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HLSC 220 > Angina and Hypertension > Flashcards

Angina and Hypertension Flashcards

1
Q

How do CCBs work on Cardiac Muscle?

A

Block cardiac muscle Ca channels
Alters electrical activity of cardiac muscle cells
SA, AV nodes and cardiac muscle

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2
Q

ACE Inhibitors: Adverse Effects? What effect can happen with a first dose? WHen are they contradicted for use?

A

Dry, nonproductive cough (problematic for some patients) reverses when therapy is stopped

Possible hyperkalemia

First-dose hypotensive effect may occur!

Contraindicated in Pregnancy

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3
Q

Nitrates used for? how are they administered?

A

Acute relief of angina – few min, lasts ~ 1 hour
SL tablet or spray
 
Prophylaxis in situations that may provoke angina eg excercise
SL, oral

Long-term prophylaxis of angina
transdermal patches (nitroglycerin)
oral (nitroglycerin, isosorbide mononitrate)

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4
Q

Vasodilators: Adverse Effects
hydralazine?

A

Dizziness, headache, anxiety, tachycardia, nausea and vomiting, diarrhea, anemia, dyspnea, edema, nasal congestion

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5
Q

How do Thiazide Diuretics work for hypertension?

A

-Decrease the plasma and extracellular fluid volumes
-decreased preload
-decreased cardiac output
-decreased total peripheral resistance
-Decreased workload of the heart, and decreased blood pressure

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6
Q

What is Losartan (Cozaar)? How does it work?

A

Angiotensin II Receptor Blockers - ARBs

Ang II receptor antagonist
Block receptors that angiotensin II activates
Blocks Ang II-mediated vasoconstriction
Blocks release of aldosterone

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7
Q

common problem for clients on CCB’s?

A

Constipation (adequate fluids and eat high-fibre foods)

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8
Q

Where do b-adrenergic receptor blockers (antagonists) mainly act? How do they work?

A

act in the periphery, mainly heart
b1-blockade
block norepinephrine/epinephrine action in heart
reduce heart rate
decrease force of heart muscle contraction

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9
Q

Examples of CCBs for dyshrimisas?

A

Diltiazem (cardiac + vascular,)
Verapamil (cardiac + vascular)

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10
Q

prazosin/Peripherally a1-adrenoceptor antagonists adverse effects?

A

Most common: Dry mouth Drowsiness Sedation Constipation

Other: Headaches Sleep disturbances Nausea Rash Cardiac disturbances (palpitations)

HIGH INCIDENCE OF ORTHOSTATIC HYPOTENSION

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11
Q

What do Organic Nitrates cause? What do they dilate? What do they do?

A

-Cause vasodilation relaxation of vascular smooth muscles
-Dilate coronary arteries

They decrease pre-load and after-load

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12
Q

diltiazem (Cardizem)
verapamil
nifedipine,

What kind of drugs are these? What are they used for the treatment of?

A

They are CCB’s used for angina

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13
Q

Example of a Peripherally a1-adrenoceptor antagonists? What does it block?

A

prazosin
Block NE contraction of blood vessels

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14
Q

Angiotensin II Receptor Blockers: Indications, what can they be combined with?

A

Can be combined with CCB’s and diuretics
-Used for treatment of Hypertension
Adjunctive agents for the treatment of HF

May be used alone or with other agents

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15
Q

b-blockers Indications/ when do we use them?

A

Hypertension
HF
Angina
Dysrhythmias

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16
Q

Dihydropyridines - DHP Adverse effects?

A

Cardiovascular:
Hypotension (dizziness), palpitations, tachycardia
flushing, peripheral edema

Gastrointestinal:
very little constipation

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17
Q

What is isosorbide mononitrate?

A

It is an organic nitrate

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18
Q

B-blocker contradictions? who do we avoid giving them to?

A

intolerance to exercise
avoided in patients with asthma

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19
Q

What kind of drugs are amlodipine, nifedipine? what do they block?

A

They are Dihydropyridines - DHPs (vascular selective) that block muscle Ca channels
Alters electrical activity of cardiac muscle cells

20
Q

What is nitroprusside (Nipride)?

A

it is a nitroprusside (Nipride) – Nitric oxide action used for the treatment of hypertension

21
Q

Example of a vasodilator?

A

hydralazine (Apresoline)

22
Q

Centrally acting a2-adrenoceptor are?
Peripherally acting a1-adrenoceptor are?

A

Centrally acting a2-adrenoceptor = agonists
Peripherally acting a1-adrenoceptor = antagonists

23
Q

Client Implications: Nitroglycerin (what must we teach our clients)?

A

never to chew or swallow SL form

Removal of old medication :
-Reduce tolerance by removing topical forms at bedtime, and apply new doses in the morning
allowing for a nitrate-free period

24
Q

ACE inhibitors: Indications/when do we use them? how are they used for hypertension and HF?

