Antihypertensive Flashcards

Question

α1-Blockers doxazosin mesylate (Cardura®) prazosin hydrochloride (Minipress®) tamsulosin hydrochloride (Flomax®)* terazosin hydrochloride (Hytrin®)

Answer 1

*Tamsulosin is not used to control BP but is indicated solely for symptomatic control of BPH.

Answer 2

Commonly used α1-blocker Reduces peripheral vascular resistance and BP by dilating both arterial and venous blood vessels

Answer 3

nebivolol hydrochloride (Bystolic®)

Answer 4

Uses: hypertension and HF Action: blocks β1-receptors and produces vasodilatation, which results in a decrease in systemic vascular resistance (SVR) Less sexual dysfunction Do not stop abruptly; must be tapered over 1 to 2 weeks.

Answer 5

Large group of safe and effective drugs Often used as first-line drugs for HF and hypertension May be combined with a thiazide diuretic or a calcium channel blocker.

Answer 6

"Pril" captopril (Capoten®) enalapril (Vasotec®) perindopril (Coversyl®) ramipril (Altace®)

Answer 7

benazepril (Lotensin®) fosinopril sodium lisinopril (Prinivil®) cilazapril (Inhibace®) quinapril (Accupril®) trandolapril (Mavik®)

Answer 8

Inhibit ACE, which is responsible for converting angiotensin I (through the action of renin) to angiotensin II Angiotensin II is a potent vasoconstrictor and causes aldosterone secretion from the adrenal glands. Block ACE, thus preventing the formation of angiotensin II Prevent the breakdown of the vasodilating substance bradykinin Ability to decrease SVR (a measure of afterload) and preload Can stop the progression of left ventricular hypertrophy Lower BP [inhibits ACE enzymes which leads to vasodilation; ACE usually leads to vasoconstriction]

Answer 9

Hypertension HF (drug used either alone or in combination with diuretics or other drugs) Slow progression of left ventricular hypertrophy after myocardial infarction (MI) (cardioprotective) Renal protective effects in patients with diabetes

Answer 10

Are not prodrugs. Prodrugs are inactive in their administered form and must be metabolized in the liver to an active form so as to be effective. Captopril and lisinopril can be used if a patient has liver dysfunction, unlike other ACE inhibitors that are prodrugs.

Answer 11

inactive in their administered form and must be metabolized in the liver to an active form so as to be effective.

Answer 12

Inhibit ACE ACE: converts angiotensin I (formed through the action of renin) to angiotensin II Angiotensin II: potent vasoconstrictor that induces aldosterone secretion by the adrenal glands Aldosterone: stimulates sodium and water resorption, which can raise BP Renin–angiotensin–aldosterone system ACE Inhibitors thus lower BP.

Answer 13

Cardiovascular and renal BP: reduce BP by decreasing SVR

Answer 14

Prevent sodium and water resorption by inhibiting aldosterone secretion Diuresis: decreases blood volume and return to the heart Decreases preload, or the left ventricular end-diastolic volume [Preload: amount the ventricles stretch at the end of diastole/ filling of blood phase] [balloon fillng with air; how much it stretches] Decreases work required of the heart

Answer 15

ACE inhibitors decrease SVR (a measure of afterload) and preload. Used to prevent complications after MI Ventricular remodeling: left ventricular hypertrophy, which is sometimes seen after MI Have been shown to decrease morbidity and mortality in patients with HF Drugs of choice for hypertensive patients with HF

Answer 16

Reduce glomerular filtration pressure Cardiovascular drugs of choice for patients with diabetes Reduce proteinuria Standard therapy for diabetic patients to prevent the progression of diabetic nephropathy

Answer 17

Fatigue, dizziness, headache, impaired taste Mood changes First-dose hypotensive effect Possible hyperkalemia Dry, nonproductive cough, which reverses when therapy is stopped Angioedema: rare but potentially fatal Others

Answer 18

Uses: prevention of ventricular remodeling after MI; reduces the risk of HF after MI Shortest half-life Must be administered 3 or 4 times throughout the day

