Term
| Non-pharm therapy for HTN |
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Definition
Lose weight even w/o changing salt intake
Salt intake works best for blacks
Less alcohol
More exercise |
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Term
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Definition
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Term
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Definition
Saluresis causing dec. EABV = dec. TPR = dec. BP -20/-10 (2-4 wks)
Activated RAAS but HR NC or slightly inc.
Reverses LVH
CO returns to pretreatment value |
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Term
| The antiHTN effect of thiazides occurs at ___. Inc. the dose above this value ___ |
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Definition
Small doses
Doesn't cause a greater fall in BP but inc. incidence of metabolic issues |
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Term
| How does salt restriction work with HCTZ? |
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Definition
| Modest salt restriction prevents the need for larger doses of HCTZ and limits the loss of K |
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Term
| Thiazides have no effect on BP in patients w/ ___ |
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Definition
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Term
| Thiazides are routinely used to prevent/reverse ___ |
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Definition
| Salt and water retention caused by other antiHTNs like arterial VD, a/B blockers, centrally-acting sympatholytics |
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Term
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Definition
Hypokalemia (from activated RAAS) = watch it w/ digoxin
(hypokalemia causing) Inhibit insulin secretion causing hyperglycemia = don't give to diabetics!
Hyperuricemia = may cause gout |
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Term
| Thiazide-induced hypokalemia can be lessened/prevented by: |
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Definition
Low doses of HCTZ + Na restriction
Cotx w/ K-sparing diuretic like amiloride, triamterene, spironolactone
Cotx w/ ACEI/ARB
Cotx w/ B-blocker
Cotx w/ K supplement |
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Term
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Definition
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Term
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Definition
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Term
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Definition
Prevents conversion of AngI to AngII as well as breakdown of bradykinin (aldosterone maintained by ACTH and plasma K)
Reversal of AngII effects on collagen synthesis = inc. compliance of large arteries = dec. SBP
Balanced VD = dec. TPR = dec. MAP (CO little changed)
NC GFr + inc. RBF = dec. FF = no salt/water retention
NC HR and baroreflex still in tact |
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Term
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Definition
HTN patients w/ HF/LVH/DM
Patients w/ systolic dysfxn post MI |
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Term
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Definition
Prego category X!!!
Angioedema
*Dry cough (give ARB or aspirin)
*Skin rash (dose-related)
*Ageusia, dysgeusia
First-dose hypotension esp. if already taking thiazide
*Dec. glomerular pressure = renal insufficiency in pt w/ bilateral renal artery stenosis or stenosis of single kidney
Hyperkalemia in pt on K-sparing diuretic or oral supplement
*Fatigue, weakness, sexual dysfxn rare
No hypokalemia, hyperglycemia, hyperuricemia |
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Term
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Definition
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Term
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Definition
| Block AT1-R = no AngII effects |
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Term
| If an additional fall in BP is desired on ARBs, add ___ |
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Definition
| Small dose of HCTZ rather than inc. dose of ARB |
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Term
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Definition
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Term
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Definition
Mild-moderate HTN
Systolic HTN
HTN in pt w/ asthma, DM, renal dysfxn, gout, hyperlipidemia
Proteinuria in NIDDM (but ACEI/ARB better) |
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Term
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Definition
L-type Ca channel is found in vascular smooth muscle
Depolarization causes them to open, allowing Ca to flow down its gradient
This Ca activates calmodulin and triggers the release of stored Ca from the SR
CCAs block L-type Ca channels in arterioles (don't block the SR channels!)
VD = dec. TPR/DBP = dec. afterload
Large arteries: inc. compliance = dec. SBP
Baroreflex inc. in sympathetic activity
CO maybe slightly inc.
