anti-hypersentives

Question 1

beta blocker meds

Answer 1

• metoprolol
• tenormin
• brevibloc
• bystolic
• inderal
• betaspace
• normodyne
• cavidilol

Question 2

types of beta blockers

Answer 2

• selective (blocks either heart beta receptors or lung beta receptors)
• nonselective (blocks both lung and heart beta receptors)

Question 3

beta blocker indications

Answer 3

• htn
• angina
• dysrhythmias
• hypertrophic cardiomyopathy
• glaucoma (topical)
• tremors & anxiety
• vascular headaches (migraines)
• adjunct use in thyrotoxicosis and pheochromocytoma

Question 4

beta blocker side effects

Answer 4

• can exacerbate depression
• can cause decline in sexual responsiveness
• weakness/fatigue

Question 5

beta blocker adverse effects

Answer 5

• Heart Block, Bradycardia
• Hypotension
• May worsen CHF…weigh risks/benefits
• Non-selectives can cause bronchospasm
• Withdraw slowly… always taper off can cause rebound angina
• Rebound hypertension (all can cause this to varying degrees)
• Masking hypoglycemia, monitor blood glucose in diabetics
• Masking s/sx of hyperthyroidism…check levels before starting drug
• Cardiogenic shock- heart is failing, no blood is getting to extremities- medical emergency

Question 6

beta blocker contraindications

Answer 6

• av block
• bradycardia
• uncompensated heart failure (caution with all HF)
• asthma, COPD (cardioselective drugs only)
• caution in DM, MG, depression

Question 7

beta blocker implications

Answer 7

• check hr, hold if <60
• teach how to check pulse daily
• check apical pulse for a full minute
• hold drug for SBP <90-110
• daily weight, check for edema
• taper off over 1-2 weeks

Question 8

combined alpha and beta blockers

Answer 8

• carvedilol and labetalol
• same as nonselective but works on alpha receptors, so more vasodilation
• may have more orthostatic hypotension
• must give IVP when pt is supine

Question 9

more info on carvedilol

Answer 9

• primarily for CHF
• increase digoxin levels
• can cause drug-induced SLE

Question 10

alpha adrenergic agent medications

Answer 10

-clonidine

Question 11

alpha adrenergic agent indications

Answer 11

• decrease bp
• reduce activity of brain
• chronic pain

Question 12

alpha adrenergic agent implications

Answer 12

• monitor for orthostatic hypotension, bradycardia, decreased sexual function, drowsiness, rebound htn
• taper drug
• caution with other cns depressants

Question 13

peripherally-acting alpha adrenergic agents

Answer 13

• prazosin
• tamsulosin
• terazosin
• give first dose at bedtime to prevent first dose effect 30-90 min later

Question 14

angiotensin-converting enzyme (ACE) inhibitors drugs

Answer 14

• captopril
• benazepril
• enalapril
• fosinopril
• ramipril

Question 15

ACE inhibitor side effects

Answer 15

• dry, persistent cough
• headache
• nausea
• diarrhea
• loss of takes (resolves in 8-12 weeks)
• weakness
• dizziness
• skin rash (rare)

Question 16

ACE inhibitor adverse effects

Answer 16

• orthostatic hypotension (first dose)
• d/c if pregnant (bbw)
• allergic reaction
• angioedema
• hyperkalemia
• worsening renal function (check bun/cr frequently)

Question 17

ACE inhibitor implications

Answer 17

• check bp for 2 hr after first dose
• caution use with diuretics (can worsen first dose hypotension)
• NSAIDs can decrease effectiveness
• watch for worsening renal insufficiency
• teach to get up slowly
• avoid hot showers/saunas can cause more vasodilation
• monitor for hyperkalemia and hyponatremia
• dont take catopril with meals

Question 18

Angiotensin II receptor blockers (ARBs) drugs

Answer 18

• iosartan
• irbesartan
• valsartan
• olmesartan

Question 19

ARBs adverse effects

Answer 19

• less ae of ace inhibitors because angio II is still present to stimulate aldosterone release
• less profound effect on k; no dry cough; can take with or without meals
• can still cause angioedema, impaired renal function, and rarely hyperkalemia

Question 20

calcium channel blockers (CCBs) drugs

Answer 20

• amlodipine
• nicardipine
• felodipine
• nifedipine
• diltiazem
• verapamil

Question 21

CCBs indications

Answer 21

• htn
• angina
• CAD
• svt dysrhythmias (diltiazem)
• raynaud’s phenomenon
• vascular (migraine) headaches
• hypertrophic cardiomyopathy

Question 22

CCBs adverse effects-

Answer 22

• Skin flushing
• Edema in ankles, feet
• Dry mouth
• Reflex Tachycardia
• Headache, nausea
• Dysrhythmias
• Hypotension
• Slow HR
• AV blocks
• Heart failure
• Acute toxicity…watch dosing
• Teach pt to take their pulse!

Question 23

CCBs drug interactions

Answer 23

• dont give with grapefruit juice (inhibits first pass liver metabolisms, will have higher serum levels and lead to toxicity)
• beta blockers with iv form at same time can cause hypotension
• digoxin and CCB can increase risk of heart blocks

Question 24

direct renin inhibitors

Answer 24

• aliskiren
• directly inhibits renin from stimulating the conversion of angiontensinogen to angio 1
• pregnancy cat d
• can cause angioedema, rash, diarrhea, renal compromise, hyperkalemia

Question 25

diuretics

Answer 25

• Current first-line drugs for HTN
• All decrease plasma and extracellular fluid volumes causing decreased preload…which causes decreased CO and decreased SVR
• Thiazides: most common (hydrochlorothiazide)
• Loop (Bumex, Lasix)
• K-sparing (Aldactone)…upcoming slid

Question 26

k-sparing diuretics

Answer 26

-Aldosterone Blockers (antagonists): diuretics that block aldosterone (thereby sparing potassium!)…Aldactone (spironolactone) and Inspra (eplerenone)

Question 27

vasodilators

Answer 27

• hydralazine
• sodium nitroprusside (icu for hypertensive crisis)
• minoxidil (not used for bp anymore)
• direct arterial vasodilators (for early signs of stage II htn and will decrease afterload in CHF
• watch for drug induced lupus erythematosus, na retention (edema), tachycardia

Question 28

dopamine

Answer 28

• opposite of other drug
• vasopressor (makes bp and co rise)
• can be given at a low renal dose to improve renal and mesenteric blood flow to improve kidney perfusion
• given in icu
• can raise bp if too low
• se: nausea, ha, angina, htn, tachycardia