Answer 19

Only ACE inhibitor available in both oral and parenteral preparations enalapril at intravenous (IV) does not require cardiac monitoring Oral enalapril sodium: prodrug Improves patient’s chances of survival after an MI Reduces the incidence of HF

Answer 20

Also referred to as angiotensin II blockers Well tolerated Do not cause a dry cough

Answer 21

losartan (Cozaar®) telmisartan (Micardis®) Other: eprosartan mesylate (Teveten®) valsartan (Diovan®) candesartan cilexetil (Atacand®) olmesartan (Benicar®) azilsartan medoxomil potassium (Edarbi®)

Answer 22

Affect primarily vascular smooth muscle and the adrenal gland Selectively block the binding of angiotensin II to the type 1 angiotensin II receptors in these tissues Block vasoconstriction and the secretion of aldosterone

Answer 23

ACE inhibitors and angiotensin II receptor blockers (ARBs) appear to be equally effective for the treatment of hypertension. Both are well tolerated. ARBs do not cause cough. There is evidence that ARBs are better tolerated and are associated with lower mortality after MI than are ACE inhibitors. It is not yet clear whether ARBs are as effective as ACE inhibitors in treating HF (cardioprotective effects) or in protecting the kidneys (as in diabetes).

Answer 24

Hypertension Adjunctive drugs for the treatment of HF May be used alone or with other drugs such as diuretics

Answer 25

Upper respiratory infections and headaches most common Dizziness, inability to sleep Diarrhea Dyspnea, heartburn Nasal congestion Back pain Fatigue Hyperkalemia is less likely to occur than with the ACE inhibitors.

Answer 26

Beneficial in patients with hypertension and HF Used with caution in patients with renal or hepatic dysfunction and in patients with renal artery stenosis Not to be taken by breastfeeding women

Answer 27

Primary use: treatment of hypertension and angina Hypertension: cause smooth muscle relaxation by blocking the binding of calcium to its receptors, thereby preventing contraction

Answer 28

Results in: Decreased peripheral smooth muscle tone Decreased SVR Decreased BP

Answer 29

Angina Hypertension: amlodipine (Norvasc®) Antidysrhythmias Migraine headaches Raynaud’s disease Cerebral artery spasms after subarachnoid hemorrhage (prevention): nimodipine

Answer 30

Hypertension: amlodipine (Norvasc®)

Answer 31

First-line antihypertensives in the Canadian Hypertension Education Program guidelines for the treatment of hypertension

Answer 32

Decrease plasma and extracellular fluid volumes Results 1. Decreased preload 2. Decreased cardiac output 3. Decreased total peripheral resistance Overall effect Decreased workload of the heart and decreased BP

Answer 33

Thiazide diuretics (e.g. hydrochlorthiazide)

Answer 34

sodium nitroprusside (Nipride®) Others: diazoxide (Proglycem®) hydralazine (Apresoline®) minoxidil (Loniten®)

Answer 35

Directly relax arteriolar or venous smooth muscle (or both) Used for their ability to cause peripheral vasodilation Results in decreased SVR

Answer 36

Treatment of hypertension May be used in combination with other drugs Sodium nitroprusside and IV diazoxide are reserved for the management of hypertensive emergencies.

Answer 37

dizziness, headache, anxiety, tachycardia, edema, dyspnea, nausea, vomiting, diarrhea, hepatitis, systemic lupus erythematosus, vitamin B6 deficiency, and rash

Answer 38

T-wave electrocardiographic changes, pericardial effusion or tamponade, angina, breast tenderness, rash, and thrombocytopenia

Answer 39

bradycardia, decreased platelet aggregation, rash, hypothyroidism, hypotension, methemoglobinemia, and (rarely) cyanide toxicity

Answer 40

Orally: routine cases of essential hypertension Injectable: hypertensive emergencies

Answer 41

Used in the critical care setting for severe hypertensive emergencies; titrated to effect by IV infusion Contraindications: known hypersensitivity to the drug, severe HF, and known inadequate cerebral perfusion (especially during neurosurgical procedures)

