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Hypertension tx
UVa med pharmacology block 3
| Question | Answer |
|---|---|
| How do ACEis treat hypertension? | block angiotensin II formation thus: decrease vasoconstriciton decrease sympathetic activity decrease aldosterone production increase natruersis |
| How many HTN drugs can be used concurrently? | up to 3 |
| How does hydralazine treat hypertension? | direct vasodilation, but must use beta blocker to prevent baroreflex and diuretic to prevent edema |
| How do DHPs treat hypertension? How does verpamil do it? | block smooth muscle Ca receptors preferentially b/c have a higher voltage potential - causes vasodilation verapamil targets both heart and VSM -> causes decreased cardiac contractility and HR as well as vasodilation |
| When should DHPs be avoided? | dont' use short acting DHPs when someon has heart disease, as will cause rebound baroreflex, thus increase heart demand |
| What is hte prototypical ARB? | losartan |
| How do B1antagonists treat hypertension? | decrease heart contractlity / HR decreased renin release in kidney, and increase natriureisis |
| How does reserpine treat hypertension? Side effects? | blocks storage of NE into synaptic vesciles used in combo w/ thiazides not really used but: diarrhea, depression, suicide.... |
| What are the side effects of alpha 2 agonists? | sedation rebound hypertension on withdrwal dry mouth impotence constipation some depression |
| How do ARBs treat hypertension? | same as ACEis except no bradykinin formation thus, less vasodilation |
| What patients will have adverse effects of B2 blockers? | those with abnormal SA or AV nodes those with PAD (vasoconstricts leg vessels) |
| How do alpha 2 agonists treat hypertension? | inhibition of sympathetic nerve activity inbhits NE release from symphathetic terminals |
| How do a1 antagonists treat hypertension? | Arteriolrar dilatation venous dilatation |
| How do thiazides reduce BP? | acute: reduce plasma volume chronic: vasodilation b/c less total body Na -> Na/Ca exchanger not as active, thus less Ca intracellularly -> dilation |
| Why should spironolactone never be given w/ an ACEi? | severe hyperK |
| What is the prototypical ACEI? | captopril |
| If someone is non responsive to a drug, what should you do? | try another class before giving additional drug but make sure you tried 3 times with this drug... |
| How does aspirin affect thiazie diuretics? | decreases natriuretic effect |
| What are side effects of hydralazine? | reflex tachycardia hypersensitivity reaction = lupus |
| What are the advantages of different generational ACEis? | longer T1/2 differences in metabolic excretion |
| What are the drugs that are used for monotherapy of hypertension? Which are proven? | *Thiazides ACE inhibittors ARBs *B antagonists a1 antagonists CC Blockers |
| What are the components of the baroreflex? | arterial vesoconstriction venous constriciton increased HR and contractlity |
| What are the mechanisms of hypertension? | increased BP needed to eliminate same amount of Na from body b/c of genetic defect or increased renal nerve activity (stress or loss of baroreceptor reflex) decreased vascular compliane and remodeling of heart and VSM |
| What are nonpharmocologic ways to reduce hypertension? | salt restriction diet exercise weight loss reduce alcohol and smoking |
| What drug should alpha1 antagonists never be used with? | DHPs b/c can cause tachycardia |
| Which is better for hypertension, DHPs or nonspecifics? | DHPs |
| How does guanethidine used to treat hypertension? | depletes noradrenergic nerve endings of NE almost never used.... |
| How is blood pressure compensated for by the body in HTN treatment? | fast response - baroreflex slow comp - reduced renal filtration causes increased sodium retention / Ang II |
| What are the side effects of alpha 1 antagonists? | orthostatic hypertension fluid retention overtime |
| What is labetolol and what is it used for? | blocks alpha and beta receptors used sometimes for essential hypertension, but mainly IV for emergency situations |
| When is someone w/ hypertension given loop diuretics? | when have severe hypertension, or impaired renal function (GFR <30) if hypertensive emergincy , give IV treat refractory edema |
| Who shouldn't get ACEis? | those w/ renal insufficiency pregnant women |
| What is the use of alpha methyl DOPA? | prodrug convert to a-methyl NE that is selective a2 agonist safe for pregnancy however ,can cause hypersensitivity reactions |
| What drugs are alpha 1 blockers usually coadminstered with? | thiazides and ACEi |
| What drugs are used for a hypertensie emergency? | labetolol IV first IV nitroprusside - not too long though b/c CN accumulation IV nitroglycerine if eclampsia hydralazine IM or IV; MgSO4 for convulsions if pheochromocytoma phenotlamine or phenoxybenzamine |
| When does someone on a1 antagonists develop orthostatic hypertension? | if on a diuretic or if this is the first time using it |
Created by:
sam.mrosenfeld
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