Pharmacology Week 8 Ppt Review - Hypertension

Front 1

What is the most common cardiovascular disease? This affects what % of Americans?

Back 1

* Hypertension is the most common cardiovascular disease.

* It affects 29.1% of Americans (NHANES 2011-12)

Front 2

Hypertension:

What is associated with an increase in

morbidity and mortality?

Back 2

* Elevated blood pressure (>120/80) is associated with an increase in morbidity and mortality

Front 3

Hypertension:

What does elevated blood pressure

eventually do?

Back 3

* Eventually, elevated blood pressure damages internal organs

Front 4

Hypertension:

A patient with hypertension is more likely to have what other 3 conditions?

Back 4

* Kidney disease

* Heart disease

* Cardiovascular problems

Front 5

Hypertension:

Hypertension is divided into categories

based on what?

What are the 3 categories?

Back 5

* Based on the cause or progression of the disease, hypertension is divided into categories:

-- Primary (idiopathic, essential)

-- Secondary

-- Malignant

Front 6

Hypertension:

What is Primary (idiopathic, essential) Hypertension caused by?

What % of patients is affected?

Back 6

* Primary (idiopathic, essential): from an unknown cause

-- 85-90% of patients

Front 7

Hypertension:
What is Secondary Hypertension caused by?
What % of patients is affected?

Back 7

* Secondary: identified/associated w/ a disease process of endocrine or renal system
-- 10% of patients

Front 8

Hypertension:

What is Malignant Hypertension caused by?

What % of patients is affected?

Back 8

* Malignant: high or rapidly rising blood pressure

-- about 5% of patients with primary or secondary hypertension

Front 9

Hypertension:

New guidelines were defined by the 2014 JNC 8. What was not addressed and

what was defined?

Back 9

* Definitions of hypertension and prehypertension were not addressed, but thresholds for pharmacologic treatment were defined

Front 10

Hypertension:

The recommended selection was among

what 4 spacific medication classes?

Back 10

* Recommended selection among 4 specific medication class (ACEI or ARB, CCB or Diuretics)

Front 11

Treatment of Hypertension - JNC 8:

Strong evidence supports treating patients 60 years and older up to what BP?

Back 11

* Strong evidential support - Age 60 years and older, treat to BP goal of less than 150/90 mmHg

Front 12

Treatment of Hypertension - JNC 8:

Strong evidence supports treating patients 30-59 years with hypertension up to what BP?

Back 12

* Strong evidential support - Age 30-59 years with hypertension, treat to diastolic goal of <90 mmHg

Front 13

Treatment of Hypertension - JNC 8:

What is there not enough evidence

to support treating?

Back 13

* Not enough evidence to support treating:

-- to a specific systolic goal in patients <60 years of age

-- patients younger than 30 years of age to a diastolic goal

Front 14

Treatment of Hypertension - JNC 8:

In the General population, patients > 60 years should be treated to what BP?

Back 14

* SBP <150 mmHg / DBP <90 mmHg

Front 15

Treatment of Hypertension - JNC 8:

In the General population, patients < 60 years should be treated to what BP?

Back 15

* SBP <140 mmHg / DBP <90 mmHg

Front 16

Treatment of Hypertension - JNC 8:

In the Diabetic or CKD (chronic kidney disease), patients all ages should be treated to what BP?

Back 16

* SBP <140 mmHg / DBP <90 mmHg

Front 17

Treatment of Hypertension:

What should be used as BP becomes greater than goal?

Back 17

* Use a step-care approach as BP become greater than goal

Front 18

Treatment of Hypertension:
What 5 lifestyle modifications are recommended in treatment of hypertension?

Back 18

* Lifestyle modifications:
-- Weight reduction
-- Physical activity
-- A diet rich in fruits and vegetables
-- Reduced contents of saturated and total fats
-- Sodium restriction

Front 19

Treatment of Hypertension:

What diets support the lifestyle modifications recommended in treatment of hypertension?

Back 19

* DASH diet, USDA Food Pattern or AHA diet

Front 20

Treatment of Hypertension:

Lifestyle modifications should be initiated at what hypertension staging?

Back 20

* This should be initiated regardless of hypertensive staging

Front 21

Treatment of Hypertension -

Initial Drug Choices:

What is the most common treatment for hypertension? How is it often used to help increase control while reducing side effects?

