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Pharmacotherapeutics > Week 8- Drugs affecting BP > Flashcards

Week 8- Drugs affecting BP Flashcards

(105 cards)

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1
Q

What elements determine blood pressure?

A
  • HR
  • SV
  • TPR
    (total peripheral resistance)
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2
Q

Why does hypertension increase your risk of CAD?

A
  • Thickening of heart muscle (becomes less efficient, less coordinated, and leads to failure
  • Increased pressure
  • Increased workload
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3
Q

Hypertension is a major risk factor for what?

A
  • CAD and cardiac death
  • stroke
  • Renal failure
  • Loss of vision
  • Dementia
  • Erectile dysfunction
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4
Q

What situations can cause hypotension?

A
  • Heart muscle is damaged and unable to pump effectively
  • Severe blood loss, volume drops dramatically
  • Extreme stress when body’s levels of norepinephrine are depleted (unable to respond to stimuli)
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5
Q

What are the 2 classifications for hypertension?

A
  • UNKNOWN CAUSE 90%(idiopathic or primary hypertension)
  • KNOWN CAUSE 10%
    (secondary hypertension)
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6
Q

What is masked hypertension?

A

Patient’s BP is less than 140/90 mm Hg in a medical setting but is hypertensive at home

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7
Q

What is white coat hypertension?

A

Patient’s BP is less than 140/90 mm Hg at home but is hypertensive in a medical setting

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8
Q

What are the non-modifiable risk factors of hypertension?

A 
Age (rigidity of blood vessels)
Gender
Ethnic Background (African decent)
Family History
Medication Use
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9
Q

What are the modifiable risk factors of hypertension?

A 
Smoking
Obesity
Poor dietary habits
High sodium intake
Sedentary lifestyle
High alcohol consumption
High stress
Medication
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10
Q

What are the symptoms of hypertension?

A
  • no symtoms

- severe hypertension may present with headaches

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11
Q

When should hypertension be treated?

A
  • at 140/90 mm Hg
  • at 130/80 mm Hg in those with diabetes
  • at 150/90 for those 80+
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12
Q

How is hypertension treated?

A
  • combination of drugs and lifestyle
  • regular follow up to ensure correct drug amounts
  • focus on adherence
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13
Q

What classifies you as having normal BP or being hypertensive?

A
  • Normal
    120/80-129/89
  • High Normal
    130/85-139/89
  • Hypertension greater than or equal to 140/90
    -Hypertension (age 80+) greater than or equal to 150/90
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14
Q

In what order are antihypertensives tried?

A

Try in following order

  • thiazide
  • ACEI
  • ARB
  • Long-acting CCB
  • Beta-blockers
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15
Q

What kind of lifestyle modifications should be made?

A
  • Healthy eating
  • Regular physical activity
  • Weight loss (waist circumference/BMI)
  • Moderation in alcohol consumption (no more than 2 drinks per day)
  • reduce dietary sodium
  • stress reduction
  • smoking cessation
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16
Q

What diet recommendations are given?

A
  • FRESH fruits and vegetable, low fat dairy, dietary and soluble FIBRE, plant protein
  • LOW in SATURATED FAT, CHOLESTEROL and Na (less than 2300mg/day)
  • Dietary POTASSIUM; Daily dietary intake greater than 80mmol
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17
Q

What are the physical activity recommendations?

A

FITT (frequency, intensity, time, type)

Frequeny: 4-7 days per week in addition to normal daily activity
Intensity: Moderate
Time: 30-60 min (you can split it up)
Type: Cardiorespiratory activity (walking jogging, cycling, non-competitive swimming)

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18
Q

What is the recommendation for weight loss?

A
  • BMI over 25, encourage weight reduction (healthy btw 18.5-24.9kg/m2)
  • Waist circumference: Men less than 102 cm and women less than 88cm
    (Measure just above iliac crest)
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19
Q

What are the alcohol intake recommendations?

A

0-2 standard drink/day
Men: 14 per week
Women: 9 per week

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20
Q

What does DASH stand for?

A

dietary approaches to stop hypertension

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21
Q

What are diuretics?

A

decrease sodium levels and blood volume

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22
Q

What are beta-blockers?

A

leads to a decrease in HR and strength of contraction; cause vasodilatation

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23
Q

What are ACEI?

A

drugs that block the conversion of angiotensin 1 into angiotensin 2; angiotensin 2 receptor blocker; blocking effects of angiotensin on blood vessels

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24
Q

What are calcium channel blockers?

