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Session 2 Pharm9
Pharm -9- Antihypertensives
| Question | Answer |
|---|---|
| what does Cardiac output (CO) x total peripheral resistance (TPR) = | Arterial blood pressure |
| How are CO and TPR controlled IE Arterial Blood pressure | baroreflexes and renin angiotensin aldosterone system |
| Where are baroreceptors found | carotid sinus and aortic arch |
| What is the most potent circulating vasoconstrictor | Angiotensin II |
| What organ is responsible for long term blood pressure control and uses mainly what system to maintain this control | The kidney and it control long term BP with the renin-angiotensin aldosterone system |
| What is the effect of Angiotensin II | stimulates aldosterone secretion leading to increased renal Na+ absorption and an increase in Blood Volume increasing B/P |
| What problems can excess endothelin cause | Fibrosis- from excessive scar formation and cardiac remodeling Hypertrophy- enotheline may induce cell prolif of cardiac myoctyes and vasculature Inflammation- lets proinflam mediators into interstitial Vasoconstriction- |
| What type of hypertension is more common Primary (essential) hypertension or Secondary Hypertension | Primary essential hypertension is more common accounts for hypertension in 90-95% or patients |
| What are the causes of secondary hypertension | chronic renal disease Na+ and water retention elevated renin levels pheochromocytoma conns syndrome |
| What is prehypertenesion ranges of SBP and DBP | 120-139 for SBP 80-89 for DBP |
| What are the ranges for SBP and DBP in stage 1 hypertension | SBP- 140-159 DBP 90-99 |
| What are the therapeutic goals on antihypertensive tx | reach target B/P of 140/90 For diabetics and chronic kidney disease 130/90 reduce hypertension to avoid morbidity and mortality associated with it reduce risk of target organ damage |
| What are the non-pharm tx for hypertension | reduce weight, alcohol, get patient to exercise, reduce dietary sodium and have a dietary review |
| What would your typical treatment be for a stage 1 hypertensive patient w/o other cardiovascular risk factors | Thiazide Diuretic for most patients |
| hat would be you typical treatment for stage 2 hypertensive w/o other cardiovascular risk factors | two-drug therapy usually Thiazide diuretic w/ ace inhibitor |
| What will your typical therapy be with patients who are hypertensive and have a history of cardiovascular diseases or risk factors | diuretics, ace inhibitors, ARBs, B-blocker and calcium channel blocker |
| What three type of diuretic agents are there | Thiazides, loop diuretics, K-sparing drugs |
| what are Hydrocholrothiazide (Esidrix) Chlorthalidone (Hygroton) Metolazone (Diulo) Indapamide (Lozol | Thiazides |
| what are Furosemide (Lasix) Bumetanide (Bumex | Loop Diuretics |
| What is Spironolactone (Aldactone) | K-Sparing Diuretic |
| What is the firs-line therapy for hypertension | Diuretic Agents |
| Which is more effective at controlling B/P in geriatric patients B-blockers or diuretic agents | Diuretic Agents |
| What is the MOA of loop diuretics | inhibits reabsorption of NaCl which increase exretion on NaCl and water decreasing ECF, lowering BP |
| Are loop diuretics indicated or contra indicated in patients with renal compromise | indicated in patients with renal compromise to control b/p |
| Aldosterone antagonist potassium sparing used w/ other diuretic to preven hypokalemia inhibition of Na+ reabsorption further reduces blood pressure | Spironolactone |
| Where does spironolactone act on glomerulus to induce its effect | acts at the collecting duct to inhibits aldosterone mediated reabsorption of Na+ and secretion of K+ |
| Where do thiazides act on the glomerulus to induce diuretic effect | acts on distal convoluted tubule to inhibit resorption of Na+ and Cl- |
| Where does Furosemide, bumetanide, torsemide, ethacrynic acid Act in the glomerulus to induce its diuretic effect | acts in the ascending loop of henle to inhibit Na/K/and Cl resorption |
| What are the major s/e of using Thiazide diuretics | Hypercalcemia, hypokalemia |
| What are the major s/e of loop diuretics | hypokalemia, hypocalcemia, metabolic alkalosis, hypernatremia |
| what are the major s/e of spironolactone | gynecomastia, hyperkalemia |
| What does activation of B1 receptors of the heart lead to | lead to iontropic effects (increased contractility), chronotropic effects (increased rate) and excess stimulation can lead to arrhythmias |
| What are Propranolol (Inderal) Nadolol (Corgard) Timolol (Betimol) Carteolol (Cartrol) Pindolol (Visken) | Non selective B1 and B2 blockers |
| What are Atenolol (Tenormin) Metoprolol (Lopressor) Acebutolol (Sectral | Selective B1 blockers |
| How do Beta blockers treat hypertension | reduce CO Reduce Sympathetic outflow reduce renin secretion reduce formation of angiotensin reduce secretion of aldosterone |
| When are Beta blockers indicated for hypertension | younger patients or co-existing condition such as -myocardial infarction -angina pectoris -chronic heart failure |
| When are non selective beta blockers contra indicated in treating hypertension | in asthmatic patients, also use caution with COPD, and Diabetes |
| What is the MOA of selective B1 blockers | B1 receptors are located mainly in cardiac muscle. Blocking them give reduction rate and force of cardiac contractility additionally reduces sympathetic outflow and renin activity |
| When would you want to use a selective B1 blocker over non selective beta blocker | may be safer for patients with bronchoconstriction usch as astham and COPD but still administer with caution |
