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NURS 212A > Hypertensive Drugs > Flashcards

Hypertensive Drugs Flashcards

(52 cards)

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1
Q

typical ranges of HTN definition

A

60+:
- SBP > 150 mm Hg
- DBP > 90 mm hg
younger than 60+/CKD/DM:
- SBP > 140 mm Hg
- DBP > 90 mm Hg

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2
Q

HTN is a major risk factor for:

A
  • CAD (coronary artery disease)
  • CVD (cardiovascular disease)
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3
Q

BP is equal to ?

A

CO X SVR
cardiac output x systemic vascular resistance

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4
Q

what are the SEVEN MAIN CATEGORIES of DRUGS to help treat HTN?

A
  1. DIURETICS
  2. ADRENERGIC DRUGS
  3. VASODILATORS
  4. ANGIOTENSIN-CONVERTING ENZYME INHIBITORS
  5. ANGIOTENSIN II RECEPTOR BLOCKERS (ARBS)
  6. CALCIUM CHANNEL BLOCKERS (CCBS)
  7. DIRECT RENIN INHIBITORS
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5
Q

describe DIURETICS

A
  • typically are the FIRST LINE for treatment of HTN
  • works by decreasing PLASMA & ECF volumes
  • results:
    DECREASES PRELOAD, CO, and TOTAL PERIPHERAL RESISTANCE
    (have a decreased workload of the heart!)
    **THIAZIDE diuretics are most commonly used
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6
Q

what are the FIVE SUBCATEGORIES of ADRENERGIC DRUGS?

A
  1. Adrenergic neuron blockers (central & peripheral)
  2. Alpha 2 receptor agonists (central)
  3. Alpha 1 receptor blockers (peripheral)
  4. Beta receptor blockers (peripheral)
  5. combo b/w alpha1 + beta receptor blockers (peripheral)
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7
Q

what are our CENTRALLY-ACTING ADRENERGIC DRUGS?

A
  • CLONIDINE
  • METHYLDOPA
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8
Q

how do centrally acting adrenergic drugs work?

A
  • stimulation of ALPHA2-ADRENERGIC RECEPTORS in the brain (reduces renin)
  • decreases SYMPATHETIC OUTFLOW of CNS + NOREPINEPHRINE

*renin - an important starter for the RAAS system that increases BP

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9
Q

what are our PERIPHERALLY ACTING ALPHA1 BLOCKERS?

A
  • DOXAZOSIN
  • PRAZOSIN
  • TERAZOSIN
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10
Q

how do peripherally acting alpha1 blockers work?

A
  • blocks the ALPHA1-ADRENERGIC RECEPTORS, this then decreases BP
  • works by DILATING ARTERIES & VEINS
  • work by increases URINE FLOW/ decreases OUTFLOW OBSTRUCTION by the prevention of SM contractions in the bladder
    **often used for BENIGN PROSTATIC HYPERPLASIA (BPH)
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11
Q

what are our BETA-BLOCKERS?

A
  • PROPRANOLOL
  • METOPROLOL
  • ATENOLOL
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12
Q

how do beta-blockers work?

A
  • reduces HR by blocking the beta1 receptors
  • reduces secretion of RENIN
  • *long term use - reduces PVR (peripheral vascular resistance)
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13
Q

what are our DUAL-ACTION alpha1 & beta receptor blockers?

A
  • LABETALOL
  • CARVEDILOL
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14
Q

how do DUAL ACTION alpha1 & beta receptor blockers work?

