Antihypertensives Flashcards Preview

Nursing Pharmacology > Antihypertensives > Flashcards

Flashcards in Antihypertensives Deck (26)
Loading flashcards...
1
Q

Thiazide MOA

A

Diuretic, true mechanism unknown - blocks sodium retention, decreases plasma volume, reducing peripheral resistance and stimulates RAAS

2
Q

Thiazide SE

A

Hypokalemia, hyponatremia, hypercalcemia, hyperuricemia, increased cholesterol, glucose, serum creatinine and triglycerides. Also causes skin rash and photosensitivity

3
Q

Thiazide monitoring

A

Hypokalemia may increase risk for HTN and diabetes (reason for high potassium diet)
Monitor serum creatinine and potassium

4
Q

Thiazide in therapy

A

Primary stroke prevention-helps decrease incidence/risk of stroke
Decrease in heart disease (has the same efficacy as calcium channel blockers and ACE inhibitors)

5
Q

Thiazide contraindications

A

Pancreatitis (increased triglycerides)
Gout (increased uric acid)
If patient already has lower potassium levels
Should also be cautious in patients with DM because thiazide can cause increased glucose

6
Q

Beta blocker MOA

A

Has B1 and B2 effects
B1: decreases HR, decreases CO, myocardial oxygen demand
Also blocks norepinephrine (which is responsible for vasoconstriction so this block results in vasodilation)
Norepinephrine triggers RAAS
B2: vascular changes blocks arterial vasodilation and bronchoconstriction
Beta blocker = negative inotrope

7
Q

Beta blocker SE

A
Bradycardia, heart block
Fatigue, SOB
Insomnia, nightmares 
Exacerbation of raynauds and peripheral arterial disease
Sexual dysfunction 
Masking symptoms of hypoglycemia: tremors, tachycardia, sweating 
Hyperglycemia 
Increase triglycerides, cholesterol 
Decrease HDL
8
Q

Beta blockers in therapy

A

Use for CHF, post MI, diabetes, a-fib, angina (decrease CO by decreasing HR), ventricular tachycardia
Can use for migraines
Second line in renal protection

9
Q

Beta blocker contraindications

A

COPD & asthma - bronchoconstriction!!
Peripheral vascular disease
2nd-3rd degree heart block
If using in CHF patients, start at a low dose and increase carefully

10
Q

Calcium channel blocker MOA

A

Vasodilator
Dihydropyridines: vasodilator - blocks calcium which causes smooth muscle relaxation (calcium needed for muscle contraction)
Non-hydropyridines: decreases HR and contractility (is a negative inotrope)

11
Q

Calcium channel blocker SE

A

Dihydropyridines: flushing, headache, postural dizziness, palpitations, tachycardia, ankle edema, gingival hyperplasia

Non-dihydropyridines: bradycardia, postural hypotension, headache, dizziness, constipation, gingival hyperplasia

12
Q

Calcium channel blockers in therapy

A
Angina 
Claudication, peripheral vascular disease, raynauds 
Isolated diastolic LV dysfunction 
HTN in COPD or asthma 
Non-Q wave MI
13
Q

Calcium channel blockers contraindications

A

Do not use non-dihydropyridines in systolic CHF patients

14
Q

ACE inhibitors & ARBs MOA

A

Block conversion of angiotensinogen 1 to angiotensin 2
Angiotensin 2 is a potent vasoconstrictor and stimulates aldosterone production, which causes sodium retention
Decrease aldosterone and increase bradykinin and vasodilatory prostaglandins
Can decrease pressure in glomerulus, decreasing GFR which increases serum creatinine

15
Q

ACE inhibitor & ARBs SE

A
Hyperkalemia 
Increased serum creatinine - renal impairment 
Dry persistent cough 
Angioedema 
Macular rash 

ARBs have less angioedema and less cough
ARBS: postural hypotension, tachycardia, dizziness, GI effects

16
Q

ACE inhibitors and ARBS in therapy

A

Diabetic nephropathy with proteinuria
CHF, post MI
Renal insufficiency

17
Q

Spironolactone MOA

A

Aldosterone inhibitor - reduces sodium reabsorption
Dose: 25-50mg daily

Can be thought of as a thiazide diuretic that is potassium sparing

18
Q

Spironolactone SE

A

Hyperkalemia, gynecomastia, irregular menses

19
Q

Spironolactone in therapy

A

PCOS

Patient with hyperaldosterone + HTN with hypokalemia is perfect candidate

20
Q

Spironolactone contraindications

A

Renal insufficiency
Serum creatinine greater than 1.5 pre therapy
Potassium greater than 4.5 pre therapy

21
Q

Hydralazine MOA

A

Vasodilator

BID-TID

22
Q

Hydralazine SE

A

Rebound tachycardia

Rebound hypotension

23
Q

Clonidine MOA

A

Central agonist
Decrease in peripheral resistance and reduced sympathetic outflow from CNS
stimulates the alpha 2 adrenergic receptors
Decrease in BP & HR

24
Q

Clonidine SE

A

Rebound HTN when discontinued
SLE like syndrome
Thrombocytopenia
Hemolytic anemia

25
Q

Clonidine monitoring

A

Lots of rebound due to BID-TID dose
Causes rebound HTN
Patch is expensive

26
Q

Clonidine in therapy

A

Failure to respond to conventional antihypertensive