| Why do you need to bring a patient slowly off of beta blockers | abrupt dc of Beta blocker can cause increased heart rate, BP and nervousness |
| What are the S/E of using a Beta Blocker | hypotension, bradycardia, fatigue, lethargy, decreased libido and sexual dysfunction |
| what are Enalapril (Vasotec) Captopril (Capoten) Ramipril (Altace) Lisinopril (Prinivil) Quinapril (Accupril | ACE inhibitors |
| What is the MOA of ACE inhibitros | block conversion of Angiotensin I to Angiotensin II causing reduction in aldosterone secretion and water and Na+ retention -also bradykinin inactivation -vascular smooth muscle vasodilation reducing TPR |
| When are ACE inhibitors indicated | indicated in patients with co existing diabetes, myocardial infarction, heart failure |
| When are Ace inhibitors contra indicated | CI- in patients with bilateral renal artery stenosis |
| What is the problem with ACE inhibitors during pregnancy | HIGHLY FETOTOXIC |
| What do angiotensin II receptor antagonists do | block the angiotensin II receptor inhibiting aldosterone secretion, causing vasodilation, and reducing TPR. Reduced diabetic nephrotoxicity |
| When are Angiotensin II receptor antagonists indicated | effective for mild hypertension, indicated in Heart Failure, Hypertension and diabetic nephropathy, |
| When are angiotesin II receptor antagonists contra indicated | CI in pregnancy and hyperkalemia |
| What is the major side effect of ACE inhibitors | Cough and Angioedema |
| What are the major s/e of Angiotensin Receptor blockers | hypotension, Dizziness |
| What are Nifedipine (Adalat) Verapamil (Isoptin)) Diltiazem (Cardizem) Nicardipine (Cardene) Felodipine (Plendil) Isradipine (Dynacirc | Calcium Channel Antagonists |
| What is the MOA of calcium channel antagonists in treating hypertension | blockade of calcium channels inhibits influx of Ca+ into vascular smooth muscle, Decreasing smooth muscle tone and vascular resistance, reducing TPR |
| When are calcium channel antagonists indicated | indicated in patients with angina, diabetes, peripheral vascualr disease and asthma |
| Why is a sustained release formula preferred for calcium channel antagonists | they have a short half life |
| What are the s/e of calcium channel antagonists | dizziness, headache, fatigue, constipation |
| What are Prazosin (Minipress) Terazosin (Hytrin) Doxazosin (Cardura | A1 Antagonists |
| Where are the actions of A1 antagonists | acts to inhibit A1 receptors on resistance vessels of skin, mucosa, intestine and kidney Dilation of resistance and conductance vessels |
| What types of hypertension are A1 antagonists used to treat | tx of mild to moderate hypertension |
| Besides hypertension what other clinical uses are A1 antagonists | used for symptomatic relief in benign prostatic hypertrophy |
| What are Labetalol (Trandate) Carvedilol (Coreg) | A1 and B1 antagonists |
| what is the MOA of A1 and B1 antagonists | reduces heart rate and contractility (Beta blockade) causes vasodilation and reduces TPR (Alpha Blockade) indicated in hypertensive emergencies and pheochromocytoma |
| What are Hydralazine (Alazine) Minoxidil (Rogaine) Sodium Nitroprusside Diazoxide (Proglycem | vasodilators |
| what are the MOA of vasodilators | causes smooth muscle relaxation and reduction of TPR |
| What do you need to do when administring Hydralazine and minoxidil | give a diuretic in conjunction to avoid Na+ and water retention |
| What is the target of centrally acting sympathomimetic adrenergic agents | targets synaptic A2 receptor via agonist |
| How do centrally acting sympathomimetic agents work | inhibit adrenergic tone -reduces nor epi release -decreases TPR -REduces baroreceptor reflex -decreases heart rate -reduced renin activity |
| this drug has a Direct action on A2 receptors reduces TPR combined w/ diuretic may cause drowsiness, dry mouth and constipation | Clonidine (catapres) |
| This drugs active metabolite is Alpha-methylnorepinephrine | Methyldopa (aldomet) |
| What is the MOA of methyldopa | activates presynaptic inhibitory Alpha adrenoreceptors and postsynaptic A2 receptors in CNS Reducing sympathetic outflow and TPR |
| What are the s/e of methyldopa | drowsiness, dry mouth, and sexual dysfunction |
| Review slide 62 | review slide 62 |
| What is a hypertensive emergency vs hypertensive urgency | Hypertensive emergency- highly elevated BP (over 180/120) w/ acute or immediately progressing organ injury Urgency- same B/P but no acute or immediately progressing target organ injury |
| what is the tx for hypertensive urgency | increase dose of current medication add a new antihypertensive agent acute administration of short acting oral agent (captopril, laetalol) |
| What special consideration do you have for hypertension during pregnancy | ACE inhibitors and Angiotensin II receptor blocers are Contra indicated METHYL DOPA is 1st line widely studied for pregnancy hypertension (also hydralazine and calcium channel blockers widely used) |
| What special consideration do you need to be aware of for hypertension in African Americans | Diuretic decrease morbidity and mortality may not respond well to monotherapy with Beta blockers or ACE inhibitors |
| What special consideration do you need to account for with obstructive airway disease patients suffering from hypertension | Avoid Beta Blockers may exacerbate obstruction |
| What special consideration do you need to account for in diabetics with hypertension | USE ACE inhibitors and Angiotensin II receptor blockers to control BP and slow renal deterioration |
Created by:
smaxsmith
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