Angina and Hypertension Flashcards by Eva Johnston

How do CCBs work on Cardiac Muscle?

Block cardiac muscle Ca channels
Alters electrical activity of cardiac muscle cells
SA, AV nodes and cardiac muscle

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ACE Inhibitors: Adverse Effects? What effect can happen with a first dose? WHen are they contradicted for use?

Dry, nonproductive cough (problematic for some patients) reverses when therapy is stopped

Possible hyperkalemia

First-dose hypotensive effect may occur!

Contraindicated in Pregnancy

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Nitrates used for? how are they administered?

Acute relief of angina – few min, lasts ~ 1 hour
SL tablet or spray
 
Prophylaxis in situations that may provoke angina eg excercise
SL, oral

Long-term prophylaxis of angina
transdermal patches (nitroglycerin)
oral (nitroglycerin, isosorbide mononitrate)

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Vasodilators: Adverse Effects
hydralazine?

Dizziness, headache, anxiety, tachycardia, nausea and vomiting, diarrhea, anemia, dyspnea, edema, nasal congestion

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How do Thiazide Diuretics work for hypertension?

-Decrease the plasma and extracellular fluid volumes
-decreased preload
-decreased cardiac output
-decreased total peripheral resistance
-Decreased workload of the heart, and decreased blood pressure

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What is Losartan (Cozaar)? How does it work?

Angiotensin II Receptor Blockers - ARBs

Ang II receptor antagonist
Block receptors that angiotensin II activates
Blocks Ang II-mediated vasoconstriction
Blocks release of aldosterone

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common problem for clients on CCB’s?

Constipation (adequate fluids and eat high-fibre foods)

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Where do b-adrenergic receptor blockers (antagonists) mainly act? How do they work?

act in the periphery, mainly heart
b1-blockade
block norepinephrine/epinephrine action in heart
reduce heart rate
decrease force of heart muscle contraction

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Examples of CCBs for dyshrimisas?

Diltiazem (cardiac + vascular,)
Verapamil (cardiac + vascular)

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prazosin/Peripherally a1-adrenoceptor antagonists adverse effects?

Most common: Dry mouth Drowsiness Sedation Constipation

Other: Headaches Sleep disturbances Nausea Rash Cardiac disturbances (palpitations)

HIGH INCIDENCE OF ORTHOSTATIC HYPOTENSION

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What do Organic Nitrates cause? What do they dilate? What do they do?

-Cause vasodilation relaxation of vascular smooth muscles
-Dilate coronary arteries

They decrease pre-load and after-load

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diltiazem (Cardizem)
verapamil
nifedipine,

What kind of drugs are these? What are they used for the treatment of?

They are CCB’s used for angina

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Example of a Peripherally a1-adrenoceptor antagonists? What does it block?

prazosin
Block NE contraction of blood vessels

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Angiotensin II Receptor Blockers: Indications, what can they be combined with?

Can be combined with CCB’s and diuretics
-Used for treatment of Hypertension
Adjunctive agents for the treatment of HF

May be used alone or with other agents

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b-blockers Indications/ when do we use them?

Hypertension
HF
Angina
Dysrhythmias

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Dihydropyridines - DHP Adverse effects?

Cardiovascular:
Hypotension (dizziness), palpitations, tachycardia
flushing, peripheral edema

Gastrointestinal:
very little constipation

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What is isosorbide mononitrate?

It is an organic nitrate

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B-blocker contradictions? who do we avoid giving them to?

intolerance to exercise
avoided in patients with asthma

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What kind of drugs are amlodipine, nifedipine? what do they block?

They are Dihydropyridines - DHPs (vascular selective) that block muscle Ca channels
Alters electrical activity of cardiac muscle cells

What is nitroprusside (Nipride)?

it is a nitroprusside (Nipride) – Nitric oxide action used for the treatment of hypertension

Example of a vasodilator?

hydralazine (Apresoline)

Centrally acting a2-adrenoceptor are?
Peripherally acting a1-adrenoceptor are?

Centrally acting a2-adrenoceptor = agonists
Peripherally acting a1-adrenoceptor = antagonists

Client Implications: Nitroglycerin (what must we teach our clients)?

never to chew or swallow SL form

Removal of old medication :
-Reduce tolerance by removing topical forms at bedtime, and apply new doses in the morning
allowing for a nitrate-free period

ACE inhibitors: Indications/when do we use them? how are they used for hypertension and HF?

