39. Antihypertensives Flashcards
normal BP
<120 and <80 mmHg
elevated BP
120-129/ <80 mmHg
HTN stage 1
130-139 or 80-89 mmHg
HTN stage 2
> 140 or > 90 mmHg
What must be done prior to labeling someone w/ HTN?
use an average based on 2 or more readings obtain on 2 or more occasions
cultural considerations for HTN medications
- ACE inhibitors and beta blockers may be less effective in African Americans
- Asian Americans are more sensitive to beta blockers and may need a lower dose
- Native Americans have a reduced response to beta blockers
nonpharmacologic control of HTN
- exercise independent of weight loss lowers BP about 8 mmHg
- salt and caffeine restrictions
- decrease alcohol
- smoking cessation
- weight loss 10 lbs lower BP about 8 mmHg
MOA of metoprolol
promotes blood pressure reduction via cardio selective beta-blocking effect: reduce HR, contractility, and renin release
Use of metoprolol
- control HTN
- acute MI
- angina
- heart failure
side effects and adverse effects of metoprolol
- fatigue/weakness
- blurred vision
- insomnia
- ED (reason for not adhering to med)
- peripheral edema
- tinnitus
- depression/bradycardia
- hypotension
- stroke
- thrombocytopenia
- DM
life threatening adverse effects of metoprolol
- AV heart block
- bronchospam
- agranulocytosis
- HF
What medications should patients taking metoprolol avoid?
NSAIDs
patient teaching and safety for metoprolol
- do NOT abruptly withdrawal
- monitor pulse and BP (don’t give if pulse < 60)
What type of medication is prazosin hydrochloride?
alpha-adrenergic blocker
MOA of prazosin
dilates peripheral blood vessels by blocking alpha-adrenergic receptors
side effects and adverse effects of prazosin
- orthostatic hypotension
- tachycardia
- pancreatitis
- elevated LFTs
- dry mouth
- ED
- urinary incontinence
- tinnitus
What is first dose phenomenon w/ prazosin?
- results in orthostatic hypotension, palpitations, dizziness, and syncope 1-3 hours after first dose
- take at bedtime to reduce effect
What can intensify hypotension when taking prazosin
alcohol
patient teaching for prazosin
risk for rebound HTN with abrupt withdrawal
What type of medicine is Lisinopril
angiotensin-converting enzyme inhibitor (ACE-i)
MOA of Lisinopril
- inhibits conversion of Ang I to Ang II -> blocks release of aldosterone
- lowers peripheral resistance
- little change in cardiac output or HR
Uses of Lisinopril
- HTN
- MI
- HF
side effects and adverse effects of lisinopril
- hypotension
- headache
- dizziness
- syncope
- hyperkalemia
- dry hacking cough (due to bradykinin)
- angioedema
Why should lisinopril not be given during pregnancy
- 1st trimester: cardiac malformation can occur
- 2nd and 3rd trimesters: impaired renal function
What type of medicine is Losartan
angiotensin II receptor blockers (ARBs)
MOA of losartan
inhibits binding of angiotensin II -> prevents release of aldosterone
uses of losartan
- HTN
- diabetic neuropathy w/ elevated CRE and proteinuria
side effects/adverse effects of losartan
- weakness
- dizziness
- cough
- hypotension
- anemia
- angioedema
- hyperkalemia
Why should Losartan not be used in pregnancy
causes injury and death to fetus
What type of medicine is Diltiazem
calcium channel blocker
MOA of diltiazem
block calcium channel in vascular smooth muscle to promote vasodilation (free Ca increases muscle contractility, peripheral resistance, and BP)
uses of diltiazem
- HTN
- angina
- dysrhythymia
contraindications for diltiazem
- pt on beta blockers
- heart failure w/ reduced ejection fraction
- sinus node dysfunction
- 2nd or 3rd degree AV block WITHOUT a pacemaker
side effects/adverse effects of diltiazem
- peripheral edema
- dizziness
- dyspepsia
- bradycardia
- hypotension
