Term
| Diseases that contribute to atherosclerosis |
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Definition
| hypertension, hyperlipidemia, type II diabetes |
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Term
| factors that contribute to atherosclerosis |
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Definition
| diet, genetics, obesity, gender, age, tobacco |
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Term
| conditions that result from atherosclerosis |
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Definition
| angina pectoris & myocardial infarction; transient ischemic attack & ischemic forms of stroke; cardiac arrhythmias & congestive heart failure |
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Term
| Thiazides & thiazide-like drugs - hydrochlorothiazide (Microzide), chlorthalidone (Thalitone), indapamide |
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Definition
| most popular drugs for chronic primary HTN; recommended for initial therapy; initially induces a natriuresis, decreasing blood volume --> decreasing cardiac output --> activates RAAS which limits degree of volume depletion & degree of decrease in BP; continued use --> decrease in peripheral vascular resistance; achieves 10 mmHg fall in diastolic BP; use low-intermediate doses; used in "volume dependent" HPN (includes African Americans, elderly HPN pts); widely used in combo with other antihypertensives |
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Term
| Side Effects of thiazides & thiazide-like drugs - hydrochlorothiazide (Microzide), chlorthalidone (Thalitone), indapamide |
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Definition
| hypokalemia (K wasters): muscular weakness, leg cramps, increase in ventricular ectopic activity --> sudden cardiac death; Hypercholesterolemia: 10-20 mg/dl increase in LDLs; Glucose Intolerance with hyperglycemia: use with caution in diabetics |
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Term
| Loop diuretics - furosemide (Lasix) |
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Definition
| most powerful diuretics; exert natriuretic effect near 20% of filtered Na load by blocking NaCl reabsorption in thick ascending limb of loop of Henle; Indications: pts w/ reduced renal Na excretion that don't respond to thiazides; short-acting --> give 2-3 times per day; SEs: hypokalemia --> weakness, cramps, cardiac arrhythmias; hypercholesterolemia; glucose intolerance w/ hyperglycemia |
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Term
| K-sparing diuretics - spiranolactone (Aldactone), eplerenone (Inspra), triamterene (Dyrenium) |
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Definition
| aldosterone antagonists that protect from K wastage by inhibiting renal output of K; all have limited natriuretic & BP lowering effects on their own; competitively block aldosterone receptors, indirectly antagonizing its actions such as reducing K loss; Major Use: tx of primary & secondary hyperaldosteronism, resistant forms of HTN; SEs: hyperkalemia, inhibition of sex steroid hormone receptors/biosynthesis |
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Term
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Definition
| adrenergic peripheral neuronal inhibitor; depletes storage of peripheral NE --> reducing NE released during nerve impulse --> decreases cardiac output & peripheral resistance --> decreases BP; action is irreversible (takes time for BP activity to fall off after stopping drug); SEs: sedation, mental depression, precipitates migraines, nasal congestion, postural hypotension, bradycardia, systemic fluid retention, diarrhea, peptic ulcers |
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Term
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Definition
| adrenergic central neuronal inhibitors; prodrug converted to methylNE which accumulates in NE storage vesicles & acts as alpha2-adrenergic agonist in vasomotor centers, dampening neural outflow; rarely used; Major Use: tx of HTN during pregnancy; SEs: peripheral fluid retention, sedation, dry mouth, "autoimmune" disorders, parkinsonian symptoms |
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Term
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Definition
| adrenergic central neuronal inhibitor; accumulates in NE storage vesicles & when released is an alpha2-adrenergic agonist; only requires a small qty to exert pharmacological actions --> transdermal patch form; Uses: tx primary HTN that provides smoother BP control with fewer SEs; ADRs & SEs: local skin rxns, dry mouth, rebound HTN if stopped quickly |
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Term
| alpha1-receptor blockers - doxazosin (Cardura), prazosin (Minipress), terazosin (Hytrin) |
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Definition
| adrenergic alpha1-receptor blockers; used for treatment of primary HTN; blocks arterial vascular alpha1-receptors inhibiting binding of NE --> decreases vasoconstriction --> decreases TPR --> decreases BP; similar effect in veins as well; slowly increase dose; give P 3x daily, give D & T 1x daily; Note: initial dose may cause SEVERE postural hypotension especially in pple already on diuretic; SEs: postural dizziness, stress-induced urinary incontinence, reflex tachycardia & systemic fluid retention; Beneficial effects: may improve glucose tolerance, may lower T-cholesterol & triglycerides & raises HDL |
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Term
| selective beta1-blockers - atenolol (Tenormin), metoprolol (Lopressor, Toprol-XL) |
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Definition
| lowers arterial BP by decreasing contractility & heart rate reducing BP; |
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Term
| nonselective beta1 & -2 blockers W/O ISA - propanolol (Inderal-LA), nadolol (Corgard), timolol |
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Definition
| lower arterial BP by decreasing contractility & heart rate reducing cardiac output, also inhibits renin release; Unfortunately, removes normal physiological level of beta-2-mediated vasodilation --> offsets decrease in TPR, limiting overall antihypertensive effect |
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Term
| nonselective beta-blockers WITH ISA - pindolol |
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Definition
| lower BP with less reduction in cardiac contractility & renin release but with more decrease in TPR; |
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Term
| Clinical Effectiveness of Beta-blockers as Antihypertensives |
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Definition