A

-Hypertension
May be used alone or with other agents (CCB, diuretics)
Renal protective effects in clients with diabetes

-HF (either alone or in combination with diuretics or other agents)
Drugs of choice in hypertensive clients with HF
Slows progression of left ventricular remodelling after an MI

25
Q

1st line therapy for hypertension in pregnancy? What kind of drug is it?

A

Methyldopa
Centrally Acting a2-Receptor Agonists

26
Q

How centrally acting a2-receptor agonists used for the treatment of hypertension? When do we usually administer them?

A

-Treatment of hypertension, either alone or with other agents
-Usually used after other agents have failed or in combination with other drugs

27
Q

ACE Inhibitors: Mechanism of Action/ how do they work? What do they also prevent?

A

Prevents Ang II vasoconstriction
Reduces peripheral resistance (afterload)

Also prevent the breakdown of bradykinin

28
Q

What are the main client implications for those taking antihypertensive medications?

A

*Drugs should not be stopped abruptly
(may cause rebound hypertensive crisis, and perhaps lead to stroke)

Clients should
-avoid smoking
-avoid eating foods high in sodium
follow other lifestyle recommendations
Instruct clients to change positions slowly to avoid syncope from postural

29
Q

How do Peripherally a1-adrenoceptor antagonists work?

A

Block a1-adrenergic receptors

30
Q

Nitroglycerin: IV, PO, SL metabolsim effect, what is it used for? what is it?

A

It is an orgainic nitrate

Large first-pass effect

SL (not po) for symptomatic treatment

Patch/po for prevention of angina

IV form used for BP control in perioperative hypertension, treatment of HF, ischemic pain, pulmonary edema associated with acute MI, and hypertensive emergencies

31
Q

What drugs provide Long-term prevention of angina?
NOT for acute exacerbations of angina

A

Beta-Blockers
Decrease HR
= decrease cardiac work
decreases myocardial oxygen demand
Decrease myocardial contractility
= decrease cardiac work
decreases myocardial oxygen demand

32
Q

What do Calcium Channel Blockers: Mechanism of action/what do they cause? what are they the first line treatment of?

A

Reduce myocardial contractility
Cause peripheral arterial vasodilation
Decreased myocardial oxygen demand
First-line agents for treatment of
angina

33
Q

What kind of drugs are ACE inhibitors (ACEIs)? What are they a first line of defence for? What are they often combined with?

A

Large group of safe and effective drugs
Often used as first-line agents for HF
and hypertension

Often combined with a thiazide diuretic or calcium channel blocker

34
Q

Broad treatment goals of anti-angina medication?

A

Reduce heart muscle metabolic demands
Improve blood flow in coronary circulation
or both!

35
Q

CCB’s Verapamil/Diltiazem Adverse Effects? on GI and cardio system?

A

Cardiovascular:
Hypotension (dizziness)
flushing, peripheral edema

Gastrointestinal:
Constipation, nausea

Other:
Rash, dermititis

36
Q

How are different from ACEIs? WHat are they generally not combined with?

A

Similar to ACEIs (but not identical)
BUT do not cause a dry cough
Generally not combined with ACEIs

37
Q

How do CCBs work on vascular muscle?

A

Inhibits Ca entry into arteriolar vascular smooth muscle cells
cause relaxation
Decreased peripheral resistance
decreased blood pressure

38
Q

Example of an ACE inhibitor that has the shortest half life? How are ACE inhibitors identified?

A

Captopril (Capoten)
Shortest half-life of the “prils”

39
Q

What is used as a First-Line Treatment of Adults with Systolic/Diastolic
Hypertension Without Other Compelling Indications?

A

Calcium Channel Blockers (CCBs)

40
Q

Example of a beta-blocker used for hypertension?

A

metoprolol

41
Q

What medications are used for Relief of symptoms of BPH (benign prostatic hypertrophy)?

A

Peripherally a1-adrenoceptor antagonists?

42
Q

Vasodilators: Adverse effects Sodium nitroprusside?

A

Bradycardia, hypotension, possible cyanide toxicity
Client Implications

43
Q

What is hydrochlorothiazide? What can it cause?

A

Thizide diuretic used to treat hypertension

possible hypokalemia

44
Q

IV sodium nitroprusside and diazoxide are reserved for?

A

the management of hypertensive emergencies

45
Q

Organic Nitrates: Adverse Effects?

A

1.) Headache (classic and predictable in almost all patients)

2.) Postural hypotension (some peripheral edema due to pooling of blood in venous system)

3.) Reflex tachycardia (partially offsets beneficial effects , may combine with B-blocker)

4.) Tolerance to drug (Over a single day! )

46
Q

Vasodilators: Mechanism of Action/Indications?

A

Directly relax arteriolar smooth muscle

HLSC 220 (18 decks)

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