What are the types of Hypertension?

Primary and Secondary

Primary Hypertension

most common
Cause of elevated BP in unknown

Secondary Hypertension

elevated BP due to a disease

What are some things that affect Blood Pressure?

cardiac output and peripheral vascular resistance

What is Cardiac Output?

amount of blood pumped out of the heart per minute

What is Peripheral Vascular Resistance?

resistance that arterioles have against the flow of blood

What are the major categories of drugs that treat Hypertension?

Diuretics, sympatholytic (alpha/beta blockers), vasodilators, calcium
blockers, ACE inhibitors, angiotensin receptor blockers, direct-acting
renin inhibitors

How do Diuretics work?

act directly on the kidney to increase water and sodium excretion

What are the adverse effects of diuretics?

decreased extracellular volume, sodium depletion (hyponatremia),
potassium depletion (hypokalemia), fluid depletion, hyperlipidemia,
hyperglycemia, GI disturbances, weakness and fatigue, orthostatic
hypotension, changes in mood/confusion

What are these drugs examples of?
Chlorothiazide, bumetanide, ameloride

Diuretics

What drugs increase water and sodium excretion?

Diuretics

What type of drugs are these examples of?
Propranolol, Acebutolol

What drugs lower BP by decreasing HR and CO?

Beta Blockers

What do Beta Blockers do?

lower BP by decreasing HR and CO

What are these drugs examples of?
Phenoxybenzamine, Prazosin

Alpha Blockers

What drugs decrease vascular resistance?

Alpha Blockers

What do Alpha Blockers do?

decrease vascular resistance

What type of drug is this an example of?
Clonidine

Centrally Acting Agents

What drugs limit sympathetic activity at the brainstem?

Centrally Acting Agents

What do centrally acting agents do?

limit sympathetic activity at the brainstem

What are these drugs examples of?
Hydralazine, Minoxidil

Vasodilators

What drugs directly vasodilate the peripheral vasculature decreasing
peripheral vascular resistance (PVR)?

Vasodilators

What are these drugs examples of?
Captopril, Enalapril

ACE Inhibitors

What drugs inhibit the enzyme that converts angiotensin 1 to
angiotensin 2, resulting in decreased peripheral resistance and
decrease fluid retention>> decreasing BP

What do ACE Inhibitors do?

inhibit conversion of angiotensin 1 to 2, lowering peripheral
resistance and decreasing fluid retention >>>lowering BP

What are these drugs examples of?
Losartan, Valsartan

Angiotensin II receptor antagonists

What drugs produce vasodilation and inhibit aldosterone release?

Angiotensin II receptor antagonists

What do Angiotnesin II receptor antagonists do?

produce vasodilation and inhibit aldosterone release

What drug is this an example of?
Aliskiren

Direct renin inhibitors

What do direct renin inhibitors do?

cause vasodilation

What type of drugs are these examples of?
Nifedipine, Diltiazem, Verapamil

Calcium Channel Blockers

What do Calcium channel blockers do?

vasodilation and decreased peripheral resistance

What do beta blockers do?

block beta 1 receptors, decreasing HR and SV

What are adverse effects of beta blockers?

Bronchoconstriction in asthma patients, excessive depression of HR,
depressed myocardial contractility, orthostatic hypotension,
hyperglycemia, hyperlipidemia, depression, fatigue, GI disturbances

What is coronary artery disease?

fat deposition in coronary artery walls causing them to become
thicker and calcified>> decreased blood flow
**atherosclerosis

How do nitrates work with coronary artery disease?

dilate vascular smooth muscle, vasodilation of veins are arteries,
decreased preload and afterload, decreases O2 demands, decreased
cardiac workload

What are the characteristics of Angina?

pain in the chest region because of mycardial ischemia
O2 supply doesnt meet demand

Describe Classic Angina

exertional or effort induced

Explain Variant Angina

Vasospastic

Explain Unstable Angina

Pain at rest

What are some beneficial effects in the body when treating angina?

balance between myocardial supply and demand

What is congestive heart failure?

A chronic condition when heart is unable to pump enough blood to meet
the needs of the peripheral tissues, causing decreased cardiac output
>> blooc accumulates in the heart, lungs, and veins of lower
extremities = congestion

What is the pathophysiology in heart failure?

decreased cardiac performance

What are some characteristics of decreased cardiac performance in
heart failure?

neurohumoral compensation
increased cardiac workload
cardiac remodeling

Explain Neurohumoral compensation for decreased cardiac performance
in heart failure

Increase in SNS which attempts to reverse the heart failure

Why is there increased cardiac workload in heart failure?

Increased preload and afterload

Explain Cardiac Remodeling in regards to decreased cardiac
performance in heart failure

causes the myocardium to enlarge, heart muscle weakens and becomes
more spherical

What are the causes of heart failure?

ischemic heart disease, myocardial infarction, valve dysfunction,
hypertension, cardiomyopathy

What are the symptoms of Heart Failure?

tired, fatigue, pulmonary edema (Shortness of breath), Peripheral
edema ( ankles swell), rapid heart rate

What drugs are used to treat heart failure?

