Chap 22 Treatment of hypertension

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cdsack
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Chap 22 Treatment of hypertension
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2011-03-24 15:39:38
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pharmacology
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test #3
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  1. aldosterone
    hormone that promotes sodium and fluid reabsorption
  2. angiotension
    potent vasoconstrictor that is produced when the renin-aldosterone-angiotensin system (RAAS) is activated
  3. angiotensin-converting enzyme (ACE)
    enzyme that catalyzes the conversion of angiotensin I to angiotensin II
  4. body mass index (BMI)
    • measure of human body size and proportion.
    • weight(kg)/ height (m2)
  5. cardiac output (CO)
    volume of blood ejected from the left ventricle in 1 minute
  6. diastolic blood pressure (DBP)
    measure of BP when the heart is at rest (diastole)
  7. diuretic
    drug that produces diuresis (urination)
  8. gynecomastia
    painful breast enlargement in men
  9. hirsutism
    excessive hair growth in women
  10. hyperkalemia
    excessive serum potassium levels
  11. hypokalemia
    deficient serum potassium levels
  12. hypernatremia
    excessive serum sodium levels
  13. hyponatremia
    deficient serum sodium levels
  14. hypertension (high BP)
    elevated diastolic or systolic blood pressure
  15. hyperuricemia
    increased uric acid levels in the blood that is produced by some diuretics and can aggravate gout
  16. metabolioc syndrome
    important risk factor of hypertension that promotes the development of atherosclerosis and cardiovascular disease
  17. nocturia
    nighttime urination
  18. orthostatic hypotension
    sudden drop in BP that occurs when arising from lying down or sitting or standing
  19. photosensitivity
    increased sensitivity to sun exposure that can result in sunburn
  20. preeclampsia
    sudden rise in BP, excessive weight gain, generilized edema, proteinuria, severe headache, and visual disturbances occurring in late pregnancy
  21. prehypertension
    systolic BP ranging between 120-139 mm Hg and diastolic BP ranging 80-89 mm Hg
  22. peripheral vascular resistance (PR)
    resistance to the flow of blood in peripheral arterial vessels that is associated with blood vessel diameter, vessel length, and viscosity
  23. RAAS
    renin-aldosterone-angiotensin system
  24. RAAS:
    system that is activated when there is a drop in renal blood flow that increases blood volume, blood flow to the kidney, vasoconstriction, and BP
  25. systolic BP (SBP)
    measure of the pressure when the heart's ventricles are contracting (systole)
  26. BP is necessary to circulate blood, O2, and nutrients to body organr and to remove CO2 and waste products
    without BP shock, circulatory collapse, and death would result
  27. BP is measured using sphygmomanometer (aneroid or mercury), or and electronic BP measuring device
  28. average normal BP is
    120/80 (systole/diastole)
  29. formula for determining BP
    BP = CO x PR
  30. Cardiac output (CO) is determined by measuring the HR and multiplying it by the stroke volume (vol. of blood injected by the ventricles)
  31. body sensors monitor blood, when decreases are detected, regulatory mechanisms are "switched on"
    sites for BP control are the kidneys, heart, blood vessels, CNS, and sympathetic nerves
  32. when the kidney detects a drop in renal blood supply, the RAAS is activated
    causes levels of aldosterone (endocrine hormone) and angiotensin to rise
  33. aldosterone and angiotensin act to ______ blood volume, blood flow, vasoconstriction, and BP
    increase
  34. heart controls the CO by increasing or decreasing rate of contractions
  35. when CNS senses drop in BP, it signals sympathetic nerves to release neurotransmitters that control heart rate and blood flow through the arteries
  36. sympathetic nerves release NE, which causes vasoconstriction and increased peripheral vascular resistance (PR)
    when PR increases, BP increases.
  37. if blood thickness (viscosity) increases, BP will also rise
  38. hypertension is the most diagnosed medical condition in the US, affecting more the 65 million Americans (25% if adult population). in canada:
    affects 3 million canadians (10% of pop.)
  39. by age 60, ______ or people have hypertension
    30-40%
  40. ______ hypertension is the predominant form of hypertension before age 50.
    diastolic
  41. after age 50, ______ is predominant form of hypertension
    systolic
  42. in more than 90% of cases, the actual cause of hypertension are UNKNOWN. (rick factors for chronic elevated high BP are known)
  43. metabolic syndrome is an important risk factor for hypertension, promoting the development of athersclerosis and cardiovascular disease
  44. hypertension risk factors
    • age: >55 in men, >65 in woman
    • diabetes mellitus
    • family history
    • metabolic syndrome
    • obesity
    • smoking
    • no exercise
    • increase total LDL or low HDL
    • diet high in salt and sat. fats
    • excessive alcholol consumption
  45. drugs that increase BP
    • NSAIDS (COX2 Inhibitors)
    • cocaine
    • decongestants
    • diet pills
    • oral contraceptives
    • glucocorticosteriods(prednisone, hydrocortisone, methylprednisone)
    • cyclosporin and tacrolimus
    • mineralcorticoids (aldosterone)
    • erythropoietin
    • licorice
    • herbals(ma huang, ephedra, bitter orange)
  46. medical conditions known to produce hypertension
    chronic kidney disease, thyroid disease, Cushing's syndrome, sleep apnea
  47. reduction of BP to normal levels is beneficial for persons with prehypertension with and without preexisting disease
  48. drug therapy should be added to the treatmet program in people who have diabetes or kidney disease if lifestyle modifications do not bring BP down
  49. stage 1 hypertension
    SBP range 140-159 mm Hg, DBP range 90-99mm Hg

