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Antihypertensives Flashcards

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1
Q

Cardiovascular disease (CVD) is usually managed with

A

with exercise, diet, stress management and a variety of pharmacological and surgical approaches

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2
Q

CVS provides the body’s cells with

A

nutrients and removes their metabolic waste efficiently

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3
Q

The response to heightened tissue demands is to:

A

Increase BP
Increase HR
Redirect blood flow to prioritize tissues under stress

***These responses are normal but are intended to be short-term immediate reactions

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4
Q

Cardiovascular medications:

A

Anti-hypertensives
Drugs to manage heart failure and angina
Drugs that interfere with coagulation

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5
Q

Drugs to treat respiratory conditions

A

Bronchodilators
Inhaled steroids
Antihistamines
Decongestants

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6
Q

BP = CO x TPR

A

CO: cardiac output is the volume of blood the heart pumps per minute. Reflects the pumping strength of the heart, its rate and rhythm, and the volume of blood returned to the heart
TPR: all the elements that create resistance to the flow of blood. Most important factor is blood vessel diameters in the systemic and pulmonary circulations

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7
Q

Average BP is

A

120/80 mm Hg

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8
Q

Hypertension – AKA the silent killer

A

140/90 mm Hg

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9
Q

Average normal resting heart rate is

A

70-72 beats per minute

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10
Q

Within physiological limits, the faster the heart beats

A

the more blood it can pump

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11
Q

A rapid HR reduces the time frame in which the heart wall itself can

A

be perfused with fresh blood

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12
Q

When drugs are used in the treatment of CVD, they are often directed at managing

A

BP or strengthening heart function, or BOTH

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13
Q

CVD Medications are grouped by function:

A 
Improve heart function
Increase blood vessel diameter
Alter blood coagulation mechanisms
Reduce blood volume
Lower blood lipid levels (reduce blood vessel blockage)
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14
Q

Sites of action for cardiovascular medications

A 
CNS-Alpha-2 agonists
Kidneys- Diuretics
Heart-Beta blockers/
Alpha-1 antagonists/
Calcium channel blockers
BOTH-Angiotensin-
     converting enzyme 
     inhibitors (ACE-i)
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15
Q

Drugs that Improve Heart Function

A

BETA BLOCKERS

Cardiac Glycosides

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16
Q

Betablockers

A

metoprolol, atenolol, propranol, lavetolol

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17
Q

Betablockers act on

A

beta-adrenergic receptors located on the surface of the heart

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18
Q

receptors are normally activated when sympathetic neurotransmitters like _________
are released during stress

A

adrenaline

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19
Q

adrenaline when activated increase _____ _____ and ______as part of ‘flight or fight’
response

A

heart’s rate and force of contraction

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20
Q

unnecessary or chronic stimulation of the beta receptors

A

begin to weaken the heart from overstress and reduce perfusion

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21
Q

Cardiac Glycosides

A

commonly called digitalis (Digoxin)

- derived from a number of naturally occurring plants such as foxglove

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22
Q

Drugs that Improve ↑ blood vessel diameter

A

Vasodilators
Alpha receptor Drugs
Ca+ Channel Blockers
Angiotensin Converting Enzyme(ACE) Inhibitor

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23
Q

Angiotensin Converting Enzyme(ACE) Inhibitor

A

lisinopri l(Zestril), captopril (Copoten), enalapril (Vasotec)