-Hypertension
May be used alone or with other agents (CCB, diuretics)
Renal protective effects in clients with diabetes

-HF (either alone or in combination with diuretics or other agents)
Drugs of choice in hypertensive clients with HF
Slows progression of left ventricular remodelling after an MI

1st line therapy for hypertension in pregnancy? What kind of drug is it?

Methyldopa Centrally Acting a2-Receptor Agonists

How centrally acting a2-receptor agonists used for the treatment of hypertension? When do we usually administer them?

-Treatment of hypertension, either alone or with other agents -Usually used after other agents have failed or in combination with other drugs

ACE Inhibitors: Mechanism of Action/ how do they work? What do they also prevent?

Prevents Ang II vasoconstriction Reduces peripheral resistance (afterload) Also prevent the breakdown of bradykinin

What are the main client implications for those taking antihypertensive medications?

*Drugs should not be stopped abruptly (may cause rebound hypertensive crisis, and perhaps lead to stroke) Clients should -avoid smoking -avoid eating foods high in sodium follow other lifestyle recommendations Instruct clients to change positions *slowly* to avoid syncope from postural

How do Peripherally a1-adrenoceptor antagonists work?

Block a1-adrenergic receptors

Nitroglycerin: IV, PO, SL metabolsim effect, what is it used for? what is it?

It is an orgainic nitrate Large first-pass effect SL (not po) for symptomatic treatment Patch/po for prevention of angina IV form used for BP control in perioperative hypertension, treatment of HF, ischemic pain, pulmonary edema associated with acute MI, and hypertensive emergencies

What drugs provide Long-term prevention of angina? NOT for acute exacerbations of angina

Beta-Blockers Decrease HR = decrease cardiac work decreases myocardial oxygen demand Decrease myocardial contractility = decrease cardiac work decreases myocardial oxygen demand

What do Calcium Channel Blockers: Mechanism of action/what do they cause? what are they the first line treatment of?

Reduce myocardial contractility Cause peripheral arterial vasodilation Decreased myocardial oxygen demand First-line agents for treatment of angina

What kind of drugs are ACE inhibitors (ACEIs)? What are they a first line of defence for? What are they often combined with?

Large group of safe and effective drugs Often used as first-line agents for HF and hypertension Often combined with a thiazide diuretic or calcium channel blocker

Broad treatment goals of anti-angina medication?

Reduce heart muscle metabolic demands Improve blood flow in coronary circulation or both!

CCB's Verapamil/Diltiazem Adverse Effects? on GI and cardio system?

Cardiovascular: Hypotension (dizziness) flushing, peripheral edema Gastrointestinal: Constipation, nausea Other: Rash, dermititis

How are different from ACEIs? WHat are they generally not combined with?

Similar to ACEIs (but not identical) BUT do not cause a dry cough Generally not combined with ACEIs

How do CCBs work on vascular muscle?

Inhibits Ca entry into arteriolar vascular smooth muscle cells cause relaxation Decreased peripheral resistance decreased blood pressure

Example of an ACE inhibitor that has the shortest half life? How are ACE inhibitors identified?

Captopril (Capoten) Shortest half-life of the "prils"

What is used as a First-Line Treatment of Adults with Systolic/Diastolic Hypertension Without Other Compelling Indications?

Calcium Channel Blockers (CCBs)

Example of a beta-blocker used for hypertension?

metoprolol

What medications are used for Relief of symptoms of BPH (benign prostatic hypertrophy)?

Peripherally a1-adrenoceptor antagonists?

Vasodilators: Adverse effects Sodium nitroprusside?

Bradycardia, *hypotension*, possible cyanide toxicity Client Implications

What is hydrochlorothiazide? What can it cause?

Thizide diuretic used to treat hypertension possible hypokalemia

IV sodium nitroprusside and diazoxide are reserved for?

the management of hypertensive emergencies

Organic Nitrates: Adverse Effects?

1.) Headache (classic and predictable in almost all patients) 2.) Postural hypotension (some peripheral edema due to pooling of blood in venous system) 3.) Reflex tachycardia (partially offsets beneficial effects , may combine with B-blocker) 4.) Tolerance to drug (Over a single day! )

Vasodilators: Mechanism of Action/Indications?

Directly relax arteriolar smooth muscle