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Hypertension DAY 2 Flashcards

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1
Q

What are the 4 general principles of hypertension medications?

A
  1. ALL can cause hypotension
  2. ALL increase risk for orthostasis/orthostatic hypotension
    - ESPECIALLY in drugs that: DILATE vessels & Decrease fluid volume***!!!
    so you’ll have more of a problem with my Lasix than with beta blockers.
  3. SOME increase risk for bradycardia. Drugs that by nature directly reduces the HR
    - EX: A beta blocker by nature directly lowers heart rate! SO, you need to know their HR BEFORE giving them! But, giving Lasix doesn’t by nature directly lowers your HR. It reduces BP by reducing fluid volume. So, you don’t need to check their HR before giving a diuretics!!
  4. NSAIDS reduce effectiveness of anti-hypertensive meds
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2
Q

How do Diuretics lower BP?

A

Diuretics increase urine (make u pee more) –> Decreases volume/preload –> Decreases stroke volume and C.O. which decreases BP!

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3
Q

What are the general principles for diuretic administration?

A
  1. FIRST LINE treatment for most patients!!!!
  2. Take meds early in the day
  3. Safety precautions for orthostatic hypotension, ESP IN OLDER PATIENTS! (it’s unsafe for them to get up by themselves without assistance since they’re more unsteady &vulnerable).
  4. Monitor weight and I&Os
    - Accurate weight measurement:
    1.) AFTER voiding
    2.) Before breakfast
    3.) Same typa clothing
    4.) Same scale & time of day
  5. Monitor electrolyes
    1) Potassium: 3.5-5.3 mEq/L
    - Signs of hyperkalemia:
  6. Muscle twitching –> cramp –> parasthsia (muscle irritable)
  7. Hypermotility & diarrhea
  8. Cardiac dysrythmia
  9. Lowers BP
    - Signs of hypokalemia:
  10. weakness, fatigue, and tired muscle
  11. decreased motility, N/V, & ILLEUS (gut not working)
  12. Cardiac arrhythmia
  13. Alkalosis, shallow breathing, irritibality, & thready pulse

2.) Sodium electrolytes
- Signs of Hyponatremia:
1) SALTLOSS (Stupor/coma, Anorexia&N/V, Lethargy, Tendon reflexes, Limp muscles, Orthostatic hypotension, Seizures&headache, Stomach cramping).

  1. DIETARY changes
    -Potassium with loops and thiazides: Potassium rich foods & potassium supplements
    - Potassium with K+ sparring: AVOID SALT substitutes (cz high in potassium)
  2. Monitor for signs of dehydration:
    1) MILD to Moderate dehydration: Dry mouth, headache & dizziness, sleepiness, concentrated urine (Darker color), & CONSTIPATION
    2) SEVERE dehydration: Extreme thirst and dry membranes, little to no urine output & VS changes, change in LOC
  3. Key drug interactions:
    1) Digoxin: increased digoxin toxicity risk. Digoxin work on potassium receptor sites, so if there’s low potassium, that’s going to leave more room for digoxin cause an increase in digoxin toxicity! SO, EVEN WITH A NORMAL LEVEL OF DIGOXIN, IF POTASSIUM IS LOW, IT CAN CAUSE DIGOXIN TOXICITY!
    2) LIthium- increased lithium toxicity risk
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4
Q

What are the prototype for Loop diuretics????

A
  1. Furosemide/Lasix
  2. BUMEtadine / BUMEx
  3. TORSEmide/ Demedex
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5
Q

What is Furosemide/Lasix?

A

LOOP diuretic!!

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6
Q

What drugs can cause Heart block and why??
What can cause heart failure??? SIGNS?

A

Beta blockers and Calcium channel blockers!! because they both reduces CONDUCTION SPEED!! when conduction speed decreases, then that will cause 1ST degree AV Block (heart block) bc of the decrease conduction speed from SA node to AV node (that’s why PR segment would be widen a lil bit because conduction takes a longer time to the AV node than usual).