    managed thru lifestyle change
  50. stage 2 hypertension
    SBP >= 160mm Hg

    DBP>= 100mm Hg

    managed thru lifestyle changes and drug therapy
  51. BP > 180/110mm Hg is a medical emergey and should be treated immediatly
  52. gestational hypertension typically occurs after 20 weeks of pregnancy in susceptible women
    can progress to preeclampsia and cause premature delivery and fetal growth retardation
  53. approx 25% of pregnant woman who have chronic hypertension for more than 4 years will develop preclampsia during pregnancy
  54. white coat hypertension
    abnormally high BP when taken by medical professional, but BP measurements taken at nonclinic setting are within normal range
  55. hypertension sometimes called "silent killer" because it can cause damage to body without obvious symptoms
  56. high BP can cause damage to kidney, heart, brain, arteries, and eyes
  57. hypertension can weaken arteries and cause aneurysms that can bleed and cause death if they occur in the brain, aorta, or abdomen
  58. hypertension can cause blindness when blood vessels in the retina are damaged and scarred
  59. for each 20mm Hg increase in SBP and 10mm Hg in DBP there is a two-fold increase in risk for death due to ischemic heart disease (IHD) and stroke
  60. hypertension is categorized as a chronis disease of lifestyle because is it associated with obesity, excessive dietary sodium intake, reduced physical activity, excessive alcohol consumption, and inadequate consumption of fruits and vegetables
  61. lifesyle modification is an important strategy and is the first step in treatment and prevention of hypertension
  62. drugs in the treatment of hypertension work at the sites of blood presure regulation:
    the kidney, heart, blood vessels, brains, and sympathetic nerves
  63. the kidney plays a major role in regulating BP and diuretics exert their effects on the kidney
    they increase the elimination of water, sodium, and selected electrolytes (K+, Cl+, HCO3-), depending on their location of action in kidney
  64. tech note!!
    natural licorice may aggravate hypertension and interfere with the affective of antihypertensive drugs, it increases Na and water retension and K depletion
  65. diuretics lower BP by decreasing PR and CO, lower PR by lowering blood volume
  66. classifications of diuretics
    • thiazide
    • loop
    • potassium sparing
  67. aldosterone antagonists
    ometimes classified as diuretics because their location of action is the kidney
  68. most thiazide diuretices share the common ending:
    "-thiazide"
  69. hydrochlorothiazide is commonly abbreviated HCTZ
  70. thiazide diuretics promote elimination of
    water, Na+, K+, Mg2+, and Cl-
  71. thiazides act at the distal convoluted tubule where they block the Na+Cl- cotransporter, interfering with Ca2+ transport into arterioles, decreasing vasoconstriction.
    PR and BP are lower
  72. thiazide diuretics should be used cautiously in patients with _______
    gout and diabetes
  73. diuretics should be used in the morning to avoid the need to urinate in the middle of the night (nocturia)
  74. thiazides are weak acids and are highly protein bound
  75. thiazide ADRs
    dehydration, hyponatremia, hypokalemia, hypomagnesia, hypochloremia, hyperuricemia, GI upset, impotence, photosensitivity
  76. effect of thiazides and loop diuretics reduced when taken with NSAIDS
  77. Loop diuretics also block sodium-potassium transporter in the ascending loop of Henle.
  78. loop diuretics are the most potent diuretics because they inhibit the reabsorption of 20-30% of Na load, whereas thiazides inhibit only 5-10% and K-sparing diuretics inhibit only 1-3%.
  79. loop diuretics readily absorbed in GI tract and 98% protein bound
  80. most loop diuretics share the same common ending:
    "-semide"
  81. loop diuretic bumetandine partially metabolized in liver, 50% is excreted unchanged in urine
    thorsemide's metabolismn in liver is greater and 20% elimated in urine
  82. potassium-sparing diuretics inhibit sodium reabsorption while avoiding potassium loss
  83. potassium-sparing diuretics effects are less than loop and thiazide, but can be increased with a thiazide
  84. fixed dose potassium-sparing combinations currently available:
    • amiloride
    • +
    • hydrochlorothiazide

