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pharm final
antihypertensive drugs
| Question | Answer |
|---|---|
| BP readings that are hypertensive | systolic > 140 and/or diastolic >90 |
| Why is hypertension a major health problem | increases demands on heart/kidney; "silent killer" |
| what percentage of causes of hypertension are unknown | 90% |
| 3 causes of hypertension | vessels constrict, cardiac contractility high, blood volume high |
| What happens with BP is elevated (what is activated in the body) | baroreceptor (fast response) stretch stimulates vagus nerve |
| What is the result of stimulation of the vagus nerve by baroreceptors in hypertension | decrease heart rate and force of contraction; decreased resistance by peripheral vasodilatation |
| what NS causes BP to decrease | sympathetic nervous system |
| What hormone causes BP to decrease | norepinephrine |
| What is the result of SNS stimulation and norepinephrine that results from decreased BP | vasoconstriction |
| effect of beta-1 receptors | increases heart rate and force |
| What happens in the kidney if BP or sodium is low | nephron releases rennin-Angiotension: aldosterone (slow process) |
| mathematical equation to produce BP | BP = resistance of artery x cardiac output |
| define stitch in relation to BP regulation | simplified treatment intervention to control hypertension |
| lifestyle changes to lower BP | diet, exercise, stop smoking |
| first line therapy for HTN | diuretics (thiazide alone) |
| 2nd line of drug therapy for HTN | Thiazides with ACE inhibitor/ARB/BB |
| 3rd line of drug therapy for HTN | increase dosage of thiazide with ACE inhibitors/ARB/BB |
| 4th line of drug therapy for HTN | add calcium channel blocker |
| 2 possible antioxidants to help decrease blood pressure | dark chocolate and grape seed extract |
| What antihypertensives work on CNS | beta blockers or alpha 2 agonists |
| What antihypertensives work on heart | beta blockers |
| What antihypertensives work on the kidney | diuretics; beta blockers; ACE inhibitors |
| what antihypertensives work on the blood vessels | alpha 1 receptor blockers; calcium channel blockers; vasodilators, AT1 receptor antagonists; ACE inhibitors |
| where do beta blockers work | CNS; heart; kidney |
| where do alpha 2 agonists work | CNS |
| where do diuretics work | kidneys |
| Where do ACE inhibitors work | kidney and blood vessels |
| where do alpha 1 receptor blockers work | blood vessels |
| Where do calcium channel blockers work | blood vessels |
| Where do vasodilators work | blood vessels |
| Where do AT1 receptor antagonists work | blood vessles |
| 5 primary antihypertensive drug categories | diuretics; calcium channel blockers, ACE inhibitors; ARBS; beta blockers |
| ACE | angiotension-converting enzyme |
| ARB | angiotensin II receptor blockers |
| dynamics of diuretics | increase urine output and decrease fluid volume/ dilates vessels |
| diuretic prototype | hydrochlorothiazide (HydroDiuril) |
| hydrochlorothiazide | diruteic |
| Diuretic kinetics | po (onset 2 hours; peak 4 hours) |
| Advantage of using diuretics | inexpensive, reduce morbidity and mortality, few side effects |
| disadvantage of using diuretics | potassium loss = biggest side effect |
| general side effects of diuretics | orthostatic hypotension; dizziness; hypokalemia |
| common ending in calcium channel blockers | "dipine" |
| Dynamics of calcium channel blockers | blocks calcium ion channels in arterial smooth muscles = vasodilation and reduced afterload |
| physiologic effect of the dynamics of calcium channel blockers | vasodilatation; reduced afterload |
| prototypes for calcium channel blockers | nifedipine (Procardia); amlodipine (Norvasc); |
| Are calcium channel blockers used for monotherapy or polytherapy | not for monotherapy |
| nifedipine (procardia) | calcium channel blocker |
| amlodipine (Norvasc) | calcium channel blocker |
| kinetics of calcium channel blockers | po (onset 10-30 minutes) |
| advantages of calcium channel blockers | usefull for elderly and African Americancs |
| Calcium channel blockers are another kind of medication along with antihypertensive | class IV antidysrhythmic |
| Are calcium channels slow or fast | slow; takes along time to work |
| disadvantages of amlodipine (Norvasc) calcium channel blocker | reflex tachycardia (causes a spike in heart rate from vasodilation) |
| Side effects associated with hypotension of amlodipine (Norvasc) calcium channel blocker | dizziness; headache; flushing |
| What is the use of amlodipine (Norvasc) calcium channel blockers linked to? | more heart attacks, depression, suicide |
| What should you avoid when taking amlodipine (Norvasc) calcium channel blockers | grapefruit juice |
| 2 antihypertensive drugs affecting renin-angiotensin system | ARBS and ACE inhibitors |
| What group of antihypertensives are known as the coughing prils | angiotension-converting enzyme (ACE) inhibitors |
| dynamics of ACE inhibitors | decrease in vascular tone; inhibit aldosterone release = secrete fluids |
| prototype of ACE inhibitors | enalapril (Vasotec); Lisinopril (Zestril) |
| enalapril (vasotec) | ACE inhibitor |
| lisinopril (Zestril) | ACE inhibitor |
| kinetics of ACE inhibitors | po; IV |
| what should you monitor when giving first dose of IV | profound hypotension |
| Side effects of ACE inhibitors | cough; skin rash |
| what type of cough is caused by ACE inhibitors | dry hacking cough; non-productive |
| What kind of skin rash is caused by ACE inhibitors | angioedema |
| What blood irregularity are caused by ACE inhibitors | neutropenia (decreased WBC); agranulocytosis |
