Antihypertensive Drugs - Ch 21, 47-50 Flashcards by claire b🩻

What are 90% of hypertension cases?

Unknown cause (idiopathic)
Aka Essential or primary hypertension

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What are 10% of hypertension cases?

Known cause
-Secondary hypertension

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What can hypertension lead to?

Cerebrovascular disease
Hypertensive retinopathy
Left ventricular dysfunction
Left ventricular hypertrophy
Coronary artery disease
Chronic kidney disease
Peripheral artery disease

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What are some benefits of treating hypertension?

Decreased heart failure by 50%
Decreased stroke by 38%
Decreased heart attack by 15%
Decreased death ny 10%

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What are some lifestyle considerations that contribute to hypertension?

Obesity
Physical exercise
Salt intake
Increase potassium intake
Dietary habits including fat intake
Alcohol
Smoking

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What blood pressure needs hypertension treatment in the general population?

<140/90

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What blood pressure needs hypertension treatment in high risk populations (e.g, CV disease, Non-DM CKD)?

≤120/NA

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What blood pressure needs hypertension treatment in diabetics?

<130/80

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What are the categories of antihypertensive drugs?

Angiotensin converting enzyme (ACE) inhibitors
Angiotensin II receptor blockers (ARBs)
Calcium channel blockers (CCBs)
Diuretics
B-adrenoreceptor blockers
Vasodilators
Adrenergic agents

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What are ACE inhibitors?

Large grouo of safe and effective drugs
Often used as first-line agents in heart failure and hypertension

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What are ACE inhibiotrs often combined with?

Thiazide diuretic or calcium channel blocker

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Examples of ACE inhibitors?

Captopril (Capoten)
Enalapril (Vasotec)
Lisinopril and quinapril

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What is unique about Captopril?

Shortest half-life of the prils

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How is Enalapril (Vasotec) administered?

Oral
Parenteral

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What is unique about lisinopril and quinapril?

Newer agents, long half lives, once-aday administration

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Why would patients with diabetes and hypertension want to use ACEIs?

ACEIS have renal protective effects in diabetics

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Why are ACEIs used to treat heart failure?

Slows progression of left ventricular remodelling after an MI

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What is the mechanism of action of ACEIs?

Prevents angitensin II vasoconstriction, which reduces peripheral resistance (afterload)

-Prevents aldosterone release, which reduces salt and water reabsorption

-Prevents the breakdown of bradykinin

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What adverse effects are associated with ACEIs?

Dry, nonproductive cough
First-dose hypotensive effect may occur
Possible hyperkalemia

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What drugs do ACE inhibitors have interactions with?

Potassium (K) supplements and K-sparing diuretics

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When is ACEIs use contraindicated?

Pregnancy

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ARBs are similar to ACEIs, but not identical, what are some differences?

Don’t cause a dry cough
-Not combined with ACEIs normally

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Examples of ARBs?

Losartan (cozaar)
Valsartan (Diovan)

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What is the mechanism of action of ARBs?

Angiotensin II receptor antagonist
-Block receptors that Ang II activates

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What are the effects of ARBs when they block receptors than Ang II activates?

Blocks Ang-II mediated vasoconstriction Blocks release of aldosterone

ARBs may be used alone, or with what other agents?

CCB Diuretics

Angiotensin II receptor blockers (ARBs) are alternatives to what?

ACE inhibitors

When is ARB use contraindicated?

Pregnancy

What are calcium channel blockers used for?

Hypertension Angina Dysrhythmias

What are the kinds of calcium channel blockers?

Benzothiazepines (cardciac + vascular) Phenylalkamines (cardiac + vascular) Dihydropyridines - DHPs (vascular selective)

Examples of Benzothiazepines?

Diltiazem (Cardizem)

Example of Phenylalkamines?

Verapamil

Examples of Dihydropyridines - DHPs?

Amlodipine, nifedipine, nimodipine

What is the effect of CCBs on cardiac muscle?

Block cardiac muscle Ca channels which alters electrical activity of cardiac muscle (SA, AV nodes and muscle)

What is the effect of CCBs on vascular muscle?

Inhibits Ca entry into arteriolar vascular smooth muscle cells which causes relaxation and decreased peripheral resistance (lowers BP)

Adverse effects: CCBs - Verapamil/Diltiazem?

Cardiovascular: Hypotension, dizziness, flushing, peripheral edema Gastrointestinal: Constipation, nausea Other: Rash, demititis

Adverse effects: CCBs - DHPs?

Cardiovascualr: Hypotension, dizziness, palpitations, tachycardia, flushing, peripheral edema Gastrointestinal: Little constipation Other: Rash, demititis

What is the mechanism of action of thiazide diuretics for hypertension treatment?

Decrease the plasma and extracellular fluid volumes which decreases preload and cardiac output, and decreases total peripheral resistance Decreased herat workload = decreased BP

What is the first line drug in guidelines for hypertension?

