Pharmacology Ch 16

Drugs for Hypertension

Cardiovascular disease

_______ includes all conditions (affects all areas of the body) affecting the heart and blood vessels…

Cardiovascular disease

_______ is the most common cause of death in Canada…

Hypertension

Most common type of cardiovascular disease is ________ (1 in 5 Canadians)…

Blood pressure

________ the force of the pressure wave from the heart’s pumping action pushing against the walls of the arteries…

systolic

______: the measure of the force of blood as your heart pushes it out, top measure…

diastolic

_______: the measure of the force of blood as ur heart relaxes and refills, bottom measure…

Blood pressure

_______ this varies throughout the day and from one day to the next (lowest when at rest)…

Hypertension

_______ is when ur blood is constantly elevated…

120/80

The optimal blood pressure is ______…

140/90

Hypertension is diagnosed when ur blood pressure is _____ or greater…

130/80

Diabetes hv impaired blood flow so they’re a little elevated, they also have a higher risk of cv disease, but there target level is ______ or less…

hypertension

130-139/80-89 is at an increased risk of progression to ________…

Silent killer

Hypertension is also known as the _______, as it can go undetected for prolonged periods of time due to lack of symptoms, its known as ______ as it damages blood vessels and organs which can lead to heart attack (MI), strokes, or heart and kidney failure, so regular testing is important…

age, race, gender and family history

Non-modifiable risk factors (factors u cant change) includes: _____, _____, ____ and ______…

smoking, obesity, diet, activity level, alcohol and stress

Modifiable risk factors ( aka lifestyle changes, that u can change) includes: _____, ______, _____, ____, _____ and _____…

Lifestyle changes

____________ can often successfully control mild hypertension…

essential and secondary hypertension

Hypertension is classified according to cause, the 2 categories of cause is: ______ and _____…

essential

______ hypertension, the cause is unknown, the cause cannot be easily identified…

secondary

______ hypertension, is identifiable, and its being caused by an underlying condition…

cardiac output, peripheral resistance and blood volume

There are 3 factors responsible for blood pressure which are: ______, ______ and _____, an increase in any of these factors will subsequently increase blood pressure, and meds for hypertension work to decrease one or more of these factors…

pregnancy

________ has an increased level of blood volume, as a lot will be lost during the birth…

cardiac output

______ the volume of blood pumped per minute…

cardiac output

_______ is determined by the number of times the heart contracts per minute (heart rate) and the amount of blood pumped by the ventricle in one contraction (stroke volume)….

Cardiac output

An increase in heart rate or stroke volume will increase _____, which in turn increases blood pressure, like during exercise ____ increases, as it gets ur heart pumping and gets more blood around….

Peripheral resistance

_______ is dependent on the diameter (aka lumen) of the blood vessel, the smaller the diameter, the more increased resistance, which increases bp, like a clogged hose that only trickles…

Blood volume

______ the total amount of blood in the vascular system (body), its relatively constant but can change due to various factors like high salt diet, as salty foods contain water and sodium that retains in the blood increasing the _______…

vasomotor center

_______ is a region in the brain responsible for regulating blood pressure as it controls the diameter of blood vessels…

emotions

______ like anger or stress can also increase blood pressure…

hormones

_______ like epinephrine or norepinephrine can also increase blood pressure…

Antidiuretic hormone (ADH)

A hormone called ______ aka vasopressin causes an increase in blood volume by reducing loss of water in urine….

Renin-angiotensin-aldosterone

_______(RAA) system can also impact blood pressure…

vasomotor center

_______ a cluster of neurons in the medulla oblongata of the brain, that has receptors that act as sensors in major arteries (called baroreceptors and chemoreceptors) that provides vital info on conditions in the vascular system, which it’ll react to info and send messages to arteries to either constrict (raise Bp) or relax (lower BP)…

RAA system

_______ a homeostatic mechanism involving the kidneys that helps regulate bp and fluid balance (its where drugs work, bp meds work in kidneys)…

Renal arteries

When the _______ detect low bp, it tries to restore homeostasis…

RAA system cascade

_______: Renin released → causes conversion of angiotensinogen in blood to angiotensin I (ATI) → ATI converted to ATII by enzyme angiotensin converting enzyme (ACE) → ATII vasoconstriction and releases aldosterone → aldosterone causes retention of Na & O₂ by kidneys → increasing blood volume

diagnosis of hypertension

________: a hcp will want several bp readings, not just one for this to be diagnosed…

180/110

In the diagnosis of hypertension a hcp will want several bp readings, not just one for it to be diagnosed, unless the reading is _____ or greater…

masked hypertension

_______: normal bp readings at doctor’s office but elevated outside office like home…

White coat phenomenon

________: elevated bp readings at doctor’s office but normal outside the office…

Home bp monitoring

________: is important as it plays a vital role in mgmt as it provides instant feedback on effectiveness of lifestyle changes and meds - increased compliance…

lifestyle modifications

______ is the cornerstone of hypertension prevention and management…

exercise, weight, diet, smoking, sodium intake, and alcohol

Lifestyle mods for hypertension includes: _____, _____, _____, _____, _____ and ______, and if they aren’t enough, meds are involved, but still important to continue positive lifestyle habits…

