Anti. HTN - Adrenergic Agents Flashcards
Types of adrenergic that lower BP
Alpha 1 antagonist
Alpha 2 agonist
Beta 1 antagonist
Beta adrenergic blokers
propranolol (non specific)
Metoprolol, atenolol (B1 specific)
Alpha adrenergic antagonists
Doxazosin, prazosin, terazosin
Alpha/beta blockers
carvedilol
labetalol
centrally acting alpha 2 agonists
clonidine
methyldopa
Beta 1 blockers cause
inhibit renin release (RAAS), decreased HR, decreased contractility, decreased conduction
suppress reflex tachycardia
decrease PVR
more effective in white population, less in black
Beta blocker indications
HTN, MI and prevent second MI
angina pectoris
HF
hyperthyroidism
cardiac dysrhythmias
migraine prophylaxis
anxiety/stage fright
pheochromocytoma
glaucoma
Beta Blocker ADR
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
beta blockers drug interactions
dangerous with other antihypertensives: such as CCB’s, clonidine
antidiabetics (insulin)
anesthesia, IV phenytoin
Beta blockers pt education
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
Carvedilol and labetalol
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
Metoprolol
blocks Beta 2 at normal doses, no bronchoconstriction or hypoglycemia
indications: HTN, angina, cardiac dysrhythmias, MI (IV), prevent second MI and cardiopretection post op
Metoprolol ADRs
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
Alpha 1 adrenergic antagonists
second line drugs in HTN
MOA; inhibit/ block alpha 1 adrenergic receptors on arterioles and veins
prevent sympathetically mediated vasoconstriction
results in decreased BP
Alpha 1 blockers indications
HTN and BPH
Alpha 1 blocker ADRs
orthostatic hypotension (especially 1st dose)
reflex tachycardia
nasal congestion
sexual dysfunction
sodium/fluid retention (edema)
weakness, GI symptoms, HA, syncope, SOB
Alpha 1 blocker pt education
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
doxazosin
peripheral acting Alpha 1 blocker
causes peripheral vasodilation and lower PVR causing lower BP
less cardiac effects because no beta action
Doxazosin ADR
hypotension
lightheadedness
dizziness
orthostatic hypotension
reflex tachycardia
nasal congestion
relax urinary sphincter tone
carvedilol and labetalol ADR
orthostatic hypotension
bradycardia
AV heart block
bronchoconstriction
mask hypoglycemia
alpha 1 blockers at on the central or peripheral system?
peripheral acting
Alpha 2 agonists work on dental or peripheral system?
central acting
Clonidine
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
clonidine indications
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
Alpha 2 ADRs
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
clonidine abuse
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
Methyldopa
pro-drug
central acting alpha 2 agonist for hypertension
preferred during pregnancy
high risk in geriatrics for CNS depression, bradycardia, hypotension
Drugs that act on RAAS
ACEi (angiotensin converting enzyme inhibitors)
ARBs (angiotensin II receptor blockers)
Direct renin inhibitors
Aldosterone antagonists
ACE inhibitors
inhibit angiotensin I converting enzyme to prevent the production of angiotensin II
decreases vasoconstriction
inhibits aldosterone release leading to sodium and water excretion
blocking Angiotensin II causes
inhibit vasoconstriction
increase renal perfusion
inhibits aldosterone release
(aka Kinase II)
blocks breakdown of Bradykinin (increase bradykinin levels)
Catopril
ACEi
enalapril
Acei
lisinopril
ACEi
ACEi drug ending
pril
ACEi indication
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
ACEi ADR
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
ACEi interactions
creates additional decrease in BP with other anti-HTNs
NSAIDS reduce effects
lithium toxicity
avoid drugs that increase K+ levels
ACEi pt education
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
ARBs
angiotensin II receptor blockers
(losartan. or valsartan)
more specific action than ACEi
