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Pharmacology > Antihypertensives > Flashcards

Antihypertensives Flashcards

1
Q

What are the stats of HTN?

A
  1. 1 in 3 ppl in the world have HTN
  2. 72 Million over 20 yrs old have HTN
  3. Only 72% are aware they have HTN
  4. 277,000 U.S. deaths in 2004
  5. 3 Times more deadly for African-Americans
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2
Q

What other effects can HTN have?

A
  1. MI
  2. CVA
  3. HF
  4. Kidney disease
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3
Q

Normal Regulation of BP

A
  1. Arterial Blood Pressure = Cardiac Output X Systemic Vascular resistance
  2. CO = HR x Stroke vol.
  3. Systemic vascular resistance is affected by radius of vessel
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4
Q

Controls of HTN

A
  1. Sypmathetic Nervous System
  2. Renal System
  3. Endocrine System
  4. Vascular Endothelium
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5
Q

Tx of HTN

A
  1. Lifestyle Modifications
  2. Intro to medication
    a. Increase or adding medications until desired BP is met.
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6
Q

What are the forest camps?

A
  1. Adrenergic blockers
  2. Calcium Channel Blockers
  3. ACE Inhibitors
  4. Direct Vasodilators
  5. Diuretics
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7
Q

Sympathetic Nervous System

A
  1. Alpha & Beta receptor sites:
    a. Alpha Adrenergic Blockers
    b. Beta1 Adrenergic Blockers
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8
Q

Adrenergic Receptors

A
  1. Alpha 1&2: Arterial constriction/Pupil dilation
    GI smooth muscle relaxation
  2. Beta 1: Increased HR/Contractility/Automaticity/Conduction
  3. Beta 2: Bronchodilation/Arteriol Constriction/Glycogenolysis
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9
Q

Alpha Adrenergic Receptors

A
  1. Blocks arteriole vasoconstriction
  2. Clinically not the first choice to Tx HTN
  3. Great @ lowering DBP
  4. Tx BPH
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10
Q

Alpha Adrenergic Receptor Contraindication

A
  1. Hypotension*
  2. Pregnancy*
  3. Tachycardia
  4. Hypersensativity
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11
Q

Alpha Adrenergic Receptor Rx Interaction

A
  1. Antacids* 1 hr

2. Alcohol- Increase Hypotension

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12
Q

Alpha Adrenergic Adverse Eeffects

A
  1. First Dose Phenomenon*
  2. Vasodilation=Flushing, Headache, Dizziness
  3. Dry mouth
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13
Q

Alpha Adrenergic RN Implication/Teaching

A
  1. Slow position change*
  2. Watch for 1st dose*
  3. 2 Weeks needed to see therapeutic results*
  4. Watch for wt gain
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14
Q

Name 1 Alpha Blocker

A
  1. Cardura
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15
Q

Name 2 Beta Blockers

A
  1. propanolol

2. atenolol

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16
Q

Beta Blocker Info

A
  1. CO is reduced=Reducing BP*
  2. Decreased 02 demand
  3. Used for cardiac arrhythmias & angina
  4. 1st line Rx
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17
Q

Beta Blocker Contraindication

A
  1. Ischemic Heart Disease*
  2. Systolic Heart Failure*
  3. Hypotension*
  4. Asthma*
  5. COPD*
  6. Diabetes
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18
Q

Beta Blocker Rx Interactions

A
  1. Adrenergic Agonist
  2. Insulin/Oral Antidiabetic Agent
  3. Alcohol
  4. Antacids
  5. NSAID’s
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19
Q

Beta Blocker Adverse Reaction

A
  1. Hypotension (Orthostatic)*
  2. Bradycardia*
  3. Bronchoconstriction*
  4. Hypoglycemia*
  5. PNS response
20
Q

Beta Blockers RN Implication/Teaching

A
  1. Do not DC Abruptly*
  2. Monitor BP for Orthostatic Hypotension, Change position slowly*
  3. Watch BP, HR, RR- HR <60=hold*
  4. Report breathing difficulty*
21
Q