Answer 42

New class: selective aldosterone blockers Blocks action of aldosterone in kidney, heart, blood vessels, and brain Contraindicated in patients with known drug allergy, elevated potassium (>5.5 mmol/L), or severe kidney impairment

Answer 43

bosentan (Tracleer®) Other drugs used to treat pulmonary hypertension: epoprostenol treprostinil ambrisentan sildenafil and tadalafil

Answer 44

Treatment of Pulmonary Hypertension Specifically indicated only for the treatment of pulmonary artery hypertension in patients with moderate to severe HF Action: blocks receptors of the hormone endothelin

Answer 45

Monitor BP and HR prior to administration of antihypertensives (client and patient). Need specific parameters. General rule: If apical HR <60 or SBP < 90 contact their HCP; medication will be held if BP and/or HR parameters are lower than above

Answer 46

(K+, possibly other electrolytes such as Na+ and Cl-, blood glucose, kidney function, liver function)

Answer 47

Before beginning therapy, obtain a thorough health history and perform a head-to-toe physical examination. Assess for contraindications to specific antihypertensive drugs. Assess for conditions that require cautious use of these drugs. Educate patients about the importance of not missing a dose and taking the medications exactly as prescribed. Instruct patients to check with their health care provider for instructions on what to do if a dose is missed; patients should never double up on doses if a dose is missed. Monitor BP during therapy; instruct patients to keep a journal of regular BP checks

Answer 48

Instruct patients that these drugs should not be stopped abruptly, because this may cause a rebound hypertensive crisis and perhaps lead to stroke. Oral forms should be given with meals so that absorption is more gradual and effective. Administer IV forms with extreme caution Must use an IV pump.

Answer 49

Remind patients that medication is only part of therapy. Encourage patients to watch their diet, stress level, weight, and alcohol intake. Instruct patients to avoid smoking and to avoid eating foods high in sodium. Encourage supervised exercise. Teach patients to change positions slowly to avoid syncope from postural hypotension.

Answer 50

Male patients who take these drugs may not be aware that impotence is an expected effect, and this may influence compliance with drug therapy. If patients are experiencing serious adverse effects or if they believe the dose or medication needs to be changed, they should contact their health care provider immediately. Monitor for adverse effects (dizziness, orthostatic hypotension, fatigue) and for toxic effects. Monitor for therapeutic effects

Answer 51

Hot tubs, showers, or baths; hot weather; prolonged sitting or standing; physical exercise; and alcohol ingestion may aggravate low BP, leading to fainting and injury. Patients should sit or lie down until symptoms subside. Patients should not take any other medications, including over-the-counter drugs, without first getting the approval of their health care provider Educate patients about lifestyle changes that may be needed. -Weight loss -Stress management -Supervised exercise -Dietary measures

Answer 52

ACE inhibitors can cause renal impairment, which can be identified by serum creatinine. ACE inhibitors can also cause hyperkalemia, so potassium levels need to be monitored. Monitor serum sodium during therapy.

Answer 53

Hypotension

Answer 54

Captopril and lisinopril

Answer 55

ACE Inhibitors

Answer 56

thickening of wall of ventricular walls-poor pumping

Answer 57

Sartan Cough chest pain

Answer 58

Orthostatic hypotension and syncope

Answer 59

release of renin from kidneys Renin acts on angiotensinogen to form angiotensin I Lungs angiotensin II acts directly on BVs stimulating vasoconstriction acts on adrenal glands to stimulate the release of aldosterone> aldosterone acts on kidneys to stimulate the reabsorption of salt (NACL) and water.

Answer 60

nebivolol hydrochloride (Bystolic®)

Answer 61

must be metabolized in the liver to an active form so as to be effective

Answer 62

PRIL captopril (Capoten®) enalapril (Vasotec®)

Answer 63

Vasodilator- peripheral vasodilation

Answer 64

α1-Blockers

Answer 65

Captopril and lisinopril are not prodrugs.