Back 21

* Thiazide diuretics most common treatment

* Often a 2 drug regiment is used to help increase control while reducing side effects

Front 22

Treatment of Hypertension -

Initial Drug Choices:

What 6 compelling indications help influence the agents that are selected for treatment?

Back 22

* Compelling indications such as:

-- Heart failure

-- Post-MI

-- High cardiovascular risk

-- Diabetes

-- Chronic kidney disease

-- Recurrent stroke prevention

Front 23

Treatment of Hypertension -
Initial Drug Choices:
In heart failure, which is the order of best treatment in improving outcomes?

a) ACEI > CCB > thiazide
b) CCB > thiazide > ACEI
c) thiazide > ACIE > CCB

Back 23

* c) In heart failure thiazide > ACEI > CCB in improving outcomes

Front 24

Treatment of Hypertension:
What are the big four antihypertensive groups? What group is no longer included?

Back 24

* The Big Four antihypertensive groups are:
-- Diuretics
-- CCBs
-- ACIEs
-- ARBs
* Beta-adrenergic blocking agents are no longer included.

Front 25

Treatment of Hypertension:

According to JNC 8, what diuretics are included as recommendations for treatment of hypertension?

Back 25

*Per JNC, only the thiazide diuretics, chlorthalidone and indapamide are included

Front 26

Treatment of Hypertension:

According to JNC8, what are no longer included in the diuretic recommendations?

Back 26

* Loop and potassium sparing diuretics are not included in the recommendation

Front 27

What is among the most common agents for treatment of hypertension?

Back 27

* Thiazide Diuretics

Front 28

Thiazide Diuretics:

What is the most commonly used thyazide?

Back 28

* hydrochlorothiazide (HCTZ) is the most commonly used thiazide

Front 29

Thiazide Diuretics:

How are many patients with hypertension treated?

Back 29

* Many patients with hypertension are treated soley with hydrochlorothiazide (HCTZ)

Front 30

Thiazide Diuretics - MOA:

What is the MOA of thiazide Diuretics?

Back 30

* Mechanism of Action (MOA) - exact MOA unknown

Front 31

Thiazide Diuretics - MOA:
What does thiazide initially inhibit and where?

Back 31

* Thiazide initially inhibits sodium reabsorption from the distal convoluted tubule of the kidneys

Front 32

Thiazide Diuretics - MOA:

What passively accompanies the sodium and what does it produce?

Back 32

* Water and chloride ions passively accompany the sodium, producing diuresis (increased urine production)

Front 33

Thiazide Diuretics - Adverse Reactions:

What may be needed from taking tiazide diuretics?

Back 33

* Potassium supplementation may be needed due to loss of K+ from diuretics

Front 34

Thiazide Diuretics - Adverse Reactions:
What 3 drugs can increase risk of arrhythmia?

Back 34

* Hypokalemia
* Digoxin
* Epinephrine

Front 35

Thiazide Diuretics - Adverse Reactions:

When should epinephrine be limited to the cardiac dose

Back 35

* Limit to cardiac dose if digoxin toxicity present & thiazide is taken

Front 36

Thiazide Diuretics - Adverse Reactions:

What are 5 other side effects to using thiazide diuretics?

Back 36

* Other side effects include:

-- Hyperglycemia

-- Hyperlipidemia

-- Hypercalcemia

-- Anorexia

-- Xerostomia

Front 37

Thiazide Diuretics - Adverse Reactions:

What is of special concern if the patient has gout?

Back 37

* Hyperuricemia is of special concern if the patient has gout

Front 38

Thiazide Diuretics:

What can reduce the antihypertensive effect of thiazide diuretics?

Back 38

* Nonsteroidal anti-inflammatory drugs (NSAIDs) can reduce the antihypertensive effect of thiazide diuretics

Front 39

Thiazide Diuretics:
Because it takes a few days to develop, use of NSAIDs to reduce the antihypertensive effect is ok for what?

Back 39

* It takes a few days to develop so use of NSAIDs ok for acute, short term use

Front 40

Loop Diuretics:

What is the most common loop diuretic?

Back 40

* Furosemide (Lasix) is the most common loop diuretic

Front 41

Loop Diuretics - MOA:
What does loop diuretics act on?

Back 41

* Acts on the ascending limb of the loop of henley and has some effect on the distal tubels

Front 42

Loop Diuretics:
What does loop inhibit reabsorption of? What is there concurrent loss of?

