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PHARMACOLOGY > 17-Drugs for Hypertension > Flashcards

17-Drugs for Hypertension Flashcards

1
Q

Primary “essential” hypertension

A
  • No known cause, can be caused due to a genetic predisposition, dietary salt intake, adrenergic tone
  • represents 90 - 95% of cases
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2
Q

Secondary hypertension

A
  • high blood pressure caused by the effects of another disease (known cause)
  • represents 5 - 10% of cases
  • examples: pheochromocytoma, adrenal cortical tumours, drugs
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3
Q

Physiological effects of hypertension (3)

A
  1. loss of responsiveness –> prolonged force thickens arterial muscles (heart recieves less blood)
  2. L ventricle thickens –> bc heart has to pump blood against a greater force (increases workload)
  3. Narrowing of lumen/atherosclerosis –> bc increased force damages inner lining of arteries
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4
Q

How can HTN lead to a loss in vision, kidney + cerebral function?

A

Tiny vessels are damaged, leading to these diseases.

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5
Q

3 factors that affect blood pressure (and what causes them)

A
  1. Blood volume: due to fluid loss + fluid retention
  2. TPR/diameter of vessels: due to SNS activity, renin/angiotensin 2, increased viscosity
  3. CO: affected by SV & HR
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6
Q

What 3 factors affect the stroke volume?

A

preload, contractility, afterload

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7
Q

What systems of the ANS affects HR?

A

SNS, PSNS, and epinephrine

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8
Q

Describe how the CV system & kidneys work to regulate high blood pressure.

A

CV system:

  • vasodilation
  • decreased SV and HR (both of these will decrease CO & BP)

Kidneys:
- increases urine output –> less BV –> decreased BP

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9
Q

Describe a high risk, moderate to high risk & low risk patient for hypertension.

A

High risk: has DM
Moderate to high risk: multiple CV risk factors, target organ damage, OVER 75
Low risk: No CV risk factors or organ damage

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10
Q

What is the reccommended amount of alcohol consumption to be considered “low risk”?

A

Men: < 14 drinks/week
Women: < 9 drinks/week

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11
Q

What is the minimum reccommended amount of physical activity?

A

4 days/week for 30-60 mins & moderate cardio

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12
Q

Start pharmacotherapy if BP is ____________ or more for a diabetic patient.

A

130/80

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13
Q

Which type of diuretic is preferred? Long-acting or short acting?

A

long-acting

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14
Q

Give an example of a short-acting diuretic

A

Hydroclorothiazide

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15
Q

T or F: Beta blockers are a first-line therapy for those 60 and above.

A

FALSE!

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16
Q

T or F: RAS inhibitors are contraindicated in pregnancy.

A

True

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17
Q

What class of drugs are first-line therapy for reducing HTN?

A

Diuretics

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18
Q

Describe the mechanism of action of diuretics for reducing blood pressure.

A

Reduces SV by blocking Na/Cl transporters in kidneys –> electrolytes & water are excreted –> BV decreases (and BP)

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19
Q

T or F: Diuretics are safe to use in pregnancy.

A

FALSE - diuretics are contraindicated in pregnancy bc the loss of fluid + electrolyte imbalances can have a damaging effect on the fetus.

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20
Q

What are some side effects/consequences of diuretics?

A

Orthostatic hypotension, hypokalemia, GI upset, hyperglycemia

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21
Q

What is the onset and duration of thiazide diuretics?

A

Onset: 2 hrs
Duration: 6-12 hrs

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22
Q

What are some nursing considerations for patients on diuretics? What should patients monitor/report?

A
  1. Monitor Na/K levels, kidney function & BP (w/in 4-6 wks of starting therapy)
  2. Monitor fluid output & weight gain/loss, report lightheadedness/dizziness
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23
Q

How does angiotensin 2 affect BP? (2 ways)

A
  1. Increases TPR in vasculature (vasoconstriction)

2. Stimulates secretion of aldosterone/ADH

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24
Q

Pharmacological inhibition of RAAS (which class of drugs are used & what does it result in?)