Answer 66

hypotension

Answer 67

alpha blockers (prasozin)

Answer 68

dry, non-productive cough renal insufficiency

Answer 69

potassium NSAIDS

Answer 70

drugs that primarily cause arterial and venous dilation on peripheral sympathetic neurons

Answer 71

amount of blood ejected from the L ventricle, L per min is the resistance to blood flow that is determined by the diameter of the BVs and the vascular musculature, calculated by dividing BP to CO

Answer 72

drugs that modify function of sympathetic NS in the BRAIN by stimulating alpha 2 receptors alpha 2 receptors are inhibitory and revrses sympathetic effect and decreases BP

Answer 73

exceeds 140/90 prevalence of HTN is highest in Africa and in low and middle-income nations Canadians who are Black, Indigenous, South Asian, and those with low socioeconomic status are at greater risk Major risk factors for CAD, cardiovascular disease, and death. Important RF for Stroke and HF, kidney failure, and peripheral vascular disease (the higher the BP, the higher the chance) for 40 to 70 YO, the risk of developing cardiovascular diseases doubles with each 20 mmHG increase in systolic BP or 10 mm Hg increase in diastolic BP

Answer 74

extremely high BP, above 180/120 medical emergency- develops rapidly and results in organ damage

Answer 75

AE of adrenergic blocking drugs involving a sudden drop in BP when pts change position

Answer 76

a drug that is inactive in its given form must be metabolized by the liver to its active form to be effective

Answer 77

unknown cause of HTN (90-95% of cases) high bp caused by another disease or medication (5 to 10%). If cause of this is eliminated, BP can return to normal

Answer 78

Bp is determined by the product of CO [4-8 L/min] and systemic vascular resistance (SVR) MAP is a product of CO and SVR Calculated as 1/3 (SBP- DBP) + DBP MAP is a better indicator of tissue perfusion as 2/3 of the cardiac cycle is spent in diastole greater or equal to 60 is necessary to maintain adequate tissue perfusion

Answer 79

B-blockers Calcium channel blockers Centrally acting adrenergics

Answer 80

ACE I Diuretics

Answer 81

Vasodilators Prostaglandin ACE I Calcium channel blockers ANGIOTENSIN II blockers

Answer 82

a1 blockers and b blockers

Answer 83

centrally acting adrenergic peripherally acting adrenergic

Answer 84

primary prevention detection treatment of HTN 130-139 over 85 to 89 mm Hg = high risk of developing HTN

Answer 85

reduce cardiovascular and renal mortality and morbidity individualized (sexual dysfunction caused by non-adherence from males), demographic, ethnocultural, cost and ease of medication administration needs to be considered as well. GOAL: BP less than 140/90 -non-automated office BP machine BP less than 135/85 -automatic office BP machine In PTS with HTN/ diabetes The goal is BP less than 130/ 80 and 140/90 respectively

Answer 86

act directly on vascular SM cells, not through a or b receptors

Answer 87

somatic NS- acts on skeletal muscles parasympathetic- acts on the heart, intestines

Answer 88

sympathetic- acts on the heart, adrenal gland

Answer 89

adrenergic and noradrenergic R (alpha or beta receptors)

Answer 90

located between the postganglionic fibre and the effector cells are called MUSCARINIC and CHOLLINERGIC receptors

Answer 91

ACh and cholinergic agonist drugs cholinergic antagonists (antichollinergic drugs)

Answer 92

Epi, NE, and adrenergic agonists drugs (adrenergic/ beta blockers)

Answer 93

postganglionic cell bodies in all autonomic ganglia and cause depolarization by opening both sodium and potassium channels

Answer 94

first line, monotherapy/ combination therapeutic effects: decreased volume of plasma and ECF which results in decreased preload. Leads to decreased CO & total peripheral resistance, which decreases the workload of the heart thiazide diurects- common in HTN treatment

Answer 95

health behaviour management thiazide, Ace-I, ARB, long-acting CCB, beta-blockers, single-pill combination B-blockers are not indicated as 1st line for ages 60 and above long-acting diuretics are preferred over short-acting ones like hydrochlorothiazide SPC- ACE-I & CCB, ARB & CCB, ACE-1 OR ARB WITH A DIURETIC RAS- contraindicated in pregnancy and caution in childbearing years

