Pharmacologic Treatment of Hypertension
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Pharmacologic Treatment of Hypertension

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Questions and Answers

What primary mechanism of action do diuretics utilize to lower blood pressure?

  • Increase erythropoietin production
  • Stimulate adrenal gland activity
  • Enhance vasoconstriction of peripheral blood vessels
  • Deplete Na+ and reduce plasma volume (correct)

    • Which of the following statements accurately describes the action of thiazide diuretics?

  • They block Na+ reabsorption in the early distal tubule. (correct)
  • They primarily act on the loop of Henle.
  • They cause vasodilation of arterial walls.
  • They are effective regardless of glomerular filtration rate (GFR).

    • What is a notable characteristic of diuretics when treating hypertension?

  • They are more effective when used in isolation.
  • Combining them with other agents increases their efficacy. (correct)
  • They have a high ceiling for efficacy.
  • They consistently lead to kidney damage.

    • Which thiazide diuretic has the longest half-life of elimination?

    <p>Chlorthalidone</p> Signup and view all the answers

    What side effect is commonly associated with the high doses of thiazide diuretics?

    <p>Decreased potassium levels</p> Signup and view all the answers

    What is the primary mechanism of action of angiotensin converting enzyme (ACE) inhibitors?

    <p>Inhibition of ACE peptidyl-dipeptidase</p> Signup and view all the answers

    Which class of antihypertensive drugs directly affects the renin-angiotensin-aldosterone system (RAAS)?

    <p>RAAS inhibitors</p> Signup and view all the answers

    What effect do angiotensin II receptor antagonists have on blood pressure?

    <p>Decrease blood pressure by blocking angiotensin II action</p> Signup and view all the answers

    Which of the following is NOT classified as a diuretic?

    <p>Amlodipine</p> Signup and view all the answers

    What is the role of aldosterone in the context of antihypertensive treatment?

    <p>Encourages sodium retention, raising blood volume</p> Signup and view all the answers

    Which medication type can act as both arterial and venous vasodilators?

    <p>Nitroprusside</p> Signup and view all the answers

    Which drug is classified as a direct renin inhibitor?

    <p>Aliskiren</p> Signup and view all the answers

    What is the effect of using β-adrenergic antagonists in antihypertensive therapy?

    <p>Decreases heart rate and myocardial contractility</p> Signup and view all the answers

    Which side effect is specifically associated with loop diuretics but not with thiazide diuretics?

    <p>Hypocalcemia</p> Signup and view all the answers

    What is the primary action of potassium-sparing diuretics like spironolactone?

    <p>Inhibit the renal absorption of sodium in exchange for potassium</p> Signup and view all the answers

    Which of the following agents is most commonly used in combination with thiazide diuretics?

    <p>Triamterene</p> Signup and view all the answers

    What common side effect can occur with both potassium-sparing diuretics and ACE inhibitors?

    <p>Hyperkalemia</p> Signup and view all the answers

    Which drug is known to cause decreased diuretic efficacy when taken with NSAIDs?

    <p>Spironolactone</p> Signup and view all the answers

    What effect do calcium channel blockers primarily have on blood pressure?

    <p>Decrease total peripheral resistance</p> Signup and view all the answers

    What is a known adverse effect of spironolactone related to its mechanism of action?

    <p>Gynecomastia</p> Signup and view all the answers

    Which condition is a contraindication for the use of thiazide diuretics?

    <p>Renal insufficiency</p> Signup and view all the answers

    What is a potential risk associated with ACEI and ARB use in patients with renal vascular disease?

    <p>Rapid and profound drop in blood pressure</p> Signup and view all the answers

    In the management of hypertension during pregnancy, which drug is considered a second-line option for severe hypertension?

    <p>Hydralazine</p> Signup and view all the answers

    Which of the following is NOT a consideration for promoting patient compliance in hypertension management?

    <p>Increasing the number of prescribed pills</p> Signup and view all the answers

    What is a requirement for combination therapy in treating hypertension?

    <p>Each component should contribute to the therapeutic effect</p> Signup and view all the answers

    What is the primary focus of therapy when addressing resistant hypertension?

    <p>Investigating and correcting identifiable causes</p> Signup and view all the answers

    Which combination of antihypertensive medications should be avoided due to the risk of adverse effects?

    <p>ACE inhibitors and ARBs</p> Signup and view all the answers

    Why is cognitive impairment a concern in hypertension management in older adults?

