What causes wind to occur?

Air flowing from regions of high pressure to low pressure

Differential heating of the Earth's surface

In aviation, wind direction is expressed in:

Degrees of the compass indicating the direction the wind is coming from

Degrees of the compass indicating the direction the wind is going

What is cyclonic flow?

Air moving into the center of a low-pressure system in a counterclockwise direction

Air moving upward due to subsidence

Air moving outward from the center of a high-pressure system

Air moving into the center of a high-pressure system in a clockwise direction

What is the primary cause of pressure differences on Earth?

Differential heating from the sun

Friction near the Earth's surface

A large section of the troposphere with uniform temperature and moisture content

A region of high pressure surrounded by low pressure

A region of low pressure surrounded by high pressure

A small section of the troposphere with varying temperature and moisture content

A narrow transition zone between two air masses

A large section of the troposphere with uniform properties

A region of high pressure surrounded by low pressure

A region of low pressure surrounded by high pressure

What is the main feature of a cold front?

Displacement of warm air upward

What happens to wind below 3,000 feet above ground level?

It backs and decreases in speed

It becomes unaffected by friction

It veers and increases in speed

Air descending at the center of a high-pressure system

Air being forced upward at the center of a low-pressure system

Air moving horizontally across the Earth's surface

What are the three factors that affect frontal weather?

Moisture content of the warm air mass, stability of the warm air mass, and speed/steepness of the front

Stability of the cold air mass, speed of the front, and pressure gradient

Temperature of the cold air mass, Coriolis force, and wind direction

Barometric pressure, wind speed, and cloud type

2.1.2 Pressure, Wind & Wx- 15q

1 .Sand soil • Has course/ large particles • they are larger than those of clay • Loses water quickly • Has less organic matter • Has good aeration • Allows good root penetration • Leaching of nutrients is more in sand soil. • Does not stick when wet 2. Clay soil • Has very fine particles which are closely packed • The soil is sticky when wet and can be moulded into any shape • It holds more water than sand and loam • It has poor drainage • It cracks when dry • It has poor aeration • It does not allow good root penetration 2 .Loam soil • Is a mixture of sand and clay particles • It half clay half sand • It can be easily moulded into a shape but easily crumbles • Holds water for a longer time than sand • It sticks on the hands when wet • It has good drainage • It has good aeration • It allows good root penetration • Loam is the best soil Soil Fertility • When soil has enough plant nutrients it is fertile • Soil fertility is the presence of nutrients in the soil • A farmer can add nutrients to the soil to make it fertile • This is done by applying fertilizers and compost. • A fertiliser is a substance that is added to the soil to increase fertility • Nutrients found in the soil include Nitrogen, Phosphorus and Potassium ( NPK ) • They are called major nutrients or macro nutrients because they are needed in large quantities Minor nutrients • Minor nutrients are needed in smaller quantities • Minor nutrients are also called micro nutrients or trace elements • Examples of minor nutrients are boron, iron, zinc, manganese, magnesium and molybdenum Soil erosion • Is the washing away of top soil by agents such as Water Wind Animals Humans 1. Water: • Water washes away soil when it rains. • Loose soil is washed away into dams and rivers. • Steep slopes also lead to soil erosion. • Ploughing 2 . Wind • The blowing away of soil by wind causes soil erosion. • When people cut down trees wind erosion easily takes place. • Type of soil also leads to wind erosion. Which soil type is easily eroded by wind? 3 . Animals • Animal cause soil erosion by overgrazing. • Overgrazing is when animals eat plant or vegetation leaving the ground surface bare. • Animals walking on the same pathway for a long time make the soil loose. • Animals that live underground also burrow loosening the soil. • This makes soil break easily and get washed away. WATER WATER CONSERVATION Water • Water is important in agriculture • It is used to: Clean farm tools Mould bricks Wash milking equipment Cool machines Provide homes(habitat) for fish Give animals drinking and bathing water Sources of Water Natural sources 1. Natural rains: • rain water from the clouds is a primary source of water. • It is used to water crops such as maize, millet, sorghum and so on during the rainy season. • Rain water that collects into the rivers and dams is used by animals and people for drinking. 2 . Rivers : • Rivers are some of the major sources of water for different activities such as fishing, boat cruising and irrigation. 3 . Streams : • A stream is a small river. • Streams supply water for irrigating garden crops especially in rural areas. • They are also a source of water for animals to drink and bath. Sources of Water 4 . Springs : • Springs are usually found on hilly areas. • They result from pressure of underground streams. • The pressure forces water underground to form a channel to the surface of the soil and flow above the ground. Sources of Water Man made sources Man discovered that water for agriculture was not enough during the rain and cool dry seasons. They decided to make structures which would harvest or collect and store water for future use. 1.Protected well: • Wells are dug in the ground by hand. • They are often lined with bricks and concrete so that they do not cave in. • Protected wells are covered, therefore are safe to drink from. 2 . borehole : • They are deep holes made by drilling machines. • Drilling can be done up to 70 metres deep. • Water is pumped using an electric pump or hand pump. Sources of Water 3 . Dams : • A dam is a large wall or barrier built to hold water to save it for future use. 4 . Weir : • A weir is made by construction a cement brick wall or concrete wall across a river to trap water and eroded soil. • water flows over the wall when the river is inflood. 5 .Water tank : • Is a temporary manmade water source. • Water from a water tank is usually harvested from roof tops or it works along a borehole or protected well as temporary storage. • Water is pumped from the borehole or protected well into the water tank. 6 . reservoir : • A large natural or manmade lake used as a source of water. PLANTS Uses of plants • Fibre for making clothes • Oil for cooking, making paint and chemicals • Sugar for tea • Wood for timber • Refreshing drinks and alcohol • Food for people and animals • Protect the soil from erosion • Plants supply us with fresh oxygen for breathing. • Some plant parts are used as medicine.

