Anti-Hypertensive Questions

Created by gbundens 

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What is hypertension defined as?

anything >= 140/90

What are the stages of hypertension defined as?

4 stages: +20mmHg systole, +10mmHg Diastole

What is essential hypertension?

dx when no primary cause for BP elevation is identified, +inherited predisposition for development; other contrib factors: high salt intake, excessive weight, emotions, sedentary lifestyle, smoking, alcohol, elevated LDL and VLDL and lower HDL cholesterol

What is secondary hypertension?

Pheochromacytoma, hyperaldosteronism, preeclampsia, renal stenosis

What are the risk of hypertension?

causes atherosclerosis in large, medium and small arteries

In general what do anti-hypertensives do?

decrease BP to result in decreased CO & vascular resistance

What is the first approach to tx hypertension?

non-pharmacological therapy- effective in maj of pt's w/ distolic btw 90-105mmHg, most effective if pt is overweight, uses tobacco prods, has >1 alcoholic drink/day, & is inactive

Diuretic used for hypertensive treatment

Thiazides- Chlorothiazide

MoA of Chlorothiazide

act on kidney to incr NA, H20 excre; decr BV, CO, BP

What do you want to avoid in pharmacological tx of hypertension?

Avoid combos of drugs that act on same site or by similar mechanism, also drugs that produce similar side effects

Uses of chlorothiazide in hypertension tx

monotherapy for Stage 1&2, edema, fluid retention; adjunct to other hypertensives; elderly & black populations (incr plasma renin)

Adverse effects of chlorothiazide

most pt tolerate well; primary complaint is Ms weakness & general feeling of being tired;Na & K loss; K loss directly affect ms's-- muscle cramps, cardiac arrhytmias, Ms weakness

Loop diuretics uses in tx of hypertension

prevent Na loss

K-sparers use in tx of hypertension

prevent K loss

ACEI's used to tx hypertension?

"-pril's" - Captopril

MoA of Captopril

blocks ACE, decr vasc resistance, BP; prevents bradykinins from converting to inactive peptide

Renin-angiotensin system (RAS)

angiotensinogen->AgI (renin from kidney); AgI -> AgII (active component, done by ACE); AgII acts on Ag receptors on VasSmMs (vasoconstriction) & adrenal glands (stim/synth of aldosterone, incr Ca, incr renal absorption of H2O, incr activity of CNS, incr SmMs cell growth

Uses of Captopril in hypertension tx

monotherapy for stages 1,2,3 of hypertension, adjunct w/ thiazide diuretics, Ca channel blockers, or beta-blockers for stage 4

Contraindication of Captopril

Pregnancy, causes renal damage in fetus causing fetal death

Adverse effects of Captopril

Dry cough, kidney problems, 1st dose effect (probs first time but better after)

ARB's used to tx hypertension

"-artan's"- Losartan

MoA of Losartan

blocks AgII binding to AT1 receptor mostly on BV & kidney, decr vasc. Resistance, decr BP; in addt'n blocks break down of bradykinin (causes dry cough)

Contraindication of Losartan

Pregnancy, causes renal damage in fetus causing fetal death

Beta-blockers used to tx hypertension

"-lol's"- Atenolol, Propranolol

MoA of Atenolol & Propranolol

compete for NE or EPI binding site (hypertension, angina, MI, arrhythmias, HF), presynap beta-1 receptor on heart blocked causing decr HR &CO

Adverse effect of Losartan

renal damage to fetus leaded to fetal death, don't use in pregnant Pt

Uses of Atenolol & propranolol in hypertension tx

monotherapy for Stage 1&2, adjunct for later stages

CI of atenolol & propranolol

elderly & black populations

Adverse effects of atenolol & propranolol

myocardial depression b/c muscle receptor on heart tells heart to beat stronger, other: fatigue, tiredness, bradycardia, asthma, incr plasma cholesterol, impotence

Dizziness SE of losartan is a direct result of _________

vessel effects

alpha-blockers used to Tx hypertension

"-osin's"- prazosin

MoA of prazosin

alpha-1 receptor in vessel walls blocked causing incr vasc resistance, decr BP

Uses of prazosin in hypertension tx

monotherapy for stage 1, adjunct w/ diuretics for stage 2

Adverse effects of prazosin

venous pooling-> orthostatic hypertension b/c vessel doesn't provide pressure therefore not enough P to push blood out of microcirculation-> not enough blood to brain; 1st dose effect, edema, nasal stuffiness, delayed ejaculation, tachycardia, dizziness, headache, incontinence

Beta-1 action vs. Alpha-1 action

B1 in heart, A1 in vessel

Ca Channel blocker effects in hypertensive tx

prevents muscle contraction

Vasodilator SEs in hypertensive tx

minoxidil causes a hair growth side effect

Diazoxide uses in hypertensive tx

used for hypertensive emergencies

What is diazoxide?

used in hypertensive emergencies, very potent, selective arterial vasodilator for major arteries, acts by opening K channels, given by IV injectino

CI's of diazoxide?

Angina pectoris, MI, aneurysm, pulmonary edema, diabetics

What is hypertension defined as?

anything >= 140/90

What are the stages of hypertension defined as?

4 stages: +20mmHg systole, +10mmHg Diastole

What is essential hypertension?

dx when no primary cause for BP elevation is identified, +inhereited predisposition for development; other contrib factors: high salt intake, excessive weight, emotions, sedentary lifestyle, smoking, alcohol, elevated LDL and VLDL and lower HDL cholesterol

What is secondary hypertension?

