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Pharm- HTN
Pharmacology 9/16/08
| Question | Answer |
|---|---|
| Mean Arterial Pressure (MAP) | A reflection of the average blood pressure in the body |
| Two equations to describe and calculate MAP | MAP = CO x TPR,MAP = Diastolic pressure + 1/3 (systolic pressure - diastolic pressure) |
| Total peripheral resistance (TPR) | The resistance to blood flow generated by the circulatory system |
| Cardiac Output (CO) | The amount of blood pumped by the left ventricle per contraction (~5L/min.) CO = HR x SV |
| Stroke volume (SV) | The amount of blood ejected from the left ventricle per contraction (~70ml) SV = EDV - ESV |
| End diastolic volume (EDV) | Amount of blood in the left ventricle at eh end of diastole (relaxation) ~120ml |
| End systolic volume (ESV) | Amount of blood remaining in the left ventricle following systole (contraction) ~50 ml |
| Preload | EDV or the amount of blood in the ventricle prior to contraction |
| Afterload | The force against which the heart must work in order to eject blood from the left ventricle into the aortaIt is a reflection of TPR |
| Contractility | The performance of the heart (force of contraction of cardiac muscle) at any given preload and afterload |
| Frank-Starling Relationship | States that as preload increases, cardiac contractility will increase |
| Normal BP Classification | Systolic: <120 Diastolic: <80 Initial Screening/Recommended Follow up: 2 yrs |
| PreHTN Classification | Systolic: 120-139 Diastolic: 80-89 Initial Screening/Recommended Follow up: Within 1 year |
| Stage I HTN Classification | Systolic: 140-159 Diastolic: 90-99 Initial Screening/Recommended Follow up: Within 2 months |
| Stage II HTN Classification | Systolic: >160 Diastolic: >100 Initial Screening/Recommended Follow up: 1 week to 1 month |
| Life Style Changes to lower BP | Extra Rest Vacations Less Stress Weight Reduction Sodium Reduction Limit alcohol consumption Exercise |
| ACE Inhibitors: MOA | MOA: Suppresses renin-angiotensin-aldosterone system which prevents angiotensinI from converting to angiotensinII Reduces peripheral resistance. |
| ACE Inhibitors: Indication and ADR | Ind: Tx of HTN; adjunctive therapy for CHF, diabetic nephropathy ADR: COUGH, dry mouth, rash, change or decrease in sense of taste, orthostatic hypotension upon initial therapy Nephrotic syndrome: agranulocytosis, neutropernia |
| Capoten | Captopril ACE Inhibitor |
| Vasotec | Enalapril ACE Inhibitor |
| Lotensin | Benzapril ACE Inhibitor |
| Monopril | Fosinopril ACE Inhibitor |
| Accupril | Quinopril ACE Inhibitor |
| Altace | Ramipril ACE Inhibitor |
| Univasc | Meoxipril ACE Inhibitor |
| Mavik | Trandolapril ACE Inhibitor |
| Angiotensin II Receptor Blocker ADR | Pregnancy Category C (1st trimester) Category D (2nd and 3rd trimester) ADR: same as ACE Inhibitors but do not see a cough |
| ARB: MOA | Block the effects of angiotensin II by blocking the binding of angiotensin II to its receptors |
| Cozaar | Losartan ARB |
| Diovan | Valsartan ARB |
| Atacand | Candesartan ARB |
| CCB: Indication and ADR | Ind: HTN, Angina, Arrhythmias ADR: dizziness, flushing, HA, peripheral edema Pregnancy Category C |
| CCB: MOA | Inhibit extracellular Ca from crossing cell membrane. Relaxes smooth muscle, depresses HR. Decrease coronary vascular resistance, increase coronary blood flow, reduce myocardial oxygen demand. |
| Adalatt, Adalatt CC, Procardia, Prcardia XL | Nifedipine CCB: Dihydropyridines Class |
| Norvasc | Amlodipine CCB: Dihydropyridines |
| Plendil | Felodipine CCB: Dihydropyridines |
| Dynacirc | Isradipine CCB: Dihydropyridines |
| Cardene, Cardene SR | Nicardipine CCB: Dihydropyridines |
| Sular | Nisodipine CCB: Dihydropyridines |
