Term
| no one drug works better htan another as a whole, there are indivdiual differences |
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Definition
| multidrug treatment required for majority of patients |
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Term
| with htn complicated byo ther disease staes, we aim for lower systolic/diastolic targets |
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Definition
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Term
| goasl of antihyeprtensive therapy |
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Definition
| either low c.o. or lwoer peripheral restiance |
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Term
| pathophys targets of antihypertensive drugs |
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Definition
sodium/plasma volume- icnrease stroke volume.
RAAs- both c.o. and peripheral restiance.
SNs- peripheral resistance
VSMC tone- peripheral restiatnce |
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Term
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Definition
| thiazides, loop diuretics, potasisum sparing diuretics, and thiazides |
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Term
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Definition
| drop i nplasma voluem leading to reduced ventricular filling adn reduced c.o. will transiently stimualte renin release- leading to transient peripheral resistancei ncrease . Also sodiu mreabosrp will increaase proximally (the inhibitors operate distally). |
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Term
| adverse effects of thiazideloop diuretics |
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Definition
hypotention and decreased gfr. stimulation of RAAS due to decreased colume- also flooding more distal neprhon with more sodium, resulting in more sodium potsisum exhcange , leading to loss of potasisum
Hyponatremia.
increased bicarbonate reabsorp in proximal nephron, linked to sodium reabsorb.
uric acid reabsorp als olinekd to sodium reabosrp proxiamlly- leads to gout.
inhbiition of insulin release- hyperglycemia.
increased calcium reaabsorption. (not loop agents).
k sparing drugs- hyperkalemia.
streoid receptor antagonism (spironolactone)- gynomasteia |
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Term
|
Definition
| most commo ndrug prescribed for htn |
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|
Term
| diuretics arem ost effective in |
|
Definition
| patients with volume expanded htn, i.e. edema seen , almost alwys added in multidrug regimens |
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Term
|
Definition
| reserved as second line for resitant htn/edema nad chf htn |
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Term
| vasodilators indications for use |
|
Definition
| msot useful as 34rd/fourth line in severe/refracotr htn. |
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Term
| direct vasodilator side efects |
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Definition
decrease in peripheral resistance causes reflex incrsaes in sns activity and incresae in heart rate and cardiac output.
decreased renal perfusion elads to increase plam renin activity leads to s odiu madn voluem retentio and edema. |
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Term
|
Definition
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Term
|
Definition
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Term
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Definition
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Term
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Definition
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|
Term
| ntiroprusside moa and toxicity |
|
Definition
| release NO,cyanide toxicity. |
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|
Term
| alpha adrenergic agonists norepi and epi |
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Definition
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Term
|
Definition
| post synpatic , emdiates vasoconstriciton |
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Term
|
Definition
| mostly presynaptic, inhibits norepi release at peripheral and cns symapthetic nerve terminals |
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|
Term
| alpha recetor antagonists moa |
|
Definition
| inhibit vasocosntrict effects of norep, lowering TPR, simliar to vasodialtors but w less tachycardia |
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|
Term
| alpha receptor antaognists side effects |
|
Definition
| may icnreases sypmtoms of hF as monotherpay, may cause postural hypotensiona nd edema |
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Term
|
Definition
| cns acting sympathetic inhibitor |
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Term
|
Definition
| cns acting sympathetic inhibitor (alpha2 recetpro agonist) |
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|
Term
| cns acting symapthetic inhbiitor |
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Definition
| alpha2 receptoragonists in emdullary brainstem. Act in CNS to decrease outflow of the SNS. |
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Term
|
Definition
| effective forh yprensive emergencies |
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|
Term
| cns actinv symapthetic ihbitior side effect |
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Definition
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|
Term
| beta 1 adrenergic receptor functino |
|
Definition
cardiac sa node (increses HR).
Cardiac muscle (increases contracitlity)
RENAL JGA cells (increases renin release) |
|
|
Term
| beta2 adrenergic eceptor effects |
|
Definition
VSMC (dilates)
Bronchial smooth msucle (nronchodialtioN)
Hepatocyptes (glycogenolysis)
Pancreatic islet cells (insulin release) |
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Term
|
Definition
| slow hR, reduce cardiac contracitliy , leads to cardiac output decrease. inhbiits renin release. |
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|
Term
| nonselectiev b1 adn b2 recetpor antagonists side effects |
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Definition
| bronchospasm, worsening dabetes, hyperlipedima , prolonged hypoglycemia, sympomts of pVD (b2 angatonism leads to vasoconastriction) |
|
|
Term
| **atenolo metorpolo, bioprolol* drug type |
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Definition
| b1 sleective, most ocmmonl ysued today |
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Term
|
Definition
| nonselective B/a blocker. vasodilatory |
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Term
|
Definition
| b1 slecetive agent which also release NO |
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|
Term
| B blockers with itnrisinsic symapthomimeitc a ctivity. |
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Definition
|
|
Term
| beta blocekrs sleected adverse effects |
|
Definition
| bradycardia, chf (inhibiting contractility of hte heart), bronchospasm , some CNS effects |
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|
Term
| indications fo beta blockers |
|
Definition
htn: more effectivei n younger patients, those wiht signso f greater adrenergic activity adn plsma renin. less BP reduction in low renin patients.