    <p>It may result in non-compliance with treatment plans</p> Signup and view all the answers

    Which thiazide-type diuretic effect is particularly beneficial for patients with osteoporosis?

    <p>Helps in slowing demineralization</p> Signup and view all the answers

    What is the primary mechanism of action of guanethidine in treating hypertension?

    <p>Prevents norepinephrine release from nerve terminals</p> Signup and view all the answers

    Which of the following side effects is NOT associated with reserpine?

    <p>Marked orthostatic hypotension</p> Signup and view all the answers

    In which condition is guanethidine primarily reserved for use?

    <p>Severe hypertension</p> Signup and view all the answers

    Which of the following vasodilators is NOT considered an arterial vasodilator?

    <p>Nitroglycerin</p> Signup and view all the answers

    Which of the following actions is associated with minoxidil when used for treating resistant hypertension?

    <p>Opens potassium channels in smooth muscle membranes</p> Signup and view all the answers

    What is a significant potential drug interaction when using reserpine?

    <p>Potentiation of CNS depressants</p> Signup and view all the answers

    What is a well-known side effect of using hydralazine?

    <p>Fluid retention</p> Signup and view all the answers

    Which medication requires combination use with a beta-blocker and a loop diuretic for effective management of hypertension?

    <p>Minoxidil</p> Signup and view all the answers

    Study Notes

    Pharmacologic Treatment

    • Pharmacologic Treatment of Hypertension is classified according to the primary site or mechanism of action
    • Renin-angiotensin-aldosterone system (RAAS) inhibitors:
      • ACE inhibitors, Angiotensin II receptor antagonists (ARBs), direct Renin inhibitors
    • Diuretics:
      • Thiazides and related agents, Loop diuretics, Potassium-sparing diuretics
    • Calcium channel blockers:
      • Dihydropyridine and non-dihydropyridine CCBs
    • Sympatholytic drugs:
      • β-adrenergic antagonists, α-adrenergic antagonists, Mixed -adrenergic antagonists, Centrally acting agents, Adrenergic neuron blocking agents
    • Vasodilators:
      • Arterial vasodilators and Arterial and venous vasodilators

    Renin-angiotensin-aldosterone System (RAAS) Inhibitors

    • ACE inhibitors:
      • Inhibit Angiotensin Converting Enzyme (ACE), a peptidyl-dipeptidase
      • Directly interfere with the conversion of angiotensin I to angiotensin II
      • Promote vasodilation and decrease aldosterone, resulting in decreased sodium and water retention
    • Angiotensin II receptor antagonists (ARBs):
      • Block the binding of angiotensin II to its receptors, mediating vasoconstriction and aldosterone release
      • Inhibit the effects of angiotensin II, promoting vasodilation and decreasing sodium and water retention
    • Direct Renin Inhibitors:
      • Inhibit the conversion of angiotensinogen to angiotensin I, reducing angiotensin II production
      • Promote vasodilation and decrease aldosterone, resulting in decreased sodium and water retention

    Diuretics

    • Thiazides and related agents:
      • Block sodium reabsorption in the early distal tubule
      • Mobilize sodium and water from arterial walls, leading to reduced peripheral vascular resistance
    • Loop diuretics:
      • Block sodium reabsorption in the ascending loop of Henle
      • Promote rapid diuresis, reducing blood volume and peripheral vascular resistance
    • Potassium-sparing diuretics:
      • Inhibit sodium reabsorption in the collecting tubule, sparing potassium and promoting sodium excretion
      • Reduce potassium loss associated with other diuretics

    Calcium Channel Blockers

    • Dihydropyridines:
      • Primarily act on vascular smooth muscle, causing vasodilation
      • Reduce peripheral vascular resistance and blood pressure
    • Non-dihydropyridines:
      • Affect both vascular smooth muscle and the heart, causing vasodilation and slowing heart rate
      • Reduce peripheral vascular resistance and blood pressure, while also reducing cardiac workload

    Sympatholytic Drugs

    • β-adrenergic antagonists:
      • Block the effects of beta-adrenergic stimulation, reducing heart rate and cardiac contractility
      • Reduce sympathetic nervous system activity, contributing to lower blood pressure
    • α-adrenergic antagonists:
      • Block the effects of alpha-adrenergic stimulation, causing vasodilation
      • Reduce vascular resistance and blood pressure
    • Mixed -adrenergic antagonists:
      • Block both alpha and beta-adrenergic receptors, providing multiple effects on blood pressure
      • Reduce sympathetic nervous system activity, resulting in vasodilation and decreased heart rate
    • Centrally acting agents:
      • Stimulate receptors in the brainstem, reducing sympathetic outflow
      • Reduce peripheral vascular resistance and blood pressure
    • Adrenergic neuron blocking agents:
      • Block the release of norepinephrine from nerve endings, reducing sympathetic activity
      • Reduce peripheral vascular resistance and blood pressure