Back 42

* Inhibits reabsorption of sodium with concurrent loss of fluids and potassium

Front 43

Loop Diuretics:

What is usually prescribed to take with florsemide?

Back 43

* Usually potassium is prescribed to take with the flurosemide to replace lost potassium

Front 44

Loop Diuretics:

Besides furosemide, what are also included as loop diuretics?

Back 44

* Other loop diuretics include bumetanide and torsemide

Front 45

Loop Diuretics:

What are loop diuretics more potent than and at a higher risk of?

Back 45

* More potent than thiazides, higher risk of adverse effects

Front 46

Loop Diuretics - Adverse effects:

What are loop diuretics' adverse effects similar to?

Back 46

* Adverse effects are similar to those from thiazide diuretics

Front 47

Loop Diuretics:

What are loop diuretics used in treatment of?

Back 47

* Used in treatment of hypertensive patients with heart failure

Front 48

Loop Diuretics:

What do loop diuretics cause?

Back 48

* Rapid diuresis

Front 49

Loop Diuretics:

What is the efficacy of loop diuretics decreased by?

Back 49

* Decreased efficacy when NSAIDs are used

Front 50

Potassium-Sparing Diuretics:
What type of diuretic action do potassium-sparing diuretics have?

Back 50

* Weak diuretics action

Front 51

Potassium-Sparing Diuretics:

What two drugs are potassium-sparing diuretics?

Back 51

Spironolactone and Triamterene

Front 52

Potassium-Sparing Diuretics:
What is spironolactone MOA? What does it result in and what is reabsorbed?

Back 52

* Spironolactone: aldostrone antagonist
-- results in sodium excretion through diuresis and loss of fluid volume
-- Potassium is reabsorbed

Front 53

Potassium-Sparing Diuretics:
What is triamterene MOA? What does it inhibit?

Back 53

* Interferes with sodium-potassium exchange by inhibiting sodium-potassium adenosine triphosphate (ATPase)

Front 54

Potassium-Sparing Diuretics:

What is used to reduce potassium loss?

Back 54

*Combo of triamterene/hctz used to reduce potassium loss

Front 55

Calcium Channel Blockers:

What is the MOA of CCBs?

Back 55

* MOA - inhibits movement of extracellular calcium ions into cells

Front 56

Calcium Channel Blockers:

How do CCBs affect smooth muscle?

Back 56

* Relaxes vascular smooth muscle and dilates coronary and peripheral arteries and arterioles, reducing afterload

Front 57

Calcium Channel Blockers:

What uncommon with CCBs?

Back 57

* Orthostatic hypotension is uncommon

Front 58

Calcium Channel Blockers:

How do CCBs affect cardiac muscle?

Back 58

* May reduce heart rate, decrease myocardial contractillity (negative inotropic effect), and slow AV nodal conduction

Front 59

Calcium Channel Blockers:

What are CCBs used to treat?

Back 59

* Used to treat hypertension and other cardiac conditions such as arrhythmia and angina

Front 60

Calcium Channel Blockers - Adverse Reactions:

What are the CNS side effects of CCBs?

Back 60

* CNS: can produce excessive hypotension, which can cause dizziness, lightheadedness, and headache

Front 61

Calcium Channel Blockers - Adverse Reactions:

What are the GI side effects of CCBs?

Back 61

* GI: nausea, vomiting, and constipation

Front 62

Calcium Channel Blockers - Adverse Reactions:

What are the Cardiovascular side effects of CCBs?

Back 62

* Cardiovascular: bradycardia and edema

Front 63

Calcium Channel Blockers - Adverse Reactions:

What are the Nasal side effects of CCBs?

Back 63

* Nasal: Nasal congestion and rhinitis (may interfere with nitrous oxide)

Front 64

Calcium Channel Blockers - Oral Effects:

What are the oral effects of CCBs?

Back 64

* Xerostomia, dysgeusia, gingival enlargement

Front 65

Calcium Channel Blockers - Oral Effects:
What may be a significant oral effect of CCBs?

Back 65

* Gingival enlargement may be significant and extend onto crown surfaces

Front 66

Calcium Channel Blockers - Oral Effects:

On discontinuation of the CCBs, what usually happens to gingival enlargement?

Back 66

* On discontinuation of the CCBs, the gingival enlargement usually reverts to normal tissue and does not reappear.

Front 67

Calcium Channel Blockers - Oral Effects:

What does changing to another CCB NOT do?