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24
Q

Ca+ Channel Blockers

A

verapamil (Isoptin), nifedipine (Procardia), ditiazem

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25
Alpha receptor Drugs
Alpha-1 receptor antagonist (Prazosin, doxazosin) and Alpha-2-receptor Agonist (Clonidine)
26
Vasodilators
Nitroglycerine vasodilators belong to a group of drugs that are chemically related to nitrates
27
nitroglycerine can be administered through a wide variety of routes
IV, | transdermally (patch, cream), sublingually, and via oral spray
28
other anti-anginal drugs that have similar mechanisms of action to antihypertensives
includes calcium-channel blockers and beta-blockers
29
nitroglycerine almost complete first-pass metabolism, so never given
orally (swallowed) | but may be sublingually, and via oral spray
30
Alpha 1 and 2 receptor found in
the CNS and the smooth muscle of blood vessel walls - alpha-1 receptors located on vascular smooth muscle cells - alpha-2 receptors found in synapses in the autonomic nervous system
31
the alpha receptors respond to sympathetic NT epinephrine and norepinephrine to
alter blood vessel tone - alpha-1 receptor activation has a direct effect to produce vasoconstriction - alpha-2 receptor activation results in a decrease in sympathetic impulses leaving the vasomotor centre resulting in peripheral vasodilation
32
Ca+ Channel Blockers commonly used to treat
high blood pressure by exerting their effects by influencing smooth muscle tone in blood vessel walls
33
Angiotensin Converting Enzyme(ACE) Inhibitor | produces vasodilation by interrupting
the activities of one of the enzymes in the renin-angiotensin system (this system plays a role in long-term blood pressure control )
34
Drugs that Improve alter blood coagulation mechanisms- there are 3 categories of drugs used in the treatment of CVD that influence blood coagulation
anticoagulants (affect blood clotting) - antithrombotics (inhibit thrombosis by altering how platelets adhere together) - thrombolytics (break down clots and thrombi that have already formed)
35
- blood coagulation is a necessary process to stop
bleeding - too much clot formation- can lead to thrombosis which can obstruct the blood vessel - inadequate clot formation- can lead to excessive bleeding
36
- anticoagulants (affect blood clotting) - antithrombotics (inhibit thrombosis by altering how platelets adhere together) - thrombolytics (break down clots and thrombi that have already formed)
Anticoagulants -Heparin (administered parenterally), coumadin- warfarin (admin orally) Antithrombotic -(asprin, persantin) Thrombolytics -(streptokinase, tPA)
37
Drugs that Improve ↓ blood volume
Diurectics -hydrochlorothiazide (Diuril), furosemide
38
Drugs that Improve | ↓ blood lipid levels (↓BV blockage)
1. Bile acid sequestrants 2. Nicotineic acid 3. Fibric acid derivatives 4. HMG Co A reductase inhibitors
39
``` Beta blockers: metoprolol (lopressor), atenolol, propranolol (Inderal), labetalol MoA ```
``` Hypertension: reduce cardiac output, therefore reducing blood pressure Ischemic heart disease: reduced heart rate and cardiac output reduce the workload of the heart Heart Failure: some beta blockers reduce peripheral resistance and workload of the heart ```
40
``` Beta blockers: metoprolol (lopressor), atenolol, propranolol (Inderal), labetalol Adverse Effects ```
``` GI: nausea and diarrhea Resp: bronchospasm (mostly asthmatics or COPD) Cardio: hypotension, heart failure, orthostatic hypotension, bradycardia Endocrine: hypoglycemia, especially in diabetics CNS: fatigue, dizziness, depression ```
41
``` Beta blockers: metoprolol (lopressor), atenolol, propranolol (Inderal), labetalol Massage Therapy Guidelines ```
``` Massage: postural hypotension. May not tolerate lying down. May cause peripheral edema Hydrotherapy: systemic treatments pose a high risk of hypotension, dizziness, falls. Beware of increasing cardiac workload Exercise: beta blockers notorious for causing fatigue during exercise ```
42
CARDIAC GLYCOSIDES | (Digoxin) MoA
``` Heart failure: reduces heart rate, but increases strength of contraction of the heart ```
43
CARDIAC GLYCOSIDES | (Digoxin) Adverse Effects
Toxicity: fatigue, nausea, vomiting, visual disturbances, HA, bradycardia-EMERGENCY. Cardio: bradycardia ,hypotension
44
CARDIAC GLYCOSIDES (Digoxin) Massage Therapy Guidelines
``` dysrhythmias are common side effects. Be aware of dyspnea, angina symptoms while working Hydrotherapy: see general guidelines for heart failure ```
45
VASODILATORS | (Nitroglycerine) MoA
``` Angina: vasodilation of coronary arteries improves blood flow to heart; vasodilation of veins and systemic arteries decrease preload and afterload (decreases workload of the heart) ```
46
VASODILATORS | (Nitroglycerine) Adverse Effects
Hypotension | Headache
47
VASODILATORS (Nitroglycerine) Massage Therapy Guidelines
