Antihypertensive Agents Flashcards
Metoprolol uses:
- Use for rapid HR, Contractility, and CO control –> therefore, decreases BP
- Used for treatment for MI
Propranolol drug class &; MOA:
Beta blocker;
Nonselective Beta-1 and Beta-2 antagonist
Labetalol effects:
Decreases HR and BP simultaneously;
BP reduction causes decreased CO and PVR.
Can depress cardiac contractility.
Minimally affects CBP or ICP
Propranolol effects:
- Decreases BP; due to decrease in myocardial contractility, HR, CO;
- Therefore causes decrease in myocardial oxygen demand.
Metoprolol (___)
(Lopressor)
Hydralazine primary effect:
Decreases BP with increase in HR, SV, and cardiac output.
Labetalol drug class &; MOA:
Primarily considered a Beta Blocker;
Nonselective beta-1 and beta-2; with selective alpha-1adrenergic antagonist.
Metoprolol —> primary reason for giving this?
Similarly to propranolol, this has a prolonged half-life; give when Esmolol works, but tachycardia keeps coming back.
Labetalol c/i:
Contraindicated in:
Bronchospastic disease ; (beta-2 antagonism causes bronchoconstriction).
Impaired cardiac conduction or underlying resting bradycardia
Esmolol primary use:
Decreases HR only
V2 receptor —> location of effect:
Renal
V1 receptor —> location of effect:
CV effects
Esmolol (___)
(Brevibloc)
Labetalol uses:
Acute and chronic HTN in pregnant pts.
Treat increases in BP and HR from stimulation (intubation)
Propranolol (_____)
(Inderal)
Metoprolol drug class and MOA:
Beta blocker;
Selective Beta-1 adrenergic receptor antagonist;
Prevents inotropic and chronotropic responses to Beta stimulation.
Hydralazine MOA:
Direct systemic arterial vasodilator causing relaxation of arterial smooth muscle;
Blocks calcium release from sarcoplasmic reticulum.
Decreases BP with increase in HR, SV, and cardiac output (CO).
Esmolol uses:
Treats perioperative tachycardia;
Pre-treatment during intubation/extubation.
Esmolol c/i:
Contraindicated in
- Bradycardia,
- Heart block,
- Cardiogenic shock,
- Heart failure
Hydralazine —> primary reason we give this:
Dr. R’s go-to when she has given labetalol, it worked, but HTN came back.
Hydralazine (_______)
Apresoline
Propranolol —> use caution in which patients?
Careful use in bronchospastic disease.
AV block, and bradycardia.
Labetalol (___)
(Trandate)
V3 receptor —> location of effect:
Pituitary
Hydralazine uses:
HTN
Heart failure
Eclampsia
Propranolol uses:
Treat Anxiety/ Panic attacks
Angina
Pheochromocytoma
Acute MI
HTN
Hydralazine —> caution in which patients??
Potential for increased ICP,
careful/contraindicated in CAD.
Propranolol —> primary reason why it is given:
Maybe labetalol works, but tachycardia keeps coming back —> give this for longer duration of action
Or, if the patient did not take their BB the AM prior to surgery and you want them to have something, we may give this in preop.
Labetalol primary use:
Simultaneously decreases BP & HR
Esmolol effects:
Decreases HR, myocardial contractility, CO, and some decrease in BP;
No rebound effects.
Esmolol drug class and MOA:
Beta blocker;
Rapid-onset and short-acting
Selective Beta-1 antagonist
Hydralazine dose:
onset:
duration:
2.5-5 mg IV titrated every 20-30 mins.
onset: 15-30 mins
duration: 4-6 hours
*start with 2.5 mg, wait 15 mins, if no response —–> give 2.5 mg more
*for OB eclampsia —> give labetalol, then hydralazine, then nipride.
Metoprolol dose:
Half-life:
1-5 mg IV (up to 15 mg)
half-life: 3-4 hrs
Propranolol dose:
Onset:
Duration:
1-3 mg IV (no more than 1 mg/min)
titrated to effect.
onset: around 2-3 mins
Duration: up to 4-6 hrs (depending on the source)
*Dr. R gives 1 mg in preop, lets that kick in and assesses further in OR
*not a first-line drug due to longer onset (use labetalol first)
Esmolol dose:
Infusion:
Onset:
Duration:
10 mg boluses IV,
Infusion of 50 mcg/kg/min **after a 0.5 mg/kg bolus
onset: RAPID
Duration: 10-15 mins (d/t metabolism by plasma esterases)
Which two antihypertensive agents are most commonly used for periop HTN and why?
Labetalol & Esmolol —> d/t fast onset.
Labetalol dose:
Onset:
Duration:
5-20 mg boluses IV
Onset: 1-2 mins
Duration: up to 6 hrs
*Dr. R usually starts by giving 10 mg, waits, reassesses, can give 10 mg more
What are 7 potentially reversible causes of hypertension?
Pain
Hypothermia
Anxiety
Increased ICP
Bladder distention
Poorly controlled HTN
Lack of anesthesia
Progression of treatment for OB eclampsia:
Labetalol, hydralazine, nipride
Esmolol metabolism:
Rapidly metabolized by plasma esterases —–> why it can be given as an infusion