Back 67

* Changing to another CCB does not appear to resolve gingival enlargement (class effect)

Front 68

Calcium Channel Blockers - Oral Effects:

What may be required if gingival enlargement does not revert to normal?

Back 68

* A gingivalectomy or gingivoplasty may be required

Front 69

Calcium Channel Blockers - Examples:

What are the two main classes of CCBs?

Back 69

Non-dihydropyridine CCBs and Dihydropyridine CCBs

Front 70

Calcium Channel Blockers - Examples:

What two drugs are in the Non-dihydropyridine CCBs class?

Back 70

* Diltiazem and verapamil

Front 71

Calcium Channel Blockers - Examples:

What is the suffix of the 6 drugs in the Dihydropyridine CCBs class?

Back 71

* Dihydropyridine CCBs end in -dipine

(amlodipine, felodipine, isradipine, nicardipine, nifedipine, nisoldipine)

Front 72

Beta-Adrenergic Blocking Agents:

Is Beta-adrenergic stimulation considered "fight or flight" or "rest and digest"?

Back 72

* Beta-adrenergic blocking agents are "fight or flight"

Front 73

Beta-Adrenergic Blocking Agents:

What is Beta1-receptor stimulation associated with?

Back 73

* Beta1-receptor stimulation is associated with increased heart rate, cardiac contractility, and AV conduction

Front 74

Beta-Adrenergic Blocking Agents:

What does Beta2-receptor stimulation cause?

Back 74

* Beta2-receptor stimulation causes bronchodilation in pulmonary tissues and vasodilation of skeletal muscles

Front 75

Beta-Adrenergic Blocking Agents:

What do nonselective Beta-adrenergic blockers block?

Back 75

* Nonselective Beta-adrenergic blocking drugs such as propranolol block both beta1- and beta2-receptors

Front 76

Beta-Adrenergic Blocking Agents:
In usual doses, what do selective beta-adrenergic blocking drugs block?

Back 76

* In usual doses select beta-adrenergic blocking drugs such as metoprolol block beta1-receptors more than beta2-receptors

Front 77

Beta-Adrenergic Blocking Agents:

What beta-adrenergic blockers are preferred for asthmatic patients and why?

Back 77

* selective beta-adrenergic blocking drugs are preferred in asthatic patients (don't block beta2), less likely to interact with epi

Front 78

Beta-Adrenergic Blocking Agents:

At large doses, what dissappears from selective beta-adrenergic blocking drugs?

Back 78

* At larger doses, the selectivity disappears

Front 79

Beta-Adrenergic Blocking Agents:

How do Beta-Adrenergic Blockers lower blood pressure?

Back 79

* Beta-adrenergic blockers lower blood pressure by decreasing cardiac output

Front 80

Beta-Adrenergic Blocking Agents:
In addition to lowering blood pressure, what else do beta-adrenergic blockers do?

Back 80

* Reduce plasma volume and venous return
* Decrease sympathetic outflow from CNS and reduces peripheral resistance

Front 81

Beta-Adrenergic Blocking Agents - Side Effects:

What are the 3 side effects by reduction?

Back 81

* bradychardia, mental depression, and decreased sexual ability

Front 82

Beta-Adrenergic Blocking Agents - Side Effects:

What do CNS side effects include?

Back 82

* CNS effects: confusion, hallucinations, dizziness, and fatigue have been reported

Front 83

Beta-Adrenergic Blocking Agents - Side Effects:

What do GI tract effect include?

Back 83

* GI tract effects: diarrhea, nausea/vomiting, may produce mild xerostomia

Front 84

Beta-Adrenergic Blocking Agents - Side Effects:

What may beta-adrenergic blocking agents exacerbate?

Back 84

* May exacerbate asthma, angina or peripheral vascular disease

Front 85

Beta-Adrenergic Blocking Agents - Side Effects:

When should patients taking beta-adrenergic blocking agents be limited to cardiac dose of epi? And what is that dose?

Back 85

* Patients that use non-selective beta-blockers should be limited to cardiac dose of epi if there is cardiovascular disease or higher blood pressure (unless careful blood pressure monitoring is done)

* 0.04 mg

Front 86

Beta-Adrenergic Blocking Agents - Side Effects:

When can usual doses of epi be given to patients with cardiovascular disease or higher blood pressure?

