Pharmacology Drugs for Hypertension

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Term Definition
What is the key point of all drugs for hypertension to keep in mind? They all do the same thing in the end, BUT they all work differently.
Sites of drug action:![keep in mind the information is based on what effects the DRUGS have on the specified area, not what that site normally does]! BrainstemSympathetic GangliaTerminals of Adrenergic NervesBeta1-Adrenergic Receptors on HeartAlpha1-Adrenergic Receptors on Blood VesselsVascular Smooth MuscleRenal Tubules
Brainstem Suppress sympathetic outflow to to heart and blood vessels.- Decrease contractility in the heart- Vasodilation in the blood vesselsAs a result: – decreased arterial vascular resistance – decrease venous return
What are the only chemicals associated with sympathetic outflow? Epinephrine + Norepinephrine
Drugs that act in the Brainstem: ClonidineMethyldopa
Sympathetic Ganglia Decreases sympathetic stimulation of the heart + blood vessels.- Primarily causes profound vasodilationAs a result:- Decreases arterial vascular resistance- Decreases venous return
Drugs that act in the Sympathetic Ganglia: Mecamylamine- No longer used in the US
Terminals of the adrenergic nerves Decrease the release norepinephrine.- Decrease sympathetic stimulation of the heart + blood vessels
Drugs that act in the adrenergic nerve terminals Adrenergic neuron blockers: ReserpineNOT used very often
Beta 1 adrenergic receptors on HEART Blocks the Beta1 adrenergic receptors found on the heart.- Prevents sympathetic stimulation of heartAs result: – Decreased heart rate- Decreased myocardial contraction
Drugs that act on Beta1 Adrenergic receptors on the heart: BETA BLOCKERS: "lol"- Metoprolol, Propanolol
Alpha 1 adrenergic receptors in BLOOD VESSELS Blocks the Alpha1 adrenergic receptors found in the blood vessels- Promotes arteriolar + venous dilationAs a result:- Decrease peripheral vascular resistance (arterial resistance)- Decrease venous return
Drugs that act on Alpha 1 Adrenergic receptors in blood vessels: ALPHA 1 BLOCKERS: "osin"- Prazosin, Doxazosin
Vascular smooth muscle Acts directly on vascular smooth muscle causing relaxation- Muscle relaxation causes vasodilation.
Drugs that act on vascular smooth muscle Direct acting vasodilators:- Hydralazine, Minoxidil
Renal tubules Promotion of diuresis: – Promote sodium + water excretion- Decreases blood volumeD
Drugs that act on renal tubules ACE INHIBITORS: "pril" Captopril, EnalaprilANGIOTENSIN II RECEPTOR BLOCKERS: "artan" Losartan, ValsartanDIRECT RENIN INHIBITOR: AliskirenALDOSTERONE ANTAGONISTS: "one" Eplerenone, Apironolactone
Hypertension Elevated BP.- Persistent systolic of 140 and/or diastolic of 90: those under 60- Persistent systolic of 150 and/or diastolic of 90: those over 60
Hypertension is a major risk factor for what other complications? – Heart disease- Stroke- Peripheral vascular disease- Renal failure- Death
How do we determine BP? Cardiac Output and SVR: Systemic Vascular ResistanceBP = CO x SVR
What is cardiac output? The amount of blood ejected from the left ventricle.
What is SVR: System vascular resistance? The resistance to blood flow determined by diameter of the blood vessel.
What is the goal of antihypertensive medications? Decrease cardiac and renal morbidity/mortality.- WE WANT TO SAVE OUR HEART AND KIDNEYS. (if we save those, we save the brain)
What's the first step of treating hypertension? Lifestyle changes including diet + activity.
Pt. would more likely be compliant with treating hypertension IF: Care is individualized.- Based on chronic diseases + quality of life.
Hypertensive emergency BP greater than diastolic of 120mmHg.- Can cause retinal hemorrhage- MI- Intracranial hemorrhage- Heart failure- Death

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