Antihypertensive Drugs

Question 1

stWhat is the equation for blood pressure?

Answer 1

Cardiac output x Systemic vascular resistance

Question 2

What is a high normal BP

Answer 2

130-139 mm Hg/ 85-89 mm Hg

Question 3

What are the 3 different types of hypertension

Answer 3

Essential hypertension: Sudden/spontaneous
Secondary hypertension: Caused by another condition
Malignant hypertension: Above 180/120, a medical emergency

Question 4

What is the goal of antihypertensive therapy?

Answer 4

Reduction of cardiovascular and renal morbidity
Achieve pressure <140/90
<130/80 for diabetics

Question 5

What does the parasympathetic NS stimulate

Answer 5

Smooth muscle, cardiac muscle, glands

Question 6

What are the 7 categories of antihypertensive drugs?

Answer 6

Adrenergic drugs
Angiotensin-converting enzyme inhibitors
Angiotensin II receptor blockers (ARBs)
Calcium channel blockers
Diuretics
Vasodilators
Direct renin inhibitors

Question 6

What does the sympathetic NS stimulate

Answer 6

Heart, blood vessels and skeletal muscle

Question 7

What are the 5 subcategories of adrenergic drugs

Answer 7

Adrenergic neuron blockers (central and peripheral)
A2 receptor agonists ( central)
A1 receptor blockers (peripheral)
Beta receptor blockers (peripheral)
Combo a1 and B receptor blockers (peripheral)

Question 8

Name an A2 receptor agonist and what does it do.

Answer 8

Clonidine is an A2 receptor agonist. Stimulates A2 adrenergic receptors in the brain which decreases sympathetic outflow in the CNS and norepinephrine production. Also reduces renin in kidneys (makes angiotensin 1)

Question 9

Name a A1 receptor blocker and what does it do

Answer 9

Doxazosin
Blocks a1 adrenergic receptors which dilates arteries and veins resulting in decreased BP
Also increases urinary flow rates by preventing smooth muscle contraction in the bladder neck and urethra so there’s no blockage/resistance

Question 10

What is doxazosin also used to treat?

Answer 10

BPH

Question 11

Name 3 beta blockers and what do they do?

Answer 11

Propranolol, metoprolol, atenolol
Reduces HR and secretion of renin (makes angiotensin I)

Question 12

What does long term use of beta blockers cause?

Answer 12

Reduced Peripheral vascular resistance

Question 13

Name a dual-action a1 and beta receptor blocker and what does it do?

Answer 13

Labetalol
Reduces HR and is a vasodilator

Question 14

What are the indications for adrenergic antihypertensives?

Answer 14

HTN, Glaucoma, BPH, Severe heart failure when used with cardiac glycosides and diuretics, menopausal flushing

Question 15

What are adverse effects of adrenergic drugs

Answer 15

Orthostatic hypotension
Dry mouth
Drowsiness, sedation
Constipation
Depression
Edema
Sexual dysfunction
Bradycardia
Headaches
Sleep disturbances
Rash
Palpitations

Question 16

Why are a2 receptor agonists (clonidine) not typically used as a first line of antihypertensive drugs?

Answer 16

High incidence of unwanted adverse effects (orthostatic hypotension, fatigue, dizziness)
Only used adjunctly with other antihypertensives when other drugs fail

Question 17

What is nebivolol HCL, what does it do and what is a nursing consideration?

Answer 17

Beta blocker
Blocks beta receptors which causes vasodilation resulting in a decrease in Systemic vascular resistance
Do not stop abruptly, taper out over 2 weeks

Question 18

What is used as a first line antihypertensive and why?

Answer 18

ACE inhibitors
Safe and very effective

Question 19

What is the suffix for ACE inhibitors?

Answer 19

“pril”

Question 20

Name 4 ACE inhibitors

Answer 20

Captopril
Enalapril
Perindopril
Ramipril

Question 21

What is the MOA of ACE inhibitors

Answer 21

Blocks ACE which converts angiotensin 1 to angiotensin 2.
Angiotensin 2 is a potent vasoconstrictor
Prevents breakdown of bradykinin which is a vasodilator

Question 22

What else can ACE inhibitors treat

Answer 22

Decrease SVR and preload (left ventricle volume)
Can stop progression of left ventricular hypertrophy

Question 23

What are the indications for ACE inhibitors

Answer 23

HTN, HF, Slow progression of Left ventricular hypertrophy after myocardial infarction
Renal protection for diabetes

Question 24

What are prodrugs

Answer 24

Prodrugs are inactive when administered and must be metabolized by the liver into an active form

Question 25

How are captopril and lisinopril different from other ACE inhibitors

Answer 25

They can be used if a patient has liver dysfunction, unlike others that are prodrugs

Question 26

How do ACE inhibitors treat HF

Answer 26

Prevent sodium and water reabsorption by inhibiting aldosterone secretion Diuretic so decreases blood volume returning to the heart Decreases preload Decreases work required of the heart

Question 27

How do ACE inhibitors provide renal protective effects?