WEATHER INSTRUMENTS • For the weather elements learnt, we use different instruments to measure and record them. • The instruments are: 1. A thermometer 2. A rain gauge 3. A wind vane 4. A cup anemometer 5. A hygrometer 6. A barometer 7. A Stevenson screen WEATHER INSTRUMENTS 1. Thermometer •It is used to measure temperature. •The unit of measurement is degrees Celcius (ᵒC). 2. Rain gauge •Is used to measure the amount of rainfall. •The unit of measurement is millimetres (mm). •In Zimbabwe more rains are experienced in summer. WEATHER INSTRUMENTS 3. Windvane •Used to determine the direction of the wind. •We always name the wind after the direction from which it blows. WEATHER INSTRUMENTS 4. Cup anemometer •It is used to measure wind speed. •It measures how quickly the set of cups turns around in a circle. •The unit of measurement is knots. 1 knot = 1.85km/hour WEATHER INSTRUMENTS 5. Barometer •It is used to measure atmospheric pressure. •Atmospheric pressure is the weight of the air on the earth. •If the pressure changes, it tells us that the weather is going to change. •High pressure means air is sinking and the weather will be clear. •Low pressure means the air is rising and there is a chance of rain. WEATHER INSTRUMENTS WEATHER INSTRUMENTS 6. Hygrometer •It is used to measure humidity. •Humidity is the amount of water vapour in the air

Recognizes or recalls specific terminology, such as: rocks, igneous, molten rock, sedimentary, fossilized organisms, metamorphic, heat, pressure, formed, physical properties, minerals, hardness, color, luster, cleavage, streak color, quartz, feldspar, mica, calcite, talc, pyrite, graphite, resources, Earth, renewable, nonrenewable, physical weathering, wind, water, ice, temperature change, plants, erosion, gravity, wind, water, ice, technology, tools, phosphate, oil, limestone, silicon, solar energy Performs basic skills:  Identify the three categories of rocks: igneous (formed from molten rock); sedimentary (pieces of other rocks and fossilized organisms); and metamorphic (formed from heat and pressure). (SC.4.E.6.1)  Identify the physical properties of common earth-forming minerals, including hardness, color, luster, cleavage, and streak color. (SC.4.E.6.2)  Recognize the role of minerals in the formation of rocks. Recognize that humans need resources found on Earth and that these are either renewable or nonrenewable. Identify resources available in Florida (water, phosphate, oil, limestone, silicon, wind, and solar energy). Describe the basic differences between physical weathering (breaking down of rock by wind, water, ice, temperature change, and plants) and erosion (movement of rock by gravity, wind, water, and ice). Identify and describe the processes of physical weathering and erosion. Investigate how technology and tools help to extend the ability of humans to observe very small things and very large things.