A

Relaxes muscle contraction or other autonomic blockers

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25
What are ARBs?
drugs that block vasoconstriction and release aldosterone
26
What are the drugs that control blood pressure?
``` diuretics BB ACEI CCB ARB ```
27
What is the first line treatment for diabetics with hypertension?
ACEI
28
What is the action of ACEI?
- blocks ACE from converting of angiotensin1 to angiotensin 2 - this leads to a decrease in BP, a decrease in aldosterone production, small increase in serum potassium and sodium, and fluid loss
29
What are ACEI indicated for?
- hypertension (first line for diabetic hypertension) - CHF - Diabetic nephropathy - Left ventricle dysfunction after MI - reduction of proteinuria and slowing progression of renal impairment
30
What are the pharmacokinetics of ACEI?
Well absorbed, widely distributed, metabolized in the liver, and excreted in the urine and feces
31
What are the contraindications of ACEI?
- allergy - impaired renal function - pregnancy and lactation - cautioned for CHF
32
What are the adverse effects of ACEI?
- Related to the effects of vasodilatation and alterations in blood flow - GI irritation - Renal insufficiency - Cough (may cause sleep disturbance)
33
What are the drug to drug interactions for ACEI?
Alloperinol | ask about NSAIDS
34
What do ACEI end in?
- pril
35
What is the prototype for ACEI and what route is it given?
Captopril - PO - (onset 15m and peak 30-90m)
36
What does ACE stand for?
angiotensin converting enzyme
37
What are ARBs?
Angiotensin 2 Receptor Blockers
38
What are ARBs indicated for?
- hypertension - adjunct for HF (such as diuretics) - used primarily for those who cannot tolerate ACEI
39
Can ARBs be used with diuretics?
- yes
40
What are ARB contraindications?
- allergy - pregnancy and lactation - cautioned for renal and hepatic dysfunction and hypovolemia
41
What are the adverse effects of ARBs?
Headache, dizziness, syncope, weakness GI complaints Skin rash or dry skin
42
What do ARBs end in?
-artan
43
What are ARB drug interactions?
Phenobarbital
44
What is syncope?
loss of consciousness due to BP falling
45
What is the prototype for ARBs?
Losartan
46
What is the action of calcium channel blockers (CCB)?
- Inhibits the movement of calcium ions across the membranes of cardiac and arterial muscle cells - depressing the impulse and leading to slowed conduction, decreased myocardial contractility, and dilation of arterioles - thus lowering BP and decreases myocardial oxygen consumption
47
What are CCB indicated for?
- treatment of ESSENTIAL HYPERTENSION in the extended release form - effective for angina - can be used for migraines
48
When are CCB contraindicated?
- allergy - heart block or sick sinus syndrome - renal and hepatic dysfunction - pregnancy and lactation
49
What are the adverse effects of CCB?
- Related to effects on CO - GI - CV
50
What is the drug interaction with CCB?
Cyclosporine
51
What do CCB end in?
- dipine | mostly however prototype is Diltiazem
52
What is the prototype for CCB?
Diltiazem
53
What are BABA?
Beta-Adrenargic Blocker Agents
54
What do beta-adrenargic blockers do?
- competitively block beta-receptors in the SNS (in the heart and juxtaglomular apparatus of the nephron)
55
What are beta-adrenargic blockers indicated for?
``` Treatment of CV problems - hypertension - angina - migraines Prevention of reinfarction after MI ```
56
Why are beta-adrenargic blockers not often used?
lots of adverse effects
57
What are the contraindications and cautions for BABA?
``` Contraindications - Allergy - Bradycardia, heart block, shock, or CHF - COPD, asthma Caution - Diabetes, hepatic dysfunction ```
58
What are the pharmacokinetics of BABA?
Absorbed in the GI tract and metabolized in the liver
59
What are the adverse reactions of BABA
- Fatigue, dizziness, depression, sleep disturbances - Bradycardia, heart block, hypotension - Bronchospasm - Nausea, vomiting, diarrhea - Decrease libido - Decreased exercise tolerance
60
What are the drug interactions with beta-adrenergic blockers (BABA)
- Clonidine - NSAIDS - Insulin or antidiabetic medications
61
What do BABA typically end in?
-olol
62
What is an off label use for BABA?
- stage fright - migraines - alcohol withdrawal syndrome - supraventricular tachycardias
63
What is the prototype for BABA?
Atenolol
64
What are the 4 classes of diuretics?
- Thiazide and Thiazide-like Diuretics - Loop Diuretics - Potassium-Sparing Diuretics - Osmotic Diuretics
65
What do diuretic do?
- work on the kidneys do decrease reabsorption of sodium, chloride, water and other substances; thus decrease the workload on the heart and decrease BP
66
What are the indications of diuretics?
- edema associated with CHF - acute pulmonary edema - HF - hypertension - Liver disease (including cirrhosis) - Renal disease - Conditions that cause hyperkalemia
67
What do you do if the hypertension is not responding to the diuretic?
Try combo therapy with anti-hypertensive - or - Monotherapy with a different type of anti-hypertensive
68
What is the action of thiazide and thiazide-like diuretics?
block chloride pump (keeps chloride and sodium in tubules)
69
What are the indications of thiazide and thiazide-like diuretics?
``` edema associated with - CHF - Liver disease - Renal disease (mono therapy or adjunct) ```
70
What are the pharmacokinetics of thiazide and thiazide-like diuretics?
Well absorbed for the GI tract, metabolized in the liver and excreted in the urine.
71
What are the contraindication and cautions of thiazide and thiazide-like diuretics?
