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Pharm - Ch. 46. 43-4
Drugs for Hypertension
| Question | Answer |
|---|---|
| List the four categories of BP as defined by the JNC7 report | Normal, prehypertension, stage 1 hypertension, stage 2 hypertension |
| What is normal BP defined as? | Below 120 mmHg systolic, below 80 mmHg diastolic |
| What is hypertension defined as? | Systolic > 140 mmHg or diastolic > 90 mmHg. |
| What is primary hypertension? | Hypertension with no known cause. Most common form. |
| What is secondary hypertension? | An elevation of BP brought on by identifiable primary cause |
| List the key components of lifestyle modification used as anti-HTN treatment | Weight loss, smoking cessation, reduction of salt and alcohol intake, following DASH diet, increasing aerobic exercise, management of potassium and calcium intake |
| What are the four factors influencing cardiac output? | Heart rate, myocardial contractility, blood volume, venous return of blood to heart |
| Peripheral vascular resistance is regulated by ________ | Ateriolar constriction |
| The baroreceptor reflex can be counteracted by a _____. | Beta blocker |
| What drugs can counteract the RAAS? | ACE inhibitors, angiotensin II receptor blocker, direct renin inhibitor, or aldosterone antagonist |
| Antihypertensive drugs acting in the brainstem suppress ____ ________ to the heart and blood vessels, resulting in __(A)_ heart rate, __(B)__ myocardial contractility, and __(C)_ | Sympathetic outflow. A) and B) decreased C) vasodilation |
| Ganglionic blockade reduces _____ stimulation of heart and blood vessels | Sympathetic |
| Antihypertensive agents acting at adrenergic nerve terminals __(A)_____ the release of __(B)____, resulting in decreased sympathetic stimulation of heart and blood vessels | A) decrease B) norepinephrine |
| How do beta blockers lower BP? | Block cardiac beta1-adrenergic receptors Suppress reflex tachycardia (from vasodilation) Block beta1 receptors of the juxtaglomerular cells Long-term reduction in vascular resistance (? mech) |
| Blockade of vascular alpha1 receptors promotes what? | Dilation of arterioles and veins. |
| How do thiazide and loop diuretics reduce BP? | Reduce blood volume via diuresis, reduce arterial resistance |
| Loop diuretics should be reserved for what type of patients? | Patients who need greater diuresis than can be achieved with thiazides and patients with low GFR |
| How do calcium channel blockers reduce BP? | Promote dilation of arterioles |
| How do ACE inhibitors reduce HTN? | Inhibition of ACE decreases formation of angiotensin II |
| How do angiotensin II receptor blockers reduce HTN? | Blockage prevents ACTION of angiotensin II |
| How do aldosterone receptor blockers reduce HTN? | Blockage promotes excretion of sodium and water, resulting in reduced blood volume |
| What types of drugs are used for hypertension? | Diuretics, ACE inhibitors, angiotensin II receptor blockers, beta1-adrenergic blockers, calcium channel blockers |
| List the prototypes for diuretics, ACE inhibitors, ARBs, beta blockers, and calcium channel blockers | Diuretics: hydrochlorothiazide, spironolactone ACE inhibitors: captopril, enalapril ARBs: losartan Beta blocker: propranolol, metoprolol Calcium channel blockers: verapamil, nifedipine |
| True or false: with ARBs you will see side effects such as cough | FALSE. ACE inhibitors can have persistent cough due to buildup of precursors |
| For a patient at stage 1 HTN, what sort of treatment is given? | Thiazide diuretics, ACE inhibitors, ARBs, beta1-adrenergic blockers, calcium channel blockers (individually or as a combo) |
| What is stage 1 HTN? | Blood pressure systolic: 140-159 Diastolic: 90-99 |
| For a patient at stage 2 HTN, what sort of treatment is given | A thiazide diuretic combined with one of the following: ACE inhibitor, ARB, beta blocker, Ca channel blocker |
| What is stage 2 HTN? | >160/>100 |
| True or false: osmotic diuretics are used as antihypertensive drugs | False. One class of diuretics NOT used. |
| What is the difference between Verapamil and Nidefipine? | Verapamil acts on both cardiac and smooth muscle while Nifedipine only acts on smooth. |
| How are beta and calcium channel blockers related? | Beta receptors can open up Ca channels to increase muscle contractility. The beta blockers can block Ca from moving into cell, so indirectly causes calcium channel blockage. Ca channel blockers directly block Ca. |
| What is the mechanism of action for Verapamil? | Relaxation of vascular smooth muscle causing vasodilation of arterioles. Affects myocardium, SA/AV nodes. |
| What are the SE of Verapamil? | Constipation, cardiosuppressive effects (HF, heart block). Reflex tachycardia more common in nifedipine. |
| What are the effects of nifedipine? | Reflex tachycardia most common complaint. Constipation less common than in verapamil. |
| List the ACE inhibitors | Captopril and enalapril |
| What is the mechanism of action for ACE inhibitors? | Inhibition of angiotensin converting enzyme decrease formation of angiotensin II. Protects kidney in diabetics/HTN pts. |
| Which drugs are less effective in African Americans? | ACE inhibitors and beta blockers |
| What are the SE of ACE inhibitors? | Persistent cough, first dose hypotension, hyperkalemia. Category D drugs. |
| What does ARB stand for? | Angiotensin II receptor blocker |
| What is an ARB prototype? | Losartan |
| What is the mechanism of action for Losartan? | Blockage of actions of angiotensin II and release of aldosterone |
| What are the SE of Losartan? | Angioedema. DOESN'T produce cough or hyperkalemia. Contraindicated in pregnancy. |
| What diuretic can also act as an aldosterone receptor blocker? | Spironolactone |
| In diabetics, which meds are preferred? | ACE inhibitors, ARBs, CCBs. Diuretics in LOW doses because of hyperglycemia. |
| What meds are preferred for treating HTN in children? | Same as adults but at lower dosages. |
| True or false; the incidence of secondary HTN is high in children | True |
| What HTN meds are preferred for the elderly? | Diuretics and beta blockers more effective. But monitor for hypotension |
| What HTN meds preferred for pregnant women? | Observe for chronic HTN and severe preeclampsia. Remember drug categories for various HTN drugs! |
| True or false: At therapeutic doses, calcium channel blockers (CCBs) act on peripeheral arterioles and veins as well as cardiac arterioles and veins | False. At therapeutic doses, CCBs act selectively on cardiac/peripheral arterioles. No significant effect on veins |
| True or false: At toxic doses, nifedipine can produce cardiac suppression | True, due to decrease in selectivity |
Created by:
choel
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