Marine and Coastal Processes.What are the hazards that usually occur along marine and coastal areas? Coastal processes, such as waves, tides, sea level changes, crustal movement, and storm surges will result to coastal erosion, submersion, and saltwater intrusion. Coastal Erosion. Coastal erosion is the wearing down of the coastlines by the movement of wind and water. It is not a constant process; instead, the rate of erosion depends on other events such as cyclones. When cyclones occur along coastal areas, the winds and waves carry the sediment away from the shoreline. Shorelines play an important role to society. They are used in transportation, fishing, and tourism. Therefore, preventing coastal erosion is of utmost priority. There are three main classifications of stabilizing the shoreline: hard stabilization, soft stabilization, and retreat. 1. Hard stabilization is done by building structures that will slow down the erosion on areas that are prone to erosion. Examples of hard stabilization structures are jetties, sea walls, and breakwaters. Though they may slow down the erosion in one area, it may hasten the erosion in other areas. 2. Soft stabilization includes the process of beach nourishment, wherein sand from an offshore location is brought to an area with a receding shoreline. It does not make use of structures like the ones used in hard stabilization. 3. Retreat is the option taken by residents near areas where coastal erosion is already severe. At this point, the authorities no longer attempt to save the shoreline but rather limit the amount of human interference in the area. Submersion. Coastal erosion happens because of the interaction of the winds and waves on the shoreline. Submersion, on the other hand, happens because of the changes in the sea level, specifically, when it rises dangerously above the normal level. This is all due to the increase in the global temperature, which, in turn, melts the glacial deposits and increases the overall sea level. Another factor that may cause submersion is the vertical movement of the plates. Landmasses can be uplifted, which can also cause changes in the sea level. It can also be caused by tsunamis and storm surges. Submersion will most likely occur in reclaimed lands. These are the areas that were originally part of oceans, riverbeds, or lakebeds. They are low-lying flatlands, so even a small rise in sea level can cause great damage on the land. To prevent this from happening not only in reclaimed lands but also in coastal areas, a hard stabilization technique is used. Sea walls are built along the coastline to protect the land from being easily flooded. Aside from sea walls, dikes can also help prevent flooding. The government can also upgrade the infrastructures built in coastal areas, regenerate mangroves, or relocate the people. There are also other proposed strategies to mitigate coastal submersion, such as imposing of setback policies and construction regulations and creating adaptive plans for coastal management. Saltwater Intrusion. In coastal areas where there is an interaction between saltwater and fresh water, saltwater intrusion is one of the hazards that are evident in that area. Saltwater intrusion is the movement of saltwater into the freshwater aquifer. The natural flow is that the fresh water, which is less dense, moves towards the denser saltwater. But if the fresh water is being withdrawn faster than it is being replenished, then there will be a change in pressure and saltwater intrusion will occur.There are a few ways of preventing saltwater intrusion. One is to stop using the well where fresh water has been depleted and let the groundwater replenish naturally via the water cycle. The other method is to build two wells: a pumping well-built farther inland and an injection well-built closer to the coast. Using the injection well, fresh water is pumped into the aquifer to prevent the saltwater from intruding. The different marine and coastal hazards often occur in the Philippines, being an archipelago with the longest coastline. Manila Bay is one of the coastal areas of the Philippines that is facing various threats from both natural and anthropological causes. Saltwater intrusion occurs due to uncontrolled withdrawal of groundwater to be used by residential, commercial, and industrial areas built around the bay. It is also frequently flooded due to poor drainage systems and improper disposal of waste. Since Manila Bay is shared by four coastal provinces, four noncoastal provinces, and the National Capital Region, each local government unit and national agencies need to collaborate in planning, developing, and managing its marine and coastal resources. And it is not only Manila Bay but other parts as well, for as long as they are in coastal areas, hazards will mostly likely occur if not immediately addressed.

