PathoPharm Exam 2

Basic causes of hypertension

high sodium, RAAS, aldosterone, SNS

aldosterone is made by the ___

adrenal cortex

How can SNS cause hypertension

vasoconstriction

Med classes used to treat hypertension

diuretics, ca channel blockers, alpha and beta blockers, vasodilators, ACEs, ARBs

high stroke volume usually ___ BP

increases

How do diuretics lower BP

get rid of fluids by increasing urine output (some also increase salt excretion)

What causes the RAAS system to activate

low blood flow to kidneys

What fluid retention and high sodium intake do to SV and BP

increases

The lungs are continuously releasing ___and the liver is continuously releasing ___, even when the RAAS system isn't active

ACE, angiotensiongen

When RAAS is activated, kidneys relase

renin

Renin and angiotensinogen interact to create

angiotensin 1

angiotensin 1 and ___ interact to create angiotensin 2

ACE

Drug class used to prevent the creation of angiotensin 2

ARBs

What drug class prevents ACE from creating angiotensin 2

ACE inhibitors

Angiotensin 2 causes ___ and also goes to the adrenal gland where it increases ___ production in the raas system

vasoconstriction, aldosterone

In the RAAS system, angiotensin 2 increases aldosterone production which causes

increased NaCl and H2O reabsrorption

Drug class that causes smooth muscle around blood vessels to relax

Ca channel blockers

Diuretic aimed at LoH to stop reabsorption of Na and H20

loop thiazide

diruetic aimed at getting rid of Na, while retaining K+

K+ sparing

What does SNS stimulation do to PVR (peripheral resistance)

increases

What does SNS stimulation do to BP and HR

increases

What drug classes are used to treat high PVR, HR, and BP

alpha and beta blockers

If you are on a diuretic, you are automatically a ___ risk

fall

furosemide

loop diuretic

turosemide

loop diuretic

Route used for loop diuretics

oral/IV

loop diuretic used most commonly for simple stable

turosemide

MoA for Loop diuretics

work in LoH to block reabsorption of sodium and water

Along with blocking sodium and water, loop diuretics also block reabsorption of

potassium, chloride, magnesium, and calcium

TA of loop diuretics

diuresis (decrease of edema, weight loss, low BP, increased urine output)

TU of loop diuretics

rapid mobilization of fluid, hypertension, heart failure

SE/Complications of loop diuretics

dehydration, hypotension, ototoxicity, hypokalemia, nocturia

If on a diuretic, and urine output is less than __ ml/hour, notify a provider

30

How can loop diuretics cause ototoxicity

low fluid in ear (causing difficulty balancing)

Hypokalemia is less than ___ mEq/L

3.5

Signs of hypokalemia

NV, leg cramps and weakness

Contraindications of loop diuretics

anuria

Interactions of loop diuretics

digoxin, additive hypotensive effects, NSAIDs

Why do digoxin and loop diuretics interact

hypokalemia and dysrhythmias

hydrochlorothiazide

thiazide diuretic

Route for thiazide diuretics

oral

MoA for thiazide diuretics

work in DCT to block reabsorption of sodium, water, and electrolytes

TA of thiazide diuretics

diuresis

Is the diuresis for thiazide diuretics more or less rapid that diuresis for loop diuretics

less

TU for thiazide diuretics

essential hypertension, heart failure

First choice for essential hypertension drug class

thiazide diuretics

Complications/SE of thiazide diuretics

dehydration, hypokalemia, hyperglycemia, nocturia

Why is diabetes a precaution for thiazide diuretics

hyperglycemia side effect

Contraindication of thiazide diuretic

renal impairment

Interactions of thiazide diuretic

digoxin, additive hypotensive effects, NSAIDs

Spironolactone

K sparing diuretic

Route for K sparing diuretic

oral

MoA of K sparing diuretic

block the action of aldosterone

TA of K sparing diuretic

diuresis by increasing sodium and water excretion (but holding onto potassium)

TU of K sparing diuretic

hypertension, edema, HF

Complications/SE of K sparing diuretics

hyperkalemia

hyperkalemia is greater then ___ mEq/L

5

Signs of hyperkalemia

dyspnea, dysrhythmias

How to treat hyperkalemia

insulin

Contraindications of K sparing diuretics

hyperkalemia, kidney failure w/ anuria, liver/kidney disease

Interactions of K sparing diuretics

ARBs and ACE inhibitors

Why to avoid K sparing diuretics interactions with ACE inhibitors and ARBs

increased risk of hyperkalemia

nifedipine

Ca channel blocker

amlodipine

Ca channel blocker

MoA of Ca channel blockers

blocking of Ca channels in blood vessels

TA of Ca channel blockers

vasodilation of vascular smooth muscle of the arteries/arterioles of the heart

TU of Ca channel blockers

decrease BP

Complications/SE of Ca channel blocker

reflex tachycardia, orthostatic hypotension, peripheral edema

Ca channel blockers often cause reflex tahcycardia, so a ___ is often given with it

beta blocker

Why are acute MI and hypotension precautions for Ca channel blockers

orthostatic hypotension side effect

Cardioselective beta blockers target ___ receptors

B1

Nonselective beta blockers target

B1 and B2

Where are B1 receptors

heart, kidneys

Where are B2 recptors

liver, lungs

Where are A1 receptors

arterioles

metropolol

cardioselective beta blocker

atenolol

cardioselective beta blocker

propranolol

nonselective beta blocker

carvedilol

alpha 1 and beta 1 blocker

labetalol

alpha 1 and beta 1 blocker

What type of beta blocker works the best

nonselective

MoA of beta 1 blockers on the heart

block SNS to decrease HR, contractility, CO and AV node conduction

MoA of beta 1 blockers on the kidneys

block renin to decrease BP, and sodium water reabsorption

MoA of alpha 1 blockers on the arterioles

block SNS causing vasodilation

TU of beta blockers

primary hypertension

Complications/SE of beta 1 blockers

bradycardia, low CO, orthostatic hypotension

Complications/SE of beta 2 blockers

bronchoconstriction, inhibited glycogenesis

What patient should be a SEVERE precaution for beta 2 blockers

asthma

Complications/SE Alpha 1 blocker

orthostatic hypotension

Why should diabetes patients be a precaution for beta blockers

bradycardia and inhibition of glycogenolysis

Can alpha blockers affect beta receptors

no

prazosin

peripheral alpha blocker

clonidine

central alpha blocker

MoA of alpha 1 blockers on arterioles

blocks SNS

MoA of central alpha blockers

decreases SNS outflow in brain and SC to alpha and beta receptors

TA of alpha 1 blockers

vasodilation

TA of central alpha blockers

vasodilation, decrease HR, CO

TU of alpha blocker

primary hypertension

Complications/SE of peripheral alpha blcokers

first dose orthostatic hypotension

How to administer prazosin

at night, monitor BP