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Flashcards in Antihypertensives Deck (45):
1

What are the stats of HTN?

1. 1 in 3 ppl in the world have HTN
2. 72 Million over 20 yrs old have HTN
3. Only 72% are aware they have HTN
4. 277,000 U.S. deaths in 2004
5. 3 Times more deadly for African-Americans

2

What other effects can HTN have?

1. MI
2. CVA
3. HF
4. Kidney disease

3

Normal Regulation of BP

1. Arterial Blood Pressure = Cardiac Output X Systemic Vascular resistance
2. CO = HR x Stroke vol.
3. Systemic vascular resistance is affected by radius of vessel

4

Controls of HTN

1. Sypmathetic Nervous System
2. Renal System
3. Endocrine System
4. Vascular Endothelium

5

Tx of HTN

1. Lifestyle Modifications
2. Intro to medication
a. Increase or adding medications until desired BP is met.

6

What are the forest camps?

1. Adrenergic blockers
2. Calcium Channel Blockers
3. ACE Inhibitors
4. Direct Vasodilators
5. Diuretics

7

Sympathetic Nervous System

1. Alpha & Beta receptor sites:
a. Alpha Adrenergic Blockers
b. Beta1 Adrenergic Blockers

8

Adrenergic Receptors

1. Alpha 1&2: Arterial constriction/Pupil dilation
GI smooth muscle relaxation
2. Beta 1: Increased HR/Contractility/Automaticity/Conduction
3. Beta 2: Bronchodilation/Arteriol Constriction/Glycogenolysis

9

Alpha Adrenergic Receptors

1. Blocks arteriole vasoconstriction
2. Clinically not the first choice to Tx HTN
3. Great @ lowering DBP
4. Tx BPH

10

Alpha Adrenergic Receptor Contraindication

1. Hypotension*
2. Pregnancy*
3. Tachycardia
4. Hypersensativity

11

Alpha Adrenergic Receptor Rx Interaction

1. Antacids* 1 hr
2. Alcohol- Increase Hypotension

12

Alpha Adrenergic Adverse Eeffects

1. First Dose Phenomenon*
2. Vasodilation=Flushing, Headache, Dizziness
3. Dry mouth

13

Alpha Adrenergic RN Implication/Teaching

1. Slow position change*
2. Watch for 1st dose*
3. 2 Weeks needed to see therapeutic results*
4. Watch for wt gain

14

Name 1 Alpha Blocker

1. Cardura

15

Name 2 Beta Blockers

1. propanolol
2. atenolol

16

Beta Blocker Info

1. CO is reduced=Reducing BP*
2. Decreased 02 demand
3. Used for cardiac arrhythmias & angina
4. 1st line Rx

17

Beta Blocker Contraindication

1. Ischemic Heart Disease*
2. Systolic Heart Failure*
3. Hypotension*
4. Asthma*
5. COPD*
6. Diabetes

18

Beta Blocker Rx Interactions

1. Adrenergic Agonist
2. Insulin/Oral Antidiabetic Agent
3. Alcohol
5. Antacids
6. NSAID's

19

Beta Blocker Adverse Reaction

1. Hypotension (Orthostatic)*
2. Bradycardia*
3. Bronchoconstriction*
4. Hypoglycemia*
5. PNS response

20

Beta Blockers RN Implication/Teaching

1. Do not DC Abruptly*
2. Monitor BP for Orthostatic Hypotension, Change position slowly*
3. Watch BP, HR, RR- HR <60=hold*
4. Report breathing difficulty*

21

Name 3 Calcium Channel Blockers

1. nifedipine (Procardia)
2. diltiazem (Cardizem)
3. verapamil

22

CCB Info

1. Actions on Ca+ channel
2. Used for
a. HTN
b. Angina
c. Peripheral Vascular Disease

23

CCB Contraindication

1. Heart Block*
2. Pregnancy*
3. Hepatic/Renal Failure*
4. pt c LV dysfunction

24

CCB Rx Interaction

1. Ca+ & Vitamin D
2. Beta Blockers
3. Digoxin
4. Cyclosporin
5. Grapefruit juice

25

CCB Adverse Effects

1. Bradycardia*
2. Depressed Heart Function*
3. Peripheral Edema*
4. Hypotension
5. Dizziness
6. Hepatic Damage

26

CCB RN Implication/Teaching

1. Watch for
a. wt gain
b. bradycardia
2. Watch hepatic values- ALT, AST
3. Do not DC abruptly
4. Avoid grapefruit

27

ACEI Info

1. Works in the RAAS, reducing BP via PVR & CO-HRxSV
2. Widely used, often first line c certain diseases
3. "Pril" medication

28

Name 2 ACEI & 1 A2RA*

1. enalapril (Vasotec)
2. lisinopril (Prinivil)
3. losartan (Cozaar)*

29

ACEI Info

1. Renal Control*
2. Kidneys Control Na+ & H20 excretion*
3. Renin-->Angiotensin-->Aldosterone Ssystem*
4. Water follows Na+
5. Increased ECF will Increase Venous Return=SV=CO=BP
6. Prostoglandins vasodilate (renal & systemic)

30

ACEI Indication

1. HTN*
2. CHF & LV dysfunction
3. Gives renal protection for DM pt

31

ACEI Contraindication

1. Renal Stenosis*
2. Pregnancy*
3. CHF
4. Hyperkalemia

32

ACEI Rx Interaction

1. Antacids
2. NSAID's
3. Alcohol
4. Nitrates
5. K+
6. Digoxin (Lithium)

33

ACEI Adverse Effects

1. Dry cough**
2. Hyperkalemia
3. 1st Dose syncope
4. Hypotension
5. Headache
6. Tachycardia/Palpitations
7. Dry mouth

34

ACEI RN Implication/Teaching

1. Avoid OTC, NSAID's**
2. Watch for renal/hepatic functions test
3. Watch electrolytes:
a. Na+
b. K+
c. Ca++

35

A2RA Info

1. 2nd Gen ACEI
2. Block angiotensin 2 receptor site*
3. Decrease PVR*
4. Takes 3-6 weeks for full effect
5. Great for pt that cannot tolerate ACEI
6. "Sartan"

36

Name 1 A2RA

1. Losartan (cozaar)

37

A2RA Contraindication

1. Pregnancy
2. Renal/Liver dysfunction
3. Hypersensativity

38

A2RA Rx Interaction

Phenobarbital

39

A2RA Adverse Effect

1. No dry cough
2. Tolerated better than ACEI
3. Headache/Weakness

40

A2RA RN Implication/Teaching

1. 1st dose phenomenon
2. Watch renal/liver enzyme values
3. Teach pt how to cope c minor effects

41

Direct vasodilators

1. Tx of moderate to severe HTN
2. Reduces PVR & CO (Preload & afterload)
3. Never used as 1st line Tx of HTN
4. Monitor labs

42

CO x SVR = BP

Cardiac output x systemic vascular resistance

43

Cardiac output equation

HR x SV = CO

44

3 primary factors controlling BP

1. Cardiac output
2. Peripheral resistance
3. Blood volume

45

Advantage of using 2 anti hypertensives

1. Fewer side effects
2. Better pt adherence