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UNRS 113 Pharmacology > Antihypertensive Drugs > Flashcards

Antihypertensive Drugs Flashcards

1
Q

alpha 1 blockers

A

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

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2
Q

antihypertensive drugs

A

medications used to treat hypertension

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3
Q

cardiac output

A

the amount of blood ejected from the left ventricle, measured in liters per minute

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4
Q

essential hypertension

A

elevated systemic arterial pressure for which no cause can be found; also called primary or idiopathic hypertension

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5
Q

hypertension

A

a common, often asymptomatic disorder in which systolic blood pressure persistently exceeds 140 mm Hg and/or diastolic pressure exceeds 90 mm Hg

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6
Q

orthostatic hypotension

A

a common adverse effect of adrenergic blocking drugs involving a sudden drop in blood pressure when a person changes position, especially when rising from a seated or horizontal position

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7
Q

prodrug

A

a drug that is inactive in its given form, and which must be metabolized to its active form in the body, generally by the liver, to be effective

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8
Q

secondary hypertension

A

high blood pressure caused by another disease such as renal,pulmonary, endocrine, or vascular disease.

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9
Q

Classes of anti-hypertensive drugs

A

diuretics, ACEI, ARBs, CCB, Beta blockers, alpha and beta blockers, vasodilators

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10
Q

ACEI drugs

A

captopril (Capoten), lisinopril (Prinivil)

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11
Q

ARBs drugs

A

losartan (Cozaar)

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12
Q

CCB drugs

A

nifedipine (Procardia), verapamil (Calan), diltiazem (Cardizem), amlodipine (Norvasc)

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13
Q

beta blocker drugs

A

metoprolol (Lopressor), atenolol (Tenormin), propranolol (Inderal)

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14
Q

alpha/beta blocker drugs

A

carvedilol (Coreg), labetalol (Trandate)

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15
Q

vasodilator drugs

A

nitroprusside (Nitropress)

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16
Q

diuretic drugs

A 
Loop diuretics (furosemide, Lasix)
Thiazide diuretics (hydrochlorothiazide, HCTZ)
Potassium-sparing diuretics (spironolactone, Aldactone)
Osmotic diuretics (mannitol)
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17
Q

ACEI

A

Mechanism of action
-Blocks conversion of angiotensin I to angiotensin II through inhibition of ACE. Prevents breakdown of bradykinins which leads to vasodilation.
Drug effects
-Vasodilator (afterload): excretion of sodium & water (preload), & renal protective
Ex: captopril (capoten) ramipril (altace)
Enalapril (vasotec) benazepril (lotensin)
Lisinopril (prinivil)
Indications
-Hypertension (especially with renal disease)
Contraindications
-Previous reaction of angioedema
Adverse effects
-dry cough, first-dose syncope, angioedema, hyperkalemia

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18
Q

ARBs

A

Mechanism of action
-block binding angiotensin II to angiotensin II receptors, preventing vasoconstriction & aldosterone formation
Drug effects
-Vasodilation of arterioles (afterload), excretion of sodium & water (preload)
Ex: losartan (Cozaar) olmesartan (benicar)
Valsartan (diovan)
Indications
-Antihypertensive for those who cannot tolerate ACEI due to cough
Adverse effects
-Similar to ACE I except for cough, hypotension, angioedema, hyperkalemia

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19
Q

CCB

A

Mechanism of action
-Prevents influx of Ca ions across cell membrane of vascular smooth muscle
Drug effects
-Dilation of peripheral & coronary arteries & arterioles (afterload)
Ex: amlodipine (norvasc) nifedipine (procardia)
diltiazem (cardizem) nicardipine (cardene)
verapamil (calan)
Indications
-HTN, angina
Contraindications
Adverse effects
-dizziness, hypotension, constipation, peripheral edema, suppression of cardiac fxn
Nursing responsibilities
-Monitor BP & HR
Patient education
-Change positions slowly
-avoid hazardous activities while dizzy
-Increase fluid & fiber intake to prevent constipation unless otherwise instructed by provider

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20
Q

beta blocker

A

Mechanism of action
-prevent sympathetic stimulation of beta receptors in heart, myocardial contractility, rate of AV conduction
Drug effects
-Decrease cardiac output
*Cardioselective (beta 1)- metoprolol (lopressor), atenolol (Tenormin), esmolol (Brevibloc)
*Nonselective (Beta 1 & 2)- propranolol (Inderal), nadolol (Corgard)
Indications
-HTN
Contraindications
-bradycardia, AV block, asthma
Adverse effects
-dizziness, bradycardia (AV block), mask signs/symptoms of hypoglycemia in diabetics, bronchoconstriction, rebound myocardium excitation
Nursing responsibilities
-Assess for contraindications, vital signs (hold & notify MD for HR>60), monitor S/S of decreased cardiac output
Patient education
-Change positions slowly, avoid hot tubs/saunas which result in vasodilation
-monitor glucose if diabetic
-do not stop abruptly