Answer 96

central action (brain) Peripheral action (heart/ BVs) 5 types adrenergic neuron blocker (central & peripheral) alpha 2 receptor agonists (central) alpha 1 receptor blockers (peripheral) beta receptor blockers (peripheral) combination alpha 1 and beta receptor blockers (peripheral)

Answer 97

clonidine & methyldopa- modify the function of SNS. the function of SNS: leads to an increased heart rate and force of contraction, the constriction of BVs, and the release of renin from the kidneys- result is HTN

Answer 98

act by stimulating the alpha 2 adrenergic receptors in the brain receptor stimulation reduces sympathetic outflow from the CNS. this reduction results in a lack of NE production which reduces BP. Also reduces the activity of renin; the hormone and enzyme that converts the protein precursor of angiotensinogen to the protein angiotensin I, the precursor of angiotensin II, a potent vasoconstrictor that raises BP

Answer 99

in the periphery doxazosin, prazosin, and terazosin- also modify the function of SNS BY: blocking the alpha 1 adrenergic receptors when alpha 1 adrenergic receptors are stimulated by NE, they increase BP. When these receptors are blocked, BP is decreased. Drug effects of alpha 1 blockers - dilate arteries and veins which reduces peripheral vascular resistance and decreases BP reduces systemic and pulmonary venous pressures and increases CO. they also increase urinary flow rates and decrease outflow obstruction by preventing smooth muscle contractions in the bladder and urethra. Beneficial in BPH

Answer 100

periphery propanolol, metoprololand atenolol for angina and conduction problems effects: reduction of the HR through beta 1 receptor blockade. Also causes a reduction in the secretion of the hormone renin which reduces both angiotensin II-mediated vasoconstriction and aldosterone-mediated volume expansion Long term use of beta blockers reduces peripheral vascular resitance

Answer 101

labetalol periphery dual antihypertensive effects- reduces HR (beta 1 receptor blockade) and vasodilation (alpha 1 receptor blockade)

Answer 102

HTN Glaucoma Clonidine- menopausal flushing prophylaxis of migraine symptoms of withdrawal symptoms alpha 1 blockers- prazosin: helps with symptoms of BPH. Used in severe HF when taken with cardiac glycosides and diuretics

Answer 103

adrenergic antihypertensive drugs- known allergy may HF, concurrent MAOIs, severe depression, peptic ulcers severe liver/ kidney disease Asthma- nonselective beta-blockers vasodilating drugs- contraindicated in HF

Answer 104

bradycardia with reflex tachycardia orthostatic hypotension dry mouth, drowsiness, dizziness, depression, edema, constipation, sexual dysfunction headache, sleep disturbances, nausea, rash, and palpitations alpha blockers- orthostatic hypotension, syncope (move slowly)

Answer 105

rebound HTN (may be true for other antihypertensive as well) nonselective blocking drugs: associated with bronchoconstriction and metabolic inhibition of glycogenolysis in the liver which can lead to hypoglycemia. Hyperglycemia can occur as adrenergic drugs can impair insulin release. change in the dosing regimen should be undertaken gradually and with appropriate patient monitoring and follow-up.

Answer 106

alcohol, benzodiazepines, and opioids- additive CNS depression clonidine- MAOIs, appetite suppressants, amphetamines (decreased hypotensive effects) diuretics, other hypertensive drugs (increased hypotensive effects) B-blockers (potentiate bradycardia and increase rebound HTN) doxazosin- CNS depressants, alcohol (increase CNS depression b-blockers, hypotensive drugs (increased hypotension)

Answer 107

clonidine- commonly used methyldopa- used in pregnancy mostly high incidence of orthostatic hypotension, fatigue, and dizziness (not 1st line)

Answer 108

alpha 2 adrenergic receptor agonists centrally actinhg decrease BP and opioid withdrawal do not D/C abruptly as it can lead to severe rebound HTN

Answer 109

doxazosin, prazosin, tamsulosin (for BPH) not for pregnancy

Answer 110

alpha 1 blocker peripherally acting reduces peripheral vascular resistance and BP bu dilating arteries and veins HTN and BPH