PASSIVE TRANSPORT Cell membranes help organisms maintain homeostasis by controlling what substances may enter or leave cells. Some substances can cross the cell membrane without any input of energy by the cell in a process known as passive transport. DIFFUSION The simplest type of passive transport is diffusion. Diffusion is the movement of molecules from an area of higher concentration to an area of lower concentration. This difference in the concentration of molecules across a distance is called a concentration gradient. Consider what happens when you add a sugar cube to a beaker of water. As shown in Figure 5-1, the sugar cube sinks to the bottom of the beaker. This sinking makes the concentration of sugar mole- cules greater at the bottom of the beaker than at the top. As the cube dissolves, the sugar molecules begin to diffuse slowly through the water, moving towards the lower concentration at the top. Diffusion is driven entirely by the molecules’ kinetic energy. Molecules are in constant motion because they have kinetic energy. Molecules move randomly, traveling in a straight line until they hit an object, such as another molecule. When they hit some- thing, they bounce off and move in a new direction, traveling in another straight line. If no object blocks their movement, they con- tinue on their path. Thus, molecules tend to move from areas where they are more concentrated to areas where they are less concentrated, or “down” their concentration gradient. In the absence of other influences, diffusion will eventually cause the molecules to be in equilibrium—the concentration of molecules will be the same throughout the space the molecules occupy. Returning to the example in Figure 5-1, if the beaker of water is left undisturbed, at some point the concentration of sugar molecules will be the same throughout the beaker. The sugar concentration will then be at equilibrium. SECTION 1 OBJECTIVES ● Explain how an equilibrium is established as a result of diffusion. ● Distinguish between diffusion and osmosis. ● Explain how substances cross the cell membrane through facilitated diffusion. ● Explain how ion channels assist the diffusion of ions across the cell membrane. VOCABULARY passive transport diffusion concentration gradient equilibrium osmosis hypotonic hypertonic isotonic contractile vacuole turgor pressure plasmolysis cytolysis facilitated diffusion carrier protein ion channel Sugar Water 1 2 3 FIGURE 5-1 Sugar molecules, initially in a high concentration at the bottom of a beaker, , will move about randomly through diffusion, , and eventually reach equilibrium, . At equilibrium the sugar concentration will be the same throughout the beaker. Diffusion occurs naturally because of the kinetic energy the molecules possess. 3 2 1 Copyright © by Holt, Rinehart and Winston. All rights reserved. 98 CHAPTER 5 It is important to understand that even at equilibrium the ran- dom movement of molecules continues. But because there is an equal concentration of molecules everywhere, molecules are just as likely to move in one direction as in any other. The random movements of many molecules in many directions balance one another, and equilibrium is maintained. Diffusion Across Membranes Cell membranes allow some molecules to pass through, but not others. If a molecule can pass through a cell membrane, it will diffuse from an area of higher concentration on one side of the membrane to an area of lower concentration on the other side. Diffusion across a membrane is also called simple diffusion, and only allows certain molecules to pass through the membrane. The simple diffusion of a molecule across a cell membrane depends on the size and type of molecule and on the chemical nature of the membrane. A membrane can be made, in part, of a phospho- lipid bilayer, and certain proteins can form pores in the membrane. Molecules that can dissolve in lipids may pass directly through the membrane by diffusion. For example, because of their nonpolar nature, both carbon dioxide and oxygen dissolve in lipids. Molecules that are very small but not soluble in lipids may diffuse across the membrane by moving through the pores in the membrane.