Drugs that decreases contraction strength will cause heart failure!! because since blood isn’t pumping blood out as much bc contraction strength has decreases.
then you won’t get good preload pushing the blood out in return (Starling Mechanism) which causes decrease in Preload and blood to build up and build up causing edema. This the same sign like LOW PERFUSION bc heart failure causes fluid not going to all over the body (poor perfusion); signs include SOB, altered mental change, drowsiness, decreased capillary refill, etc…

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7
Q

What is the MOST POTENT diuretics???

A

LOOP diuretics!!!

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8
Q

Which diuretic is the FIRST LINE TREATMENT for mild hypertension?

A

Thiazide hypertension!!!

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9
Q

What’s is Potassium Sparing Diuretics considered to be? What does it mean?

A

Aldosterone INHIBITOR (antagonism) — Sodium and water excreted and POTASSIUM is retained !

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10
Q

What drugs can cause HEART BLOCK OR 1ST DEGREE AV BLOCK??? WHY??

A

Beta blockers and Calcium channel blockers!!!!

Because 1ST degree AV block happens when the conduction from SA node to AV node takes a long time (that’s why PR segment is widen if u see the ECG) And these drugs cause it because they both DECREASES CONDUCTION SPEED!!!!

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11
Q

What is the prototype for Potassiun Sparing diuretic?

A

Spironolactone / Aldactone!!!

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12
Q

What would you give to someone who OVERDOSED on Beta Blockers??????

A

Antidote: GLUCAGON!!!

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13
Q

What endocrine effects/ sex hormones changes are possible for Potassium Sparing diuretics???

A
  1. Mestrual changes
  2. Gynecomastia (enlargement of the breast)
  3. Hirsutism (unwanted growth of facial hair)
  4. Impotence (men won’t be able to get or maintain erection)
  5. Voice changes
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14
Q

What does Glucagon do? What do you give it through? Sign/symptoms?

A
  1. INCREASES HR & Contractility
  2. IV Bolus, possible drip
  3. S/E: N/V and HYPERGLYCEMIA!
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15
Q

Which Antihypertensives do you need to ASSESS the patients HEART RATE BEFORE giving it??

A

(remember from the general principles!!!!! it’s only those drugs that work directlY on reducing the heart rate because they may cause bradycardia!! so a pt. with diuretic wouldn’t need to be checked for HR bc they don’t directLY by nature work on reducing the HR but more on reducing the volume)!!!

  • ## Central Acting Alpha2 Agonists
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16
Q

Which drug helps with alcohol withdrawal?

A

Alpha 2 adrenergic agonists

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17
Q

What drugs are in the Alpha1- Beta blockers????

A
  1. Labetalol (Normodyne and Trandate)
  2. Curvedilol (Coreg)

(NON-SELECTIVE BETA BLOCKADE)

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18
Q

What general things do u know about Alpha1- Beta blockers

A
  1. They are using NON-SELECTIVE beta blockade!!!
  2. Decreases HR (DUHHH)
  3. Used for HYPERTENSIVE EMERGENCIES!!!
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19
Q

What are the drugs of Calcium Channel Blockers?????

A

“Noo.. Very Nice Drugs, Aha!”

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20
Q

What are the general things you need to KNOW for Calcium Channel blockers???

A
  1. Lowers HR
  2. Other adverse effects:
    1) Heart failure (cz of decrease in contraction strength)
    2) Arrhytmias: Bradycardia (cz of Low HR), AV BLOCK (cz of decreased conduction speed), and ventricular rhythms..
    3) Constipation    * !!!
    4) CNS Changes: like sleepy and dizzy***
  3. NO GRAPEFRUIT JUICEE!!!!!! –> can increase drug levels and HYPOtensive affect
    **4. Verapamil and Diltiazem (Cardizem) increase risk FOR DIGOXIN ACTIVITY!!!
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21
Q

What’s the antidote for Calcium Channel blockers (when u overdose)????

A

GLUCAGON!!!!!!!!!!

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22
Q

Which 2 calcium channel blockers cause an increase risk for DIGOXIN activity???

A
  1. Verapamil (Calan)
  2. Diltiazem (Cardizem)

VERA and DILTIA (v and d)

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23
Q

What drugs can cause Heart failure? What signs would you see?

