Antihypertensives

Question 1

Preload

Answer 1

Volume of blood in ventricles at the end of diastole

Question 2

Afterload

Answer 2

Resistance left ventricle must overcome to circulate blood

Question 3

Highest Contributor to Hypertension

Answer 3

Atherosclerosis

Question 4

Normal Blood Pressure

Answer 4

S < 120

D < 80

Question 5

Prehypertension

Answer 5

S 120-139

D 80-89

Question 6

Stage 1 Hypertension

Answer 6

S 140-159

D 90-99

Question 7

Stage 2 Hypertension

Answer 7

S > 160

D > 100

Question 8

Primary Hypertension

Answer 8

No identifiable cause

Chronic, progressive disorder

Question 9

Secondary Hypertension

Answer 9

Identifiable primary cause

Possible to treat the cause directly

Question 10

Hypertension Medication Guidelines

Answer 10

Start medications in lowest available dose

Change medication groups instead of increasing dose if 1st medication is ineffective

Medication dosages are patient-specific

Question 11

Clonidine and Methyldopa

Answer 11

Centrally acting adrenergic drugs

Stimulate alpha-2 adrenergic receptors in the brain

Decrease sympathetic outflow from CNS

Results in decreased BP

Question 12

Methyldopa

Answer 12

Treats pregnancy-induced hypertension

Question 13

Clonidine

Answer 13

Also used for opioid withdrawal

Question 14

Metaprolol

Answer 14

Beta blocker

Reduces heart rate through beta-1 receptor blockade

Causes reduced secretion of renin

Long-term use causes reduced peripheral vascular resistance

Question 15

Labetalol and Carvedilol

Answer 15

Dual-action alpha-1 and beta receptor blockers

Used for increased blood pressure

Dual antihypertensive effects of reduction in heart rate (beta-1 receptor blockade) and vasodilation (alpha-1 receptor blockade)

Question 16

Carvedilol

Answer 16

Used for hypertension, mild to moderate heart failure in conjunction with digoxin, diuretics, and ACE inhibitors

Widely used drug that is well tolerated

Question 17

Adrenergic Drugs

Answer 17

Used to treat hypertension, glaucoma, BPH, severe heart failure

Question 18

Adrenergic Drugs Adverse Effects

Answer 18

HIGH INCIDENCE OF OTHROSTATIC HYPOTENSION

Bradycardia with reflex tachycardia

Drowsiness

Impotence

Question 19

ACE Inhibitors

Answer 19

Large group of safe and effective drugs

Often used as first-line drugs for HF and HTN

May be combined with thiazide diuretic or CCB

Question 20

Captopril and Lisinopril

Answer 20

ACE Inhibitors

NOT prodrugs (inactive in administered form and must be metabolized in the liver to an active form)

CAPTOPIL AND LISINOPRIL CAN BE USED IF A PATIENT HAS LIVER DYSFUNCTION, UNILKE OTHER ACE INHIBITORS THAT ARE PRODRUGS

Question 21

ACE Inhibitors Mechanism of Action

Answer 21

Block ACE and prevent angiotensin II

Prevent breakdown of vasodilating substance bradykinin

Result in decreased afterload (SVR), vasodilation, and decreased BP

Prevent sodium and water reabsorption

Diuresis (decreases blood volume and return to the heart)

Question 22

RENAL PROTECTIVE Effects of ACE Inhibitors

Answer 22

Reduce glomerular filtration pressure

Reduce proteinuria

Prevent progression of diabetic nephropathy

Question 23

CARDIOPROTECTIVE Effects of ACE Inhibitors

Answer 23

Decrease SVR (a measure of afterload)

Used to prevent complications after MI

Ventricular remodeling after MI

Decrease morbidity and mortality in patients with HF

Drug of choice for hypertensive patients with HF

Question 24

Adverse Effects of ACE Inhibitors

Answer 24

Dry, nonproductive cough (causes patients to stop medication)

Hyperkalemia

Question 25

Captopril (Capoten)

Answer 25

Used for prevention of ventricular remodeling after MI Shortest half-life Must be administered PO multiple times throughout the day

Question 26

Enalapril (Vasotec)

Answer 26

ONLY ACE INHIBITOR AVAILABLE IN BOTH ORAL AND PARENTERAL PREPERATIONS Does not require cardiac monitoring Oral enalapril is a PRODRUG Reduces the incidence of HF

Question 27

Angiotensin II Receptor Blockers

Answer 27

Well tolerated Do not cause a dry cough Allow angiotensin I to be converted to angiotensin II, but block receptors that receive angiotensin II Block vasoconstriction and the release of aldosterone

Question 28

Losartan (Cozaar)

Answer 28

Angiotensin II Receptor Blocker

Question 29

Indications for ARBs

Answer 29

Hypertension Adjunctive for the treatment of HF May be used alone or with other drugs

Question 30

ARB Adverse Effects

Answer 30

Chest pain, fatigue, hypoglycemia, diarrhea

Question 31

Calcium Channel Blockers

Answer 31

PRIMARILY TREAT HYPERTENSION AND ANGINA CAUSE SMOOTH MUSCLE RELAXATION BY BLOCKING BINDING OF CALCIUM TO ITS RECEPTORS, THEREBY PREVENTING CONTRACTION Decrease SVR, BP, peripheral smooth muscle tone

Question 32

Indications for CCBs

Answer 32

Angina, hypertension, dysrhythmias, migraines

Question 33

Verapamil (Calan, Isoptin) and Diltiazem (Cardizem)

Answer 33

Calcium channel blockers Can be given IV push followed by continuous infusion as well as PO Used for atrial dysrhythmias

Question 34

Amlodipine (Norvasc)

Answer 34

Calcium channel blocker, given in pills Used for atrial dysrhythmias

Question 35

Adverse Effects of Verapamil

Answer 35

Constipation is the most common complaint Results from blockade of calcium channels in smooth muscle of intestine

Question 36

Adverse Effects of Diltiazem

Answer 36

Less constipation, dizziness, flushing, headache, edema, exacerbates HF Do not drink grapefruit juice

Question 37

Diuretics

Answer 37

FIRST-LINE ANTIHYPERTENSIVES DECREASE VOLUME AND PROTEINS Decrease preload, CO, peripheral resistance, and overall workload and BP

Question 38

Vasodilators

Answer 38

Typically used in emergency situations Act directly on smooth muscle to cause muscle relaxation Used for severe hypertension

Question 39

Hypertensive Emergency

Answer 39

Blood pressure > 180/120 mmHg and must be lowered immediately to prevent damage to target organs

Question 40

Hypertensive Urgency

Answer 40

Blood pressure is very high but no evidence of immediate or progressive target organ damage

Question 41

Nursing Implications

Answer 41

African-Americans respond best to diuretics and CCBs as first line drugs Instruct patients not to stop drugs abruptly Administer IV forms with extreme caution and use IV pump for infusions Remind patients that medication is only part of the therapy Avoid salt substitutes due to high potassium Instruct patients to report unusual SOB