Unit 4: antihypertensive drugs

CO x total peripheral resistance

bp calc

vasomotor center of medulla

role: min-to-min bp regulation

baroreceptors

role: reflex tachycardia

insuline resistance, hyperinsulinemia, dyslipidemia, ab obesity

4 metabolic abnorms that can lead to HTN

diuretic, sympatholytic (alpha/beta blocker), vasodilator, renin angiotensin system inhibitors, Ca channel blocker

5 types of antihypertensive drugs

diuretic

often 1^st choice to treat mild to mod HTN

alpha/beta blocker, presynaptic adrenergic inhibitor, centrally acting agent, ganglionic blockers

5 classes of sympatholytic drug

beta blocker

used to inhibit SA node

alpha blocker

used to inhibit vasoconstriction

diuretic

decrease plasma/extracellular fluid vol; also treats HF and kidney disorders

diuretic

result: decrease preload/CO/TPR

diuretic

most common side effect: dehydration, decrease electrolytes

carbonic anhydrase inhibitor, loop, thiazides, K sparing, osmotic

5 classes of diuretics

carbonic anhydrase inhibitors

inhibits bicarbonate reabsorption in prox collecting tubule

loop

inhibits Na/K/Cl co-transport in loop of henle; K depleting

loop

decrease blood K lvls by inhibiting NaCl reabsorption in loop of henle

thiazide

inhibits NaCl reabsorption in distal collecting tubule; decrease blood K lvl

K sparing

prevent K loss that occur w/ loop/thiazide diuretics

k sparing

spironolactone: an aldosterone agonist; inhibits Na reabsorption/K secretion; inhibits aldosterone in distal tubule

k sparing

amiloride/triamterene: block Na channels

block beta 1/beta 1-2/alpha receptors; presynaptic adrenergic inhibitors; alpha 2 stim in BS (central acting); ganglionic blocker

6 methods of sympatholytics

presynaptic adrenergic inhibitor

inhibits NE release from peripheral neurons

beta blocker

side effects: bronchoconstrict, excessively depress hr/contractility, orthostatic hypotension, impaired glucose/lipid metabolism, depress/fatigue, GI disturbance

alpha blocker

side effects: reflex tachycardia, orthostatic hypotension, increase cardiac disease due to vasodilation

presynaptic adrenergic inhibitor

side effects: bradycardia, arrhythmia, drowsy, depress, GI disturbance

centrally acting agents

side effects: dry mouth, dizzy, sedition

ganglionic blockers

side effects: GI disturbance, urinary retention, visual disturbance, orthostatic hypotension due to inhibition of both sides of ANS

vasodilators

directly relaxes arteriolar smooth m

vasodilator

result: decrease systemic vascular response, decrease afterload, peripheral vasodilate

vasodilator

side effects: reflex tachycardia, dizzy, orthostatic hypotension, weak, nausea, fluid retention

angiotensinogen, renin, angiotensin 1, angiotensin-converting enzyme (ACE), 2

.___ (liver) + ___ (kidney) → ___ + ___ → ___ → increase bp (vasoconstrict, increase aldosterone release, increase Na/water retention, vascular remodeling/hypertrophy, decrease vascular compliance)

direct renin inhibitor, ACE inhibitor, blockade of angiotensin 2 receptors

3 classes of renin angiotensin system inhibitors

direct renin inhibitor

side effects: dry cough, GI prob, angioedema

ACE inhibitors

side effects: skin rash; dry, nonproductive cough; hematologic effects (neutropenia, agranulocytosis); angioedema

blockade of angiotensin 2 receptors

side effects: upper respiratory infection, HA, dizzy; no cough difficulties

Ca channel blocker

cause smooth m relax by blocking Ca binding to receptor, preventing m contract

Ca channel blocker

causes decreased peripheral smooth m tone and systemic vascular resistance

Ca channel blocker

used to treat: angina, hypertension, dysrhythmia, migraine HAs

Ca channel blocker

side effects: CV (orthostatic hypotension, palpitation, tachycardia), GI (constipation, nausea), rash, flushing, peripheral edema, dermatitis