A

Beta blockers and Calcium chanel blockers! because both decreases CONTRACTION strength. heart won’t have enough force to pump blood out, then fluids won’t be perfused to the whole body and fluids gonna pile up and up causes edema (pulmonary edema = left side of heart; and peripheral edema = right side). SO SIGNS OF HEART FAILURE IS ALSO SIGNS OF POOR PERFUSION!!! Including: weakness, fatigue, mental status changes, SOB, decreased capillary refill, ect…

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24
Q

WHAT should you not consume with Calcium Channel Blockers???????

A

GRAPEFRUIT JUICE!!!!!!!!

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25
What is the prototype for ACE inhibitor???
CAPtopril (Capoten). "PRIL" drugs!!!
26
How does ACE inhibitor lower BP
It inhibits the production of Angiotensin I --> II.
27
What are the 8 general things I need to know about ACE inhibitors????
*1. Cardiovascular and Renal PROTECTIVE USE!!! 2. Increase risk for lithium toxicity!!! 3. Increase risk for Neutropenia (low WBC) -- LOOK FOR SIGNS OF INFECTIONS 4. Don't give to PREGNANT patients ---------- 5. ** Watch for 1st dose orthostatic hypotension!!! esp if combined with diuretics! 6. Can cause CAPTOPRIL COUGH!!! - occurs in 5-10% - Most common reason pt. stop the treatment - DO NOT STOP TAKING THE DRUG BUT CONTACT HCP SO THEY CAN SWITCH TO ANOTHER DRUG!!! 7. Angioedema - constricts airway - *STOP IMMEDIATELY!!! GIVE EPINEPHRINE SUBCUTANEOUSLY!!! - *Most common in: AFRICAN AMERICAN & PPL WHO ALREADY HAVE LUNG ISSUE (copd, asthma, etc) 8. Watch Potassium and Sodium levels - Avoid eating potassium supplements & salt substitutes (cz they're high in potassium) - Don't take with Potassium Sparing Diuretics!!!! (or other drug that hold on to potassiums)
28
What are drugs in the Angiotensin II Blockers Classification??
1. Losartan (Cozaar) OTHER "SARTAN" drugs!!!!!!
29
What are the 7 things you need to know about LOOP diuretics??
1. HIGHLY potent diuretic drugs 2. Monitor lipid leves, electrolytes (esp potassium) 3. Increased calcium excretion. Implications: Calcium loss & bone mineralization 4. CHECK FOR SULFA ALLERGIES 5. Ototoxicity potential ( so don't give too quickly). SIGNS: hearing loss & ringing in the ears. 6. SLOW administration of IV!!!!!! (too quick can cause drop blood pressure to be too low ) 7. HYPERURICEMIA** Implications: 1. Fluid loss 2. Blood concentration 3. Decreased uric acid excretion 4. Crystal Formation (in joint spaces the causes lots of pain)
30
If someone is on diuretics, would you want to dehydrate them patient or no????
YES! MAKING SURE THEY'RE still drinking good fluid volume!!! ( if they're dehydrated it can cause them to have vascoconstriction in order to compensate which causes increased in bp.) make sure u hydrate them so that this doesn't happen
31
What are the prototypes for thiazide diuretics?????
1. Hydrochlorothiazide (HCTZ) and chlorothiazide
32
What are the 4 things you need to know about thiazide diuretics?
1. WEAKER than loop diuretics BUTTT FIRST LINE of TREATMENT for mild hypertension; ** 2. Not recommended for pt. with renal insufficiency 3. Check for sulfa allergies***** 4. Monitor lipid levels, elytes, uric acid!!!
33
What is the prototype for potassium sparing diuretics????
1. Spiranolactone (Aldactone)
34
What are the 3 things you need to know about potassium sparring diuretics????