P.S. Ch13 Fluid Pressure Sec 1&2

Chapter 22 Antihypertensive Drugs Hypertension Defined (JNC-8) Pharmacology Overview 7 main categories of drugs to treat HTN Adrenergic drugs (old friend) Angiotensin-converting enzyme (ACE) inhibitors Angiotensin II receptor blockers (ARBs) Calcium channel blockers (CCBs) Diuretics Vasodilators Direct renin inhibitors A. Adrenergic Drugs: 5 Subcategories and where they act A1. Adrenergic neuron blockers (central and peripheral)- we won’t talk about this A2. Alpha1 receptor blockers (peripheral) A3. Alpha2 receptor agonists (central) A4. Beta receptor blockers (peripheral) A5. Combined α and β receptor blockers (peripheral) A2. Peripherally Acting Adrenergic DrugAlpha1 Blockers (we’ve met these) Doxazosin, prazosin, alfuzosin Block alpha1-receptors which causes BP to decrease Reduces peripheral vascular resistance and BP by dilating both arterial and venous blood vessels Main Use: benign prostatic hyperplasia (BPH) Alpha1 Blockers REMEMBER Tamsulosin (Flomax)* is an α1 blocker BUT *Tamsulosin is not used to control BP, just for BPH. A3. Centrally Acting Adrenergic DrugsAlpha 2 agonist Clonidine and methyldopa 1- Stimulate alpha2-adrenergic receptors. in the brain Decreases sympathetic outflow from the CNS which decreases NE production 2. Stimulate alpha2-adrenergic receptors in kidneys remember alpha 2 opposes alpha 1 Dilates peripheral blood vessels → lowers peripheral resistance → Results in decreased BP So ….Clonidine (Catapres) Used primarily for its ability to decrease blood pressure in an urgent setting Also use in opioid withdrawal as previously discussed Oral (multiple times a day), and topical patch formulations Do not stop abruptly as it may lead to rebound hypertension In reality, Clonidine and methyldopa Not prescribed as first-line home antiHTN drugs High incidence of unwanted adverse effects: orthostatic hypotension, fatigue, and dizziness MIGHT be uses as adjunct drugs after other drugs have failed, in conjunction with other antiHTN such as diuretics A4. Adrenergic Drugs Selective Beta 1 Blockers Metoprolol, Atenolol Reduction of HR through β1 receptor blockade (remember adrenergic blocking of this receptor???) HR results in BP Cause reduced secretion of renin = BP A4. Adrenergic Drugs Selective Beta1 Blockers Nebivolol (Bystolic) Uses: hypertension and HF Action: blocks β1 receptors and produces vasodilatation, which results in a decrease in SVR High doses loses selectivity and blocks both β1 and β2 Less sexual dysfunction All BB- Do not stop abruptly; must be tapered over 1 to 2 weeks A4. Adrenergic Drugs NONSelective Beta Blockers Propranolol Acts equally on β1 and β2 Other uses include situational anxiety associated with public speaking, test taking As mentioned on previous slide, nebivolol at high doses becomes beta nonselective A5. Dual-Action Adrenergic Drugs α1 and β Receptor Blockers Dual antihypertensive effects of reduction in heart rate (beta1 receptor blockade) and vasodilation (alpha1 receptor blockade) Examples are carvedilol (common) and labetalol (not as common) A5. Dual-Action Adrenergic Drugs α1 and β Receptor Blockers Carvedilol (Coreg) Widely used drug that is well tolerated Uses: HTN, mild to moderate HF in conjunction with digoxin, diuretics, and ACE inhibitors Contraindications: severe bradycardia or unstable HF, bronchospastic conditions such as asthma, and various cardiac conduction problems Adrenergic Drugs Indications - HTN But also for Glaucoma (topical) BPH: doxazosin, prazosin, and terazosin (2 for 1) Management of severe HF when used with cardiac glycosides and diuretics Contraindications Acute HF- have to stabilize first MOAIs- yeah doesn’t everything interact with MAOIs? Peptic ulcers Severe liver/kidney disease Asthma (with beta blockers) Adrenergic Drugs: Adverse Effects Orthostatic hypotension 1st-dose syncope Rebound hypertension with abrupt discontinuation Most common: Dry mouth, drowsiness, constipation, sedation Interactions- always check for specific drug interactions Can cause additive CNS depression with alcohol, benzodiazepines, opioids Question #1 When