6.4 antihypertensive chapter 23 antihypertensives

Term Definition
centrally acting adrenergic drugs drugs that modify the function of the sympathetic nervous system in the brain by stimulating a2-receptors – a2 receptors are inhibitory = dec BP
malignant hypertension extremely high BP usually above 180/120
orthostatic hypertension common ADE of adrenergic blocking drugs involving a sudden drop in BP when patients change position
prodrug a drug that is inactive in its given form and which must be metabolized to its active form in the body – generally by the liver to be effective
secondary hypertension high BP caused by another disease such as kidney, pulmonary, endocrine, or vascular disease
B- blockers and angiotensin covering enzyme inhibits have been found to be more effective in white people than black peole
blood pressure = cardiac output x systemic vascular resustance
MAP may be a better indicatior of tissue perfusion
MAP of ____ is believed to be necessary to maintain adequate tissues perfusion 60
Cardiac output is the amount of blood ejected from the left ventricle and is measure in L/min
SVR (after load) is the resistance of blood flow that is determined by the diameter of rat blood vessel and the vascular musculature
important considerations in planning drug therapy are whether the patient has multiple medical problems and what impact drug therapy will have on the patient's quality of life
diuretics are highly effective class of antihypertensive drugs they are first line antihypertensives for the treatment of hypertension
primary effect of diuretics is decreasing the volumes of plasma and extracellular fluid which results in decrease preload = decreased cardiac output and total peripheral resistance
thiazide diuretics (hydrochlorothiazide and chlorothialidone) are the most commonly used dietetics for hypertension
there are 5 subcategories in the adrenergic antihypertensive category – each either has central action (in the brain) or peripheral action (heart and vessels adrenergic neuron blocker (central and peripheral), a2-receptor agonist (central), a1-rec block (peripheral), b-blockers (peripheral), combo a1 and b-
centrally acting adrenergic drugs act b y stimulating the a2 adrenergic receptors in the brain = lack of norepinephrine production which reduces BP
stimulation of the a2 adrenergic receptors also affects the kidneys reducing the activity of renin
a1 blockers block a1 that are stimulated by circulating epinephrine (which produces inc BP) blocking = dec BP
dual action of a1 and B-receptor blocker laberalol hydrochloride acts in the periphery at the heart and blood vessels. reduction in heart rate and vasodilation
contraindications of adrenergic antihypertensive drugs acute heart failure, concurrent use of MAOI, severe depression, peptic ulcer, and sever liver or kidney disease, Asthma
most common ADE of adrenergic drugs bradycardia, with reflex tachycardia, orthostatic and post exercise hypotension, drug mouth, drowsiness, dizziness, depression, edema
abrupt discontinuation of centrally acting a2 agonists can result in rebound hypertension
adrenergic drugs interactions cause additive effects with alcohol, benzodiazepines, and opioids
ACE inhibitors are often used as one of the first line drugs for heart failure and hypertension
ACE inhibitor also used as first line with people with _____ in order to protect the _______ diabetes, kidneys
catopril and lisinopril are the only two ACE inhibitors that are not prodrugs which means its an important advantage in treating people with liver dysfunction
All newer ACE inhibitors have long half lives and long duration of actions which allows for once a day dosing – promotes better patient adherence
ACE inhibitors when used in pregnancy (second and third trimesters) can cause significant fetal morbidity or mortality
ACE inhibits inhibit angiotensin converting enzyme which is responsible for converting Antiotensiin 1 to Angiotensin II which stimulates aldosterone secretion
primary effects of ACE inhibitors are cardiovascular and renal
cardiovascular effects of ACE are due to their reduce BP by dec systemic vascular resistance – done by prevent breakdown of vasodilation bradykinin and substance P – prevent prod angio II
ACE inhibitors are beneficial in treatment of heart failure because they prevent sodium and water resorption by inhibiting aldosterone secretion – causes diuresis with dec blood volume and return to heart
ACE inhibitors can stop the progression of left ventricular hypertrophy which is sometimes seen after MI – cardioprotective effect
ACE inhibitors also have a protective effect on the kidneys because they reduce glomerular filtration pressure
ACE inhibitors contraindicated in patientss with baseline potassium of 5mmol/L, lactating women, children, and patients with bilateral renal artery stenosis.
ADE from ACE inhibitors major CNS effects, fatigue, dizziness, mood changes, and headaches. dry non-productive cough
Interactions with ACE inhibitors NSAIDS, lithium carbonate, potassium supplements
Angiotensin II blockers (ARBS) similar to ACE inhibitors
in contrast to ACE inhibitors ARBs primarily affect vascular smooth muscle and the adrenal gland
clinically ACE inhibitors and ARBs appear to be equally effective for treatment of hypertension – but ARBs do not cause cough
contraindications for ARBs pregnancy, lactation – use with caution in older adults with kidney dysfunction
ADE with ARBs most common upper respiratory infections and headache. dizziness, inability to sleep, diarrhea, dyspnea, heartburn, nasal congestion..
calcium channel blockers used primarily for treatment of hypertension and angina
calcium channel blockers effectiveness is related to their ability to cause smooth muscle relaxation by blocking the binding of calcium to its receptors
Calcium channel blockers first line drug for treatment of hypertension
Amlodipine mestolate (Norvasc) is the CCB most commonly used to treat hypertension
Vasodilators act directly on arterial and venous smooth muscle to cause relaxation
vasodilators do not work through adrenergic receptors

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