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PHARMACOLOGY > 17-Drugs for Hypertension > Flashcards

17-Drugs for Hypertension Flashcards

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1
Q

Primary “essential” hypertension

A
  • No known cause, can be caused due to a genetic predisposition, dietary salt intake, adrenergic tone
  • represents 90 - 95% of cases
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2
Q

Secondary hypertension

A
  • high blood pressure caused by the effects of another disease (known cause)
  • represents 5 - 10% of cases
  • examples: pheochromocytoma, adrenal cortical tumours, drugs
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3
Q

Physiological effects of hypertension (3)

A
  1. loss of responsiveness –> prolonged force thickens arterial muscles (heart recieves less blood)
  2. L ventricle thickens –> bc heart has to pump blood against a greater force (increases workload)
  3. Narrowing of lumen/atherosclerosis –> bc increased force damages inner lining of arteries
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4
Q

How can HTN lead to a loss in vision, kidney + cerebral function?

A

Tiny vessels are damaged, leading to these diseases.

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5
Q

3 factors that affect blood pressure (and what causes them)

A
  1. Blood volume: due to fluid loss + fluid retention
  2. TPR/diameter of vessels: due to SNS activity, renin/angiotensin 2, increased viscosity
  3. CO: affected by SV & HR
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6
Q

What 3 factors affect the stroke volume?

A

preload, contractility, afterload

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7
Q

What systems of the ANS affects HR?

A

SNS, PSNS, and epinephrine

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8
Q

Describe how the CV system & kidneys work to regulate high blood pressure.

A

CV system:

  • vasodilation
  • decreased SV and HR (both of these will decrease CO & BP)

Kidneys:
- increases urine output –> less BV –> decreased BP

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9
Q

Describe a high risk, moderate to high risk & low risk patient for hypertension.

A

High risk: has DM
Moderate to high risk: multiple CV risk factors, target organ damage, OVER 75
Low risk: No CV risk factors or organ damage

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10
Q

What is the reccommended amount of alcohol consumption to be considered “low risk”?

A

Men: < 14 drinks/week
Women: < 9 drinks/week

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11
Q

What is the minimum reccommended amount of physical activity?

A

4 days/week for 30-60 mins & moderate cardio

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12
Q

Start pharmacotherapy if BP is ____________ or more for a diabetic patient.

A

130/80

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13
Q

Which type of diuretic is preferred? Long-acting or short acting?

A

long-acting

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14
Q

Give an example of a short-acting diuretic

A

Hydroclorothiazide

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15
Q

T or F: Beta blockers are a first-line therapy for those 60 and above.

A

FALSE!

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16
Q

T or F: RAS inhibitors are contraindicated in pregnancy.

A

True

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17
Q

What class of drugs are first-line therapy for reducing HTN?

A

Diuretics

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18
Q

Describe the mechanism of action of diuretics for reducing blood pressure.

A

Reduces SV by blocking Na/Cl transporters in kidneys –> electrolytes & water are excreted –> BV decreases (and BP)

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19
Q

T or F: Diuretics are safe to use in pregnancy.

A

FALSE - diuretics are contraindicated in pregnancy bc the loss of fluid + electrolyte imbalances can have a damaging effect on the fetus.

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20
Q

What are some side effects/consequences of diuretics?

A

Orthostatic hypotension, hypokalemia, GI upset, hyperglycemia

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21
Q

What is the onset and duration of thiazide diuretics?

A

Onset: 2 hrs
Duration: 6-12 hrs

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22
Q

What are some nursing considerations for patients on diuretics? What should patients monitor/report?

A
  1. Monitor Na/K levels, kidney function & BP (w/in 4-6 wks of starting therapy)
  2. Monitor fluid output & weight gain/loss, report lightheadedness/dizziness
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23
Q

How does angiotensin 2 affect BP? (2 ways)

A
  1. Increases TPR in vasculature (vasoconstriction)

2. Stimulates secretion of aldosterone/ADH

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24
Q

Pharmacological inhibition of RAAS (which class of drugs are used & what does it result in?)