Answer 111

beta receptor blocker- nebivolol

Answer 112

beta 1 selective blocker HTN decreases SVR reduces sexual dysfunction do not stop abruptly, tapered over 1-2 weeks

Answer 113

safe and efficacious- one of the 1st line for HTN and HF, diabetes for kidney protection catopril

Answer 114

short half-life- dosed more frequently than other ACE I

Answer 115

captopril and lisonopril an advantage for people with liver dysfunction

Answer 116

ACE I available parenterally

Answer 117

significant fetal morbidity or mortality during 2nd and 3rd trimester (do not use in pregnancy)

Answer 118

Kininase- an enzyme that normally breaks down bradykinin, a potent vasodilator inhibit ACE enzymes which are responsible for converting angiotensin I (formed from the action of renin) to angiotensin II angitensin II- potent vasocontrictor and induces aldoesterone secretion Aldosterone stimulates NA and water resorption- which can raise BP together they are referred to as the renin-angiotensin-aldosterone system > inhibiting this process BP is lowered

Answer 119

cardiovascular and renal cardio > ability to reduce BP by decreasing SVR. By preventing the breakdown of the vasodilating substance bradykinin and substance P (another potent vasodilator), thus preventing the formation of angiotensin II this decreases the afterload- the resistance against which the left ventricle must pump to eject its volume of blood during contraction Effective in the treatment of HF because they prevent sodium and water resorption by inhibiting aldosterone secretion. This causes diuresis, which decreases blood volume and return to the heart, This in turn decreases preload- the left ventricular end-diastolic volume and the work required of the heart

Answer 120

HTN, HF decrease preload and afterload stop the progression of left ventricular hypertrophy- MI (ventricular remodelling). The ability of ACE-I to stop this is called (cardioprotective effects) protects kidney- decreases GF pressure- a choice for diabetes- reduces proteinuria and diabetic neuropathy Contraindications -allergy, angioedema, -baseline potassium level of 5 mmol/L because this medication can cause HYPERKALEMIA -kidney decline -women who are lactating, children, bilateral renal artery stenosis AEs fatigue, mood changes, headache, dizziness DRY NON-PRODUCTIVE COUGH- reversible with discontinuation of therapy (switched to an ARB Hyperkalemia, hypotension loss of state, rash, anemia, neutropenia, thrombocytosis, agrunocytosis acute kidney failure serum potassium levels must be monitored carefully

Answer 121

hypotension treatment is symptomatic and supportive- give IV fluids to expand BV hemodialysis is effective for the removal of captopril and lisonopril

Answer 122

NSAIDS- reduces antihypertensive effect, may also predispose pts to acute kidney injury lithium carbonate- lithium toxicity potassium- hyperkalemia

Answer 123

minimize and prevent left ventricular dilation and dysfunction (ventricular remodelling) that can occur in the acute period after an MI reduce the risk of HF short half-life - given 3-4 times a day

Answer 124

oral and parenteral (only one) IV-does not require cardia monitoring unlike beta blockers and CCBs do. slightly longer half life- given BID prodrug, pt must have a functioning liver for drug to be converted into an active form improve chances of survival after MI to reduce HF

Answer 125

similar to ACE I losartan, valsartan, eprosartan, irbesartan, candesartan, telmisartan, azilsartan block the binding of angiotensin II to type 1 angiotensin II receptors. type 1 receptor- mediate effects of important effectors in controlling BP and volume in the cardiovascular system, type 1 R are activated by angiotensin II with resulting effects that include vasoconstriction and aldosterone synthesis and secretion ACE I such as enalapril- blocks the conversion of angiotensin I to angiotensin II, but angiotensin II may be formed by other enzymes that are not blocked by ACE I *in contrast to ACE I- ARBs primarily affect vascular smooth muscle and the adrenal gland. By selectively blocking the binding of angiotensin II to the type 1 angiotensin II receptors in these tissues. ARBs block vasoconstriction and the secretion of aldosterone. Angiotensin II receptors have been found in other tissues throughout the body, but the effects of ARB blocking the R are unknown. Aldosterone stimulates NA and water resorption- which can raise BP ARBs do not cause cough! lower mortality after an MI than ACE Is Indication> potent vasodilating properties HF, HTN decrease SVR (a measure of afterload)