Considerations as for clients with ischemic heart disease
48
ALPHA RECEPTOR DRUGS- Alpha-2-receptor agonist (clonidine) MoA
Hypertension: acts on the CNS to cause peripheral vasodilation
49
ALPHA RECEPTOR DRUGS- Alpha-2-receptor agonist (clonidine) Adverse Effects
``` CNS: fatigue, drowsiness, sedation Cardio: orthostatic hypotension, hypotension ```
50
ALPHA RECEPTOR DRUGS- Alpha-2-receptor agonist (clonidine) Massage Therapy Guidelines
``` Massage: postural hypotension Hydrotherapy: systemic heat treatments increase risk of hypotension and syncope ```
51
ALPHA RECEPTOR DRUGS-Alpha-1-receptor antagonist ( Prazosin, doxazosin) MoA
``` Hypertension: vasodilation and reduces the force of contraction of the heart Angina: reduces the workload of the heart by reducing contractility ```
52
ALPHA RECEPTOR DRUGS-Alpha-1-receptor antagonist ( Prazosin, doxazosin) Adverse Effects
``` Cardio: edema, bradycardia, congestive heart failure, hypotension, dizziness ```
53
``` ALPHA RECEPTOR DRUGS-Alpha-1-receptor antagonist ( Prazosin, doxazosin) Massage Therapy Guidelines ```
``` Massage: postural hypotension-take care when changing positions. Peripheral edema-poorly treated with massage Hydrotherapy: systemic heat treatments increase risk of hypotension and syncope ```
54
Calcium Channel Blockers: verapamil (Isoptin), nifedipine (Procardia), ditiazem MoA
``` Hypertension: vasodilation and reduces the force of contraction of the heart Angina: reduces the workload of the heart by reducing contractility ```
55
Calcium Channel Blockers: verapamil (Isoptin), nifedipine (Procardia), ditiazem Adverse Effects
``` Cardio: edema, bradycardia, congestive heart failure, hypotension, dizziness ```
56
``` Calcium Channel Blockers: verapamil (Isoptin), nifedipine (Procardia), ditiazem Massage Therapy Guidelines ```
``` Massage: postural hypotension, peripheral edema Hydrotherapy: systemic heat treatments increase risk of hypotension and syncope ```
57
ACE Inhibitors: lisinopril (Zestril), captopril (Copoten), enalapril (Vasotec) MoA
``` Hypertension: vasodilation and reduces blood volume, due to reduced angiotensin II formation ```
58
ACE Inhibitors: lisinopril (Zestril), captopril (Copoten), enalapril (Vasotec) Adverse Effects
Cardio: dizziness, hypotension Resp: cough Fluids: hyperkalemia
59
``` ACE Inhibitors: lisinopril (Zestril), captopril (Copoten), enalapril (Vasotec) Massage Therapy Guidelines ```
``` hypotension-take care when changing position. May not tolerate prone position Hydrotherapy: see calcium channel blockers ```
60
``` Anticoagulants: Heparin (administered parenterally), coumadin- warfarin (administered orally) MoA ```
``` Heparin: activation of antithrombin III and decreased activity of thrombin Coumadin (warfarin): antagonizes vitamin K, needed for clotting factors II, IV, IX, and X ```
61
``` Anticoagulants: Heparin (administered parenterally), coumadin- warfarin (administered orally) Adverse Effects ```
``` Cardio: hemorrhage, ecchymosis Note: Coumadin levels can be altered by a wide range of food and drugs, resulting in under or overdose ```
62
``` Anticoagulants: Heparin (administered parenterally), coumadin- warfarin (administered orally) Massage Guidelines ```
``` Massage: these agents are much more likely to cause hematomas or eccymoses with deep work. Light modalities are necessary ```
63
Antithrombotics prevent or impair
platelet aggregation reduce the risk of dangerous thrombus | formation ---> ANTIPLATELET DRUGS
64
Antithrombotics used in prevention of
arterial thrombosis, especially in the coronary and cerebral arteries
65
thrombi develop as a result of platelet activation with the presence of
thromboxane A2 | causing platelets to aggregate
66
thrombi typically comprises of
aggregated platelets, entrapped red blood cells, and fibrin
67
platelets are important in controlling bleeding but thrombi can be dangerous if
they obstruct | blood vessels
68
aspirin: inhibits
the formation of thromboxanes
69
single dose of aspirin can inhibit platelet aggregation for up to
a week
70
a platelets lifespan is only 6-10 days, so aspirin can inactivate platelets for
most or | all of their short lifespan
71
Thrombolytics | promote disintegration of
clots and thrombi that have already formed
72
disintegration of clots and thrombi depends on the presence of
plasmin (enzyme responsible for breaking down fibrin | mesh)
73
any drug that increases plasmin formation has the potential to be used to
promote clot and | thrombus dissolution
74
streptokinase: drug that is an enzyme that combines with plasminogen to form a
plasminogen-streptokinase complex which facilitates plasmin formation
75
thrombolytics (tPA) are used in the treatment of
arterial and venous thrombi, after strokes and | heart attacks, and to clear IV catheters and other such devices

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