140/90

Pharmacotherapy (drugs) is added when lifestyle modifications are not enough to keep bp below _______…

130/80

Pharmacotherapy (drugs) is added when lifestyle modifications are not enough to keep bp for diabetes patients below _______…

180/110

Pharmacotherapy (drugs) is definitely added if lifestyle modifications are not enough when a patients bp is _______ as just one reading alone…

diuretics, calcium channel blockers, agents affecting raa system and direct acting vasodilators

there are 5 major classes of drugs for hypertension which includes: _____, _____, _____, _____ and _____…

Degree of bp elevation, concurrent med conditions and the patients risk factors

The selection of the specific drug for hypertension depends on: ______, ______ and ______, normally one drug is started at a time and re-assessed at predetermined time, if a second drug is added its of different class and added when 1st drug is at target dose, combination meds is common and increases compliance…

diuretics

______ often the drug of first choice for treating mild to moderate hypertension…

diuretics

______: drug class for hypertension, MOA: act on the kidneys to increase volume of urine production (thereby reducing blood volume), these want to be taken early in the morning or else you’d be peeing all night, frequently prescribed w/ other antihypertensives to enhance effectiveness…

diuretics

_______: drug class for hypertension adverse effects include: electrolyte level changes (hypo/hyperkalemia K), dehydration, hypovolemia (low bv), orthostatic (postural) hypotension (dizzy, faint after rising too quick), photosensitivity, hyperglycemia (sugar), increase uric acid levels, and ototoxicity (hearing loss)….

Spironolactone (Aldactone), Triamterene, Amiloride

The diuretics for hypertension for hyperkalemia (high K), K sparing drugs includes: ______, _____ and _____…

Furosemide (Lasix)

______ this potent diuretic is more likely to cause severe K loss, hypovolemia (low bv) and hypotension (low bp)….

Furosemide (Lasix), HCTZ (Hydrodiuril), Indapamide (Lozide)

The diuretics for hypertension for hypokalemia (low K), cause excess K excretion includes a loop and thiazides: ______, ______, and _____…

Calcium channel blockers (CCB)

_______ contraction of the heart muscle (myocardium) is regulated by amount of calcium ions entering the cell (Ca entering thru channels initiates contraction)…

Calcium channel blockers (CCB)

______ also cause smooth muscle of arteries to relax lowering peripheral resistance, some are selective for calcium channel in the arteries (only work on channels), whereas others affect both arteries and myocardium (channels & heart muscle)…

Diltiazem (Cardizem) and Verapamil (Isoptin)

Calcium channel blockers (ccb) for hypertension drugs, non-selective (heart and blood vessels) includes: ____ and _____…

Nifedipine (Adalat), Felodipine, Amlodipine (Norvasc)

Calcium channel blockers (ccb) for hypertension drugs, selective (heart and blood vessels) includes: ____, _____, and _____…

pine

“_____” are CCB’s and diltiazem & Verapamil are exceptions to the rule…

calcium channel blockers (CCB)

_______: drug class for hypertension adverse effects include: hypotension (low bp), bradycardia (low hr), flushing/headache and peripheral edema (swelling vessels around body), these symptoms cause patients to stop or switch to a different med…

Reflex tachycardia

Another symptom of CCB’s is ______, a condition that occurs when hr increases as a result of rapid fall in bp, this happens due to potent vasodilating effects…

Diltiazem (Cardizem) and Nifedipine (Adalat)

Grapefruit choice may increase symptoms of CCB’s, and ______ and _____ interact with grapefruit juice…

Drugs affecting the raa system

______ is a class for hypertension that affects a system using these types of drugs: ACE inhibitors, ARBs, and Direct renin inhibitors…

Angiotensin converting enzyme (ACE) inhibitors

_____ is a type of drug that affects the raa system as they block conversion of ATI to ATII, and most end in “prils”…

Angiotensin receptor blockers (ARBs)

______ is a type of drug that affects the raa system as directly block the effects of ATII on its receptors, and most end in “sartans”…

Direct renin inhibitors

______ is a type of drug that affects the raa system as it blocks the enzyme renin from initiating the raa system cascade, aliskiren (Rasilez)…

Aliskiren (Rasilez)

Direct renin inhibitor drug that affects the raa system as it blocks the enzyme renin from initiating the raa system cascade includes: _____…

ACE inhibitors

_________ block the conversion of ATI to ATII, it decreases bp by 2 mechanisms: lowers peripheral resistance and decreases blood volume…

lower peripheral resistance and decreases blood volume

What are the 2 mechanisms that Ace inhibitors use to decrease bp: _____ and _____…

cough

ACE inhibitors always hv a persistent _____ which is what makes patients switch meds to ARBs…

