43: Drugs Effecting BP

Question 1

BP Meds Effect on Kidneys

Answer 1

Increase Na+ and H2O loss

Question 2

BP Meds Effect on Arterioles

Answer 2

Decrease peripheral resistance

Question 3

BP Meds Effect on Veins

Answer 3

Decrease venous return and lower cardiac output

Question 4

BP Meds Effect on Heart

Answer 4

Reduce cardiac output

Question 5

BP Meds Effect on Sympathetic Brain Centers

Answer 5

Lower sympathetic stimulation

Question 6

Types of Anti-Hyptertensive Medications (7):

Answer 6

1. Diuretics
2. ACE Inhibitors
3. Angiotensin II Receptor Antagonists
4. Anti-Adrenergic / Sympatholytic
5. Beta-Adrenergic Blockers
6. Calcium Channel Blockers
7. Direct Acting Vasodilators

Question 7

Adrenergic Alpha-1 Receptors Role

Answer 7

Stimulation causes peripheral constriction and increases BP

*Sympathomimetic Effect

Question 8

Adrenergic Alpha-2 Receptors Role

Answer 8

Located within the brain

Question 9

Adrenergic Beta-1 Receptors Role

Answer 9

Located mainly in the heart

Question 10

Adrenergic Beta-2 Receptors Role

Answer 10

Located mainly in the bronchi and vasculature

Question 11

Renin

Answer 11

Produced by kidney, produces Angiotensin I

Question 12

Angiotensin

Answer 12

Inactive until lysed into Angiotensin II

Question 13

Angiotensin II

Answer 13

Potent vasoconstrictor, stimulates aldosterone from adrenal medulla

Question 14

ACE Inhibitor Characteristics

Answer 14

Angiotensin-Converting Enzyme Inhibitor
Prevent Ang I –> Ang II
Reduces Aldosterone

Question 15

ACE Inhibitor Prototype

Answer 15

Captopril (Capoten)

Question 16

Captopril: Pharmacotheurapeutics

Answer 16

HTN, CHF, Diabetic Neuropathy, Left Ventricular Dysfunction

Question 17

Captopril / ACE Inhibitor: Pharmokinetics

Answer 17

Oral
Metab: Liver
Excreted: Kidneys
1/2L: 2h

Question 18

Captopril / ACE Inhibitor: Contraindications

Answer 18

2/3rd trimester pregnancy

Hypersensitivity

Question 19

Captopril / ACE Inhibitor: Adverse Effects

Answer 19

Persistent Non-Productive Cough
Angioedema
Rash
Ortho Hypotension
Neutropenia
Dyspnea

Question 20

For Captopril Max Effect, Give When

Answer 20

1 hour before meals because food decreases absorption

Question 21

Monitoring Captopril Side Effects

Answer 21

Monitor patient 2 hours after dose and until BP settles
Assess blood labs for hyponatremia and neuropenia
Assess urine for proteinuria

Question 22

Angiotensin II Receptor Blocker (Antagonist) Mechanism

Answer 22

Compete for binding of Angiotensin II, decreasing vasoconstriction and ADH secretion

Question 23

Angtiotensin II Antagonist Primary Use

Answer 23

ARBs is the first-line treatment for severe hypertension with electrocardiographic (ECG) evidence of left ventricular hypertrophy

Question 24

Angtiotensin II Antagonist Prototype

Answer 24

Losartan (Cozaar)

Question 25

Losartan: Pharmacotherapeutics

Answer 25

HTN, Diabetic Neuropathy, Left Ventricle Dysfunction

Question 26

Losartan: Pharmacokinetics

Answer 26

First pass metabolism Peak: 1h 1/2L: 2h Excrete: urine + stool

Question 27

Losartan: Contraindications

Answer 27

Hypersensitivity

Question 28

Losartan: Adverse Effects

Answer 28

``` Hypotension Diarrhea Dyspepsia Renal Dysfunction Cough Angioedema Asthenia Dizziness Fatigue ```

Question 29

Losartan: Drug Interactions

Answer 29

``` Lithium Fluconazole Indomethacin Rifampin Grapefruit Juice (Decreases metabolism) ```

Question 30

Which Clients to Not Tx W/ Losartan

Answer 30

Liver Dysfunction | Reduced efficacy in African Americans

Question 31

Losartan Risks

Answer 31

Risk For Injury (of Neonate/Fetus) Risk for Falls (Dizziness) Risk for Infection (Upper Respiratory)

Question 32

Losartan Monitor Adverse Effects by

Answer 32

Monitor Cr, BUN, Hgb, Hemocrit | Contact MD if taking K+ supplement

Question 33

Losartan Famly Teaching:

Answer 33

Fetal Effects Lifestyle modification S/S to report

Question 34

Losartan: Ongoing Assessment

Answer 34

Monitor BP throughout use until goal achieved

Question 35

Beta Aderenergic Blockers Function

Answer 35

Blocks both B-1/2 to reduce cardiac contractility, reducing arterial pressure Blocks sympathetic stim at sinus node, decrease HR + CO = lower BP

Question 36

Beta Adrenergic: Prototype

Answer 36

Labetalol (Normodyne, Trandate)

Question 37

Labetalol: Use

Answer 37

Tx of HTN

Question 38

Labetalol: Pharmocokinetics

Answer 38

Oral Peak: 2-4h Crosses BBB

Question 39

Labetalol: Contraindications

Answer 39

``` Bradycardia Heart Block Asthma Cardiogenic Shock Edema ```

Question 40

Labetalol: Adverse Effects

Answer 40

``` Bronchconstriction Bronchospasms Impotence Diarrhea Dizziness Increase BUN + Cr Tingling of Scalp ```

Question 41

Maximize Labetalol by giving with

Answer 41

Food to maximize bioavailibility

Question 42

Minimize Labetalol adverse effects by

Answer 42

Preparing IVs carefully Observe for signs of HF Monitor BP

Question 43

List of Beta Blockers

Answer 43

Propranolol HCL (Inderal) prototype Atenolol (Tenormin) Acebutolol(monitan) Metoprolol tartrate (Lopressor): can be given as IV, monitor BP and ECG every 5-15 minutes during administration

Question 44

Direct Acting Vasodilators: Prototype

Answer 44

Hydralazine (Apresoline)

Question 45

Direct Acting Vasodilators: Pharmacdynamics

Answer 45

Directly dilates arterioles, decreases peripheral resistance, decreases BP

Question 46

Direct Acting Vasodilators: Adverse Effects

Answer 46

Tachycardia Palpitations Nausea Anorexia

Question 47

Calcium Channel Blockers: Used to Tx

Answer 47

HTN Dsyrhytmias Angina Pectoris

Question 48

Calcium Channel Blockers: Mechanism

Answer 48

Block influx of Ca2+ in myocardial cells, reduces vasoconstriction, dilates coronary and peripheral arteries

Question 49

Calcium Channel Blockers: Adverse Effects

Answer 49

``` Wheezing Constipation Headache Muscle Cramps Hypotension Dizziness Bradycardia Heart Block ```

Question 50

Calcium Channel Blockers: Contraindications

Answer 50

``` Can worsen HF and MI Pts w/ Hepatic or Renal Failure Pregnancy or Lactating Respiratory Disorders More hypotensive in elderly Gradual discontinuation ```

Question 51

Calcium Channel Blockers: Drugs

Answer 51

``` Nifedipine (procardia) Amlodipine besylate (Norvasc) Diltiazem HCL (Cardizem) VerapamilHCl (Isoptin) Feldipine (plendil) ```