| Calan, Calan SR, Covera-HS, Isoptin | Verapamil CCB: Phenylalkylamines |
| Cardizen CD, Cardizem SR, Cardizem, Dilactor XR, Tiazac | Diltiazem CCB: Benzothiazepine |
| Vascor | Bepridil CCB:Diarylaminopropylamine |
| Lasix | Furosemide Diuretic: Loop Diuretic |
| Bumex | Bumetanide Diuretic: Loop Diuretic |
| Hydrodiuril | Hydrochlorthiazide Diuretic: Thiazide |
| Hygroton | Chlorthalidone Diuretic: Thiazide |
| Dyrenium | Triamterene Diuretic: Potassium sparing |
| Midamor | Amiloride Diuretic: Potassium sparing |
| Aldactone | Spironolactone Diuretic: Potassium sparing |
| Inspra | Eplerenone Diuretic: Potassium sparing |
| Loop Diuretics: MOA | Inhibit reabsorption of sodium and chloride in the ascending loop of Henle, interfering with the chloride-binding co-transport system. Causes increased excretion of water, Na, Cl, Mg, and Ca. |
| Loop Diuretics: Indication/Contraindication | Ind: HTN, management of edema in CHF and hepatic or renal disease CI: Severe Hyponatremia, Severe Hypokalemia, Anuria, Sulfa allergy, Nursing mothers/infants |
| Loop Diuretics: ADR | Hyponatremia, Hypokalemia, Hypomagnesemia, Hypocalcemia, Hyperuricemia, Dehydration, Ototoxicity, Tinnitus |
| Thiazide Diuretics: MOA | Inhibits Na reabsorption in the distal tubule causing increased secretion of Na, water, potassium, and hydrogen. |
| Thiazide Diuretics: Indications/Contraindications | Ind: Mild to moderate HTN, treatment of edema in CHF and nephrotic syndrome CI: Anuria, sulfa allergy |
| Thiazide Diuretics: MOA | Inhibits Na reabsorption in the distal tubule causing increased secretion of Na. |
| Thiazide Diuretics: ADR | Hypokalemia, Hyponatremia, Hypocholoremia, Hypomagnesemia, Hyperuricemia, Hypercalcemia, Hyperphosphemia, Dehydration, Hypotensioin, Hyperlipidemia, Hyperglycemia, Erectile dysfunction |
| Potassium Sparing Diuretics: MOA | Blocks Na channels in the luminal membrane of the distal convoluted tubule and cortical collecting duct, thus inhibiting the elimination of potassium. |
| Spironolactone: Indication | Potassium Sparing Diuretic Ind: HTN, edema associated with excessive aldosterone excretion, hypokalemia Pregnancy Category D |
| Spironolactone: MOA | Potassium Sparing Diuretic MOA: Competes with aldosterone for receptor sites in distal renal tubules, increasing NaCl and water excretion while conserving K levels |
| Spironolactone: ADR | Hyperkalemia, Arrhythmia, Confusion, Deepening of voice in females, Increased hair growth in females, Erectile Dysfunction, Increased thirst |
| Beta Adrenoceptor Antagonists: "Beta Blockers" Indications | HTN, CAD, CHF (metoprolol and carvedilol only), beneficial in Angina and Atrial fibrillation. |
| Inderal, Ipran | Propranolol (hepatically cleared) Beta Blocker: Non-selective between beta 1 and beta 2 receptors |
| Cogard | Nadolol (renally cleared) Beta Blocker: Non-selective between beta 1 and beta 2 |
| Lopressor | Metoprolol tartrate Beta Blocker: Beta 1 selective antagonist |
| Toprol XL | Metoprolol succinate Beta Blocker: Beta 1 selective antagonist |
| Tenormin | Atenolol Beta Blocker: Beta 1 selective antagonist |
| Normodyne, Trandate | Labetolol Beta Blocker: Alpha 1, Beta 1, Beta 2 selective antagonist |
| Coreg | Carvedilol Beta Blocker: Alpha 1, Beta 1, Beta 2 selective antagoist |
| ADR Beta Blockers | Bradycardia Induce heart failure in susceptible patients Bronchoconstriction Impotence Metabolic effects (can increase glucose and lipids) |
| Beta Blockers Contraindications | 2nd and 3rd degree AV heart block Cardiogenick hock Asthma and COPD |
| Beta Blockers Pecautions | Rebound HTN if suddenly stop beta blocker Masks Hypoglycemia (except diapharesis) |
Created by:
Marywood
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