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Pharm > Anti. HTN - Adrenergic Agents > Flashcards

Anti. HTN - Adrenergic Agents Flashcards

1
Q

Types of adrenergic that lower BP

A

Alpha 1 antagonist
Alpha 2 agonist
Beta 1 antagonist

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2
Q

Beta adrenergic blokers

A

propranolol (non specific)
Metoprolol, atenolol (B1 specific)

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3
Q

Alpha adrenergic antagonists

A

Doxazosin, prazosin, terazosin

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4
Q

Alpha/beta blockers

A

carvedilol
labetalol

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5
Q

centrally acting alpha 2 agonists

A

clonidine
methyldopa

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6
Q

Beta 1 blockers cause

A

inhibit renin release (RAAS), decreased HR, decreased contractility, decreased conduction

suppress reflex tachycardia

decrease PVR

more effective in white population, less in black

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7
Q

Beta blocker indications

A

HTN, MI and prevent second MI
angina pectoris
HF
hyperthyroidism
cardiac dysrhythmias
migraine prophylaxis
anxiety/stage fright
pheochromocytoma
glaucoma

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8
Q

Beta Blocker ADR

A

Brady cardia
decreased contractility
decreased CO
Decreased AV conduction
HF (pulmonary edema)
Bronchoconstriction (in non selective drugs (propanolol))
hypoglycemia (inhibits glycogenolysis with 1st gen)
masked hypoglycemia
fatigue, drowsiness
depression
sexual dysfunction
insomnia
bizarre dreams
mask hypothyroidism

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9
Q

beta blockers drug interactions

A

dangerous with other antihypertensives: such as CCB’s, clonidine
antidiabetics (insulin)
anesthesia, IV phenytoin

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10
Q

Beta blockers pt education

A

fixed schedule
do not stop abruptly
take with or without food
Signs of HF: SOB, PM cough, edema in extremities
avoid OTC decongestants and cough/cold meds (pseudoephedrine/phenylephrine)
orthostatic hypotension
check pulse (if less than 50, hold)
weight, diet, and exercise management
Assess for signs of depression, fatigue, sexual disfunction

Cardio-protection post MI, post op or in acute hospitalized illness - keep HR down
Avoid activities that require alertness
Diabetics: know signs and symptoms of hypoglycemia

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11
Q

Carvedilol and labetalol

A

block both alpha 1 and beta receptors;

vasodilation beta blockers, cause vasodilation and are non selective beta blockers

reduce heart rate and contractility; suppress renin release

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12
Q

Metoprolol

A

blocks Beta 2 at normal doses, no bronchoconstriction or hypoglycemia

indications: HTN, angina, cardiac dysrhythmias, MI (IV), prevent second MI and cardiopretection post op

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13
Q

Metoprolol ADRs

A

bradycardia, AV heart Block, rebound tachycardia, rare CNS

warn about hypersensitivity
masks signs of hypoglycemia in diabetes
can exacerbate HF, asthma, heart blocks or slow hear

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14
Q

Alpha 1 adrenergic antagonists

A

second line drugs in HTN

MOA; inhibit/ block alpha 1 adrenergic receptors on arterioles and veins

prevent sympathetically mediated vasoconstriction
results in decreased BP

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15
Q

Alpha 1 blockers indications

A

HTN and BPH

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16
Q

Alpha 1 blocker ADRs

A

orthostatic hypotension (especially 1st dose)
reflex tachycardia
nasal congestion
sexual dysfunction
sodium/fluid retention (edema)
weakness, GI symptoms, HA, syncope, SOB

17
Q

Alpha 1 blocker pt education

A

first dose hypotensive reaction
(avoid rapid postural changes, potential fainting and falls)
effects may take 4-6 weeks
may relax bladder sphincter
Extravasion can occur with tissue

18
Q

doxazosin

A

peripheral acting Alpha 1 blocker
causes peripheral vasodilation and lower PVR causing lower BP

less cardiac effects because no beta action

19
Q

Doxazosin ADR

A

hypotension
lightheadedness
dizziness
orthostatic hypotension
reflex tachycardia
nasal congestion
relax urinary sphincter tone

20
Q

carvedilol and labetalol ADR

A

orthostatic hypotension
bradycardia
AV heart block
bronchoconstriction
mask hypoglycemia

21
Q

alpha 1 blockers at on the central or peripheral system?

A

peripheral acting

22
Q

Alpha 2 agonists work on dental or peripheral system?

A

central acting

23
Q

Clonidine

A

central acting alpha 2 agonist

acts in the brainstem to reduce sympathetic outflow to blood vessels and heart

generalized decrease in sympathetic tone

Brady cardia and decreased CO

vasodilation and lower CO

overall decreases HR, PVR and BP

24
Q

clonidine indications

A

mild - moderate HTN

other approved indications:
severe pain (neuropathic, cancer)
management of ADHD

Off label uses:
manage opioid and methadone withdrawal
manage smoking stoping
tourettes. syndrome
behavior disorders in kids

25
Q

Alpha 2 ADRs

A

CNS: HA, dizziness, drowsy, sedation, fatigue
CV: rebound HTN (high risk if stopped abruptly), bradycardia, AV block
Xerostomia (dry mouth)
skin issues (dermatitis)
abuse (euphoria, hallucination)
severe hypotension
hypertensive crisis if alpha 1 receptors affected

26
Q

clonidine abuse

A

cocaine, opioid abusers abuse clonidine
subjective effects such as euphoria, sedation, hallucinations
can intensify affects of benzodiazepines, cocaine, and opioids
costs less, so abusers get the high for less money

27
Q

Methyldopa

A

pro-drug
central acting alpha 2 agonist for hypertension
preferred during pregnancy
high risk in geriatrics for CNS depression, bradycardia, hypotension

28
Q

Drugs that act on RAAS

A

ACEi (angiotensin converting enzyme inhibitors)
ARBs (angiotensin II receptor blockers)
Direct renin inhibitors
Aldosterone antagonists

29
Q

ACE inhibitors

A

inhibit angiotensin I converting enzyme to prevent the production of angiotensin II

decreases vasoconstriction

inhibits aldosterone release leading to sodium and water excretion

30
Q

blocking Angiotensin II causes

A

inhibit vasoconstriction
increase renal perfusion
inhibits aldosterone release
(aka Kinase II)
blocks breakdown of Bradykinin (increase bradykinin levels)

31
Q

Catopril

A

ACEi

32
Q

enalapril

A

Acei

33
Q

lisinopril

A

ACEi

34
Q

ACEi drug ending

A

pril

35
Q

ACEi indication

A

HTN
HF (increased blood flow, decreased after load, decreased pulmonary congestion, decreased peripheral edema
diabetic and non-diabetic nephropathy (enapril)
MI
Safe in asthmatics, no weakness or sexual dysfunction, no hyperglycemia, safe in gout

36
Q

ACEi ADR

A

orthostatic hypotension
persistent dry cough (r/t increase in bradykinin)
hyperkalemia
renal failure (do not used in renal stenosis, requires adaquate hydration)
angioedema
rare naturopenia
fetal danger

37
Q

ACEi interactions

A

creates additional decrease in BP with other anti-HTNs
NSAIDS reduce effects
lithium toxicity
avoid drugs that increase K+ levels

38
Q

ACEi pt education

A

effects may take several weeks
taste impairment
cough, report if persistent
hypotension
hyperkalemia (avoid K+ sparing diuretics, or salt subs, or supplements
avoid in pregnancy or renal stenosis

39
Q

ARBs

A

angiotensin II receptor blockers
(losartan. or valsartan)
more specific action than ACEi

Pharm (9 decks)

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