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HTN pharmacology
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| Question | Answer |
|---|---|
| What are 3 elements of blood pressure ? | blood volume,peripheral resistance and cardiac output |
| What is the normal rang of main arterial pressure (MAP)? | 70 - 100 mm Hg |
| Cardiac output is ? | SV x HR |
| Cerebral perfusion pressure(CPP) is ? | The difference between main arterial pressure( MAP) and intercranial pressure( ICP) |
| What is the normal rang of CPP and ICP respectively? | 55-60 mmHg and 5-15 mmHg (in adults) |
| What is the normal capillary pressures at arteriole | 35 mmHg |
| The normal range of Capillary ‘hydrostatic pressure? | 35-18 mmHg |
| The range of Venous pressure is ? | 18 mmHg |
| List down the three types of hypertension ? | 1.Essential HTN (idiopathic) 2.Secondary HTN 3.Gestational HTN (preeclampsia) |
| what are the characteristic of orthostatic hypotension? | >drop of SBP > 20 mmHg or DBP >10 Due to venous pooling in lower extremities transient (compensated once baroreceptors intervene – slow to intervene in elderly! ) |
| Who are at risk of orthostatic hypotension ? | Elderly Dehydrated or fluid restricted patients Antihypertensive medication patients |
| What is the pharmacological management of hypotension ? | titrate drugs; adrenergic agonists if ER |
| What is the underline cause of Secondary HTN? | Organ disease: like Chf, diabetes, renal, adrenal, congenital defects |
| Please clearly describe the inflammatory etiology (immune) theory of gestational HTN (preeclampsia) | => inflammatory cytokine release => endothelial changes => at risk for: clotting (to fix damage) => organ damage + placental flow compromise; + risk of DIC: clotting & thrombocytopenia |
| List treatment of gestational HTN (preeclampsia) | sodium restriction, antihypertensive medications |
| What do you think the emergency treatment of malignant HTN (hypertensive crisis)? | Drug class: Direct Acting Vasodilators like Nipride (Nitroprusside) IV/ET; Hydralazine PO/IV |
| What is the mechanism action of Nipride on treating malignant HTN (hypertensive crisis)? | stimulates endothelial cell-produced NITRIC OXIDE |
| List at list three side effect of Nipride | reflex tachycardia; hypotension, syncope; headache |
| List the HTN treatment medication classes | Direct acting Vasodilators Diuretics Renin-Angiotensin drugs ACE inhibitors (angiotensin-converting enzyme) Calcium channel blockers (decrease CO) Adrenergic agents (decrease vasoconstriction & CO) |
| In which part of the kidney Loop diuretics acts ? and what is its mechanism of action? | site : at the loop of Henle action:Loop of Henle: Blocks Na+, Cl-, K+ re-absorption => increased Na, K, Cl out => with H20 |
| What is the most common side effect of loop diuretics? | hypokalemia |
| What are thiazides diuretics? | includes : hydrochlorothiazide (HZTZ) chlorothiazide (Diuril) metolazone (Zaroxolyn) |
| What mechanism of action and where can thiazides diuretics work? | Site: distal convoluted tubule Action: decrease in re-absorption of Na, Cl, K +> increased Na, K, Cl out => with H20 |
| Discuss the mechanism actions of potassium sparing (aka Aldosterone antagonists) and list the common drug in this class | action: antagonizes renal aldosterone => increases Na out & keeps K+ in Drugs: spironolactone (Aldactone) s/e: hyperkalemia |
| Where K sparing drugs act and what is the common side effect of this drug families? | Site:Collecting distal tubule side effect:hyperkalemia |
| Which foods should be avoided with potassium Sparing Diuretics, to avoid complications? | Potassium-Rich Fruit like banana |
| What is clinical importance of using diuretic combo (Thiazide & K+ sparing combination: Aldactazide)? | Used very frequently Balances out K+ PO adminstration_safe to use Excellent maintenance therapy for HTN |
| What do you know about mannitol (Osmitrol) and Isosorbide? | high solute, travel unchanged pulls water into circulation & into renal tubules (Proximal tubule & Loop of Henle) inhibit ‘Renin’ release used to treat :Cerebral edema,Intraocular hypertension and low use for CV |
| What is the mechanism action of angiotensin-converting enzyme’ inibitors (ACE) Inhibitors | Inhibit ACE => vasodilate NB:potent; titrate to effect!They are first line for htn |
| List at list three drug lists of ACEI family | Drugs: ‘-prils’ Enalapril (Vasotec) Captopril Monopril Ramipril (Altace) |
| What is the most common reported side effect of ACEI? | severe hypotension |
| Please explain the MOA of Angiotensin II receptor blockers’ (ARBs) | angiotensin II receptors antagonized. This leads to decreased afterload => decreased preload |
| List drugs ARBs and its side effect | drugs: Losartan (Cozaar); Ibesartan (Avapro) s/e: hypotension |
| Is ARBs drug best for Hypertensive emergency? | NO . due to its slow onset of action (a few weeks to full effect) |
| What are the common synergy (Thiazide diuretic + ARB) drugs ? | Hyzaar and Cosart |
| Explain the over all action of calcium channel blocker | Overall: ↓ heart rate (cardio-s.) ↓ cardiac output (cardio-s.) optimize cardiac contractions ↓ blood pressure (smooth-s.) |
| Tell us about GINSENG | ‘Calcium channel antagonist’ herbal (NHP) therapeutic dose: 20-30 mg/day |
| What is the mechanism action of adrenergic antagonists (aka ’blockers)? | antagonize the sympathetic nervous system at various adrenergic receptors => decrease catecholamine activity |
| What is the physiologic effect of Alpha1 receptors? | Cause vasoconstriction (increased peripheral resistance) Pupil dilatation Increased closure of the internal urinary sphincter Secretions |
| Could you explain effect of Alpha 2 receptors? | Vasoconstriction of arteries Vasoconstriction of veins Decreased GI motility Decreased smooth muscle motility Contraction of male genitalia during ejaculation |
| List Alpha 1 receptors antagonist and both alpha 1&2) antagonist drugs | Prazosin (alpha 1), Phentolamine (alpha 1&2) |
| Discuss the normal effect of Beta1 and 2 receptors | Beta1 receptors: Cardiac muscle- Increased myocardial activity and increased heart rate AV node conduction Beta2 receptors: Smooth muscles in blood vessels, bronchi, in the periphery and stimulation leads to vasodilation/bronchodilation!!! |
| List drug list antagonists beta 1, both beta 1 & beta 2 antagonist | Atenolol (beta 1); Propranolol (beta 1 & beta 2); Metoprolol (beta 1& high doses effect beta 2) |
| What do you think the action and side effect of beta-blocker | .Action Decrease heart rate Decrease contraction Decrease rate of A_V conduction Side effect:Decrease BP,bradycardia GI disturbance ..... |
| Most used combine medication of diuretic (thiazide) + adrenergic antagonist? | Med: Lopressor HCT |
| What is the MOA of centrally acting alpha 2 adrenergic agonists’ and what are the common drugs of this family? | MOA: stimulate (agonise) CNS’s negative feedback mechanism at alpha 2 receptors (vasomotor center) => inhibits release of norepinephrine (NE) => decreased sympathetic ton Drugs: Clonidine; Methyldopa |
| The common side effect of of centrally acting alpha 2 adrenergic agonists is ? | hypotension and headache |
Created by:
aynalem
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