1. Weaker diuretic and antihypertensive effect!!!!!!! 2. POTASSIUM IS CONSERVED: 1) Hyperkalemia potential 2) AVOID combining with potassium supplements or other drugs that contribute to retain such as ACE inhibitors or ARBs 3) AVOID salt substitutes (high in potassium) 4) DON;T EAT potassium rich foods 5) CAREFUL in patients with renal dysfunction, NOT FOR patients with severe kidney disease!!!! 3. ENDOCRINE EFFECTS (works on estrogen & progesterone, our sex hormones): Menstrual changes, GYNECOMASTIA (enlargement of breast tissue), HIRSUTISM (Unwanted facial growth), IMPOTENCE (not being able to get/maintain erection), VOICE CHANGES!!!
35
What drug classification can cause endocrine effects??? what are they?
Potassium Sparring Diuretics!!! 1. menstrual changes 2. Gynecomastia 3. Hirsutism 4. Impotence 5. voice changes
36
What are the prototypes for Central Acting Alpa 2 Agonists???
1. Clonidine (Catapress) 2. Methyldopa (Aldomet)
37
How do Central Acting Alpa 2 Agonists lOWER BP??
1. Relaxes blood vessels (remember, this means it can cause orthostatic hypotension) 2. Decreases HR** (remember, this means u need to know their HR before giving the drugs to them) 3. Decreases contraction strength
38
What are the 5 essential things we need to know about Central Acting Alpa 2 Agonists???
1. DONT STOP ABRUPTLY bc it can cause rebound hypertension 2. Cause DROWSINESS, careful driving!! (adverse effect lasts 4-6 weeks) 3. Caution with elderly; ORTHOSTATIC HYPOTENSION and COGNITIVE dysfunction 4. Use as ALCOHOL WITHDRAWAL***! 5. LOWERS HR; SO KNOW THEIR HR BEFORE giving em so u don't cause bradycardia
39
What are the prototypes for Peripheral Alpha1 Adrenergic Blockers????
1. Prazosin (Minipress) 2. Terazosin 3. Doxazosin (Treat BPH benign prostatic hyperplasia)
40
How do Alpha1 Adrenergic Blockers help with BP?
Vasodilates & relaxes bladder neck and prostate gland !!!
41
What are the 2 things essential to know about Alpha1 Adrenergic Blockers?
1. 1st dose hypotension, ORTHOSTATIC hypotension - When to give 1st dose??? When they're already recumbent (laying down) 2. Additional response to alpha1 blockade? 1. relaxes bladder neck and prostate gland 2. MIOSIS* 3. INHIBITION OF EJACULATION*
42
What are the Beta blockers prototypes??
Metoprolol (Lopressor) & any other "LOL" drugs!
43
How do Beta blockers Lower BP?
1. Decreases HR 2. Decreases contraction strength 3. Decreases conduction speed 4. Decreases speed of conduction 5. Decreases renin release
44
What are the 6 Essential things to know about Beta blockers????
1. Heart rate decreases (ASSESS HR BEFORE GIVING TO PREVENT BRADYCARDIA) 2. **Can cause/worsen heart blocks (1st degree AV Block) because we're slowing down conduction speed thru the AV node!! 3. Monitor for heart failure!! Because decreases in contraction strength will cause this which leads to low perfusion. thus SIGNS of heart failure is LOW PERFUSION: SOB, edema, Altered mental changes, fatigue, etc.. 4. Common side effects: Fatigue, Weakness, "Beta blocker Blues" or Depression, Sexual dysfunction, and Weight gain!!! 5. Watch for diabetic patients!!!! WHY? 1.) "Masking" of symptoms of Hypoglycemia 2.) Decreased GLUCONEOGENESIS or GLYCOGENOLYSIS 6. Relative selectivity vs. Non-selective (Non selective drugs HAVE MORE SIDE EFFECTS!!!!). Blockade of beta 2 receptors can cause: Bronchoconstrition --> bad for ppl with pulmonary disease; Inhibition of glycogeneolysis with SOME beta blockers (NOT METOPROLOL***) - Bad for those who are diabetics and taking insulin - Selective: Metoprolol, Atenolol, Esmolol - Nonselective: Propranolol, Nadolol, Labetalol, Carvelol
45
Which out of selective vs non selective have more side effects???
NON-SELECTIVE BETA blocker DRUGS
46
Does metoprolol cause the inhibition glycogeneolysis??
NOOO
47
What are the Selective and Non-selective Beta blockade drugs??
1. Selective: Metoprolol, Atenolol, Esmolol 2. Nonselective: Propranolol, Nadolol, Labetalol, Carvelol
48