ACE inhibitors

______: minor side effects of this are usually persistent cough and postural orthostatic hypotension (dizzy, faint when rising too quick), Serious: angioedema (swelling beneath skin or mucosa membrane), its effect on K levels is it saves them so hyperkalemia and its contraindicated in pregnancy…

ARBs

______: blocks ATII receptor, which inhibits its effects on blood vessel dilation and increases Na excretion by the kidneys, similar to that of ACEI (cousin)…

ARBs

______: adverse affects similar to ACEI is dry cough and angioedema but are much less common, hypotension, hyperkalemia (saves K) and its also contraindicated in pregnancy…

Adrenergic blockers

_______ is one of the 5 classes for hypertension which could be alpha (alpha 1 only, 2 don’t do anything) or beta blockers (Cardio-selective: Beta 1, & Non-cardio-selective: Beta 1 & 2) …

Adrenergic blockers

________ are for adrenergic receptors found in the sympathetic nervous system, because stimulation of these causes fight or flight responses such as faster heart rate which increases bp and bronchodilation…

cardio-selective beta-blockers

_______: these adrenergic blockers act as antagonists at the beta-1 receptors on the heart, so they decrease hr and contractility (benefits post MI due to decreased myocardium oxygen demand), but these in higher doses are lost…

Metoprolol (Lopressor), Bisoprolol (Monocor), Carvedilol

Drugs of cardio-selective beta-blockers are adrenergic blockers that act as antagonists at the beta-1 receptors on the heart, so they decrease hr and contractility, but in higher doses are lost, includes: ______, ______ and _______…

Non-specific beta-blockers

_______: these adrenergic blockers block beta receptors in the respiratory system (causing bronchoconstriction) and vasodilation…

Propanolol (Inderal), Labetolol (Trandate)

Drugs of non-specific beta blockers are adrenergic blockers that block beta receptors in the respiratory system (causing bronchoconstriction) and vasodilation, includes: ______ and ______ (alpha & beta)…

Labetolol (Trandate)

______, this non-specific beta blocker is the drug of choice for pregnant patients w/ high blood pressure…

Beta-blockers

_______: adverse effects of this includes: bradycardia, hypotension, rebound tachycardia if stopped abruptly (taper needed), fatigue & activity tolerance (causes hr to become less responsive to exertion), hypo/hyperglycemia, masking of hypoglycemia (palpitations (tachycardia), tremor, anxiety, sweating (not masked)), dyspnea (more common w/ non-selective agents & patients w/ asthma) and Impotence (inability to take effective action)….

Alpha-1 blockers

_______: blocks alpha-1 adrenergic receptors in arteries and veins, which reduces peripheral vascular resistance (opens up vessels), there is usually little change in hr or co, not really used for hypertension anymore, often end in “zosin”…

Doxazosin (Cardura), Prazosin, Terazosin (Hytrin)

Drugs of of alpha-1 blockers that block alpha-1 adrenergic receptors in arteries and veins, that reduces peripheral vascular resistance (opens up vessels) includes: _____, ______ and _____…

Centrally acting alpha-2 agonists

________: activates alpha-2 receptors in brain which causes peripheral arterial vasodilation…

Methyldopa (Aldomet), Clonidine

Drugs of centrally acting alpha-2 agonists activates alpha-2 receptors in brain which causes peripheral arterial vasodilation includes: ______ and ______…

Clonidine

_______: This centrally acting alpha-2 agonist is usually reserved to treat hypertension uncontrolled by other drugs, and is also used for hot flashes in menopause, tourettes and helps manage symptoms with opioid withdrawal…

direct-acting vasodilators

_______: used mainly in treating hypertensive crisis (Used to bring down bp quickly), not tolerated well…

Direct-acting vasodilators

______: have the potential to produce serious adverse effects like reflex tachycardia…

Nitroprusside and Hydralazine

Drugs of direct acting vasodilators used mainly for hypertensive crisis includes: ______ and _____…

Hydralazine

______: this direct-acting vasodilator has a adverse effect of SLE (lupus)- like syndrome (like arthralgia, arthritis, fever, myalgia, and pulmonary symptoms)…

Blood pressure

________ is caused by the pumping action of the heart…

Hypertension

Failure to treat ________ can lead to stroke, heart failure or myocardial infarction (MI)…

Hypertension

Several risk factors contribute to the development of __________ and some are modifiable…

Blood pressure

The primary factors responsible for _________ are cardiac output, peripheral resistance and blood volume…

Blood pressure

Many nervous and hormonal factors help to keep _________ within normal limits…

Arterial blood pressure

Hypertension is characterized by the consistent elevation of ________________…

Home

________ blood pressure monitoring plays a vital role in the diagnosis (and mgmt) of hypertension….

Lifestyle

Positive _________ changes can reduce blood pressure and lessen the need for medications…

Severity

Selection of specific antihypertensive drugs depends on the _________ of the disease…

Diuretics

_________ are often the drug of first choice for treating mild to moderate hypertension…

Calcium channel blockers (CCBs)

_________ cause vasodilation (open vessels) and hv emerged as important drugs in the treatment of hypertension…