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        |    essential or primary hypertension |  | Definition 
 
        |    90 to 95% of cases where cause is unknown |  | 
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        |    Ethnicity with highest rates of hypertension |  | Definition 
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        |    Chronic hypertension can lead to damage of.... |  | Definition 
 
        |   The cardiovascular system CNS Renal system Retinal damage |  | 
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        |  -Obesity -Stress -Lack of exercise -Diet (excess salt) -Alcohol Intake -Cigarette Smoking |  | 
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        |    percentage of adults with hypertension |  | Definition 
 
        |    50% of people over the age of 60 |  | 
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        | -reduce weight to normal BMI -DASH eating plan -Dietary Sodium reduction -Increase Physical activity -Reduce alcohol consumption |  | 
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        | most common drug choice for stage 1 hypertention |  | Definition 
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        | Most common drug choice for Stage 2 hypertension |  | Definition 
 
        | 2 drug combination   -usually Thiazide-type diuretic and either an Ace inhibitor, Angiotensin receptor blocker, Ca channel blocker or a Beta blocker |  | 
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        | are used to reduce blood volume, which reduces venous return, which reduces stroke volume, which reduces CO, which decreases MAP |  | Definition 
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        | drugs that block myocardial contractility, which decreases SV, then CO, then MAP |  | Definition 
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        | Adverse effect of Diuretics |  | Definition 
 
        | Due to volume and sodium depletion, renin is secreted which will elevate the BP |  | 
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        | First choice diuretic for noncomplicated cases |  | Definition 
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        | chlorothiazide & hydrochorothiazide |  | 
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        | -loop diuretic -Has high ceiling -used to get rid of edema fast |  | 
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        | potassium sparing diuretics |  | Definition 
 
        | 1. Spironolactone   2.Triamterene   3. Amiloride |  | 
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        | 1. Selective Alpha-1 recep blockers (prazosin) 2.Beta-Adrenergic blockers(Propranolol) 3. Agents that act on CNS (methyldopa, clonidine) |  | 
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        | how do Selective Alpha-1 Antagonists decrease BP? |  | Definition 
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        | Adverse effect of using alpha-1 antagonist |  | Definition 
 
        | 1st dose phenomenon (orthostatic hypotension), fluid retention, dizziness, headache |  | 
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        | When and how are selective Alpha-1 antagonist used to treat hypertension? |  | Definition 
 
        | -used in refractory HT -used in stage 1 and 2 in combination with a diuretic and a beta blocker |  | 
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        | Selective alpha-1 antagonist |  | Definition 
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        | non-selective beta blocker (1st generation) |  | Definition 
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        | Selective B1 blocker (2nd generation) |  | Definition 
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        | B-blocker with intrinsic sympathomimetric activity (ISA) 3rd generation |  | Definition 
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        | ways that beta blockers lower BP |  | Definition 
 
        | 1. block cardiac beta-1 receptors & lower CO   2. Block renal Beta-1 recepors & lower renin which lowers PVR |  | 
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        | used to treat diabetes and asthma |  | 
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        | mechanism by which Propanolol works |  | Definition 
 
        | blocks cardiac B1 to lower co & blocks renal B1 to lower renin & PVR |  | 
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        | Adverse effecct Propranolol |  | Definition 
 
        | bradycardia, blocks B2 receptors in airways |  | 
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        | Pharmacokinetics of Propranolol |  | Definition 
 
        | heavily metabolized by first pass 30 to 50%   t1/2- 3-5 hrs |  | 
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        | Used for stage 1 and stage 2 alone or with a diuretic and/or vasodilator |  | 
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        | propranolol drug interactions |  | Definition 
 
        | cant be used with verapamil, diltiazem (Ca channel blockers) or Digitalis b/c they slow A/V node conduction |  | 
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        | A1, B1 and B2 blocker Beta blocking is more prominent. some ISA property |  | 
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        | When and how is Labetalol used? |  | Definition 
 
        | Used in hypertensive emergencies and can be given both orally or by IV |  | 
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        | an A2 agonist that suppresses SNS output from the CNS |  | 
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        | a2 agonist that decreases SNS activity |  | 
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        | Methyldopa & Clonidine main effects |  | Definition 
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        | Methyldopa & Clonidine Adverse effects |  | Definition 
 
        | sedation, bradycardia, rebound hypertension, postural hypotension |  | 
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        | types of vasodilator drugs |  | Definition 
 
        | 1. CA entry blockers   2. Potassium channel openers   3. direct acting vasodilators |  | 
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        | Names of Ca entry blockers |  | Definition 
 
        | Verapamil   Diltiazem   Nifedipine |  | 
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        | Mechanism of action for Ca blockers |  | Definition 
 
        | inhibit Ca entry through L-type voltage gated channels |  | 
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        | Only blocks vascular Ca channel, no effect on the heart |  | 
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        | vasodilation, which lower PVR, which lower BP |  | 
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        | Nifedipine (Procardia) adverse effects |  | Definition 
 
        | ankle edema, reflex tachycardia with short acting version (now have aProcardia SR) |  | 
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        | Hypertension (most effective in african americans) Not useful as Antiarrhythmic drug |  | 
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        | Verapamil & Diltiazem Mechanism for action |  | Definition 
 
        | Block Ca channels in the vascuature and in the heart and A/V node |  | 
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        | Verapamil & Diltiazem Main effects |  | Definition 
 
        | Vasodialate which leads to lower BP |  | 
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        | Verapamil & Diltiazem Adverse effects |  | Definition 
 
        | ankle edema & others similar to nifedipine, but no reflex tachycardia |  | 
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        | Verapamil & Diltiazem Drug interactions |  | Definition 
 
        | caution for AV block when used with beta blockers or digitalis |  | 
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        | Verapamil & Diltiazem Use |  | Definition 
 
        | to treat hypertension, angina and arrhythmias |  | 
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        | K channel opener  opens Ca channels on smooth muscle, K leaves cell, cell hyperpolarizes, leads to vasodialation, which lowers PVR, which lower BP |  | 
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        | relex tachycardia, Na and fluid retention |  | 
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        | Vasodilator   -metabolite is NO, which activate cGMP, which vasodialates arteries and veins, which lower PVR, which lowers BP   |  | 
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        | Na-Nitroprusside Adverse Effects |  | Definition 
 
        | Reflex tachycardia, can lead to severe hypotension |  | 
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        | When is Na-Nitroprusside used? |  | Definition 
 
        | In hypertensive emergencies   Its very fast acting and has a short half life |  | 
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        | Drugs that effect RAS (renin Angiotensis system) |  | Definition 
 
        | ACE inhibitors (captopril)   Angiotensin II receptor blockers (Losartan) |  | 
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        | ACE inhibitor   -inhibits ACE, which decreaces Ang II, which decreaces PVR, which decreaces BP |  | 
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        | Captopril adverse effects |  | Definition 
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        | used in stage 1 and 2 hypertension, Congestive heart failure |  | 
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        | Angiotensin II receptor blocker   -selectively blocks Ang II AT-1 receptor, which decreases PVR, which decreases BP |  | 
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        | some Hyperkalemia as in ACE inhibitors, but no cough |  | 
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