Anti-Hypertension Drug Therapy Deck 2 Flashcards
Beta blocker types
Cardio-Selective
Nonselective
Combined
Cardio-Selective example
atenolol, metoprolol
nonselective example
propranolol block B1 and B2
combined example
Carvedilol: blocks alpha 1 and beta 1 and beta 2
Labetalol: block alpha 1 and beta 1
beta blocker indication
Use to manage HTN in patients with: angina, tachyarrhythmias, MI, and glaucoma
beta blocker are not to be used as f
first line therapy, especially in patients over age 60
BB Action
Impedes the action of catecholamines at adrenergic receptors
Reduces heart rate
Reduces force of myocardial contraction
Reduces the velocity of impulse conduction through AV node
Reduces the automaticity of ectopic pacemakers
Reduces the release of renin in the kidneys
BB net effect
Net effect: decreased cardiac output, sympathetic outflow; reduce cardiac morbidity and mortality
BB SE
Side effects: may cause – bronchospasm, depression, bradyarrhythmia, insomnia, mask hypoglycemia
BB are
Lipid soluble, adjust dosage with advancing age
BB are bio transofred in the
Bio-transformed in the liver, rest eliminated in kidney
Metoprolol is easier
easier on kidneys than atenolol
BB Contraindications
Do not use in patients with a history of sick sinus syndrome, heart failure, or 2nd or 3rd degree AV block
BB precautions
not stop abruptly in patient with CVD
BB do not
not stop abruptly in patient with CVD
BB not specific recomend
Net effect: decreased cardiac output, sympathetic outflow; reduce cardiac morbidity and mortality
Supplemental Drug Classes
Centrally Acting Alpha2 Agonists
Peripherally Acting Adrenergic Antagonists
Direct-Acting Peripheral Vasodilators
Alpha 1 Receptor Blockers
Centrally Acting Alpha 2 Agonists example
Clonidine, methyldopa
Centrally Acting Alpha 2 Agonists MOA
Stimulates alpha 2 receptors in the brainstem
Subdues sympathetic outflow to heart, kidneys, and peripheral vasculature
Reduces renin activity
Centrally Acting Alpha 2 Agonists net effect
Not considered first line treatment except in Pregnancy (methyldopa)
Centrally Acting Alpha 2 Agonists not considered
Not considered first line treatment except in Pregnancy (methyldopa)
Centrally Acting Alpha 2 Agonists are
2nd or 3rd adjunct therapy.
Centrally Acting Alpha 2 Agonists often adminstered with a
diuretic because of tendency to cause fluid rention
Centrally Acting Alpha2 Agonists SE
Side effects: Na retention with weight gain, drowsiness, sedation, dizziness, orthostatic hypotension, restlessness and nervousness, depression, dry mouth
Centrally Acting Alpha2 Agonists SE GI
SE GI: constipation, abdominal pain, hepatitis
Centrally Acting Alpha2 Agonists first dose
severe coronary insufficiency, renal failure
Centrally Acting Alpha2 Agonists abrupt
severe coronary insufficiency, renal failure
Centrally Acting Alpha2 Agonists precations
severe coronary insufficiency, renal failure
Peripherally Acting Adrenergic Antagonists example
reserpine
Peripherally Acting Adrenergic Antagonists MOA
Inhibits the sympathetic nervous system by depleting norepinephrine stores in the vesicles of adrenergic nerve endings
Depletes dopamine, precursor to norepinephrine
Peripherally Acting Adrenergic Antagonists net effect
Net effect: Decrease in peripheral vascular resistance (PVR) and decrease in BP
Peripherally Acting Adrenergic Antagonists only availible
Only available agent is reserpine
Peripherally Acting Adrenergic Antagonists now widely
Not widely used due to side effects
Peripherally Acting Adrenergic Antagonists less
effective over time
Peripherally Acting Adrenergic Antagonists SE
multiple psycho-emotional and neurological; weight gain and fluid retention over time, orthostatic hypotension, arrhythmias, angina, impaired sexual functioning
Peripherally Acting Adrenergic Antagonists precautions
cardiac, cerebrovascular or renal insufficiency
Peripherally Acting Adrenergic Antagonists contraindications
Depression, PUD, ulcerative colitis, gallstones, ECT
Selective dilation of arteriolies example
Hydralazine
Selective dilation of veins
example
Nitroglycerin
Dilation of arterioles and veins example
Prazosin
Hydralazine for vasodialaotrs
Essential hypertension Hypertensive crisis Angina pectoris Heart failure Myocardial infarction Pheochromocytoma Peripheral vascular disease Pulmonary arterial hypertension Production of controlled hypotension during surgery
Adverse effects related to vasodilation
Postural hypotension
Reflex tachycardia
Expansion of blood volume
Postural hypotension
Teach patients about symptoms of
hypotension (lightheadedness, dizziness) and advise them to sit or lie down if these occur. Avoid abrupt transitions from a supine or seated position to an upright position.
Hydralazine does what
Selective dilation of arterioles
Mechanism unknown
Hydralazine postural hypotension is
minimal
Hydralazine uses
Essential hypertension
Hypertensive crisis
Heart failure
Hydralazine ADR
Reflex tachycardia
Increased blood volume
Systemic lupus erythematosus–like syndrome
Headache, dizziness, weakness, and fatigue
Interactions
Other antihypertensive agents
Avoid excessive hypotension
Combined with beta blocker to protect against reflex tachycardia and with diuretics to prevent sodium and water retention and expansion of blood volume