Back 86

* When taking selective beta1-blockers

-- BUT... remember they lose selectivity at higher doses

Front 87

Beta-Adrenergic Blocking Agents - Side Effects:
When cardiovascular disease or higher blood pressure patients on non-selective beta-blockers are given the cardiac dose of epi, what may happen with the vasopressor?

Back 87

* May have a two- to fourfold increase in vasopressor response resulting in hypertension

Front 88

Beta-Adrenergic Blocking Agents - Side Effects:

When cardiovascular disease or higher blood pressure patients on non-selective beta-blockers are given the cardiac dose of epi, what leads to a hypertensive response?

Back 88

* Non select beta blockers prevent the vasodilation which leaves the alpha vasoconstriction from the epi unopposed, leading to a hypertensive response

Front 89

Beta-Adrenergic Blocking Agents - Side Effects:

When cardiovascular disease or higher blood pressure patients on non-selective beta-blockers are given the cardiac dose of epi, which patients are at risk of having a stroke?

Back 89

May not be harmful in majority of patients ( can cause headache), but those with vascular abnormalities present in the brain may have a stroke

Front 90

Beta-Adrenergic Blocking Agents:

What are 4 generic beta1-selective blockers?

Back 90

* Metaprozolol (Lopressor/Toprol XL)

* Atenolol (Tenormin)

* Mizoprolol (Zebeta)

* Nebivolol (bystolic)

Front 91

Beta-Adrenergic Blocking Agents:

What are 4 generic non-selective beta-blockers?

Back 91

* Propranolol (Inderal LA)

* Nadolol (Corgard)

* Sotolol

* Timolol (Blocadren)

Front 92

Beta-Adrenergic Blocking Agents:

What are 3 beta-blockers with intrinsic sympathomomimetic activities?

Back 92

* Acebutolol (Sectral)

Penbutolol (Levatol)

Pindolol (Visken)

Front 93

Beta-Adrenergic Blocking Agents:
What are 2 generic beta-blockers with alpha-blocking activity?

Back 93

* Carvedilol (Coreg)
* Labetalol

Front 94

Antiotensin-Related Agents:

What are two types of drugs whos mechanism involves antiotensin?

Back 94

* ACEIs and ARBS

Front 95

Antiotensin-Related Agents:
What is an ACE?

Back 95

* ACE - An enzyme that converts angiotensin I to II, which results in vasoconstriction as part of normal regulation of blood pressure system

Front 96

Antiotensin-Related Agents:
What do ACEIs prevent?

Back 96

* ACEIs prevent the convenrsion of angiotensin I to angiotension II

Front 97

Antiotensin-Related Agents:

What do many ACEIs end in?

Back 97

* Many ACESIs end in -pril e.g. lisingpril

Front 98

Antiotensin-Related Agents:
What do ARBs attach to and what do they block the effect of?

Back 98

* Arbs attach to the angiotensin II receptor and block the effect of angiotensin II.

Front 99

Antiotensin-Related Agents:
What is the common suffix for ARBs?

Back 99

* The common suffix for ARBs is -sartan

Front 100

Antiotensin-Related Agents:

What is the prototype for ARBs?

Back 100

* Losartan (Cozaar) is the prototype for ARBs

Front 101

Antiotensin-Related Agents:

Are angiotensin-related agents safe during pregnancy?

Back 101

* No. Angiotensin-related agents are teratogenic and should be avoided in pregnancy

Front 102

Angiotensin-Converting Enzyme Inhibitors (ACEIs) - Adverse Reactions:

What are the cardiovascular adverse reactions?

Back 102

* Cardiovascular: hypotension has produced lightheadedness, and fainting. Tachycardia and chest pain have been noted.

Front 103

Angiotensin-Converting Enzyme Inhibitors (ACEIs) - Adverse Reactions:

What are the CNS adverse reactions?

Back 103

* CNS: may include dizziness, insomnia, fatigue, and headache

Front 104

Angiotensin-Converting Enzyme Inhibitors (ACEIs) - Adverse Reactions:

What are the GI adverse reactions?

Back 104

* GI: nausea, vomiting and diarrhea can occur

Front 105

Angiotensin-Converting Enzyme Inhibitors (ACEIs) - Adverse Reactions:

What is the most notable adverse reaction?

Back 105

* A dry, hacking cough can occur

Front 106

Angiotensin-Converting Enzyme Inhibitors (ACEIs):

Are ACEIs safe during pregnancy?