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21
Q

alpha/beta blocker

A

Mechanism of action
-alpha 1 blockade promotes dilation of arterioles and veins. Beta 1 blockade reduces HR & contractility. Blockade of beta 1 receptors on juxtaglomerular cells suppresses release of renin.
Ex: carvedilol (coreg) labetalol (trandate)

22
Q

vasodilator

A

Mechanism of action
-Direct vasodilation of arteries & veins resulting in rapid reduction of BP
Indications
-Hypertensive crisis
Adverse effects
-excessive hypotension, monitor EKG, avoid prolonged use due to cyanide poisoning
Ex: nitroprusside (Nitropress) I.V. only
Nursing responsibilities & Patient education
-HTN is silent killer, must educate about importance of adherence despite lack of symptoms
-Remind patient meds is only part of therapy. Teach DASH diet, smoking cessation, weight management, regular aerobic exercise, sodium intake, moderate alcohol consumption
-Teach to keep journal of BP
-If pts are experiencing serious adverse effects contact physician immediately
-teach pts to change positions slowly due to syncope from postural hypotension
-male impotence is common side effect of these drugs, encourage males to speak w/provider if this occurs
-Monitor adverse effects (hypotension, dizzy, fatigue) & toxic effects (bp maintained at >140/90 for pts <60 yrs & comorbidities.

23
Q

Eighth Joint National Committee (JNC 8) on the Prevention, Detection, Evaluation, and Treatment of High Blood Pressure

A

Patient >60yrs of age without comorbidity treatment goal is <140/90 mmHg

24
Q

State recommended lifestyle modifications to decrease HTN

A 
Weight reduction
Dash eating plan
Dietary sodium  restriction
Aerobic activity
Moderation of alcohol consumption
25
Q

Describe the normal anatomy & physiology of the renal system

A 
Fxn of kidney:
		-Cleansing, excrete metabolic waste, substance
		-Maintain extracellular volume &amp; composition
		-Maintain acid-base balance
	Process of kidney
		-filtration
		-reabsorption
		-active secretion
	Fxn unit of kidney= Nephron
		-glomerulus
		-proximal convoluted tubule
		-loop of henle
		-distal convoluted tubule
		-collecting duct
26
Q

Loop diuretics (furosemide, Lasix)

A

Mechanism of action
-blocks reabsorption of Na+ & Cl- in ascending limb of loop of Henle (prevents reabsorption of water)
Drug effects
-produces extensive diuresis (since 20% of filtered Na+ & Cl- is reabsorbed)
Ex: furosemide (lasix) bumetanide (bumex)
Torsemide (demadex)
Indications
-pulmonary edema caused by heart failure
Contraindications
-End stage renal disease, anuria
Adverse effects
-severe dehydration, hypotension, hypokalemia (14-60%), ototoxicity, hyperglycemia, hyperuricemia (40%)
Interactions
-digoxin
Nursing responsibilities
-Monitor fluid volume status
-Monitor blood pressure
-monitor electrolytes (K+)
Patient education
-Monitor weight & blood pressure
-change positions slowly
-Eat potassium rich foods (i.e. bananas, potatoes, dried fruit, tomatoes, spinach, citrus fruits)
-take early in day
-teach about signs/symptoms of hypokalemia & contact prescriber right away if signs occur

27
Q

Discuss the effects of aldosterone on the distal tubule of the nephron

A

aldosterone

28
Q

Potassium-sparing diuretics (spironolactone, Aldactone)

A

Mechanism of action
-Blocks action of aldosterone in the distal tubule which results in potassium retention and excretion of sodium and water
Drug effects
-counter acts potassium-wasting effect of more powerful diuretics. Mild diuresis effect.
Ex spironolactone (aldactone) amiloride (mildamor) triamterene (dyrenium)
Indications
-frequent combined with thiazide & loop diuretics to counterbalance potassium-wasting
Contraindications
-renal failure or anuria, hyperkalemia
Adverse effects
-hyperkalemia (if used alone), gynecomastia, impotence, menstrual irregularities
Interactions:
-ACE inhibitors, ARBs, direct renin inhibitors, potassium supplements
Nursing responsibilities
-monitor fluid volume status, BP, electrolytes (K+)
Patient education
-Teach patients to keep log of BP & weight
-avoid salt substitutes that contain K+

29
Q

Osmotic diuretics (mannitol)