less effectivei ne nderly
cardiac dysordiasd: tachy arrythmias, chronic LV dysfunciton/HF. Coronary artery disease. Hypertrophic subaortic stenosis
Noncardiac disorder migraine headache prevention. Essentail tremor and performance anxiety |
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|
Term
| Calcium channel angtonist moa |
|
Definition
| voltate sensitive calcium chanels (l type) allow entry of extraceslluar calcium in to smooht muscle, this intracelualr calcium medialtes exciataiotn-contaraciton cobuling. ca chanennl angatonigsts bind the a1 subunit of hte l channel producing relaxation of VSM/myocardium |
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Term
|
Definition
| dihydropidine, calcium channel blocekrs, mainly vasodilating effect |
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|
Term
| Verapamil hydrochloride, diltiazem hydrochloride |
|
Definition
| calcium channel blcoker, primarily negativei onotropci, and negativve chronotropic agents |
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|
Term
| calcium channel angatonist advantages in htn |
|
Definition
very common due to broad effectivenes. metabolially eurttral, no effectson glucose ,electrolyes usric acids, lips.
No renal, CNS , or pulmonary adverseeffects..
However is inhibitor hf hepatic p450 isozymes |
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Term
|
Definition
| angiotensionogen converted to angiotensin I via renin. Angiotensin I convereted to Angiotensin Ii via ACE. |
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Term
|
Definition
vsm - vasoconstraiction, adrnela increases aldosterone levles. prox nephron, icnrease sodium retention,
JGA cells, inhbit r enin release .
cardiac and vascualr tisuse, profibrotic/remodelling |
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|
Term
| Renin physiological regulation |
|
Definition
| decrease in renal perfusion icnreases renin release, icnreased b1 increses renin release. AT2 negative feedback decreases renin release. |
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Term
| the RAs pathway inhbiitors |
|
Definition
direct rein inhibitor blocks renin keeping conversoin from angiotensigoen to angiotensin 1 , b clocekrs block renin
ACE inhibitorskeep convertion from angiotensin I to angiotensin Ii , ARB- angiotensin receptor blocker, and aldosterone antagonists |
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Term
|
Definition
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|
Term
| best tolerated RAAs pathway inhbitior |
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Definition
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|
Term
|
Definition
|
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Term
|
Definition
| metabolism via cyt p450 to more active metabolite |
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|
Term
| losartan non caridac beneficia lefects |
|
Definition
| slwo progression of nepthropathy i ntype II diabetics |
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|
Term
|
Definition
|
|
Term
| direct renin inhibitor contraidnicatiosn |
|
Definition
|
|
Term
| direct renin ihbiitor efect on renin concentration |
|
Definition
| renin concentration ICNRESEs , hwoever activity , DECREAsES |
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|
Term
| potential adverse effects of RAAS pathway inhbitors |
|
Definition
hyperkalemia- aldosterone inhibition
hypotension
worsen renal inssuficeincy- too much glomerula efferent arteiral vasodialtion.
fetal injury- ang II improtatn for fetal diff. all inhbiitors of RAA are contraindicatedi n pregnancy.
5. ACE-I- causes cough and angioedema. |
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|
Term
| aism of lcincia lexam in patient with elevated bp |
|
Definition
| confirm diagnosis and seveirty of htn. serch for secodnary cuases of htn. Identify adidtional cardio and renal sik factors. dientify medical disorders that may impact treatment. idnetify cluest hat presdiect bp resposnvienes sto parti cular drug classes. prior patient experience iwth antihypertensive agents |
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|
Term
| major comorbid hypertensive conditions |
|
Definition
| cardiovsacular disroders, renal disease, and diabetes me llitus . |
|
|
Term
|
Definition
| b cblcoekrs, central inhbiitors |
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|
Term
| sxual dysfunciton worsened by |
|
Definition
| beta blcokers, central inhibitors, spironolcatone |
|
|
Term
|
Definition
| b blocekrs- especially nosnelective |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| hybrid appraotch antihyeprtensive drug selection |
|
Definition
pathophys /clnica lexsam (signs of flud reetension signs ofsymapthetic oeractivity, PRA ,presdicintg BP resposne. )
Demographci factors- race and age. Indivdiual patietn experience.
Major comorbid conditiosn: cardio disroders, renaldisease ,diabetes mellituse.
Conditions worsed by certain agents .
conditions improved |
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Term
|
Definition
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|
Term
| esential termeor performacne anxiety improved by |
|
Definition
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|
Term
| migrain headaches improved by |
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Definition
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|
Term
| osteoporosiss improved by |
|
Definition
| thiazide diurectics (icnreased calcium retention) |
|
|
Term
| kidney stonesi mproved by |
|
Definition
| thiazide diurectics (decrease urinary calcium) |
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|
Term
| chronic diarrhea imrpoved b |
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Definition
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Term
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Definition
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Term
|
Definition
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Term
|
Definition
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Term
|
Definition
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Term
|
Definition
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Term
|
Definition
|
|
Term
|
Definition
| claciu mblcoker with negative ionotropic/chronotropic affect |
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