Diuretics

Examples of thiazides/thiazide-like diurteics?

Hydrochlorothiazide (hyrodiuril) Chlorthalidone (thiazide-like) -longer acting

What can thiazide use possibly lead to?

Hypokalemia Digoxin interation

What kind of diuretics are preferred for HTN?

Longer acting over short acting

Examples of longer-acting (thiazide-like) diuretics?

Clorthalidone, indapamide

Examples of shorter-acting (thiazide) diuretics?

Hydrochlorothiazide

What are some reccomended sungle pill combinations used to treat HTN?

ACEI + CCB ACEI + diuretic ARB + diuretic ARB + CCB

What are the 4 adrenoceptors subtypes?

α1 α2 β1 β2

What are β-adrenoreceptor blockers?

β-adrenoreptor antagonists, β1-blockade Act in the periphery, mainly heart Block norepinephine/epinephrine action in heart

What do beta-blockers reduce?

↓Heart rate ↓Force of heart muscle contraction ↓Stroke volume

Examples of β-adrenoreceptor blockers?

Metoprolol (Lopressor) Atenolol Propanolol (Inderal)

What kind of β-adrenoreceptor blockers are β1- selective?

Metoprolol Atenolol

What kind of β-adrenoreceptor blockers are non-selective?

Propanolol

What are β-adrenoreceptor blockers used for?

Hypertension Heart failure Angina Dysrhythmias

What do β-adrenoreceptor blockers cause an intolerance to?

Excercise

Who should avoid using β-adrenoreceptor blockers ?

Asthma patients

What are dual α1 and β-receptor blockers?

Act in the periphery of heart and blood vesseels Reduce heart rate cause vasodilation

What adrenergic recpetor is blocked to cause reduced heart rate?

β1-receptors

What adrenergic receptor is blocked to cause vasodilation?

α1 receptors

Examples of dual α1 and β-receptor blockers?

Labetalol Carvedilol

How do centrally acting α2 adrenoceptors interact with the body?

Agonists

How do peripherally acting α1 adrenoceptors interact with the body?

Antagonists

What do centrally acting α2-recepotor agonists do?

Stimulate α2-adrenergic receptors in the brainstem to reduce norepinephrine release, decrease SNS outflow from CNS, cause vasodilation (decrease BP)

Examples of centrally acting α2-recepotor agonists?

Clonidine (Catapres) Methyldopa

What centrally acting α2-recepotor agonist is rarely used?

Clonidine (Catapres)

What is the 1st line therapy for hypertension in pregnancy?

Methyldopa -Pro-drug

When are centrally acting α2-recepotor agonists usually used?

After other agents have failed or in combination with other drugs due to adverse effects

Adverse effects associated with centrally acting α2-recepotor agonists?

Sedation Dry mouth

What do peripherally acting α1-recepotor antagonists do?

Block α1-adrenergic receptors Block NE contraction of blood vessels

Examples of peripherally acting α1-recepotor antagonists?

Prazosin (minipres) Doxazosin Terazosin

Peripherally acting α1-recepotor antagonists provide relief of symptoms of what?

BPH - Benign prostatic hypertrophy

Peripherally acting α1-recepotor antagonists are used in combination with what to treat severe HF?

Cardiac glycosides and diuretics

what adverse effects are associated with α-receptor adrenergic agents?

Dry mouth Sedation, drowsiness Costipation Headaches Nausea Cardiac disturbances (palpitations) Sleep disturbances rash

α-receptors have a high indicence of what?

Orthostatic hypotension

What is the mechanism of action of vasodilators?

Directly relax arteriolar smooth muscle (peripheral vasodilation)

What are vasodilators used for?

Hypertension -Soemtimes in combination with other drugs

Examples of vasodilators?

Hydralazine (Apresoline) diazoxide minoxidil Sodium nitroprusside (Nipride) (Nitirc oxide action)

What vasodilators are administed IV in hypertensive emergencies?

IV Sodium nitroprusside and diazoxide

What adverse effects are associated with hydralazine (vasodilator)?

Dizziness, headache, anxiety Tachycardia nausea and vomiting diarrhea anemia dyspnea edema nasal congestion

What adverse effects are associated with sodium nitroprusside (vasodilator)?

Bradycardia Hypotension Possible cyanide toxicity

Why should antihypertensive drugs not be stopped abruptly?

May cause rebound hypertensive crisis and lead to stroke

What should the nurse teach the patient if they are using antihypertensive drugs?

Avoid smoking Avoid eating foods high in sodium e.g, tinned osups, packaged meals Change lifestyle Change positions slowly Avoid aggravating low BP

What aggravates low BP?

Hot tubs, showers, baths Hot weather Prolonged sitting or standing Intense physical exercise Alcohol ingestion

Antihypertensive Drugs - Ch 21, 47-50 Flashcards

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