Back 106

* No, they are teratogenic and should be avoided in pregnancy

Front 107

Angiotensin-Converting Enzyme Inhibitors (ACEIs):

What is the suffix for ASEIs drugs?

Back 107

* ACEIs drugs end in -pril

e.g. benazepril (Lotensin), captopril (Capoten), enalapril (Vasotec), fosinopril (Monopril),

lisinopril (Zestril, Prinivil), moexipril (Univasc), iperindopril (Aceon), quinaqril (Accupril), quinapril (Accupril), ramipril (Altace), and trandolapril (Mavik)

Front 108

Angiotensin Receptor Blockers (ARBs):

Because ARBs are more specific than ACEIs, what may be expected?

Back 108

* ARBs are more specific than ACEIs and may be expected to have fewer adverse reactions

Front 109

Angiotensin Receptor Blockers (ARBs) - Adverse Reactions:

What are the CNS adverse reactions?

Back 109

* CNS: can include dizziness, fatigue, insomnia, and headache

Front 110

Angiotensin Receptor Blockers (ARBs) - Adverse Reactions:

What are the GI adverse reactions?

Back 110

* GI: losartan can produce diarrhea

Front 111

Angiotensin Receptor Blockers (ARBs) - Adverse Reactions:

What are the Pain adverse reactions?

Back 111

* Pain: both muscle cramps, leg and back pain have been reported with losartan

Front 112

Angiotensin Receptor Blockers (ARBs) - Adverse Reactions:

What adverse reaction rarely occurs?

Back 112

* Angioedema can occur, rarely

Front 113

Angiotensin Receptor Blockers (ARBs):
Are ARBs safe for pregnancy?

Back 113

* No, they are taratogenic and should be avoided in pregnancy

Front 114

Angiotensin Receptor Blockers (ARBs):

What is the suffix for ARBs drugs?

Back 114

* ARBs drugs end in -sartan

e.g. candesartan (Atacand), eprosartan (Tevetan), irbesartan (Avapro), losartan (Cozaar), olmesartan (Benicar), telmisartan (Micardis), and valsartan (Diovan)

Front 115

Renin Inhibitors:

What are renin inhibitors?

Back 115

* A new class of drugs approved by the U.S. Food and Drug Administration for treatment of hypertension

Front 116

Renin Inhibitors:

What is aliskiren (Tekturna)?

Back 116

* The first of a new class of drugs, the renin inhibitors

Front 117

Renin Inhibitors:
How do renin inhibitors work?

Back 117

* Work by binding to renin (Direct renin inhibitor) which then reduces the level of angiotensin I, angiotensin II, and aldostrone

Front 118

Renin Inhibitors:

Are renin inhibitors safe for pregnancy?

Back 118

No, teratogenic and are contraindicated in pregnancy

Front 119

Renin Inhibitors:

In which patients should renin inhibitors NOT be used in conjunction with ACEIs and ARBS?

Back 119

* Do not use in conjunction with ACEIs or ARBs in diabetics or in patients whos GFR <60mL/min/1.73m2

Front 120

Renin Inhibitors:
In which patients should renin inhibitors be used with caution?

Back 120

* Use with caution in patients:
-- who have a history of angioedema
-- with worsening renal function
-- with low renal blood flow

Front 121

alpha1-Adrenergic Blocking Agents

for Hypertension:

What do adrenergic blockers include?

Back 121

* the adrenergic blockers include the alpha-blockers and the beta-blockers previously described

-- alpha1 and alpha2

Front 122

alpha1-Adrenergic Blocking Agents

for Hypertension:

Alpha1-blocking agents produce what?

Back 122

* Alpha1-blocking agents produce peripheral vasodilation in the arteriols and venules that decreases peripheral vascular resistance

Front 123

alpha1-Adrenergic Blocking Agents

for Hypertension:

What do they have a minimal effect on?

Back 123

* Minimal effect on cardiac output or renal blood flow

Front 124

alpha1-Adrenergic Blocking Agents

for Hypertension:

alpha1-Adrenergic blockers result in a reduction in what?

Back 124

* Result in a reduction in urethral resistance and pressure, bladder outlet resistance, and urinary symptoms

Front 125

alpha1-Adrenergic Blocking Agents

for Hypertension:

What are alpha1-adrenergic blockers used in management of?

Back 125

* Used in management of older men who have an enlarged prostate gland

Front 126

alpha1-Adrenergic Blocking Agents - Adverse Reactions:

What can the orthostatic hypotension adverse reaction result in?