| What is a risk with agranulocytosis in ACE inhibitors | increased risk of infection |
| When should you give ACE inhibitors | at bedtime due to profound hypotension |
| What should you monitor when giving ACE inhibitors | signs of infection |
| What group of antihypertensives are known as the sartan sisters | angiotension II receptor blockers (ARBs) |
| ARB dynamics | blocks angiotension II after formed |
| ARB prototype | losartan (Cozaar) |
| What is angiotension II | potent vasoconstrictor |
| losartan (Cozaar) | ARB |
| kinetics of ARBs | po (slow) often given with other drugs |
| advantage of ARBs | dose not cause cough or angioedema |
| What other antihypertensives are more likely tried before ARBs | diuretics; ACE inhibitors |
| What NS are peripheral blood vessels innervated by | sympathetic nervous system ONLY |
| Adrenergic antagonists work with what nervous systems | autonomic nervous system; sympathetic division |
| what does autonomic nervous system control | involuntary body function |
| What is the sympathetic division of the autonomic nervous system in charge of | fight-or-flight response (adrenalin) |
| Effect of adrenergic antagonists on BP | slows pulse and BP down |
| what antihypertensives are known as "olol twins" | beta-adrenergic blockers |
| Beta blocker dynamics | block binding of norepinephrine to heart |
| physiologic effect of beta blockers | decrease heart rate and contractility |
| beta blocker prototype | propranolol (inderal); atenolol (Tenormin) |
| propranolol (inderal) | beta blocker |
| atenolol (tenormin) | beta blocker |
| kientics of propranolol (inderal) | po, IV |
| kinetics of atenolol (tenormin) | po |
| side effects of beta blocker | fatigue, impotence, bradycardia, Steven-Johnson syndrome, agranylocytosis |
| define Steven-Johnson syndrome | toxic epeidermal necrolysis; skin breaks out in patches of "raw" area |
| alpha 1 adreneric blocker prototype | prozasin (HCl) minipress |
| prozasin hcl (minipress) | alpha 1 adrenergic blocker |
| alpha 1 adrenergic blocker dynamics | prevent norepinephrine from acting on alpha receptors in arteries in smooth muscles (VESSELS) |
| side effects of alpha 1 adrenergic blockers | orthostatic hyptension, dizziness, fainting, first dose phenomenon |
| define first dose phenomenon | BP will decrease the first time you take it |
| What antihypertensives have the first dose phenomenon | alpha 1 adrenergic blockers |
| When should alpha 1 adrenergic blockers be taken | at bedtime due to first dose phenomenon |
| alpha 2 adrenergic antagonist prototype | clonidine hydrochloride (Catapres); methylodopa (Aldomet) |
| clonidine hydrochloride (Catapres) | alpha 2 adrenergic antagonist |
| methyldopa (aldomet) | alpha 2 adrenergic antagonist |
| dynamics of alpha 2 adrenergic antagonist | blocks the binding of norepinephrine to the HEART |
| How do alpha 2 adrenergic antagonists decrease BP | decrease cardiac output |
| How do alpha 2 adrenergic antagonists suppress renin production | cause decreased flow to kidney which reduces renal resistance |
| When are alpha 2 adrenergic antagonists best | when given with diuretic due to sodium retention |
| alpha 2 adrenergic antagonists kinetics | po (30 minutes to 1 hour); transdermal (Catapress TTS) |
| What is needed before alpha 2 adrenergic antagonists are given | eye exam due to retinal degeneration |
| what happens if alpha 2 adrenergic antagonists are discontinued after long-term therapy | rebound hypertension (BP will spike back up after discontinued) |
| What antihypertensives are known as "strong DAV" | direct acting arteriolar |
| dynamics of direct acting arteriolar | direct relaxation of peripheral arteries (BP drops immediately) |
| use of direct acting arteriolar | hyptertensive emergency |
| direct acting arteriolar prototype | hydrazaline (Apresoline); diazoxide (hyperstat) |
| hydrazaline (apresoline) | direct acting arteriolar prototype |
| diazoxide (hyperstat) | direct acting arteriolar prototype |
| kinetics of direct acting arteriolar | rapid IV push; half life 2 minutes (gets in and gets out) |
| nursing implications for direct acting arteriolar | give to patient in recumbent position; monitor BP every 5 minutes |
| What is an adverse effect of direct acting arterolar | reflex tachycardia (compensatory) |
| what medications should be given along with direct acting arteriolar | beta blocker (slow down relfex tachycardia) and diuretic (sodium and water retention) |
| prototype of direct acting arteries and veins | sodium nitropresside (Nipride) |
| dynamics of direct acting arteries and veins | relaxes both arteries/veins |
| kinetics of direct acting arteries and veins | IV emergency |
| Side effects of direct acting arteries and veins | nausea, agitation, muscle twitching |
| nursing implications for direct acting arteries and veins | monitor, caution with renal problem |
| What is direct acting arteries and veins drugs sensitive to | light (wrapped with foil) |
| What happens when sodium nitropresside (Nipride) reacts with light | converts to thiocynatie in liver, can have toxicity |
| Signs of cyanide poisoning with sodium nitropresside | coma, dilated pupils, pink color (looks like sunburn) |
| Antidote for sodium nitropresside (Nipride) | amylnitrate inhalation |
| life style changes to decrease BPO | reduce salt in diet; reduce intake of caffeine/alcohol; quit smoking; loose weight |
| Teaching for when on antihypertenisve medicaiton | weight twice a week; monitor BP; limit vasodilating bath |
| why is there a problem with compliance in antihypertensive medications | side effects make patients feel worse (don't stop medications abruptly) |
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