A
  • ACE inhibitors & ARBs

- decreases TPR & BV

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25
Q

Describe the mechanism of action of ACE inhibitors.

A
  • prevents conversion of angiotensin 2
  • increases production of vasodilatory kinins
  • inhibits aldosterone secretion (reduces Na & water retention)

*All these things decreases TPR & BV

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26
Q

T or F: ACE inhibitors should be combined with NSAIDs to manage HTN.

A

FALSE! Using them in conjunction w/ NSAIDs decreases the antihypertensive activity.

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27
Q

What is the first dose phenomenon?

A

A sudden drop in BP leads to reflex tachycardia (more likely to pass out/fall).

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28
Q

Angioedema

A

Allergic rxn of the lips, mouth and throat (medical emergency)

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29
Q

Side effects of ACE inhibitors

A
  • persistent dry cough
  • hyperkalemia
  • constipation/GI irritation
  • angioedema
  • first dose phenomenon
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30
Q

Describe the mechanism of action of ARBs.

A
  • blocks angiotensin 2 receptors in arteries + adrenal cortex
  • inhibits release of aldosterone
  • no effect on bradykinin

*These things decrease TPR & BV

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31
Q

T or F: ACE inhibitors are more efficacious than ARBs.

A

False, they are equal in efficacy!

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32
Q

Describe the mechanism of action of CCBs.

A
  • Relaxes vascular smooth muscle & decreases TPR by blocking Ca channels (no contractions).
  • It slows the HR and reduces CO.
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33
Q

Selective vs non-selective CCBs.

A

Selective: only affects the vasculature (vasodilation)

Non-selective: affects both the heart and vasculature (effective for treating angina)

34
Q

What should you avoid while taking a calcium channel blocker?

A

Grapefruit juice bc it increases serum CCB levels

35
Q

Beta blockers (action, side effects, caution)

A

Beta adrenergic antagonists reduce HR & treat CV conditions (MI, angina). May cause fatigue & activity intolerance. Use w/ caution in those with diabetes, depression, asthma or COPD.

36
Q

Why should you use cardioselective drugs if the patient has COPD or asthma?

A

Bc B1 affects only the heart, whereas B2 blockers will cause the bronchioles to constrict, making the asthma/COPD worse.

37
Q

How often should patients w/ HTN be monitored?

A

Every 1-2 months (until BP for 2 consecutive visits are below target). Then, it should be monitored every 3-6 months.

38
Q

Methyldopa (centrally acting)

A
  • inhibits sympathetic output to decrease BP

- preferred agent for controlling BP in pregnancy

39
Q

A 3-5x greater risk is associated with?

A

Obesity

40
Q

A 2-3x greater risk is associated with

A

diabetes

41
Q

What decent are more susceptible to hypertension?

A
  • south asian
  • african
  • aboriginal
42
Q

Which kind of hypertension accounts for 90-95% of cases?

A

Primary

43
Q

Which kinda of hypertension accounts for 5-10% ?

A

Secondary hypertension

44
Q

Mean BP resulting in hypertension

A

more than 180/110

45
Q

mean bp less than 180/110 meaning

A
  • depends on diabetic diagnosis
  • above 130/80; HTN
    No diabetes
  • above 130/85- HTN
46
Q

List lifestyle recommendations

A
  • reduce sodium intake
  • healthy lifestyle
  • low risk alcohol consumption
  • regular physical activity
  • maintenance of ideal weight
  • smoke cessation
  • stress management
47
Q

Which medications should not be used for those with darker skin tones?

A
  • ACE INHIBITORS AND ANGIOTENSIN RECEPTOR BLOCKERS
48
Q

T/F: Diuretics work for everyone and are first line therapy

A

true

49
Q

What are second line agents?

A

calcium channel blockers

50
Q

What drug class is not used for monotherapy for individuals over 60?

A

Beta blockers

- there bp is decreased and does not help with CVA or MI risk

51
Q

Which is the best approach for HTN control?

A

multi-modal approach; low dose and variety of drugs

52
Q

What is a type of diuretic that is the first line therapy?

