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antihypertensives
antihypertensives
75
Medical
Graduate
12/11/2011

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Term
no one drug works better htan another as a whole, there are indivdiual differences
Definition
multidrug treatment required for majority of patients
Term
with htn complicated byo ther disease staes, we aim for lower systolic/diastolic targets
Definition
Term
goasl of antihyeprtensive therapy
Definition
either low c.o. or lwoer peripheral restiance
Term
pathophys targets of antihypertensive drugs
Definition
sodium/plasma volume- icnrease stroke volume.

RAAs- both c.o. and peripheral restiance.

SNs- peripheral resistance

VSMC tone- peripheral restiatnce
Term
diuretics used for htn
Definition
thiazides, loop diuretics, potasisum sparing diuretics, and thiazides
Term
diuretics goal
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).
Term
adverse effects of thiazideloop diuretics
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
Term
Hydrochlorothiazide
Definition
most commo ndrug prescribed for htn
Term
diuretics arem ost effective in
Definition
patients with volume expanded htn, i.e. edema seen , almost alwys added in multidrug regimens
Term
loopd diuretics use
Definition
reserved as second line for resitant htn/edema nad chf htn
Term
vasodilators indications for use
Definition
msot useful as 34rd/fourth line in severe/refracotr htn.
Term
direct vasodilator side efects
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.
Term
hydralazine drug type
Definition
vasodilator
Term
minoxidil drug type
Definition
vasodilator
Term
nitroprusside type
Definition
vasodilator
Term
minoxidil side effect
Definition
hypertrichosis, rogaine
Term
ntiroprusside moa and toxicity
Definition
release NO,cyanide toxicity.
Term
alpha adrenergic agonists norepi and epi
Definition
norepi>ejpi
Term
a1 receptor funciton
Definition
post synpatic , emdiates vasoconstriciton
Term
a2 receptor
Definition
mostly presynaptic, inhibits norepi release at peripheral and cns symapthetic nerve terminals
Term
alpha recetor antagonists moa
Definition
inhibit vasocosntrict effects of norep, lowering TPR, simliar to vasodialtors but w less tachycardia
Term
alpha receptor antaognists side effects
Definition
may icnreases sypmtoms of hF as monotherpay, may cause postural hypotensiona nd edema
Term
Clonidine drug type
Definition
cns acting sympathetic inhibitor
Term
alpha methyldopa
Definition
cns acting sympathetic inhibitor (alpha2 recetpro agonist)
Term
cns acting symapthetic inhbiitor
Definition
alpha2 receptoragonists in emdullary brainstem. Act in CNS to decrease outflow of the SNS.
Term
clonidine use
Definition
effective forh yprensive emergencies
Term
cns actinv symapthetic ihbitior side effect
Definition
sedation
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)
Term
beta blcoker moA
Definition
slow hR, reduce cardiac contracitliy , leads to cardiac output decrease. inhbiits renin release.
Term
nonselectiev b1 adn b2 recetpor antagonists side effects
Definition
bronchospasm, worsening dabetes, hyperlipedima , prolonged hypoglycemia, sympomts of pVD (b2 angatonism leads to vasoconastriction)
Term
**atenolo metorpolo, bioprolol* drug type
Definition
b1 sleective, most ocmmonl ysued today
Term
Lbetalol, carvediolol
Definition
nonselective B/a blocker. vasodilatory
Term
Nebivolol
Definition
b1 slecetive agent which also release NO
Term
B blockers with itnrisinsic symapthomimeitc a ctivity.
Definition
Term
beta blocekrs sleected adverse effects
Definition
bradycardia, chf (inhibiting contractility of hte heart), bronchospasm , some CNS effects
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
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
Term
nIfedipine, nicardipine
Definition
dihydropidine, calcium channel blocekrs, mainly vasodilating effect
Term
Verapamil hydrochloride, diltiazem hydrochloride
Definition
calcium channel blcoker, primarily negativei onotropci, and negativve chronotropic agents
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
Term
RAAs pathway
Definition
angiotensionogen converted to angiotensin I via renin. Angiotensin I convereted to Angiotensin Ii via ACE.
Term
effects at AT1 receptor
Definition
vsm - vasoconstraiction, adrnela increases aldosterone levles. prox nephron, icnrease sodium retention,

JGA cells, inhbit r enin release .

cardiac and vascualr tisuse, profibrotic/remodelling
Term
Renin physiological regulation
Definition
decrease in renal perfusion icnreases renin release, icnreased b1 increses renin release. AT2 negative feedback decreases renin release.
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
Term
ARB contraindication
Definition
pregnancy
Term
best tolerated RAAs pathway inhbitior
Definition
ARB
Term
Losartan
Definition
prototype ARB
Term
Losartan emtabolism
Definition
metabolism via cyt p450 to more active metabolite
Term
losartan non caridac beneficia lefects
Definition
slwo progression of nepthropathy i ntype II diabetics
Term
aliskrien
Definition
direct renin inhbiitor
Term
direct renin inhibitor contraidnicatiosn
Definition
pregnancy
Term
direct renin ihbiitor efect on renin concentration
Definition
renin concentration ICNRESEs , hwoever activity , DECREAsES
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.
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
Term
major comorbid hypertensive conditions
Definition
cardiovsacular disroders, renal disease, and diabetes me llitus .
Term
depression worsened by
Definition
b cblcoekrs, central inhbiitors
Term
sxual dysfunciton worsened by
Definition
beta blcokers, central inhibitors, spironolcatone
Term
asthma worsened by
Definition
b blocekrs- especially nosnelective
Term
gout worsened by
Definition
diuetics
Term
constipationw orsened by
Definition
verapamil
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
Term
BPH improved by
Definition
alpha blocekrs
Term
esential termeor performacne anxiety improved by
Definition
b blocekrs
Term
migrain headaches improved by
Definition
bblcoekrs, CCBs
Term
osteoporosiss improved by
Definition
thiazide diurectics (icnreased calcium retention)
Term
kidney stonesi mproved by
Definition
thiazide diurectics (decrease urinary calcium)
Term
chronic diarrhea imrpoved b
Definition
verapamil
Term
propanolol
Definition
nonselective b blocekr
Term
atenolol
Definition
b1 selective antagonist
Term
metaprolol
Definition
b1 sleective antagonist
Term
bioprolol
Definition
b1 selective antagonist
Term
carvedilol
Definition
b/a antagonist
Term
lebatlol
Definition
b/a angatoinst
Term
deltaiazem hydrochloride
Definition
claciu mblcoker with negative ionotropic/chronotropic affect
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