Back 126

* Orthostatic Hypotension: can result in dizziness and syncope

Front 127

alpha1-Adrenergic Blocking Agents - Adverse Reactions:
What are the CNS adverse reactions?

Back 127

* CNS: can cause CNS depression, producing either drowsiness or excitation and headache

Front 128

alpha1-Adrenergic Blocking Agents - Adverse Reactions:
What are the Cardiovascular adverse reactions?
What is another side effect?

Back 128

* Cardiovascular: tachycardia, arrhythmias, and palpitations can occure
-- Peripheral edema is another side effect

Front 129

alpha1-Adrenergic Blocking Agents:

What do alpha1-adrenergic blockers end in?

Back 129

* alpha1-adrenergic drugs end in -azosin

e.g. doxazosin (Cardura), prazosin (Minipress), and terazosin (Hytrin)

Front 130

alpha1-Adrenergic Blocking Agents:

In addition to hypertension, Doxazosin and Terazosin are both indicated for the management of what?

Back 130

In addition to the treatment of hypertension, Daxazosin and Terazosin are both indicated for the management of benign prostetic hypertrophy (BPH)

Front 131

Other Anti-hypertensive Agents:

Why are these other anti-hypertensive agents used less often than the previous drug classes?

Back 131

* Because they generally have more or less tolerated adverse reactions

Front 132

Other Anti-hypertensive Agents:
"Other anti-hypertensive agents" includes what other centrally acting agents?

Back 132

* Clonidine
* Guanethidine
* Reserpine
* Hydralazine

Front 133

clonidine (Catapres):

What is clonidine (Catapres)?

Back 133

* A CNS- mediated (centrally acting) antihypertensive drug that reduces peripheral resistance through a CNS-mediated action on the alpha receptor

Front 134

clonidine (Catapres):
What does stimulation of presynaptic central alpha2- adrenergic receptors result in?

Back 134

* results in a decreased sympathetic outflow

Front 135

clonidine (Catapres):

How does it affect hypertension?

Back 135

* Reduces heart rate, cardiac output, and total peripheral resistance

Front 136

clonidine (Catapres):

How is it administered?

Back 136

* May be administered orally or by transdermal patch

Front 137

clonidine (Catapres) - Adverse Reactions:

Adverse reactions inclused a high incidence of what?

Back 137

* sedation and dizziness

Front 138

clonidine (Catapres) - Adverse Reactions:

Why can abrupt discontinuation result in?

Back 138

* Rapid elevation of blood pressure has occurred with abrupt discontinuation

Front 139

clonidine (Catapres) - Adverse Reactions:
What contributes to postural hypotension when used in a patient taking clonidine?

Back 139

* CNS depressants often used for conscious-sedation techniques in dentistry

Front 140

clonidine (Catapres) - Adverse Reactions:
clonidine has a high incidence of what 3 things; (?%) of one ?

Back 140

* A high incidence of xerostomia (40%), parotid gland swelling, and pain

Front 141

Other Centrally Acting Anti-hypertensive Agents:

What are the other two centrally acting antihypertensive agents available?

Back 141

* methyldopa (Aldomet) and guanabenz (Wytensin)

Front 142

Other Centrally Acting Anti-hypertensive Agents:
What are the adverse effects and indications of methyldopa and guanabenz?

Back 142

* adverse effects are similar and indications are similar to clonidine

Front 143

Other Centrally Acting Anti-hypertensive Agents: What may methyldopa and guanabenz be combined with in essential hypertension management?

Back 143

* may be combined with diuretics in essential hypertension management

Front 144

Management of the Dental Patient Taking Anti-hypertensive Agents:

What should be checked for and managed?

Back 144

* Xerostomia

Front 145

Management of the Dental Patient Taking Anti-hypertensive Agents:

If taking CCB's, what should be checked for?

Back 145

* Gingival enlargement

Front 146

Management of the Dental Patient Taking Anti-hypertensive Agents:

What should be checked at each appointment

Back 146

* Blood pressure

Front 147

Management of the Dental Patient Taking Anti-hypertensive Agents:

What may be indicated for high stressed patients?

Back 147

* stress reduction protocol, anti-anxiety medication

Front 148

Management of the Dental Patient Taking Anti-hypertensive Agents:

If on diuretics, what symptoms should be checked for?

Back 148

* check for symptoms of hypokalemia, which may exacerbate arrhythmias from epinephrine