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