A

Thiaizide like diuretics

53
Q

Thiaizide Functions

A
  • reduce stroke volume
  • block Na/Cl transporter
  • Excrete electrolytes and water
  • reduce blood volume
54
Q

Which patients should not use or be mindful of thiazides

A
  • renal disease
  • diabetes
  • gout
  • liver disease
  • hyperlipidemia
  • some pregnancys
55
Q

When should thiazides be administered? What is there onset and duration

A

In the morning to prevent nocturia

  • 2 hr onset
  • 6-12 hour duration
56
Q

Adverse effects of thiazides

A
  • gi disturbances
  • orthostatic hypertension
  • hyperglycaemia
  • fluid and electrolyte imbalance
57
Q

Which drug class should not be used to treat HTN? and why?

A

Loop diuretics

- pulls over alot of water from kindey

58
Q

Who are loop diuretics most useful for?

A
  • edema patients and congestive heart failure patients
59
Q

Which drug decrease efficacy of thiazides?

A

Nsaids

60
Q

What should one monitor while taking diuretics?

A
  • sodium and potassium levels
  • kindey function
  • bp
  • fluid output and input with weight
  • report dizziness or light headedness
61
Q

HTN; Total peripheral resistance

A
  • liver in constantly releasing angiotensionogen
62
Q

Function of renin

A
  • released by kidneys in response to low bp

- converts angiotensin into angiotensin 1

63
Q

When is renin released

A

when low bp is noted

64
Q

How to inhibitors of RAAs help HTN

A
  • decrease BP
  • angiotensin 2 is not produced
  • eliminate vasoconstriction
  • improve tpr
  • stop kidney from taking fluids
65
Q

Types of RAA’S to decrease HTN

A
  • ACE inhibitors

- Angiotensin 2 receptor blockers

66
Q

What do ACE inhibitors end in?

A

PRIL

67
Q

Function of ACE inhibitors?

A
  • decrease PR
  • decrease BV
  • Block converter of angiotensin 1 to 2
  • increase vasodilatory kinins
  • inhibit aldosterone secretion
68
Q

When should ACE inhibitors be used with caution?

A
  • in pregnancy

- monitor with potassium sparing diuretics and supplements

69
Q

Adverse effects of ACE inhibitors

A
  • hyperkalemia
  • dry cough
  • GI irritation and constipation
  • drop in BP/ tachycardia
  • allergic reactions
70
Q

When should angiotensin 2 receptor blockers be used?

A

When cough is really irritating

71
Q

Function of Angiotensin 2 receptor blockers

A
  • decrease peripheral resistance
  • decreased bv
  • block angiotensin 2 receptors in SM and adrenal cortex
  • inhibit aldosterone release
  • no effect on bradykinin
72
Q

T/F: Ace inhibitors and angiotensin 2 receptor blockers have same efficacy?

A

true

73
Q

Calcium Channel blockers have two types what are they?

A
  • non selective and selective
74
Q

When should you use caution with CBBS?

A

Those with liver and kidney impairment

75
Q

adverse effects of CCBS

A
  • dizziness
  • lightheadedness
  • fatigue
  • hypotension and reflex tachy
  • nausea
  • flushing
76
Q

When and on whom are beta blockers most effective?

A

patients less than 60

- previous MI, angina

77
Q

Function of alpha and beta adrenergic antagonists?

A
  • alpha 1 receptor blockers
  • cardio selective b1 receptor blockers
  • non selective b1 and 2 receptor blockers
  • block adrenergic effect on arterioles
  • block action of NE and E on cardiac muscle
  • decrease renin secretion by kidneys
78
Q

What is used an adjuvant?

A

beta blocker

79
Q

Adverse effects of alpha and beta adrenergic antagonists?

A
  • reduction in HR can cause fatigue and activity intolerance
80
Q

Precautions for those using Alpha and beta adrenergic antagonists

A
  • diabetes
  • asthma or COPD
  • sleep disturbances
  • depression

PHARMACOLOGY (27 decks)

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