Lotensin ACE Inhibitors

Fosinopril

Monopril ACE Inhibitors

Moexipril

Univasc ACE Inhibitors

Quinapril

Accupril ACE Inhibitor

Ramipril

Altace ACE Inhibitor

Trandolapril

Mavik ACE Inhibitor

DON’T cause bradykinin release and fewer respiratory side-effects (particularly coughing)

Angiotensin II-Receptor Blockers (“ARBs”)

Losartan

Cozaar ARB

Valsartan

Diovan ARB

Candesartan

Atacand ARB

Eprosartan

Teveten ARB

Irbesartan

Avapro ARB

Telmisartan

Micardis ARB

Olmesartan

Benicar ARB

Aliskiren

Tekturna Renin Inhibitor

Capoten

Captopril ACE Inhibitor

Vasotec

Enalapril ACE Inhibitor

Mavik

Trandolapril ACE Inhibitor

Altace

Ramipril ACE Inhibitor

Accupril

Quinapril ACE Inhibitor

Univasc

Moexipril ACE Inhibitor

Monopril

Fosinopril ACE Inhibitor

Lotensin

Benazepril ACE Inhibitor

Prinivil, Zestril

Lisinopril ACE Inhibitor

- Act by decreasing the outflow of sympathetic firing from the CNS. - Decreased peripheral vascular tone - Used in combination therapies

α₂-Agonists or Centrally Acting Sympathoplegics

α₂-Agonists major side effect

All tend to cause sedation as a major side-effect

Clonidine

Catapres, Duraclon α₂-Agonist

Clonidine useful in what patients? why?

Dilates peripheral vessels but not renal arteries | Useful in HTN complicated by renal disease

α-Methyldopa

Aldomet α₂-Agonist

α-Methyldopa has less what?

less trans-placental passage

blocking α₁ SNS stimulation causes what?

smooth muscles to relax......resulting in both venous and arterial dilation

Prazosin

Minipres α₁-Blockers

Doxazosin

Cardura α₁-Blockers

Terazosin

Hytrin α₁-Blockers

Hydralazine

Apresoline

Hydralazine (Apresoline) how does it work?

Causes endothelial cells to release nitric oxide—a potent vasodilator causing smooth muscle relaxation

Hydralazine (Apresoline) greatest effect

Arterial & arteriole effect >>venous effect

Hydralazine (Apresoline) does what to SVR and BP?

SVR falls. | Arterial pressure drops

Hydralazine (Apresoline) typical adult dose

Typical adult bolus: 2.5-5.0mg q15 minutes (maximum20-40mg

Hydralazine (Apresoline) dose for severe acute HTN

Typical dose for severe acute HTN (including pregnancy-induced): 10-20 mg slow IV

Nitroglycerin does what at lower doses?

At lower doses venous dilation>arterial

Nitroglycerin does what at higher doses?

At higher doses arterial dilation>venous

Used for treatment of angina for > 100 year

Nitroglycerin

How does Nitroglycerin work?

Converted to nitric oxide by mitochondrial | enzymes

Nitroglycerin decreases what ? (4)

Decreases B.P., pulmonary capillary wedge pressure, and SVR. Decrease myocardial O2 demand during ischemia while leaving contractility unaffected

pts with “coronary spasms” or “air down | the coronaries" use what often ?

Nitroglycerin

How to administer Nitroglycerin on bypass?

Dosing on bypass typically via bolus or IV | infusion to affect, tends to be site specific

Nitroglycerin Typical adult dose

Typical adult dose:–50-100μg bolus–0.1-7.0μ g/kg/minute

Nitroglycerin Typical pediatric infusion

Typical pediatric infusion:–0.1-0.5μg/kg/minute

Nitroprusside

“Nipride” or “Nitropress"

Nitroprusside (Nipride or Nitropress)

Potent arterial & capacitance dilator. ...so it decreases both preload and afterload which helps increase C.O. in patients with heart failure

Nitroprusside (Nipride or Nitropress) MUST be given how?

parenterally

Nitroprusside (Nipride or Nitropress) used to control what on CPB?

Very commonly used to control BP on CPB | both bolus and IV drip

Nitroprusside (Nipride or Nitropress) breaks down into what 2 things?

Breaks down in the blood stream into nitric | oxide and cyanide

Nitroprusside (Nipride or Nitropress) T1/2?

1-2 minutes

Nitroprusside (Nipride or Nitropress) toxic metabolite ?

toxic metabolite thiocyanate has a half-life of many days

Nitroprusside (Nipride or Nitropress) normal adult dosage?

Normal adult dosage is 0.5-10.0 μg/kg/min (peds receive the low end of this dose)

Nitroprusside (Nipride or Nitropress) can cause toxicity when?

DO NOT give at higher dosages for more than ten minutes or toxicity can result

Cyanide “shuts down” what?

cellular metabolism

Nitroprusside & NTG are often used at what point of bypass

at CPB termination

Topic 7 Antihypertensive Flashcards

(91 cards)