A
  • have DUAL HTN EFFECTS on the HEART RATE *blocks beta receptors & has VASODILATION *alpha1 receptors
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15
Q

adrenergic drugs (indications)

A
  • HTN
  • GLAUCOMA
  • managing severe HF (can be used with cardiac glycosides & diuretics)
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16
Q

adrenergic drugs (contraindications)

A
  • acute HF
  • MAOIs
  • PEPTIC ULCERS
  • severe LIVER/KIDNEY DISEASE
  • asthma (w/beta blockers)
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17
Q

adrenergic effects - adverse effects

A
  • can cause FIRST-DOSE SYNCOPE
  • BRADYCARDIA wl REFLEX TACHYCARDIA
  • DRY MOUTH
  • DROWSINESS + SEDATION
  • CONSTIPATION
  • DEPRESSION
  • EDEMA
  • SEXUAL DYSFXN
  • HEADACHES
  • RASHES/NAUSEA
  • REBOUND HTN
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18
Q

Adrenergic drugs - drug interactions

A
  • cns depression w/ ALCOHOL, BENZOs, OPIOIDS
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19
Q

other info for alpha2-adrenergic receptors

A
  • has a HIGH INCIDENCE of UNWANTED ADV EFFECTS (orthostatic hypotension, fatigue, dizziness)
  • is used with other anti-HTN in conjunction
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20
Q

clonidine (catapres)

A
  • decreases BP (main use)
  • also used to manage OPIOID WITHDRAWAL
  • can be ORAL & TOPICAL
  • leads to REBOUND HTN
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21
Q

tamsulosin (flomax)

Study These Flashcards
A
  • not used to control BP
  • indicated for use of BPH
22
Q

doxazosin

Study These Flashcards
A
  • alpha1 blocker
  • reduces BP by DILATION of BV
23
Q

carvedilol (coreg)

Study These Flashcards
A
  • well tolerated
  • dual action
  • used for HTN, HF (with digoxin, diuretics, ACE inhibitors)
  • CONTRAINDICATIONS; DA, cardiogenic shock, severe bradycardia, asthma, conduction sys issues
24
Q

nebivolol (bystolic)