No salt/water retention b/c direct natriuretic effect at renal tubules
NC RAAS |
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Term
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Definition
Pedal edema from dilation of precap. sphincters
Paradoxical angina from dilating healthy arteries more than atherosclerotic ones thus causing ischemia in the latter areas
Hypotension
GERD |
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Term
| B-blockers are a cheap/effective way to manage HTN, but... |
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Definition
| Dec. glomerular pressure = inc. FF = salt/water retention that limits antiHTN effect = pseudotolerance |
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Term
| In tx of HTN, B-blockers are combined w/ ___ |
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Definition
| Thiazides to cause a further reduction in BP and prevent any salt/water retention that may occur in response to the fall in glomerular pressure |
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Term
| HTN drugs that don't cause salt/water retention |
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Definition
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Term
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Definition
Diazoxide
Labetalol
Na nitroprusside |
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Term
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Definition
Block cardiac B1R = prevent symp stimulation = dec. HR
Block a1R in vasculature = balanced VD = dec. TPR = dec. MAP = dec. preload and afterload
Partial agonist at vascular a2R = active VD
Dec. glomerular pressure = inc. FF = salt/water retention
NC RAAS |
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Term
| Labetalol: HTN emergency effects |
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Definition
IV push = smooth effect = onset 2-4 min, peak 10-15, duration 2-4 hrs
NC HR
NC CO = cerebral/coronary/renal blood flows maintained
Can use in preeclampsia |
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Term
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Definition
Orthostatic hypotension
Headaches
Fatigue
Dec. sexual fxn |
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Term
| aMeDA: indications, effects |
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Definition
Pediatric and prego HTN
Slow fall in BP prevents MI/CVA |
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Term
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Definition
Sedation
Dry mouth
Rebound HTN
Fatigue, flu-like syndrome
Pos. Coomb's
Hepatitis |
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Term
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Definition
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Term
| Clonidine: indications, MOA |
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Definition
Used w/ diuretic to tx mild/mod HTN
Lipid soluble = enters brain
Stim postsynaptic a2R in rostral ventrolateral medulla = inhibit symp outflow |
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Term
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Definition
Dec. glomerular pressure = inc. FF = salt/water retention = pseudotolerance
RAAS suppressed |
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Term
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Definition
Sedation: can persist!
Dry mouth
Vivid dreams, restlessness, depression
Orthostatic intolerance, bradycardia, slowed AV conduction
Withdrawal syndrome |
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Term
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Definition
Diazoxide
Hydralazine
Minoxidil |
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Term
| Arterial VD for HTN: effects |
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Definition
Dec. TPR = dec. DBP = dec. afterload
Baroreflex inc. in symp. activity
-Inc. HR and dp/dt
-Venoconstriction = inc. preload
-Together = inc. CO (give w/ B-blocker to temper this otherwise feels like the heart is pounding, also prevents secondary hyperaldosteronism)
-Inc. RAAS = salt/water retention |
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Term
| Arterial VD for HTN: indications |
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Definition
Patients w/ severe HTN resistant to combined tx w/ first line drugs
Severe HTN: can't be used as single drugs b/c of tachycardia and inc. EABV
Diazoxide: can be used to arrest labor in eclampsia |
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Term
| Minoxidil can also be used as... |
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Definition
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Term
| Hydralazine has a ___ onset whereas minoxidil has a ___ onset. |
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Definition
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Term
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Definition
Tachycardia, palpitations, angina
Edema
Hydralazine: SHIP! = fever, arthralgia, arthritis
Diazoxide: hyperglycemia |
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Term
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Definition
Balanced VD!
-Dec. TPR = dec. DBP = baroreflex inc. HR
-Venodilation = dec. preload
-NC CO
Not given long enough to cause salt/water retention
If given to patients w/ CHF, balanced VD = inc. CO = hemodynamic saluresis |
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Term
| Na nitroprusside: pharmacokinetics |
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Definition
t1/2 = 30s = dose titration based on hemodynamic response
Can only give to supine patients
Must be in D5W covered w/ foil via slow IV |
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Term
| Na nitroprusside: indications |
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Definition
HTN emergencies
Controlled hypotension during surgery
Halt acute dissecting aortic aneurysm
Inc. CO in CHF
Dec. myocardial O2 demand post MI |
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Term
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Definition
Tachycardia, palpitations
Thiocyanate intoxication: anorexia, nausia, delirium, hallucinations, psychosis, metabolic acidosis (counter w/ furosemide to improve renal fxn!) |
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Term
| The goal of antiHTN therapy is... |
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Definition
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Term
| If patients have an inadequate response to a single agent... |
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Definition
Use a different class of first-line agents
Then add second drug from another class of first-line agents
Then add a third drug from another class of first-line agents |
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Term
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Definition
Systolic HTN a result of dec. arterial compliance = wide PP
Tx w/ ACEI/ARB, DHP to inc. compliance |
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Term
| Drugs that cause salt/water retention |
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Definition
B-blockers
a-blockers
Clonidine
Arterial VD |
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Term
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Definition
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Term
| VD that NC CO = balanced VD |
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Definition
ACEI/ARBs
Labetalol
Centrally acting = aMeDA, clonidine
Na nitroprusside
DHPs not nifedipine |
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Term
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Definition
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