``` CONTRAINDICATION - Allergy to thiazides or sulfonamides - Fluid and electrolyte imbalances, and renal and liver disease - Bipolar disorders - Pregnancy and lactation CAUTIONS - Gout - Systemic lupus - Diabetes - Hyperparathyroidism ```
72
What are the adverse effects of thiazide and thiazide-like diuretics?
- Related to interference with the normal regulatory mechanisms of the nephron - Hypokalemia - Decreased calcium excretion - Altered blood glucose levels - Urine will be slightly alkalinized (polyuria, noturia) - orthostatic hypotension - GI (nausea, vomiting, diarrhea, anorexia, dry mouth)
73
What is hypokalemia?
Hypokalemia- less than 3.5 mmol/L of potassium in the blood (common signs muscle cramping; can effect the heart muscle) Normal 3.5-5 mmol/L
74
What are the drug-to-drug interactions with thiazide and thiazide-like diuretics?
- Cholestyramine or colestipol - Digoxin - Antidiabetic agents
75
What is the thiazide diuretic prototype?
hydrochlorothiazide | - PO (onset 2h, peak 4-6h, duration 6-12h)
76
Name some loop diuretics.
Furosemide (Lasix) - Most commonly used; less powerful than new drugs; larger margin of safety for home use Bumetanide (Bumex) and Torsemide (Demadex) - New drugs; more powerful than Lasix
77
Which loop diuretic is most commonly used and why?
Furosemide (Lasix) | - Most commonly used; less powerful than new drugs; larger margin of safety for home use
78
Furosemide (Lasix) is the prototype for what drug type?
loop diuretics
79
Hydrochlorothiazide is the prototype for what drug type?
thiazide and thiazide like diuretics
80
What is the action of loop diuretics?
Block the chloride pump in the ascending loop of Henle | This causes reabsorption of sodium and chloride
81
What are loop diuretics indicated for?
``` Acute CHF Acute pulmonary edema Edema associated with CHF Edema associated with renal or liver disease Hypertension ```
82
What are the contraindications and cautions for loop diuretics?
``` CONTRAINDICATIONS - Allergy - Electrolyte depletion - Anuria (failure to produce urine) - Severe renal failure - Hepatic coma - Pregnancy and lactation CAUTIONS - SLE, gout, and diabetes mellitus ```
83
What are the adverse effects of loop diuretics?
- Related to the imbalance in electrolytes and fluid - Hypokalemia - Alkalosis - Hypocalcemia
84
What drugs interact with loop diuretics?
- aminoglycosides or cisplatine - anticoagulation - Indomethacin, NSAIDS, saliylates
85
What is the prototype of loop diuretics?
furosemide
86
What is flurosemide the prototype of?
loop diuretics
87
What routes can loop diuretics be given in?
PO, IV, IM
88
What is the action of potassium sparing diuretics?
- Cause a loss of sodium while retaining potassium | - Block the actions of aldosterone in the distal tubule
89
What are the indications of potassium-sparing diuretics?
- Adjuncts with thiazide or loop diuretics | - Patients who are at risk for hypokalemia
90
What are the pharmokinetics of potassium sparing diuretics?
- Well absorbed, protein bound, and widely distributed | - Metabolized in the liver and excreted in the urine
91
What is hyperkalemia?
potassium over 5mmol/L
92
What are the contraindications and cautions of potassium sparing diuretics?
Contraindications - Allergy - Hyperkalemia, renal disease, or anuria - Patients taking amiloride or triamterene Cautions - pregnancy and lactation
93
What are the drug interactions with potassium sparing diuretics?
salicylates
94
What are the adverse effects of potassium sparing diuretics?
hyperkalemia
95
What is the prototype of potassium sparing diuretics?
spironolactone
96
What is spironolactone the prototype of?
potassium sparing diuretics
97
What is an off label use of potassium sparing diuretics?
- acne
98
How long have potassium sparing diuretics been around?
long time
99
Are potassium sparing diuretics expensive?
no
100
What nursing interventions are needed when patients are taking diuretics?
TEACHING - educate on the importance of not missing a dose and taking meds as prescribed - never double a dose if one was missed - keep a BP journal - change positions slowly - report changes in breathing, swelling, or excess fatigue - take oral form with meals - impotence is expected - dont change dose on own, contact doctor - be cautious with fluid loss (heat, activity, alcohol) - consult doc before taking OTC meds
101
What does the nurse need to monitor?
- adverse effects - BP - therapeutic effects - IV with extreme caution with IV pump
102
What effects the adherence of patients?
- healthcare giver advice
103
What is the single most important modifiable factor?
adherence
104
What are the 5 dimensions or factors that determine adherence (RNAO)?
Social economic factors- what people around you do, finance, etc Health system factors- availability, if they don’t like HCP Therapy-related factors- side effects Patient-related factors- age, sex, education, income, where you live (urban vs rural) Condition-related factor- severity of their disease or other diseases they have at the same time -RNAO
105
What are the CHEP 2013 strategies to improve patient adherence?
- Tailoring pill-taking to fit patients’ daily habits - Simplifying medication regimens to once-daily dosing - Multidisciplinary team approach - Encouraging greater patient responsibility/autonomy in monitoring their blood pressure and adjusting their prescriptions - Educating patients and patients’ families about their disease/treatment regimens

Pharmacotherapeutics (7 decks)

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