Answer 27

Reduce glomerular filtration pressure Reduce proteinuria Prevents progression of diabetic nephropathy

Question 28

What are adverse effects of ACE inhibitors?

Answer 28

Fatigue, dizziness, headache, impaired taste, mood changes, Dry, nonproductive cough that reverses when therapy is stopped. Angioedema First dose hypotension Possible hyperkalemia

Question 29

Which ACE inhibitor has the shortest half life and needs to be given the most often? How many times must be administered?

Answer 29

Captopril. 3 to 4 times a day

Question 30

Enalapril is the only ACE inhibitor available in _____ and ____ forms

Answer 30

Oral and IV

Question 31

What is the suffix for ARBs

Answer 31

"sartan"

Question 32

Name 2 ARBs

Answer 32

Losartan Telmisartan

Question 33

What is the MOA for ARBs

Answer 33

Selectively block the binding of angiotensin 2 to to angiotensin 2 receptors in vascular smooth muscle and adrenal glands Blocks vasoconstriction and the secretion of aldosterone

Question 34

What is difference between ACE inhibitors and ARBs

Answer 34

Both well tolerated and effective ARBs do not cause a cough

Question 35

________ are better tolerated than ____________ and are associated with lower mortality after MI

Answer 35

ARBS, ACE inhibitors

Question 36

T/F: ARBs are as effective as ACE inhibitors in treating HF and protecting the kidneys

Answer 36

False

Question 37

What are the indications for ARBs

Answer 37

HTN Adjunctive drugs for the treatment of HF

Question 38

What are the adverse effects of ARBs

Answer 38

Upper respiratory infections, headaches, dizziness, inability to sleep, diarrhea, dyspnea, heartburn, nasal congestion, back pain, fatigue

Question 39

T/F: Hyperkalemia is more likely to occur with ARBs than ACE inhibitors

Answer 39

False; It is less likely

Question 40

What are the contraindications with losartan

Answer 40

Breastfeeding women Used with caution in patients with renal or hepatic dysfunction or renal artery stenosis

Question 41

How do Calcium channel blockers decrease HTN ?

Answer 41

Cause smooth muscle relaxation by blocking the binding of calcium to its receptors, thereby preventing contractions. Decreases peripheral smooth muscle tone, SVR and BP

Question 42

What are the indications for Calcium channel blockers

Answer 42

Angina HTN Antidysrhythmias Migraines Raynaud's disease Cerebral artery spasm prevention

Question 43

Name a calcium channel blocker

Answer 43

Amlodipine

Question 44

How do diuretics lower BP

Answer 44

Decrease plasma and ECF volumes. Decreases preload, cardiac output and total peripheral resistance Overall decreases heart workload and BP

Question 45

What is the common diuretic used to treat HTN

Answer 45

Hydroclorthiazide

Question 46

Name a vasodilator

Answer 46

Sodium nitroprusside

Question 47

What is the MOA of vasodilators?

Answer 47

Direct vasodilation of arteries and/or veins Decreases SVR

Question 48

What are the indications for Vasodilators

Answer 48

HTN Hypertensive emergencies

Question 49

What are the adverse effects sodium nitroprusside

Answer 49

Bradycardia, decreased platelet aggregation, rash, hypothyroidism, Hypotension, Methemoglobinemia, Cyanide toxicity

Question 50

What are the contraindications of sodium nitroprusside?

Answer 50

Allergy, Severe HF, Known inadequate cerebral perfusion

Question 51

What is a general rule regarding patients BP and administering an antihypertensive

Answer 51

If apical HR <60 or systolic BP <90, hold meds and contact physician

Question 52

Teach patients to______ to avoid syncope from postural hypotension.

Answer 52

Change positions slowly

Question 53

What is a consideration for male patients on these drugs?

Answer 53

Impotence is an expected effect

Question 54

Why shouldn't antihypertensives be stopped abruptly

Answer 54

Can cause rebound hypertensive crisis which could lead to a stroke