| less effective in elderly & African Americans; Chines ppl are more sensitive; Useful in: HTN with tachycardia & high cardiac output, HTN accompanied by angina, arrhythmias |
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Term
| Side Effects of Beta-blockers |
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Definition
| Cardiovascular: bradycardia, reduced exercise ability, fatigue, slow A-V conduction, decreased ventricular contractility, rebound HTN; Pulmonary: bronchoconstriction; Metabolic: masks tachycardia in hypoglycemic events, insulin resistance, hypertriglyceridemia & decreased HDL; CNS: bad dreams, hallucinations |
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Term
| combined alpha-1 & beta-receptor blocker - labetalol (Trandate) |
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Definition
| adrenergic alpha-1- & nonselective beta-blocker; causes decrease in peripheral resistance --> decreased BP; Uses: oral --> tx of more severe primary HTN, IV --> hypertensive emergency; SEs: postural dizziness, bradycardia, A-V block at high doses |
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Term
| NO-releasing beta-1 blocker - nebivolol (Bystolic) |
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Definition
| selective competitive beta-1 blocker that increase production & release of NO; decreasess renin release, HR, contractility, & increases NO to dilate vascular smooth muscle; Uses: HTN with impaired endothelial cell fcn, mild-moderate HTN; SEs: headache, fatigue, similar to beta-1 blockers |
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Term
| arteriolar vasodilators - hydralazine |
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Definition
| decreases arterial BP by decreasing TPR by directly dilating arterioles (not veins); releases NO from arteriolar endothelium; acetylated into inactive metabolites ("slow" & "rapid" acetylators); dilate resistance arterioles --> increase capillary hydrostatic pressure --> increased filtration of fluid + renal retention of Na & H2O --> arterial BP --> activates SNA & renal compensatory rxns --> stimulates heart & retention of Na & H2O; SEs: tachycardia, edema, loss of HTNsive efficacy; use with beta blocker & diuretic; "third drug option" for those not responding to diuretic & adrenergic inhibitor or other "second" choice drug; SEs: lupus-like rxn |
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Term
| arteriolar vasodilator - minoxidil |
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Definition
| decreases arterial BP by decreasing TPR thru direct dilation of arterioles; acts via active sulfate metabolite --> opens ATP-sensitive K channels in arteriolar smooth muscle cells; SEs: tachycardia, edema, loss of antiHTNsive effect, HAIR GROWTH; Uses: tx of most severe HTN when renal insufficiency is present |
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Term
| dihydropyridine Calcium Channel Blockers (CCBs) |
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Definition
| amlodipine (Norvasc), felodipine (Plendil), nifedipine (Procardia XL) |
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Term
| dihydropyridine CCBs - amlodipine (Norvasc), nifedipine (Procardia XL), felodipine (Plendil) |
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Definition
| lower BP by reducing Ca entry into arterial vascular smooth muscle cells through arterial L-type Ca channels --> reduces arterial vascular tone --> decrease in TPR --> decrease in BP; Uses: effective in all HTNs, especially elderly & African-Americans; SEs: slight postural dizziness, ankle edema, tachycardia; avoid rapid, fast-acting preps --> too many MIs |
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Term
| other CCBs - verapamil (Calan), diltiazem (Cardizem) |
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Definition
| act in heart --> decrease Ca entry in ventricular L-type Ca channels --> decrease ventricular contractility --> decreased cardiac output; Uses: treat all types of HTN, especially in elderly & African-Americans; SEs: directly suppresses HR & AV conduction, nausea, HA, constipation, V --> seroius myocardial depression (excessive bradycardia) |
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Term
| Angiotensin Converting Enzyme Inhibitors (ACEIs) |
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Definition
| captopril (Capoten), enalapril (Vasotec), lisinopril (Prinivil, Zestril), fosinopril (Monopril), quinapril (Accupril), ramipril (Altace) |
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Term
| Angiotensin II Receptor Blockers (ARBs) |
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Definition
| losartan (Cozaar), valsartan (Diovan), candesartan (Atacand) |
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Term
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Definition
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Term
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Definition
| inhibits angiotensin converting enzyme; decreases TPR & BP; inhibits synthesis of aldosterone --> decrease in Na & fluid retention; increases availability of bradykinin & related PG vasodilators --> further decrease BP & peripheral vascular resistance; inhibits angiotensin-II-facilitated release of NE --> prevent reflex tachycardia |
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Term
| Clinical Uses of ACEIs, ARBs, & Renin Inhibitors |
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Definition
| "normal renin" & "high renin" primary HTN, HTN 2ndary to diabetic nephropathy; DO NOT USE in pts with established bilateral renovascular HTN; |
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Term
| ARBs - losartan (Cozaar), valsartan (Diovan), candesartan (Atacand) |
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Definition
| competitive angiotensin-II receptor antagonists; causes decrease in TPR & BP, inhibits aldosterone synthesis --> reduces Na & H2O retention; inhibit angiotensin-II-facilitated release of NE --> prevent reflex tachycardia |
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Term
| Side Effects with ACEIs, ARBs, & Renin Inhibitors |
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Definition
| hyperkalemia, hypotension; nonproductive cough (increased bradykinin, ACEIs); angioedema of face, mouth; harm fetal development --> avoid during pregnancy |
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Term
| Drug Interactions with ACEIs, ARBs, & Renin Inhibitors |
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Definition
| K-sparing diuretics or K supplements --> hyperkalemia worsens; NSAIDs --> impair ACEIs by blocking bradykinin-mediated vasodilation |
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