Drugs for Hypertension

Question 1

normal BP

Answer 1

Below 120/80 mm Hg

Question 2

Prehypertension: (BP)

Answer 2

120-139/80-89

Question 3

Stage 1 hypertension

Answer 3

140-159/90-99

Question 4

Stage 2 hypertension

Answer 4

greater than of equal to 160/100

Question 5

Primary (essential):

Answer 5

no identifiable cause

Question 6

secondary

Answer 6

due to identifiable cause

Question 7

Joint National Committee, 7th Report

Answer 7

Target BP <130/80 for patients w/Diabetes Mellitus or Chronic Kidney Disease

Question 8

3rd leading cause of death throughout the world

Answer 8

“Essential” or “Primary” Hypertension

Question 9

“Essential” or “Primary” Hypertension is 1 in every _____ deaths worldwide

Answer 9

8

Question 10

what percent of americans of hypertension stage one

Answer 10

30%

Question 11

In people under 80, lowering blood pressure

Answer 11

reduces the risk of stroke by 40%; %. It also cuts their odds of a heart attack by 27 % and heart failure by 54%

Question 12

The risk of CVD

Answer 12

beginning with a blood pressure of 115/75 mm Hg, doubles with each increment of 20/10 mm Hg

Question 13

Consequences of Hypertension

Answer 13

Heart Disease; Angina; Myocardial Infarction; Renal- disease; Stroke; Peripheral artery disease; Retinopathy

Question 14

heart disease

Answer 14

Left ventricular hypertrophy (enlarged left ventricle)

Question 15

Peripheral artery disease

Answer 15

poor circulation

Question 16

Why do we treat blood pressure?

Answer 16

• For every 20 mm Hg increase in normal systolic blood pressure from ages 40 to 69, mortality from ischemic heart disease and stroke doubles.

Question 17

Untreated Systolic Blood Pressure has been shown to be a more important predictor of

Answer 17

mortality and CV complications than untreated elevated Diastolic Blood Pressure

Question 18

Factors Increasing Cardiovascular Risk

Answer 18

Cigarette smoking; Obesity; inadequate exercise; dsylipidema; diabetes; Family history of premature cardiovascular disease; Advancing Age; Microalbuminemia

Question 19

Microalbuminemia

Answer 19

(spilling protein into urine)

Question 20

dyslipidemia

Answer 20

high cholesterol

Question 21

Necessary Lifestyle Changes

Answer 21

Weight loss; Sodium restriction (2000 mgs per day); Fruits, vegetables, low-fat dairy , low total fat (30% of calories), low saturated fats, low cholesterol; Alcohol restriction; aerobic exercise; Smoking cessation; Potassium and calcium intake (fruits and veggies)

Question 22

arterial pressure =

Answer 22

cardiac output x peripheral resistance

Question 23

Is there a rule of thumb when starting BP drugs?

Answer 23

Initiate therapy with 2 drugs, either separately or in a fixed-dose combination in patients with SBP greater than 20 mm Hg above the desired goal; One component should usually be a thiazide-type diuretic but other combinations may be appropriate

Question 24

diuretics

Answer 24

reduce preload

Question 25

beta blockers

Answer 25

”olols”, “alols”, “ilols”—decrease contractile state of heart and heart rate (decrease cardiac output)

Question 26

ACE inhibitors

Answer 26

the “prils”—block AT2 via ACE inhibition

Question 27

ARBs

Answer 27

the “sartans”—block AT2 tissue receptors

Question 28

Drugs that block aldosterone

Answer 28

spironolactone, eprelrenone

Question 29

Calcium channel blockers

Answer 29

the “dipines” and others—block calcium channels on peripheral vessels

Question 30

Alpha-1 blockers

Answer 30

the “osins”—rarely used for hypertension; (prazosin/Minipress

Question 31

Alpha-2 agonists

Answer 31

act within brainstem to suppress sympathetic outflow to heart and blood vessels (clonidine/Catapres)

Question 32

Vasodilators

Answer 32

hydralazine/Apresoline, minoxidil/Loniten, sodium nitroprusside/Nipride, nitroglycerine

Question 33

Antihypertensive mechanisms: sites of drug action

Answer 33

Brainstem; Sympathetic ganglia; Terminals of adrenergic nerves; Beta1-adrenergic receptors on the heart; Alpha1-adrenergic receptors on blood vessels; Vascular smooth muscle; Renal tubules; Beta1 receptors on juxtaglomerular cells; Angiotensin-converting enzyme; Angiotensin II receptors; Aldosterone receptors

Question 34

Hydralazine (Apresoline)

Answer 34

Direct-acting vasodilator of arterioles; Peripheral resistance and arterial BP decrease

Question 35

Hydralazine (Apresoline) can cause

Answer 35

tachycardia, palpitations, nausea, anorexia, reflex Systemic Lupus Erythematosus Syndrome, increased blood volume

Question 36

Because of minimal venous dilation with Hydralazine (Apresoline) risk of

Answer 36

orthostatic hypotension is low

Question 37

Sodium Nitroprusside (Nipride) mixed with

Answer 37

Mixed arterial and venous vasodilator

Question 38

Sodium Nitroprusside (Nipride) given to

Answer 38

Given to rapidly reduce blood pressure in clients with hypertensive crisis

Question 39

Sodium Nitroprusside (Nipride)

Answer 39

IV drug, light sensitive (must be covered in dark colored bag); Cyanide is a metabolite of this drug

Question 40

Sodium Nitroprusside (Nipride) result of prolonged use

Answer 40

Cyanide poisoning may result from prolonged use

Question 41

Clonidine (Catapress)

Answer 41

Centrally acting antihypertensive (acts on brain stem)

Question 42

Clonidine (Catapress) called

Answer 42

an alpha 2-agonists –by activating central alpha 2 receptors in brain, clonidine reduces sympathetic outflow to blood vessels and heart. Result? major vasodilation-and bradycardia

Question 43

Clonidine (Catapress) side effects

Answer 43

: drowsiness, poor concentration, forgetfulness, vivid dreams, dry mouth

Question 44

Clonidine (Catapress) abrupt withdraw

Answer 44

will result in rebound hypertension

Question 45

do not use Clonidine (Catapress) in

Answer 45

pregnancy

Question 46

with Clonidine (Catapress) major severe pain with

Answer 46

cancer pts

Question 47

methyldopa (Aldomet) similar

Answer 47

same class) as clonidine (Catapres)

Question 48

methyldopa (Aldomet) inhibits

Answer 48

sympathetic outflow to blood vessels-vasodilates

Question 49

methyldopa (Aldomet) can lead to

Answer 49

hemolytic anemia (10-20% chance) -withdraw drug immediately (monitor for +Coombs test-of the patients who have a Coombs, only 5% develop hemolytic anemia)

Question 50

when pt pregnant this is the DOC

Answer 50

methyldopa (Aldomet)

Question 51

Coombs test detects

Answer 51

presence of antibodies directed against patient’s own red blood cells

Question 52

Prazosin hydrochloride (Minipress)

Answer 52

Peripherally acting alpha1-adrenergic blocking agent (sympatholytic)

Question 53

Prazosin hydrochloride (Minipress) dilates

Answer 53

both arteries and veins

Question 54

Prazosin hydrochloride (Minipress) treats

Answer 54

mild to moderate hypertension

Question 55

with Prazosin hydrochloride (Minipress)

Answer 55

Watch for first dose syncope; major orthostatic hypotension