Answer 126

allergy, pregnancy, lactation caution in OAs and pts with kidney dysfunction because of increased sensitivity to their effects and risk of AEs Assess BP and apical impulse (like other drugs) interaction- can promote hyperkalemia (esp. when taking with potassium drugs)

Answer 127

upper respiratory infections, and headache dizziness, inability to sleep, diarrhea, dyspnea, heartburn, nasal congestion, back pain, and fatigue Rarely, anxiety, muscle pain, sinusitis, cough, and insomnia Hyperkalemia is less likely to occur with ARBs than with ACE I

Answer 128

hypotension and tachycardia bradycardia occurs less often treatment is symptomatic and supportive -IV fluids to expand BV

Answer 129

HTN, HF used in caution in pts with kidney/ liver dysfunction, renal artery stenosis not for breastfeeding women- AE on the infant

Answer 130

HTN, angina (antihypertensive, antidysrhythmic) treat HTN by their ability to cause smooth muscle relaxation by blocking the binding of calcium to its receptors first line amlodipine nimodipine- prevents cerebral artery spasms that occur after a subarachnoid hemorrhage used to treat Raynaud's disease and migraine

Answer 131

act directly on arterial and venous smooth muscle to cause relaxation. DO NOT WORK through adrenergic receptors minoxidil, hydralazine, diazoxide, sodium nitroprusside direct-acting vasodilators- ability to cause peripheral vasodilation. This reduces SVR. Most nitable effets- hypotensive effect MINOXIDIL- HAIR GROWTH indication- HTN emergencies in which BP is severely elevated contra- allergy, hypotension, CAD, HF secondary ti diastolic dysfunction AE- dizziness, headache, anxiety, N & V, diarrhea, hepatitis, lupus Minoxidil AE- T wave ECG changes, pericardial effusion, angina, breast tenderness, rash, thrombocytopenia sodium nitroprusside AE: bradycardia, decreased platelet aggregation, rash, hypothyroidism, hypotension, methemoglobinemia, cyanide toxicity (byproduct of nitroprusside)

Answer 132

work primarily through arteriolar vasodilation

Answer 133

arteriolar and venous effects given in intensive care, IV (for severe HTN emergencies)- overdose; d/c infusion contains cyanide- released upon its metabolism- can cause cyanide toxicity antidote-sodium nitrite and sodium thiosulfate for injection and amyl nitrite for inhalation contra- allergy, severe HF, inadequate cerebral perfusion

Answer 134

produces hypotension, tachycardia, skin flushing treatment-supportive and symptomatic- administer IV fluids, digitalization if needed, and the administration of beta blockers for the control of tachycardia epinephrine should not be used because of excessive cardia stimulation

Answer 135

other antihypertensive drugs

Answer 136

essential HTN less common now has an injection form may not require cardiac monitoring contra- drug allergy, CAD, mitral valve dysfunction direct acting peripheral vasodilator

Answer 137

most recent treat primary HTN sole drug- aliskiren

Answer 138

mild to moderate HTN monotherapy/ combination action- it binds directly to the renin enzyme and blocks the conversion of angiotensinogen to angiotensin I and angiotensin II. This action results in the reduction of plasma renin activity and angiotensin I, angiotensin II, and aldosterone. AES: HEADACHE, DIZZINESS, FATIGUE

Answer 139

selective aldosterone blockers. reduces BP by blocking actions of aldosterone at its R in kidneys, heart, BVs, and brain. not for those with elevated serum potassium levels (higher than 5.5) or severe kidney impairment HTN, postmyocardial infarction

Answer 140

works by blocking receptors of the hormone endothelin- which acts to stimulate the narrowing of BVs by binding endothelin Rs in the endothelial (innermost) lining of BVs and in vascular smooth muscle pulmonary artery HTN Ambrisentain is similar to bosentan Pulmonary HTN- epoprostenol and treprostinil