administering an alpha-adrenergic drug for hypertension, it is most important for the nurse to assess the patient for the development of what response? Hypotension Hyperkalemia Oliguria Respiratory distress Answer A Hypotension This is a key point in patient education These drugs have strong vasodilating properties and may cause severe hypotension, especially at the beginning of therapy. B. Angiotensin-Converting Enzyme Inhibitorsaka ACE Inhibitors or ACEi Large group of safe and effective drugs Currently are 10 ACEi Often used as first-line drugs for HF and hypertension May be combined with a thiazide diuretic, loop diuretic, or Calcium Channel Blocker (CCB) You need to understand the basics ACE Inhibitors: Review RAAS ACE converts angiotensin I, formed through the action of renin, to angiotensin II Angiotensin 2 is a potent vasoconstrictor and also induces aldosterone secretion by the adrenal glands Aldosterone stimulates sodium resorption (H20 follows Na Both act to raise BP which causes kidneys to reduce renin production ACEi= Great drug to treat HTN BUT contraindicated in pregnancy (2nd,3rd trimester due to fetal renal damage) and breastfeeding first few weeks after birth B. ACE Inhibitors - PRIL Lisinopril (Prinivil) super common, often the 1st drug Enalapril (Vasotec) also common Captopril (Capoten) great if liver disease present Benazepril (Lotensin) Fosinopril (Monopril) Perindopril (Aceon) Quinapril (Accupril) Ramipril (Altace) Trandolapril (Mavik) Primary Effects of the ACE Inhibitors Prevent Na (and H2O) resorption by inhibiting aldosterone secretion (volume reduction) (GO BACK TO RAAS DIAGRAM) blood volume decreases work of the heart preload, or the left ventricular end-diastolic volume which is important in HF ACE SUMMARY OF ACTIVITY 1) Prevent vasoconstriction caused by angiotensin 2 (2) Prevent aldosterone secretion  less sodium and water resorption Cardioprotective Effects of ACEi They slow progression of left ventricular hypertrophy (ventricular remodeling) after MI so considered cardioprotective ACE inhibitors have been shown to decrease morbidity and mortality in patients with HF Renal Protective Effects of ACEi ACE inhibitors: reduce glomerular filtration pressure by volume reduction Cardiovascular drug of choice for patients with diabetes since it helps protect kidneys by reducing pressure. Sometimes used low dose for kidney protection with DM without HTN B. ACEi Enalapril (Vasotec) Only ACEi available in both oral and IV Enalapril IV does not require cardiac monitoring Oral enalapril: prodrug (metabolized in liver) Improves patient’s chances of survival after an MI Reduces the incidence of HF B. ACEi Captopril (Capoten) Uses: prevention of ventricular remodeling after MI; reduce the risk of HF after MI Shortest half-life Must be administered multiple times throughout the day so this limits its use Not a prodrug so good for patient with liver disease Question #2 A patient with diabetes has a new prescription for the ACE inhibitor lisinopril. She questions this order because her provider has never told her that she has hypertension. What is the best explanation for this order? The doctor knows best The patient is confused This medication has cardioprotective properties This medication has a protective effect on the kidneys for patients with diabetes Answer D ACE inhibitors have been shown to have a protective effect on the kidneys because they reduce glomerular filtration pressure. This property makes them the cardiovascular drug of choice for patients with diabetes. Question #3 A patient with a history of pancreatitis and cirrhosis is also being treated for hypertension. Which drug will most likely be ordered for this patient? Clonidine Prazosin Diltiazem Captopril Answer D Captopril Captopril is not a prodrug; therefore, it does not need to be metabolized by the liver to be effective. This is an advantage in patients with liver disease. ACE Inhibitors: Adverse Effects *Dry, nonproductive cough, which reverses when therapy is stopped. This is a class effect Dizziness- Note: First-dose hypotensive effect may occur Headache & Fatigue Possible hyperkalemia ** Angioedema: rare but potentially fatal Not safe in pregnancy-are contraindicated during the second and third trimesters of pregnancy because of increased risk of fetal renal damage C. Angiotensin II Receptor Blockers(ARB) Considered an alternative to ACEi Less likely to cause a dry cough and hyper K+ that is common with ACE inhibitors Angiotensin II Receptor Blockers: Mechanism of Action Go back to RAAS diagram! ARBs affect primarily 2 places 1. Vascular smooth muscle - blocks vasoconstriction 2. Adrenal gland -Selectively blocks the binding of Ang 2 to certain Ang 2 receptors inhibiting secretion of aldosterone Lowers volume retention and BP Angiotensin II Receptor Blockers -ARTAN Losartan (Cozaar)- very common Eprosartan (Teveten) Valsartan (Diovan) Irbesartan (Avapro) Candesartan (Atacand) Olmesartan (Benicar) Telmisartan (Micardis) Azilsartan (Edarbi) C. ARB Losartan (Cozaar) Beneficial in patients with HTN and HF Used with caution in patients with kidney or liver dysfunction and in patients with renal artery stenosis ***Not safe for breastfeeding women and should not be used in pregnancy (Cat C 1st trimester, Cat D 2nd-3rd trimester), potential fetal toxicity Appear to be equally effective for the treatment of hypertension and well tolerated ARBs less likely to cause cough and hyperK+ but can still happen Evidence that ARBs are associated with lower mortality after MI than ACE inhibitors Never take ACEi and ARBs at the same time* 5. Calcium Channel Blockers (CCB) Primary use: HTN, angina, some dysrhythmias Cause smooth muscle relaxation by blocking the binding of calcium to its receptors, preventing muscle contraction Results in: Relaxed blood vessels to the heart Decreased peripheral smooth muscle tone Decreased SVResistance Decreased BP E. Diuretics First-line antiHTN in JNC 8 guidelines Decreases fluid volume The results from diuresis: preload, Peripheral resistance Overall effect  Decreased workload of the heart and decreased BP Thiazide diuretics are the most commonly used diuretics for HTN Ie hydrochlorothiazide (HCTZ), chlorthalidone We will discuss diuretics further in the chapter on diuretics F. Vasodilators Directly relax arterial or venous smooth muscle (or both) Results in: Decreased SVR Decreased afterload Peripheral vasodilation Indicated for treatment of HTN May be used in combination with other drugs F. Vasodilators Hydralazine (Apresoline) Orally: routine cases of essential hypertension Injectable: hypertensive emergencies BiDil: specifically indicated as an adjunct for treatment of HF in African-American patients F. Vasodilators Sodium Nitroprusside (Nitropress) *Sodium nitroprusside and IV diazoxide are reserved for the management of hypertensive emergencies. Contraindications: severe HF, known inadequate cerebral perfusion (especially during neurosurgical procedures) F. Vasodilators Adverse Effects Hydralazine: dizziness, headache, tachycardia, edema, dyspnea, N/V/D, vitamin B6 deficiency, rash Sodium nitroprusside: hypotension, bradycardia, decreased platelet aggregation, rash G. Direct Renin Inhibitors Aliskirin (Tekturna) Blocks the RAS pathway at the point of activation. Inhibiting renin production prevents the downstream production of Ang II (potent vasoconstrictor) Adverse effects: N/V, severe hypotension, hyponatremia, hyperkalemia… Contraindicated in patients with DM taking ACEi or ARB Miscellaneous Antihypertensives Eplerenone (Inspra) Newer class of drugs called selective aldosterone blockers (remember RAAS?) Reduces BP by blocking the actions of aldosterone at its corresponding receptors in the kidney, heart, blood vessels, and brain Indications: routine treatment of hypertension and for post-MI HF Contraindicated if serum potassium levels are high (above 5.6 mEq/L) A Special Form of HTNTreatment of Pulmonary Hypertension Sildenafil and Tadalafil Commonly used for erectile dysfunction Used for pulmonary hypertension but with different trade names Sildenafil: Revatio* (Viagra for ED) Tadalafil: Adcirca* (Cialis for ED)

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