Name 3 Calcium Channel Blockers

A
  1. nifedipine (Procardia)
  2. diltiazem (Cardizem)
  3. verapamil
22
Q

CCB Info

A
  1. Actions on Ca+ channel
  2. Used for
    a. HTN
    b. Angina
    c. Peripheral Vascular Disease
23
Q

CCB Contraindication

A
  1. Heart Block*
  2. Pregnancy*
  3. Hepatic/Renal Failure*
  4. pt c LV dysfunction
24
Q

CCB Rx Interaction

A
  1. Ca+ & Vitamin D
  2. Beta Blockers
  3. Digoxin
  4. Cyclosporin
  5. Grapefruit juice
25
Q

CCB Adverse Effects

A
  1. Bradycardia*
  2. Depressed Heart Function*
  3. Peripheral Edema*
  4. Hypotension
  5. Dizziness
  6. Hepatic Damage
26
Q

CCB RN Implication/Teaching

A
  1. Watch for
    a. wt gain
    b. bradycardia
  2. Watch hepatic values- ALT, AST
  3. Do not DC abruptly
  4. Avoid grapefruit
27
Q

ACEI Info

A
  1. Works in the RAAS, reducing BP via PVR & CO-HRxSV
  2. Widely used, often first line c certain diseases
  3. “Pril” medication
28
Q

Name 2 ACEI & 1 A2RA*

A
  1. enalapril (Vasotec)
  2. lisinopril (Prinivil)
  3. losartan (Cozaar)*
29
Q

ACEI Info

A
  1. Renal Control*
  2. Kidneys Control Na+ & H20 excretion*
  3. Renin–>Angiotensin–>Aldosterone Ssystem*
  4. Water follows Na+
  5. Increased ECF will Increase Venous Return=SV=CO=BP
  6. Prostoglandins vasodilate (renal & systemic)
30
Q

ACEI Indication

A
  1. HTN*
  2. CHF & LV dysfunction
  3. Gives renal protection for DM pt
31
Q

ACEI Contraindication

A
  1. Renal Stenosis*
  2. Pregnancy*
  3. CHF
  4. Hyperkalemia
32
Q

ACEI Rx Interaction

A
  1. Antacids
  2. NSAID’s
  3. Alcohol
  4. Nitrates
  5. K+
  6. Digoxin (Lithium)
33
Q

ACEI Adverse Effects

A
  1. Dry cough**
  2. Hyperkalemia
  3. 1st Dose syncope
  4. Hypotension
  5. Headache
  6. Tachycardia/Palpitations
  7. Dry mouth
34
Q

ACEI RN Implication/Teaching

A
  1. Avoid OTC, NSAID’s**
  2. Watch for renal/hepatic functions test
  3. Watch electrolytes:
    a. Na+
    b. K+
    c. Ca++
35
Q

A2RA Info

A
  1. 2nd Gen ACEI
  2. Block angiotensin 2 receptor site*
  3. Decrease PVR*
  4. Takes 3-6 weeks for full effect
  5. Great for pt that cannot tolerate ACEI
  6. “Sartan”
36
Q

Name 1 A2RA

A
  1. Losartan (cozaar)
37
Q

A2RA Contraindication

A
  1. Pregnancy
  2. Renal/Liver dysfunction
  3. Hypersensativity
38
Q

A2RA Rx Interaction

A

Phenobarbital

39
Q

A2RA Adverse Effect

A
  1. No dry cough
  2. Tolerated better than ACEI
  3. Headache/Weakness
40
Q

A2RA RN Implication/Teaching

A
  1. 1st dose phenomenon
  2. Watch renal/liver enzyme values
  3. Teach pt how to cope c minor effects
41
Q

Direct vasodilators

A
  1. Tx of moderate to severe HTN
  2. Reduces PVR & CO (Preload & afterload)
  3. Never used as 1st line Tx of HTN
  4. Monitor labs
42
Q

CO x SVR = BP

A

Cardiac output x systemic vascular resistance

43
Q

Cardiac output equation

A

HR x SV = CO

44
Q

3 primary factors controlling BP

A
  1. Cardiac output
  2. Peripheral resistance
  3. Blood volume
45
Q

Advantage of using 2 anti hypertensives

A
  1. Fewer side effects

2. Better pt adherence

Pharmacology (19 decks)

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