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Pharmacotherapeutics > Antihypertensives > Flashcards

Antihypertensives Flashcards

1
Q

Preload

A

Volume of blood in ventricles at the end of diastole

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2
Q

Afterload

A

Resistance left ventricle must overcome to circulate blood

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3
Q

Highest Contributor to Hypertension

A

Atherosclerosis

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4
Q

Normal Blood Pressure

A

S < 120

D < 80

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5
Q

Prehypertension

A

S 120-139

D 80-89

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6
Q

Stage 1 Hypertension

A

S 140-159

D 90-99

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7
Q

Stage 2 Hypertension

A

S > 160

D > 100

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8
Q

Primary Hypertension

A

No identifiable cause

Chronic, progressive disorder

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9
Q

Secondary Hypertension

A

Identifiable primary cause

Possible to treat the cause directly

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10
Q

Hypertension Medication Guidelines

A

Start medications in lowest available dose

Change medication groups instead of increasing dose if 1st medication is ineffective

Medication dosages are patient-specific

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11
Q

Clonidine and Methyldopa

A

Centrally acting adrenergic drugs

Stimulate alpha-2 adrenergic receptors in the brain

Decrease sympathetic outflow from CNS

Results in decreased BP

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12
Q

Methyldopa

A

Treats pregnancy-induced hypertension

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13
Q

Clonidine

A

Also used for opioid withdrawal

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14
Q

Metaprolol

A

Beta blocker

Reduces heart rate through beta-1 receptor blockade

Causes reduced secretion of renin

Long-term use causes reduced peripheral vascular resistance

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15
Q

Labetalol and Carvedilol

A

Dual-action alpha-1 and beta receptor blockers

Used for increased blood pressure

Dual antihypertensive effects of reduction in heart rate (beta-1 receptor blockade) and vasodilation (alpha-1 receptor blockade)

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16
Q

Carvedilol

A

Used for hypertension, mild to moderate heart failure in conjunction with digoxin, diuretics, and ACE inhibitors

Widely used drug that is well tolerated

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17
Q

Adrenergic Drugs

A

Used to treat hypertension, glaucoma, BPH, severe heart failure

18
Q

Adrenergic Drugs Adverse Effects

A

HIGH INCIDENCE OF OTHROSTATIC HYPOTENSION

Bradycardia with reflex tachycardia

Drowsiness

Impotence

19
Q

ACE Inhibitors

A

Large group of safe and effective drugs

Often used as first-line drugs for HF and HTN

May be combined with thiazide diuretic or CCB

20
Q

Captopril and Lisinopril

A

ACE Inhibitors

NOT prodrugs (inactive in administered form and must be metabolized in the liver to an active form)

CAPTOPIL AND LISINOPRIL CAN BE USED IF A PATIENT HAS LIVER DYSFUNCTION, UNILKE OTHER ACE INHIBITORS THAT ARE PRODRUGS

21
Q

ACE Inhibitors Mechanism of Action

A

Block ACE and prevent angiotensin II

Prevent breakdown of vasodilating substance bradykinin

Result in decreased afterload (SVR), vasodilation, and decreased BP

Prevent sodium and water reabsorption

Diuresis (decreases blood volume and return to the heart)

22
Q

RENAL PROTECTIVE Effects of ACE Inhibitors

A

Reduce glomerular filtration pressure

Reduce proteinuria

Prevent progression of diabetic nephropathy

23
Q

CARDIOPROTECTIVE Effects of ACE Inhibitors

A

Decrease SVR (a measure of afterload)

Used to prevent complications after MI

Ventricular remodeling after MI

Decrease morbidity and mortality in patients with HF

Drug of choice for hypertensive patients with HF

24
Q

Adverse Effects of ACE Inhibitors

A

Dry, nonproductive cough (causes patients to stop medication)

Hyperkalemia

25
Q

Captopril (Capoten)

A

Used for prevention of ventricular remodeling after MI

Shortest half-life

Must be administered PO multiple times throughout the day

26
Q

Enalapril (Vasotec)

A

ONLY ACE INHIBITOR AVAILABLE IN BOTH ORAL AND PARENTERAL PREPERATIONS

Does not require cardiac monitoring

Oral enalapril is a PRODRUG

Reduces the incidence of HF

27
Q

Angiotensin II Receptor Blockers

A

Well tolerated

Do not cause a dry cough

Allow angiotensin I to be converted to angiotensin II, but block receptors that receive angiotensin II

Block vasoconstriction and the release of aldosterone

28
Q

Losartan (Cozaar)

A

Angiotensin II Receptor Blocker

29
Q

Indications for ARBs

A

Hypertension

Adjunctive for the treatment of HF

May be used alone or with other drugs

30
Q

ARB Adverse Effects

A

Chest pain, fatigue, hypoglycemia, diarrhea

31
Q

Calcium Channel Blockers

A

PRIMARILY TREAT HYPERTENSION AND ANGINA

CAUSE SMOOTH MUSCLE RELAXATION BY BLOCKING BINDING OF CALCIUM TO ITS RECEPTORS, THEREBY PREVENTING CONTRACTION

Decrease SVR, BP, peripheral smooth muscle tone

32
Q

Indications for CCBs

A

Angina, hypertension, dysrhythmias, migraines

33
Q

Verapamil (Calan, Isoptin) and Diltiazem (Cardizem)

A

Calcium channel blockers

Can be given IV push followed by continuous infusion as well as PO

Used for atrial dysrhythmias

34
Q

Amlodipine (Norvasc)

A

Calcium channel blocker, given in pills

Used for atrial dysrhythmias

35
Q

Adverse Effects of Verapamil

A

Constipation is the most common complaint

Results from blockade of calcium channels in smooth muscle of intestine

36
Q

Adverse Effects of Diltiazem

A

Less constipation, dizziness, flushing, headache, edema, exacerbates HF

Do not drink grapefruit juice

37
Q

Diuretics

A

FIRST-LINE ANTIHYPERTENSIVES

DECREASE VOLUME AND PROTEINS

Decrease preload, CO, peripheral resistance, and overall workload and BP

38
Q

Vasodilators

A

Typically used in emergency situations

Act directly on smooth muscle to cause muscle relaxation

Used for severe hypertension

39
Q

Hypertensive Emergency

A

Blood pressure > 180/120 mmHg and must be lowered immediately to prevent damage to target organs

40
Q

Hypertensive Urgency

A

Blood pressure is very high but no evidence of immediate or progressive target organ damage

41
Q

Nursing Implications

A

African-Americans respond best to diuretics and CCBs as first line drugs

Instruct patients not to stop drugs abruptly

Administer IV forms with extreme caution and use IV pump for infusions

Remind patients that medication is only part of the therapy

Avoid salt substitutes due to high potassium

Instruct patients to report unusual SOB

Pharmacotherapeutics (37 decks)

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