    Vasodilators

    • Arterial vasodilators:
      • Relax the smooth muscle of arterioles, directly reducing peripheral vascular resistance
      • Primarily affect arteries, reducing blood pressure without significantly impacting venous capacitance
    • Arterial and venous vasodilators:
      • Relax the smooth muscle of both arteries and veins, reducing blood pressure and venous capacitance

    Guanethidine

    • Prevents norepinephrine release from nerve terminals
    • Effective, but has severe side effects
    • Reserved for severe hypertension
    • Side effects: marked orthostatic hypotension, diarrhea, bradycardia, impotence; does not enter CNS

    Reserpine

    • Binds to storage vesicles in CNS and peripheral adrenergic neurons where it blocks the ATP-dependent proton pump that transports amines into the vesicle.
    • The binding is irreversible.
    • New vesicles need to be synthesized.
    • The antihypertensive effect probably results from both the central and peripheral actions.
    • Binding results in a dysfunctional vesicle, causing nerve endings to lose the ability to concentrate and store NE and DA.
    • The catecholamines leak into the cytoplasm where they are metabolized by MAO.
    • Little or no neurotransmitter is released when the nerves are depolarized.
    • Disrupts norepinephrine vesicular storage, probably through both central and peripheral action.
    • Can be used to treat mild-to-moderate hypertension

    Minoxidil

    • Orally effective
    • Used mainly for treating resistant hypertension
    • Opens potassium channels in smooth muscle membranes
    • Must be used in combination with a beta-blocker and a loop diuretic

    Renal Vascular Disease

    • ACEI or ARBs should be used with caution for patients with Renal vascular disease.
    • Rapid and profound drop in BP as well as renal failure can occur.
    • Avoid in bilateral renal artery stenosis.

    Pregnancy

    • Almost all cardiovascular drugs are either risk category C or D during pregnancy
    • Chronic/transient hypertension vs. Preeclampsia
    • Not much data available from controlled clinical studies
    • Treatment options include: Methyldopa, Labetalol, CCBs, Hydralazine, BBs
    • In severe hypertension during pregnancy, intravenous labetalol, oral methyldopa, or oral nifedipine is recommended
    • Intravenous hydralazine is a second-line option.
    • Avoid: ACEI, ARBs, diuretics.

    Combination Therapy

    • Combination therapy for hypertension may have superior efficacy compared to monotherapy
    • Each drug component should contribute to the therapeutic effect.
    • Dosage forms must be satisfactory regarding bioavailability, absence of unwanted interactions, and careful selection of doses for each component.
    • ACEIs and ARBs should not be used in combination.

    Causes of Resistant Hypertension

    • Improper BP measurement
    • Excess sodium intake
    • Inadequate diuretic therapy
    • Medication:
      • Inadequate doses
      • Compliance issues
      • Drug interactions
      • OTC/herbals/dietary supplements
    • Excess alcohol intake
    • Identifiable causes of HT

    Promoting Patient Compliance

    • Educate the patient regarding proper use of medicine as well as the disease state
    • Include social support networks
    • Include the patient in decision making
    • Avoid drugs with numerous side effects
    • Simplify the drug regimen
    • Provide positive reinforcement
    • Maintain continuity of care
    • Individualize treatment

    Additional Considerations in Antihypertensive Drug Choices

    • Thiazide-type diuretics are useful in slowing demineralization in osteoporosis
    • BBs are useful in the treatment of atrial tachyarrhythmias/fibrillation, migraine, thyrotoxicosis, essential tremor, or perioperative HT
    • CCBs are useful in Raynaud’s syndrome and certain arrhythmias
    • Alpha-blockers are useful in prostatism

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    Pharmacotherapy of Hypertension PDF

    Description

    This quiz covers the pharmacologic treatments available for hypertension, focusing on mechanisms such as RAAS inhibitors, diuretics, calcium channel blockers, sympatholytic drugs, and vasodilators. Test your knowledge on the classification and action of various antihypertensives and their respective categories.

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