A

Mechanism of action
-decrease cerebral edema by raising serum osmolality which draws fluid into vascular space. Creates osmotic effect in nephron causing increased secretion of water.
Drug effects
-the greater the amount of mannitol the greater the diuresis (available in 5-25%)
Ex mannitol (osmitrol)
Indications
-cerebral edema, prevention of kidney injury in hypovolemic shock
Contraindications
-renal failure, pulmonary edema caused by heart failure
Adverse effects
-can precipitate heart failure & pulmonary edema
Nursing responsibilities
-Monitor fluid volume status, BP, electrolytes, use filler in I.V. tubing. Monitor signs & symptoms for heart failure & notify prescriber immediately
Patient education

30
Q

Normal serum potassium level

A

(approximately 3.5-5.0 mEq/L)

31
Q

Normal kidney function as demonstrated by:

A

Urine output of at least 30 mL/hr
Serum creatinine level between 0.6-1.2 mg/dL
BUN levels between 10 to 20 mg/dL

32
Q

hypertension stages

A

pre
stage 1
stage 2

  • hypertension: persistent systolic pressure >140 mmHG and/or >90 mm Hg
  • essential hypertension: when specific cause of hypertension is unknown
  • secondary hypertension: hypertension that is caused by another disease
33
Q

Know why HTN is called “the silent killer,” define the term “end organ damage”, and state the long-term consequences of untreated hypertension

A
  • HTN called “silent killer” due to lack of symptoms
  • end of organ damage:
  • Long -term consequences of untreated HTN: stroke, heart failure, end stage renal failure, coronary artery disease, peripheral vascular disease
34
Q

Define blood pressure and discuss the determinants of blood pressure

A

-Blood pressure: measures how hard blood presses against walls.
*systolic pressure: max pressure felt on artery during left ventricular contraction
*diastolic pressure: resting pressure blood exerts between each contraction
-Determinants: BP= CO x PVR & HTN= high BP
Arterial pressure = cardiac output x peripheral resistance

35
Q

Define blood pressure and discuss the determinants of blood pressure

A

-Blood pressure: measures how hard blood presses against walls.
*systolic pressure: max pressure felt on artery during left ventricular contraction
*diastolic pressure: resting pressure blood exerts between each contraction
-Determinants: BP= CO x PVR & HTN= high BP
Arterial pressure = cardiac output x peripheral resistance

36
Q

Know drug classes used to treat hypertension in patients with chronic kidney disease (CKD) including rationale for their use

A

treatment of hypertension in pt w/CKD include ACEI or ARB to improve kidney outcomes

37
Q

Drug classes suffixes & prefixes

A

-olol beta blockers, ACEI -pril, ARBs -sartan, CCB -dipine

38
Q

Afferent arterioles

A

The small blood vessels approaching the glomerulus (proximal part of the nephron

39
Q

Aldosterone

A

A mineralocorticoid steroid hormone produced by the adrenal cortex that regulates sodium and water balance

40
Q

Ascites

A

Intraperitoneal accumulation of fluid (defined as a volume of 500 mL or more) containing large amounts of protein and electrolytes.

41
Q

Collecting duct

A

The most distal part of the nephron between the distal convoluted tubule and the ureters, which lead to the urinary bladder.

42
Q

Distal convoluted tubule

A

The part of the nephron immediately distal to the ascending loop of Henle and proximal to the collecting duct.

43
Q

Diuretics

A

Drugs or other substances that tend to promote the formation and excretion of urine.

44
Q

Efferent arterioles

A

The small blood vessels exiting the glomerulus. At this point blood has completed its filtration in the glomerulus

45
Q

Filtrate

A

The material that passes through a filter. In the case of the kidney, the filter is the glomerulus and the filtrate is the material extracted from the blood (normally liquid) that becomes urine.

46
Q

Glomerular capsule

A

The open, rounded, and most proximal part of the proximal convoluted tubule that surrounds the glomerulus and receives the filtrate from the blood

47
Q

Glomerular filtration rate (GFR)

A

An estimate of the volume of blood that passes through the glomeruli of the kidney per minute.

48
Q

Glomerulus

A

The cluster of kidney capillaries that marks the beginning of the nephron and is immediately proximal to the proximal convoluted tubule.

49
Q

Loop of Henle

A

The part of the nephron between the proximal and distal convoluted tubules

50
Q

Nephron

A

The functional filtration unit of the kidney, consisting of (in anatomic order from proximal to distal) the glomerulus, proximal convoluted tubule, loop of Henle, distal convoluted tubule, and collecting duct, which empties urine into the ureters. There are approximately 1 million nephrons in each kidney

51
Q

Open-angle glaucoma

A

A condition in which pressure is elevated in the eye because of obstruction of the outflow of aqueous humor

52
Q

Proximal convoluted (twisted) tubule

A

The part of the nephron that is immediately distal to the glomerulus and proximal to the loop of Henle.

UNRS 113 Pharmacology (3 decks)

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