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Treatment of Hypertension Flashcards

1
Q

risk of end organ damage lowest at what BP?

A

115/75

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2
Q

Risk of end organ damages with every of increment of what mm Hg?

A

20/10

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3
Q

increase of systolic BP with age reflects progressive _________ of arterial circulation

A

stiffening

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4
Q

BP reading of systolic 130-139 and diastolic 80-89 indicates what stage of hypertension?

A

stage 1, assess 10 yr risk, if >10% risk give BP med

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5
Q

BP reading of systolic >140 and diastolic >90 indicates what stage of HTN?

A

stage 2, give 2 BP lowering meds of different classes

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6
Q

black patients usually respond well to treatment with _______ and _______, but have smaller BP reductions with ACE inhibitors/ARBs/and Beta blockers

A

calcium channel blockers, diuretics

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7
Q

progression of hypertension with age - cardiac output _______ and TPR ________

A

decreases

increases

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8
Q

drugs that deplete the body of sodium and reduce blood volume

A

diuretics

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9
Q

reduce peripheral vascular resistance

A

agents that interacts with angiotensin

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10
Q

relax vascular smooth muscle and dilate resistance vessels

A

direct vasodilators

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11
Q

reduce peripheral vascular resistance, inhibit cardiac function, increase venous pooling

A

sympatholytic agents

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12
Q
  • thiazide diuretics inhibit _____ reabsorption in DCT

- use at low dose to lower ______ and high dose second to loop diuretics in _______

A

NaCl

BP, CHF

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13
Q

________ is the preferred thiazide diuretic bc of long half life and proven trial reduction of CVD

A

chlorthalidone

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14
Q

thiazide diuretics are most effective in what patient populations?

A

african americans and elderly

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15
Q

this drug class clinically used for:

  • HTN, low dose
  • CHF, higher dose
  • nephrolithiasis: due to idiopathic hypercalciuria to reduce urine calcium concentration
  • nephroenic diabetes insipidus: to reduce polyuria and polydipsia
A

thiazide diuretics

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16
Q

adverse effects of this drug are:

  • hypokalemic metabolic alkalosis
  • hyponatremia
  • hyperGLUC: glycemia, lipidemia, uricemia, calcemia
  • erectile dysfunction, sulfa allergy
A

thiazide diuretics

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17
Q

the only ACE inhibitor that’s an active drug?

A

captopril

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18
Q

ACE inhibitors work by inhibiting conversion of ang-1 to ang-2, which decreases _________, also increased ______ levels

A

peripheral vascular resistance

bradykinin

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19
Q

ACE inhibitors do not cause ________ because of concurrent baroreceptor resetting or vagal activation

A

reflex tachycardia

20
Q

ACE inhibitors are most effective in what population?

A

young and middle aged Caucasians

21
Q
  • side effects of this drug include:
  • dry, hacking, nonproductive cough
  • hyperkalemia due to inhibited aldosterone
  • angioedema and anaphylaxis
  • acute renal failure
  • do not use in combo with ARBs or direct renin inhibitor
  • contraindicated in pregnancy
A

ACE inhibitors

22
Q
  • sartans
  • more specific than ACE inhibitors, do not affect bradykinin metabolism
  • more complete inhibition of angiotensin action
A

angiotensin receptor antagonists (ARBs)

23
Q

-verapamil, diltiazem, amlodipine, felodipine, isradipine, nicardipine, nifedipine, nimodipine, nisoldipine

A

calcium channel blockers

24
Q

calcium channel blockers work by reducing intracellular calcium, _____ arteriolar smooth muscles, leading to _______ and lower BP

A

relax

vasodilation

25
calcium channel blockers most effective in what population?
elderly and african americans (similar to thiazide effectiveness)
26
CCBs: - _______ are the strongest vasodilators, but are most likely to produce reflex tachy - _______ has the strongest cardiac effects, and don't cause reflex tachy b/c they depress SA and AV node conduction
dihydropyridines (nifedipine) verapamil
27
____ and ____ are CCBs that are contrainidicated in patients with SA or AV noe abnormalities b/c they cause bradycardia
verapamil, diltiazem
28
atenolol, betaxolol, bisoprolol, and metoprolol are _______ beta blockers
cardioselective
29
nebivolol is a cardioselective and _______ beta blocker
vasodilatory (NO production)
30
nadolol and propanolol and ________ beta blockers
non-cardioselective
31
acebutolol, penbutolol, pindolol, and carteolol are beta blockers with _________ activity
intrinsic sympathomimetic
32
carvedilol and labetolol are beta blockers with __________ activity
alpha and beta receptor (a1 antagonists)
33
beta blockers are most effective in which population?
caucasians, young hypertensives
34
beta blockers are combined with other antihypertensives to counteract: - ______ caused by vasodilators - _________ caused by thiazide and loop diuretics
reflex tachy increased renin secretion
35
- beta blockers delay recovery of normoglycemia b/c it inhibits hyperglycemic responses mediated by ______ - significant risk of new onst diabetes - abrupt cessation can lead to tachycardia, angina, MI
epinephrine
36
- renin inhibitor - orally active - dose dependent reduction of plasma renin and BP - avoid in pregnancy
aliskiren
37
- blocks renin secretion | - reduction in renal sympathetic nerve activity
clonidine
38
- zosins - reduce norepi induced vasoconstriction to dilate both arteries and veins - BP falls b/c of decreased peripheral vascular resistance - second line for BPH - adverse hypotension, dizziniess, palpitations
alpha antagonists
39
clonidine, methyldopa, and guanfacine are _________ drugs - act on alpha-2 receptors, reduce peripheral vascular resistance - sedation and dry mouth, sudden withdrawal leads to hypertensice crissi - methyldopa limited to pregnancy
centrally acting sympatholytics
40
-oral vasodilators for chronic antihypertensive treatment
hydralazine or minoxidil
41
- sodium nitroprusside - diazoxide - fenoldopam - enalprilat - nicardipine - hydralazine - act on smooth muscle to cause relaxation and reduced vascular resistance
IV vasodilators
42
hydralazine, monoxidil, and diazoxidde dilate _______ selectively
arteries
43
_______ is a balanced vasodilator of both arteries and veins
sodium nitroprusside
44
adverse effects of this drug: - reflex tachy - increased mycocardial contractions - increased renin secretion - fluid retention - headaches - flushing, palpitations
vasodilators
45
- the vasodilator _______ may cause a lupus like syndrome | - _______ causes hypertrichosis (rogaine)
hydralazine minoxidil
46
in pregnant women, use a _______ or _______, methyldopa and hydralazine may also be used
beta blocker (labetolol) CCB (nifedipine)

IC (29 decks)

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