    • triamterene
    • +
    • hydrochlorothiazide
  85. hyperkalemia is the most common ARD for K-sparing diuretics, risk increased if prescribed with ACE inhibitors
  86. K-sparing diuretics should be used cautiously in patients with congestive heart failure who are taking digoxin
  87. ______ is a hormone that is released when the kidney perceives a drop in blood flow and BP
    aldosterone
  88. aldosterone causes sodium and water reabsorption
  89. spironolactone is a competitive antagonist of aldosterone, blocks the effects of aldosterone on Na channels, decreases Na reabsorption, and inhibits K elimination
  90. spironolactone is sometimes classified as a k-sparing diuretic
  91. hyperkalemia is a serious ADR caused by spironolactone
    other ADRs are nausea, unpleasant aftertaste, gynecomastia (breast enlargement in males), hirsutism, impotence, and menstraul irregularities.
  92. Angiotension-converting enzyme inhibitors (ACEIs) share the common ending:
    "-pril"
  93. ACEIs lower SBP and DBP by their blocking action on ACE.
  94. ACE converts angiotensin I to angiotensin II
    When angiotensin II levels rise, BP increases because angiotensin II is a vasoconstrictor, stimulates the release of aldosterone, and promotes the release of NE from sympathetic neurons
  95. ACEIs inhibit the activity of ACE, reducing angiotensin II and aldosterone levels
    • decrease reabsorption of sodium in the renal tubules
    • cause accumilation of bradykinins reducing PR, further lowering BP
  96. ACEIs would not be drug of choice for people with liver function because prodrugs have limited activity until they undergo metabolism
  97. Fosinopril is a good choice for patients with decreased kidney function beacuse it is eliminated by the liver (50%) and the kidney (50%).
    All other ACEIs are 90% eliminated by the kidney and can accumulate if kidney disease is present
  98. dry cough is a common side effect of ACEIs
  99. ACEIs are contraindicated in pregnancy because they can interfere with fetal development of the kidneys and fetal death has been reported
  100. Angiotensin II receptor blockers (ARBs) are competitive antagonists at the angiotensin II receptor site
    they lower BP by blocking the bindng of angiotensin and inhibit growth of smooth muscle stimulated by angiotensin II, reducing ventricular and arterial hypertophy that is associated with chrons hypertension
  101. Angiotensin II receptor blockers (ARBs) share a common ending:
    "-sartan"
  102. ARBs are similar to ACEIs in effectiveness but no not produce dry cough, perhaps because they do not increase bradykinen levels like ACEIs
  103. Losartan is one of the first ARBs to be marketed
  104. ARBs adverse reactions are
    fatigue, abdominal pain, dizziness, dry mouth, constipation, impotence, and muscle cramps
  105. ARBs are contraindicated in the second and third trimester of pregnancy because they can interfere with fetal development of the kidneys and fetal death has been reported
  106. β-blockers lower BP by decreasing HR and PR
  107. β-blockers used in the treatment off hypertension may be selective (β1) or nonselective (β12)
  108. all β-blockers decrease BP, but selective β1-blockers are less likely to produce bronchospasms
    selectivitiy is higher when doses are higher
  109. all β-blockers decrease HR, especially during exercise, and decrease force of contractions in the heart lowering CO
  110. β-blockers are contraindicated in asthma and diabetes
  111. β-blocers should not be discontinued abruptly because this may cause the onset of arrythmias or angina.
    important drug interactions exist between β-blockers and cimetidine and salicylates
  112. administration of α1-blockers produces vascular relaxation, which reduces PR and lowers BP
    α1-blockers also reduce LDL cholesterol levels, making them useful in the treatment of IHD
  113. α1-blockers share a common generic name ending:
    "-zosin"
  114. α1-blockers have ability to reduce urethral resistance and increase urine flow, making them effective in the treatment of benign prostatic hyperplasia (BPH)
  115. CCBs are effective at lowering BP beacuse of their ability to relax blood vessels, decreasing PR.
    also decrease HR and rate of contractions, lowering CO.
  116. methyldopa is a prodrug that mimics the autoinhibitory effects of NE.
    when methyldopa binds to receptors, efferent sympathetic activity is reduced, blood vessels dialate, and PR is decreased
  117. clonidine inhibits NE release from CNS and peripheral sites, and reserpine depletes neuronal stores of NE at CNS and peripheral sites
    prolonged use results in decreases in HR and CO, further reducing BP
  118. hydralzine and minoxidil decrease PR and reduce BP by relaxing vascular smooth muscle
  119. hydralazine is recommended for hypertensive emergencies (parenteral use) and is safe for the treatment of preeclampsia in pregnant women
  120. hydralazine can cause lupus-like syndrome
    minoxidil causes facial hair growth, has been reformulated for topical use for treatment of baldness

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