Cardiac glycosides, diuretics, vasodilators, beta blockers,
aldosterone receptor blockers

What are these drugs examples of?
Digitalis, Digoxin

Cardiac Glycosides

What drugs used to treat heart failure increase the force of
myocardial infarction?

Cardiac glycosides

What do Cardiac Glycosides do?

increase the force of myocardial contraction

What drugs used to treat heart failure eliminate excess sodium and water?

Diuretics

What Vasodilator drugs are used to treat heart failure?

ACE inhibitors and direct vasodilators

What do Beta Blockers do in the treatment of heart failure?

Block SNS

What drugs used to treat heart failure promote sodium and water loss
and protect the heart from remodeling?

Aldosterone receptor blockers

What ACE Inhibitors are used for heart failure?

Captopril, Enalpril, Ramipril, Lisinopril, Benzapril, Moexipril,
Quinapril, Trandolapril, Fosinopril

How do ACE inhibitors work for heart failure?

inhibit the enzyme that converts angiotensin 1 to 2 causing
vasodilation and decreased cardiac workload

What do opoids bind to?

Mu, Kappa, Delta, Sigma

What happens when opoids bind to MU receptors?

analgesia, respiratory depression, miosis, reduced intestinal
motility, euphoria, physical dependence

What happens when opoids being to Kappa receptors?

analgesia, miosis, respiratory depression, sedation

What happens when opoids bind to Delta receptors?

analgesia

What happens when Opoids bing to Sigma receptors?

psychomimetic effects

What are the effects of opoids?

Analgesia, cough suppression, treatment of diarrhea and dyspnea

What is Analgesia?

relieves the perception and sensation of pain

What are signs and symptoms of Opoid withdrawal?

body ache, diarrhea,gooseflesh, nausea, loss of appetite, runny nose,
shivering, sneezing, cramps, insomnia, fever, sweating. yawning,
irritability, tachycardia, fatigue

How do you reverse respiratory depression produced by narcotic analgesics?

ventilator support, opoid antagonist (naloxone), monitor the patient

What are some uses of opoid analgesics besides pain?

treat diarrhea, dyspnea, and cough

How do Salicylates work on the body?

Inhibit PGE2 synthesis, raising pain threshold
also have an anti inflammatory effect that could contribute

What is an example of a Salicylate?

Aspirin

How do NSAIDS work?

relieve moderate pain, lower fever, reduce inflammation, inhibit
platelet aggregation

What are adverse effects of NSAIDS?

gastrointestinal issues, renal issues, respiratory actions,
cardiovascular, hypersensitivity, reyes syndrome

What are renal issues associated with NSAIDS?

hypertension, oliguria, fluid retention, renal failure

What respiratory actions are seen with the use of NSAIDS (adverse effects)?

increased ventilation
could cause paralysis

What is Reyes Syndrome?

childhood disorder that develops after an apparent recovery from the
flu or chicken pox with vomiting, liver problems, and encephalopathy,
progressing to combative behavior, delirium, and a coma

What drug should be used in children with an acute viral illness? (to
avoid Reyes Syndrome)

Acetaminophen

What drugs are associated with Reyes Syndrome?

Salicylates

Salicylates and high doses of aspirin are dangerous and often fatal,
Why? How do you treat these effects?

respiratory depression
Sodium Bicarb

What are the therapeutic effects of corticosteroids?

treatment of endocrine disorders, inflammatory disorders, certain
cancers, suppress immune responses

What physical effects do corticosteroids have on the body?

influence metabolism, increase capillary permeability, suppressed
vasoconstriction, hypernatremia, hyperkalemia, edema, hypertension,
and hypoglycemia

How do corticosteroids reduce inflammation?

glucocorticoids reduce heat, erythema, swelling, and tenderness

What are the adverse effects of corticosteroids?

adrenal insufficiency, infection, peptic ulcer disease, fluid and
electrolyte disturbances, osteoporosis, glucose intolerance, myopathy,
psychological disturbances, cutaneous atrophy, cataracts, negative
nitrogen balance, iatrogenic Cushings Syndrome, growth retardation

Recommendations for long term use of corticosteroids

smallest dose possible, gradual withdrawal

What are COX 2 inhibitors and how do they differ from nonselective?

COX2 is the "bad" COX and the inhibition of it can have
beneficial effects, suppressing inflammation, alleviating pain and
reducing fever

What do COX 2 inhibitors do?

suppress inflammation to alleviate pain and reduce fever

In what patients should NSAIDS (like aspirin) be avoided?

elderly, patients who receive high doses for long periods of time,
people with history of peptic ulcer disease

Opioid physical dependence

abstinence syndrome will occur if drug use is abruptly discontinued
and is an expected conequence of chronic opioid use

Opioid Addiction

loss of control over drug use, preoccupation with the drug, and
continued use despite consequences
*Not a natural consequence