Answer 141

pulmonary artery HTN analogue of prostacyclin, a metabolite of arachidonic acid, a naturally occurring prostaglandin that lowers BP; by dilating pulmonary and systemic BVs and by inhibiting platelet aggregation

Answer 142

systolic- 120 to 129 diastolic- 80 to 89

Answer 143

serum sodium, potassium, chloride, magnesium, calcium serum levels of troponin (elevated after an MI, a reliable indicator of a heart attack) kidney function studies- including blood urea test, creatinine liver function studies, ALT, AST scans and imaging studies- noninvasive ophthalmoscopic exam of the eye structures assess for conditions- CAD, Addison's disease, culture, race, ethnicity, obesity, preeclampsia...

Answer 144

assess BP, HR, weight fluid retention and edema- assess heart and breath sounds, intake and output, dependent edema associated with first dose syncope - encourage pt to lay supine on 1st dose/ give at hs

Answer 145

dizziness and syncope

Answer 146

WBCs serum potassium sodium levels protein in urine

Answer 147

block both b1 and b2 receptors and will have both heart and respiratory effects may cause exacerbation of respiratory diseases because of increased bronchoconstriction due to beta 2 blocking) or exacerbation of HF (negative inotropic effects- decreased contractility due to beta 1 blocking)

Answer 148

cardiac system is affected (pulse and BP will decrease) assess BP and apical pulse rate before each dose If systolic BP is less than 90 mm HG or pulse is less than 60 betas/ min (notify DR)

Answer 149

beta 1 blocker to avoid bronchoconstriction

Answer 150

non-selective beta-blockers may be effective

Answer 151

on the heart (decrease contractility) may worsen HF

Answer 152

BP, apical pulse rate, respiratory status (because of the adverse effect of a dry hacking cough) report angioedema immediately- wean off to avoid rebound HTN Monitor sodium and potassium levels potassium increases as an adverse effect loss of taste may take weeks to see the full effects potassium supplements are not needed

Answer 153

CCBs cause smooth muscle relaxation by blocking the binding of calcium to its receptors

Answer 154

caution in OAs and kidney dysfunction tolerated with meals reduce dosage if pt has hypovolemia/ liver dysfunction report dyspnea, dizziness, excessive fatigue

Answer 155

baseline neurological assessment, LOC, cognitive ability hypotension, dizziness, syncope never give drug without adequate monitoring always dilute nitroprusside; never infuse at the max dose for more than 10 minutes; may cause cyanide and thiocyanate toxicity; when combined with sodium thiosulfate, toxicity is reduced -dilute the drug -avoid use of infusion that has turned blue, green, red -use volume infusion pump, IV -monitor BP -beware of cyanide production

Answer 156

120- 139 mm Hg - systolic 80- 89 mm Hg - diastolic those with diabetes- less than 130/80

Answer 157

dizziness and electrolyte imbalances

Answer 158

AEs are more pronounced; hypotension, sedation, bradycardia, edema

Answer 159

negative inotropic (decreases cardiac contractility)

Answer 160

increase heart contractility

Answer 161

decreased HR decreased conduction

Answer 162

HTN impacts vasculature of the eyes-reliable indicator of the long term effectiveness of treatment than BP readings

Answer 163

first dose syncope- avoid situations that exacerbate this avoid activities that require mental alertness report dizziness, palpitations, and orthostatic hypotension assess sexual functioning

Answer 164

change position slowly to avoid syncope, dizziness, and falls report pulse rate of less than 60/ systolic less than 90 mm Hg avoid heat, prolonged sitting, standing, exercise

Answer 165

prevent vasoconstriction caused by angiotensin II prevent aldosterone which stops sodium and water resorption prevent breakdown of bradykinin (a potent vasodilator) by angiotensin II

Answer 166

work by blocking the binding of angiotensin at the receptors; which decreases BP

Answer 167

may be used to treat angina, dysrhythmias, and HTN help reduce BP by relaxing smooth muscles and dilating BVs. if calcium is not present, the smooth muscle cannot contract

Antihypertensive Flashcards

(192 cards)