What are the prototypes for Alpha1-Beta Blockers????
1. Labetalol (Normodyne and Trandate) 2. Carvelol (Coreg)
49
What are the 3 things to know about Alpha1-Beta Blockers????
1. NON-SELECTIVE beta blockade. Implications? NOT good for those who have pulmonary disease cz of bronchoconstricting) 2. HR DECREASES (ASSESS BEFORE) 3. ** USED for HYPERTENSIVE EMERGENCIES!!!!!!
50
What are the prototypes for Calcium Channel blockers?
"No... Very Nice Drugs, Aha!" 1. Nifedipine (Procardia) 2. Verapamil (Calan) 3. Nicardipine (Cardene) 4. Diltiazem (Cardizem) 5. Amlodipine (Norvac)
51
How do calcium channel blockers lower BP??
1. Dilates blood vessels 2. Decreases HR 3. Decreases contraction strength 4. Decreases conduction speed
52
What are the things you need to know about calcium channel blockers???
1. Lowers HR (ASSESS BEFORE!!!) 2. Possible adverse effects include: 1) Heart failure (bc of Reduces in contraction strength; signs will be like of low perfused) 2) Arrhythmias (bradycardia, AV blocks--> bc of decreases in conduction speed; Ventricular rhythms) 3) Constipation 4) CNS changes like sleepy and dizzy 3. AVOID GRAPEFRUIT JUICE!!!!!! - Increased drug levels and hypotensive affect 4. Verapamil and Diltiazem INCREASE risk for digoxin toxicity!!!
53
What is the antidote for Calcium channel blockers??
GLUCAGON!!!
54
What are the prototypes of ACE inhibitors ??
1. Captopril (Capoten) and other "PRIL" drugs!
55
How do ACE inhibitors lower BP?
Inhibit the conversion of Angiotensin 1 to 2!
56
What are the 8 things to know about ACE inhibitors?
1. Cardiovascular and Renal protective use 2. Risk for lithium Toxicity 3. Risk for neutropenia -- look for signs of infections (being sick all the time for ex) 4. DON'T use in PREGNANT woman ----------- 5. Watch for 1st dose Orthostatic Hypotension!!! ESP if combined with diuretic! 6. Watch for CATOPRIL COUGH!!!! - Occurs in 5-10% patients - Most common cause for not taking this drug - DON'T STOP THE DRUG BUT LET HCP KNOW SO THAT THEY CAN SWITCH TO SMTH ELSE!! 7. ANGIOEDEMA potential - Airway constricts - STOP THE DRUG IMMEDIATELY AND GIVE EPINEPHRINE SUBCUTANEOUSLY* - Who is most at risk?? African American and ppl with pulmonary disease like COPD & asthma 8. Watch sodium and potassium levels 1. AVOID potassium supplements and salt substitutes 2. Not be taken with POTASSIUM SPARING DIURETIC!!
57
For ACE inhibitor what drug would you combine with and will make an even greater risk in Orthostatic hypotension?
If combined with diuretics!!!
58
wHAT OTHER drug would you not recommend taking ACE inhibitors with???? Why?
POTASSIUM SPARING DIURETICS!! Because that'll increase potassium retention!!
59
What are the key drug interactions of all diuretics (Need to avoid/be careful of)
1. DIGOXIN 2. LITHIUM
60
Which diuretics can cause OTOTOXICITY???? WHAT are the implications for ototoxicity??
LOOP DIURETICS!!!!!!! implications: loss of hearing & ringing in the ears!
61
What is the most potent diuretic???
LOOP DIURETIC!!!
62
Which drug can cause Hyperuricemia??? implications of it?
LOOP DIURETIC!!!! (Thiazide can also!!!) Implications: 1. Fluid loss 2. Blood concentration 3. Decreased uric acid excretion 4. CRYSTAL formation
63
Which drugs can cause SULFA ALLERGIES???
LOOP and THIAZIDE diuretics!!!!!
64
What drugs cause endocrine effects??
Potassium sparring diuretics!!!!
65
Which drugs not good for patients who have renal insuffiecinecy/ kidney disease??
Thiazide and Potassium Sparing diuretics!!!!
66
Which drug can be used as a ALCOHOL WITHDRAWAL??????
ALPHA 2 AGONISM!!
67
WHAT ARE THE patient teaching for ALPHA 2 AGONISM DRUGS????