Study These Flashcards
A
  • for HTN and HF
  • is a beta blocker (blocks beta receptors, increases vasodilation)
  • should NOT STOP ABRUPTLY - should be tapered over 1 - 2 weeks
25
what are our VASODILATORS?
- DIAZOXIDE (HYPERSTAT) - HYDRALAZINE (APRESOLINE) - MINOXIDIL (ROGAINE) *also used for hair regrowth - NITROPRUSSIDE (NITROPRESS)
26
MOA - vasodilators
- directly RELAXES the arteriolar or venous SM - decreases SVR, afterload
27
vasodilators indications
- can be used in combo with other drugs; main treatment for HTN - sodium nitroprusside & IV diazoxide; for HYPERTENSIVE EMERGENCIES
28
vasodilators - adv effects
HYDRALAZINE: dizziness, N/V, tachycardia, SLE. rashes, dyspnea, hepatitis, vitamin B6 deficiency MINOXIDIL: T-WAVE CHANGES, pericardial effusion/TAMPONADE, breast tenderness, rashes, thrombocytopenia SODIUM NITROPRUSSIDE; bradycardia, decreases plat. rashes, hypothyroidism/tension. *rare - cyanide toxicity
29
Bidil
- specific adjunct for treatment of HF in african-american patients
30
hydralazine forms
can be ORAL or INJECTABLE - injectable form, mainly used for hypertensive emergencies
31
sodium nitroprusside (nitropress)
- important for ICU setting + severe HTN emergencies - contraindications: DA, severe HR, inadequate CEREBRAL PERFUSION **neurosurgical procedures
32
ACE inhibitors
- SAFE & overall effective drugs - often are FIRST-LINE DRUGS for HF & HTN - can be combined with a THIAZIDE DIURETIC or CCB
33
list of ACE INHIBITORS
Captopril (Capoten) Benazepril (Lotensin) Enalapril (Vasotec) Fosinopril (Monopril) Lisinopril (Prinivil) Perindopril (Aceon) Quinapril (Accupril) Ramipril (Altace) Trandolapril (Mavik) *all end in PRIL
34
ACE inhibitors - indications
- HTN - HF (can be used alone or in combo) - slow progression of LEFT VENTRICULAR HYPERTROPHY after MI *cardioprotective - renal protection *DM patients
35
MOA ACE inhibitors
- inhibitor of ACE - ACE > angiotensin I > angiotenin II - (AII) > vasoconstriction + secretes ALDOSTERONE (adrenal glands) - ALDOSTERONE = more Na + H20 resorption = raises BP
36
primary effects of ACE inhibitors
- reduces BP by decreasing SVR - prevents Na + H2o resorption - creates DIURESIS - decreases work of heart & preload
37
cardioprotective effects of ACE inhibitors
- decreases SVR - prevents complications after MI (ex. ventricular hypertrophy) - decreases morbidity & mortality - considered *drug of choice for HF
38
renal protective effects of ACE inhibitors
- reduces GFR pressure - drug of choice for DM patients** with cardio issues - reduces PROTEINURIA - helps to prevent DIABETIC NEPHROPATHY
39
ACE inhibitors - adverse effects
- fatigue, dizziness, headaches, mood changes, impaired taste - HYPERKALEMIA - dry + nonproductive cough - ANGIOEDEMA - rare/can be fatal - can have FIRST-DOSE HYPOTENSIVE EFFECT
40
what lab values need to be monitored for ACE inhibitors?
- can cause RENAL IMPAIRMENT; creatinine - can cause HYPERKALEMIA; potassium levels
41
captopril (capoten)
- prevents vent. remodeling after HI - reduces risk of HF after MI - has the SHORTEST HALF-LIFE (needs multiple administrations)
42
enalapril (vasotec)
- only ACE that is both ORAL & PARENTERAL - IV route X does not need cardiac monitoring - oral route; PRODRUG - improves chance of survival after MI
43
what are our ARBS (angiotensin II blockers)?
Losartan (Cozaar) Eprosartan (Teveten) Valsartan (Diovan) Irbesartan (Avapro) Candesartan (Atacand) Olmesartan (Benicar) Telmisartan (Micardis) Azilsartan (Edarbi) *all end in SARTAN
44
MOA - ARBs
- affects the VASC SM and ADRENAL GLANDS - blocks binding of AII - blocks VASOCONSTRICTION and secretion of ALDOSTERONE
45
describe and compare ARBs and ACEs
- both are effective/well tolerated for treating HTN - ARBS - DO NOT CAUSE COUGHS vs. ACEs - can cause COUGH - ARBS are more better tolerated/lower mortality after MI
46
ARBs - common adverse effects
- chest pain - fatigue/weakness - HYPOglycemia - diarrhea/UTIs - anemia *less risk for HYPERKALEMIA and COUGH
47
lorsartan (cozar)
- for HTN and HF - careful with RENAL or HEPATIC FAILURE - is NOT SAFE for breastfeeding women/pregnancy
48
calcium channel blockers MOA
- used for HTN and ANGINA - work by causing SM relaxation - blocks CALCIUM to RECEPTORS (X muscle contraction) - decreases SM tone, BP, and SVR
49
indications - CCB
- angina - HTN *amlodipine (norvasc) - dysrhythmias - migraines - raynaud's disease - cerebral artery spasms - subara hemorrhages *nimodipine
50
eplerenone (inspra)
- type of SELECTIVE ALDOSTERONE BLOCKER - blocks ALDOSTERONE at its receptors in the body (kidneys, heart, BV, brain) - for HTN, post-MI HF - is CONTRAINDICATED for HYPERKALEMIA (above 5.6)
51
nursing implications
- always assess! and monitor BP - educate about dosing - assess contraindications and conditions - do not stop meds abruptly - can cause HTN crisis/strokes - oral form - given with FOOD *better absorption - avoid smoking/high Na - changing positions can aid to avoid syncope + hypotension - MALE patients; impotence *expected effect
52
what factors can AGGRAVATE a LOW BP?
- hot tubs, showers, or baths - physical exercise - alcohol ingestion

NURS 212A (32 decks)

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