A
  • ACE inhibitors & ARBs

- decreases TPR & BV

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25
Describe the mechanism of action of ACE inhibitors.
- prevents conversion of angiotensin 2 - increases production of vasodilatory kinins - inhibits aldosterone secretion (reduces Na & water retention) *All these things decreases TPR & BV
26
T or F: ACE inhibitors should be combined with NSAIDs to manage HTN.
FALSE! Using them in conjunction w/ NSAIDs decreases the antihypertensive activity.
27
What is the first dose phenomenon?
A sudden drop in BP leads to reflex tachycardia (more likely to pass out/fall).
28
Angioedema
Allergic rxn of the lips, mouth and throat (medical emergency)
29
Side effects of ACE inhibitors
- persistent dry cough - hyperkalemia - constipation/GI irritation - angioedema - first dose phenomenon
30
Describe the mechanism of action of ARBs.
- blocks angiotensin 2 receptors in arteries + adrenal cortex - inhibits release of aldosterone - no effect on bradykinin *These things decrease TPR & BV
31
T or F: ACE inhibitors are more efficacious than ARBs.
False, they are equal in efficacy!
32
Describe the mechanism of action of CCBs.
- Relaxes vascular smooth muscle & decreases TPR by blocking Ca channels (no contractions). - It slows the HR and reduces CO.
33
Selective vs non-selective CCBs.
Selective: only affects the vasculature (vasodilation) | Non-selective: affects both the heart and vasculature (effective for treating angina)
34
What should you avoid while taking a calcium channel blocker?
Grapefruit juice bc it increases serum CCB levels
35
Beta blockers (action, side effects, caution)
Beta adrenergic antagonists reduce HR & treat CV conditions (MI, angina). May cause fatigue & activity intolerance. Use w/ caution in those with diabetes, depression, asthma or COPD.
36
Why should you use cardioselective drugs if the patient has COPD or asthma?
Bc B1 affects only the heart, whereas B2 blockers will cause the bronchioles to constrict, making the asthma/COPD worse.
37
How often should patients w/ HTN be monitored?
Every 1-2 months (until BP for 2 consecutive visits are below target). Then, it should be monitored every 3-6 months.
38
Methyldopa (centrally acting)
- inhibits sympathetic output to decrease BP | - preferred agent for controlling BP in pregnancy
39
A 3-5x greater risk is associated with?
Obesity
40
A 2-3x greater risk is associated with
diabetes
41
What decent are more susceptible to hypertension?
- south asian - african - aboriginal
42
Which kind of hypertension accounts for 90-95% of cases?
Primary
43
Which kinda of hypertension accounts for 5-10% ?
Secondary hypertension
44
Mean BP resulting in hypertension
more than 180/110
45
mean bp less than 180/110 meaning
- depends on diabetic diagnosis - above 130/80; HTN No diabetes - above 130/85- HTN
46
List lifestyle recommendations
- reduce sodium intake - healthy lifestyle - low risk alcohol consumption - regular physical activity - maintenance of ideal weight - smoke cessation - stress management
47
Which medications should not be used for those with darker skin tones?
- ACE INHIBITORS AND ANGIOTENSIN RECEPTOR BLOCKERS
48
T/F: Diuretics work for everyone and are first line therapy
true
49
What are second line agents?
calcium channel blockers
50
What drug class is not used for monotherapy for individuals over 60?
Beta blockers | - there bp is decreased and does not help with CVA or MI risk
51
Which is the best approach for HTN control?
multi-modal approach; low dose and variety of drugs
52
What is a type of diuretic that is the first line therapy?
Thiaizide like diuretics
53
Thiaizide Functions
- reduce stroke volume - block Na/Cl transporter - Excrete electrolytes and water - reduce blood volume
54
Which patients should not use or be mindful of thiazides
- renal disease - diabetes - gout - liver disease - hyperlipidemia - some pregnancys
55
When should thiazides be administered? What is there onset and duration
In the morning to prevent nocturia - 2 hr onset - 6-12 hour duration
56
Adverse effects of thiazides
- gi disturbances - orthostatic hypertension - hyperglycaemia - fluid and electrolyte imbalance
57
Which drug class should not be used to treat HTN? and why?
Loop diuretics | - pulls over alot of water from kindey
58
Who are loop diuretics most useful for?
- edema patients and congestive heart failure patients
59
Which drug decrease efficacy of thiazides?
Nsaids
60
What should one monitor while taking diuretics?
- sodium and potassium levels - kindey function - bp - fluid output and input with weight - report dizziness or light headedness
61
HTN; Total peripheral resistance
- liver in constantly releasing angiotensionogen
62
Function of renin
- released by kidneys in response to low bp | - converts angiotensin into angiotensin 1
63
When is renin released
when low bp is noted
64
How to inhibitors of RAAs help HTN
- decrease BP - angiotensin 2 is not produced - eliminate vasoconstriction - improve tpr - stop kidney from taking fluids
65
Types of RAA'S to decrease HTN
- ACE inhibitors | - Angiotensin 2 receptor blockers
66
What do ACE inhibitors end in?
PRIL
67
Function of ACE inhibitors?
- decrease PR - decrease BV - Block converter of angiotensin 1 to 2 - increase vasodilatory kinins - inhibit aldosterone secretion
68
When should ACE inhibitors be used with caution?
- in pregnancy | - monitor with potassium sparing diuretics and supplements
69
Adverse effects of ACE inhibitors
- hyperkalemia - dry cough - GI irritation and constipation - drop in BP/ tachycardia - allergic reactions
70
When should angiotensin 2 receptor blockers be used?
When cough is really irritating
71
Function of Angiotensin 2 receptor blockers
- decrease peripheral resistance - decreased bv - block angiotensin 2 receptors in SM and adrenal cortex - inhibit aldosterone release - no effect on bradykinin
72
T/F: Ace inhibitors and angiotensin 2 receptor blockers have same efficacy?
true
73
Calcium Channel blockers have two types what are they?
- non selective and selective
74
When should you use caution with CBBS?
Those with liver and kidney impairment
75
adverse effects of CCBS
- dizziness - lightheadedness - fatigue - hypotension and reflex tachy - nausea - flushing
76
When and on whom are beta blockers most effective?
patients less than 60 | - previous MI, angina
77
Function of alpha and beta adrenergic antagonists?
- alpha 1 receptor blockers - cardio selective b1 receptor blockers - non selective b1 and 2 receptor blockers - block adrenergic effect on arterioles - block action of NE and E on cardiac muscle - decrease renin secretion by kidneys
78
What is used an adjuvant?
beta blocker
79
Adverse effects of alpha and beta adrenergic antagonists?
- reduction in HR can cause fatigue and activity intolerance
80
Precautions for those using Alpha and beta adrenergic antagonists
- diabetes - asthma or COPD - sleep disturbances - depression

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