1. DON'T STOP ABRUPTLY bc it can cause rebound hypertension 2. Can cause drowsiness (Adverse effects 4-6 weeks) 3. Orthostatic hypotension AND cognitive dysfunction; SO DON'T DRIVE WHILE TAKING THIS MED!!! 4. can be used as ALCOHOL withdrawal!!!! 5. HR Decreases (for nurses: check their HR before giving this so they don't have bradycardia!!!!!)
68
What's the generic name for Prazosin? What type of drug is this?
Prazosin (Minipress) This is ALPHA 1 BLOCKER!!!
69
What are the side effects of Beta blockers???
Fatigue, weakness, "Beta blocker Blues" or Depression, Sexual dysfunction, and WEIGHT gain
70
Which drug is used for hypertensive emergencies??
Alpha1-Beta blockers!!!
71
What are the prototypes for Alpha1-Beta blockers????
1. Labetalol (Normodyne and Trandate) 2. Carvedilol (Coreg)
72
How does Glucagon work?? Through what can you use it? And what are its S/E?
- Glucagon increases HR and contractility - IV bolus, possible drip - S/E: N/V and hyperglycemia!!
73
What are the essential things you need to know about Alpha1-Beta blockers?
1. Non-selective beta blockade 2. Decreases HR (assess HR before) 3. Used for HYPERTENSIVE EMERGENCIES
74
How does Calcium channel blockers lower BP?
1. Vasodilation 2. Decreases HR 3. Decreases contractility 4. Decreases Conduction speed
75
What are the 4 important things to know about Calcium channel blockers??
1. Lowers HR 2. Other possible adverse effects: 1) Heart failure 2) Arrhtymias (Bradycardia, 1st degree AV block, ventricles rhythms) 3) CONSTIPATION* 4) CNS changes** 3. AVOID GRAPEFRUIT JUICE!!!! ** 4. Diltiazem (Cardizem) and Verapamil (Calon) INCREASE RISK FOR DIGOXIN TOXICITY**!!!!!
76
Which drug causes Constipation AND CNS changes?
Calcium Channel blockers!!!!!
77
Which 2 calcium channel drugs cause increase risk for Digoxin?
"DVd" Diltiazem (Cardizem) and Verapamil (Calan)
78
If you see a patient saying that they have been sick with fever this month 5 times already. What type of drug would you think may cause that?
ACE inhibitors!!!! Because ACE inhibitors increase risk for NEUTROPENIA! Look signs for INFECTION!!!! In this case, the patient has infection!!!
79
What kind of treatment would you do for patient who is taking ACE inhibitor and then later develop Angioedema??
ANGIOEDEMA = STOP IMMEDIATELY!! THEN, Give EPINEPHRINE SUBCUTANEOUSLY !!!!
80
Who is at most risk for the angioedema effect of an ACE inhibitor drug?????
1. AFRICAN American 2. Ppl who already have pulmonary disease (COPD, Asthma, emphysema, etc)
81
Do not combine ACE Inhibitor with what drug?
Potassium Sparring diuretics!!!!
82
What could happen if you take ACE inhibitors and Diuretics together?
Higher risk for Orthostatic hypotension!
83
Which drug is it that may cause the CAPTOPRIL cough????
ACE inhibitors only!
84
Potassium Sparring diuretic should always NOT be with what drug???
ACE inhibitors!! (and also ARBs)!!
85
What are the prototype for Angiotensin II Blockers (ARBs)?????***
Losartan (Cozaar) and other "SARTAN"*** drugs!!!!!
86
What are important things to know about ARBs (angiotensin II inhibitors)???
1. Works the same as ACE inhibitors, but, there's NO cardiovascular protective use & NO Cough!! 2. Risk for Lithium toxicity 3. Risk for Hyperkalemia 4. Potential for angioedema (but less likely) 5. DON'T GIVE TO PREGNANT patient *** 6. With Losartan (Cozaar), watch for Heart Failure!!!!!****
87
Which drugs are not good to take for Pregnant patients???
ACE inhibitors, ARBs, and Direct renin
88
What kind of OTC would you want to avoid with Antihypertensives?????******
OTC Cold remedies like Decongestants!!!!!!!!! So, pseudoephedrine (Sudafed) drug should be AVOIDED!!!!!!

ADULT Health (24 decks)

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