Pheochromacytoma, hyperaldosteronism, preeclampsia, renal stenosis

What are the risk of hypertension?

causes atherosclerosis in large, medium and small arteries

In general what do anti-hypertensives do?

decrease BP to result in decreased CO & vascular resistance

What is the first approach to tx hypertension?

non-pharmacological therapy- effective in maj of pt's w/ distolic btw 90-105mmHg, most effective if pt is overweight, uses tobacco prods, has >1 alcoholic drink/day, & is inactive

Diuretic used for hypertensive treatment

Thiazides- Chlorothiazide

MoA of Chlorothiazide

act on kidney to incr NA, H20 excre; decr BV, CO, BP

What do you want to avoid in pharmacological tx of hypertension?

Avoid combos of drugs that act on same site or by similar mechanism, also drugs that produce similar side effects

Uses of chlorothiazide in hypertension tx

monotherapy for Stage 1&2, edema, fluid retention; adjunct to other hypertensives; elderly & black populations (incr plasma renin)

Adverse effects of chlorothiazide

most pt tolerate well; primary complaint is Ms weakness & general feeling of being tired;Na & K loss; K loss directly affect ms's-- muscle cramps, cardiac arrhytmias, Ms weakness

Loop diuretics uses in tx of hypertension

prevent Na loss

K-sparers use in tx of hypertension

prevent K loss

ACEI's used to tx hypertension?

"-pril's" - Captopril

MoA of Captopril

blocks ACE, decr vasc resistance, BP; prevents bradykinins from converting to inactive peptide

Renin-angiotensin system (RAS)

angiotensinogen->AgI (renin from kidney); AgI -> AgII (active component, done by ACE); AgII acts on Ag receptors on VasSmMs (vasoconstriction) & adrenal glands (stim/synth of aldosterone, incr Ca, incr renal absorption of H2O, incr activity of CNS, incr SmMs cell growth

Uses of Captopril in hypertension tx

monotherapy for stages 1,2,3 of hypertension, adjunct w/ thiazide diuretics, Ca channel blockers, or beta-blockers for stage 4

Contraindication of Captopril

Pregnancy, causes renal damage in fetus causing fetal death

Adverse effects of Captopril

Dry cough, kidney problems, 1st dose effect (probs first time but better after)

ARB's used to tx hypertension

"-artan's"- Losartan

MoA of Losartan

blocks AgII binding to AT1 receptor mostly on BV & kidney, decr vasc. Resistance, decr BP; in addtn blocks break down of bradykinin (causes dry cough)

Contraindication of Losartan

Pregnancy, causes renal damage in fetus causing fetal death

Beta-blockers used to tx hypertension

"-lol's"- Atenolol, Propranolol

MoA of Atenolol & Propranolol

compete for NE or EPI binding site (hypertension, angina, MI, arrhytmias, HF), presynap beta-1 receptor on heart blocked causing decr HR &CO

Adverse effect of Losartan

renal damage to fetus leaded to fetal death, don't use in pregnant Pt

Uses of Atenolol & propranolol in hypertension tx

monotherapy for Stage 1&2, adjunct for later stages

CI of atenolol & propranolol

elderly & black populations

Adverse effects of atenolol & propranolol

myocardial depression b/c muscle receptor on heart tells heart to beat stronger, other: fatigue, tiredness, bradycardia, asthma, incr plasma cholesterol, impotence

Dizziness SE of losartan is a direct result of _________

vessel effects

alpha-blockers used to Tx hypertension

"-osin's"- prazosin

MoA of prazosin

alpha-1 receptor in vessel walls blocked causing incr vasc resistance, decr BP

Uses of prazosin in hypertension tx

monotherapy for stage 1, adjunct w/ diuretics for stage 2

Adverse effects of prazosin

venous pooling-> orthostatic hypertension b/c vessel doesn't provide pressure therefore not enough P to push blood out of microcirculation-> not enough blood to brain; 1st dose effect, edema, nasal stuffiness, delayed ejaculation, tachycardia, dizziness, headache, incontinence

Beta-1 action vs. Alpha-1 action

B1 in heart, A1 in vessel

Ca Channel blocker effects in hypertensive tx

prevents muscle contraction

Vasodilator SEs in hypertensive tx

minoxidil causes a hair growth side effect

Diazoxide uses in hypertensive tx

used for hypertensive emergencies

What is diazoxide?

used in hypertensive emergencies, very potent, selective arterial vasodilator for major arteries, acts by opening K channels, given by IV injectino

CI's of diazoxide?

Angina pectoris, MI, aneurism, pulmonary edema, diabetics

What is hypertension the major cause of?

CVD morbidity, but only 1/4 adequately treated

A reduction in CVD M&M can be achieved through ___________

hypertension control

Impt features of Diuretics for antihypertension

decr blood vol, good for older & black pt's, Adv rxn: hyperlipidemia & K loss

Impt features of ACEI's

decrease vascular resistance; Adv Rxn: renal damage, fetal death

Impt features of ARB's

decrease vascular resistance; Adv Rxn: renal damage, fetal death

Impt features of Beta-blockers

decrease HR & CO; Adv Rxn: myocardial depression

Prototypic beta-blocker for antihypertensives

propranolol

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