anti-hypersentives Flashcards
1
Q
beta blocker meds
A
- metoprolol
- tenormin
- brevibloc
- bystolic
- inderal
- betaspace
- normodyne
- cavidilol
2
Q
types of beta blockers
A
- selective (blocks either heart beta receptors or lung beta receptors)
- nonselective (blocks both lung and heart beta receptors)
3
Q
beta blocker indications
A
- htn
- angina
- dysrhythmias
- hypertrophic cardiomyopathy
- glaucoma (topical)
- tremors & anxiety
- vascular headaches (migraines)
- adjunct use in thyrotoxicosis and pheochromocytoma
4
Q
beta blocker side effects
A
- can exacerbate depression
- can cause decline in sexual responsiveness
- weakness/fatigue
5
Q
beta blocker adverse effects
A
- 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
6
Q
beta blocker contraindications
A
- av block
- bradycardia
- uncompensated heart failure (caution with all HF)
- asthma, COPD (cardioselective drugs only)
- caution in DM, MG, depression
7
Q
beta blocker implications
A
- 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
8
Q
combined alpha and beta blockers
A
- 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
9
Q
more info on carvedilol
A
- primarily for CHF
- increase digoxin levels
- can cause drug-induced SLE
10
Q
alpha adrenergic agent medications
A
-clonidine
11
Q
alpha adrenergic agent indications
A
- decrease bp
- reduce activity of brain
- chronic pain
12
Q
alpha adrenergic agent implications
A
- monitor for orthostatic hypotension, bradycardia, decreased sexual function, drowsiness, rebound htn
- taper drug
- caution with other cns depressants
13
Q
peripherally-acting alpha adrenergic agents
A
- prazosin
- tamsulosin
- terazosin
- give first dose at bedtime to prevent first dose effect 30-90 min later
14
Q
angiotensin-converting enzyme (ACE) inhibitors drugs
A
- captopril
- benazepril
- enalapril
- fosinopril
- ramipril
15
Q
ACE inhibitor side effects
A
- dry, persistent cough
- headache
- nausea
- diarrhea
- loss of takes (resolves in 8-12 weeks)
- weakness
- dizziness
- skin rash (rare)
16
Q
ACE inhibitor adverse effects
A
- orthostatic hypotension (first dose)
- d/c if pregnant (bbw)
- allergic reaction
- angioedema
- hyperkalemia
- worsening renal function (check bun/cr frequently)
17
Q
ACE inhibitor implications
A
- 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
18
Q
Angiotensin II receptor blockers (ARBs) drugs
A
- iosartan
- irbesartan
- valsartan
- olmesartan
19
Q
ARBs adverse effects
A
- 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
20
Q
calcium channel blockers (CCBs) drugs
A
- amlodipine
- nicardipine
- felodipine
- nifedipine
- diltiazem
- verapamil
21
Q
CCBs indications
A
- htn
- angina
- CAD
- svt dysrhythmias (diltiazem)
- raynaud’s phenomenon
- vascular (migraine) headaches
- hypertrophic cardiomyopathy
22
Q
CCBs adverse effects-
A
- 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!
23
Q
CCBs drug interactions
A
- 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
24
Q
direct renin inhibitors
A
- aliskiren
- directly inhibits renin from stimulating the conversion of angiontensinogen to angio 1
- pregnancy cat d
- can cause angioedema, rash, diarrhea, renal compromise, hyperkalemia
25
diuretics
- 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
26
k-sparing diuretics
-Aldosterone Blockers (antagonists): diuretics that block aldosterone (thereby sparing potassium!)…Aldactone (spironolactone) and Inspra (eplerenone)
27
vasodilators
- 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
28
dopamine
- 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
