Antihypertensive drugs Flashcards
What is the formula for blood pressure?
cardiac output times systemic vascular resistance
What is high normal BP?
This is when blood pressure is high but not yet considered hypertension. The ranger 130-139/85-89
What percent of cases are essential hypertension?
90 -95% of cases this is idiopathic or primary
What is secondary hypertension and what percent of cases are this?
5-10% and is normally as a result of renal artery disease, sleep apnea, thyroid disease
What is malignant hypertension?
This is when BP is above 180/120 which is a medical emergency
WHat are the goals of antihypertensive therapy?
To reduce cardiovascular and renal morbidity, and achieve a pressure less than 140/90. If diabetic we want 130/80, if its with chronic kidney disease we want 140/90
What is the relationship between the autonomic nervous system and hypertension
Parasympathetic stimulates smooth muscle, cardiac muscle, and glands. the sympathetic stimulates the heart, blood vessels, and skeletal muscle
WHat are the five subcategories of adrenergic drugs?
adrenergic nueron blockers, alpha2 receptor agonists, alpha 1 receptor blockers, beta receptor blockers, combination alpha 1 and beta receptor blockers
What is the MOA of centrally acting adrenergic drugs and what is the main example of this?
This stimulates, alpha 2 adrenergic receptors in the brain which reduces renin production in the kidneys. it also inhibits the production of norepinephrine, eventually resulting in decreased BP
What do peripheral acting alpha 1 receptors do and what is the main example of this?
It blocks alpha 1 adrenergic receptors which decreases the blood pressure. It also dialates the arteries and veins and increases urinary flow rates. Main example is doxazosin
How do beta blockers work, and what are the three main examples
It reduces the heart rate by blocking beta 1 receptors which reduces renin secretion. Examples are propanolol, metoprolol, atenolol
What type of drug is labetalol
It is a beta-blocker and alpha one receptor. It reduces heart rate and causes vasodilation
What are the indications of adrenergic drugs
They are used for treatment of hypertension, glaucoma, heart failure
What are the adverse effects of adrenergic drugs?
ORTHOSTATIC hypotension, bradycardia with reflex tachycardia, dry mouth, drowsiness, constipation,
What is doxazosin?
It is an alpha 1 blocker and it reduces the peripheral vascular resistance and BP
What is an alpha 2 adrenergic receptor stimulator?
It is not a first-line hypertensive drug, they cause unwanted adverse effects and are used when other drugs fail to provide therapeutic effect
What is an example of beta receptor blockers, when would you use it and what is the MOA
An example is nebivolol hydrochloride, it is used for hypertension and heart failure. It blocks beta receptors and produces vasodilation which causes systemic vascular resistance
How do ACE inhibitors work? What are examples of this?
They are safe and effective drugs used as the first line against hypertension. Examples are captopril, enalapril, ramipril, perindopril
What is the MOA of ACE inhibitors?
They inhibit ACE and cause aldosterone secretion. results in BP lowering
What are indications of ACE inhibitors
Hypertension, heart failure, slow progression of left ventricular hypertension, and renal protective effects for diabetic patients
Which ACE inhibitors are not prodrugs, and why is this important
Captopril and lisinopril are not prodrugs and this is important for patients who have liver dysfunction
What are the cardioprotective effects of ACE inhibitors
They decrease SVR, ventricular remodelling, decreases morbidity for patients with heart failure, drugs of choice for hypertensive patients
ACE inhibitors renal protective effects?
Reduces pressure related to glomerular filtration pressure, reduces proteinuria preventing nephropathy
WHat are some adverse effects of ACE inhibitors?
Fatigue, dizziness, headache, impaired taste, hyperkalemia, DRY NONPRODUCTIVE cough
What are important facts for captopril?
used for prevention of ventricular remodelling after MI, has the shortest half life of all ACE inhibitors, should be administered 3 or 4 times a day
What are some important things to know about enalapril?
It is available in oral and parenteral forms, oral form is a prodrug, improves chances of survival after myocardial infarction
What are the two examples of angiotensin 2 receptor blockers?
Losartan, telmisartan
How do angiotensin 2 receptor blockers work?
It affects the vascular smooth muscle and adrenal gland, selectively block the binding of angiotensin 2 to the receptors, block vasoconstriction and block vasoconstriction and secretion of aldosterone
What is the difference between ACE inhibitors and angiotensin 2 receptor blockers
Ace inhibitors decrease BP by inhibiting production of ACE which raises blood pressure while angiotensin 2 blockers prevent angiotensin from cashing vasoconstriction
What are adverse effects of ARBs (angiotensin 2 receptor blockers
Upper respiratory infections, headaches, heartburn, fatigue
losartan
Angiotensin 2 receptor blocker
WHat are calcium channel blockers and what is the main example?
They cause the relaxation of smooth muscle by blocking the binding of calcium to receptors which prevents contraction. The main use is for hypertension and angina. Example would be amlodipine
WHat is the MOA of diuretics and what are its effects
It is a firstline antihypertensive drug that deceases plasma and ECF volumes. This results in decreased preload, cardiac output, and total peripheral resistance. Over effect is decreasing workload of heart which reduces heart rate
WHat is the main diuretic drug
hydrochlorthiazide
How do vasodilators work and what is the main example
They relax arteries and veins so they cause peripheral vasodilation which decreases the SVR. The main example is sodium nitroprusside
What are the adverse effects of vasodilators
Bradycardia, hypthyroidism, hypotension, platelet aggregation, cyanide toxicity
When is sodium nitroprusside used?
Used in critical care settings for hypertensive emergencies,
WHat are other classes of drugs that are used to treat hypertension?
selective aldosterone blockers and they work by blocking action of aldosterone.
What are parameters when providing hypertensive care?
Hold drugs when a patients HR is less than 60 and SBP is greater than 90
What is a nursing implication to be aware of when caring for male patients
Teach them that certain antihypertensive drugs may cause impotence.
What are the important facts to be aware of when it comes to ACE inhibitors?
They can cause renal impairment and may cause hyperkalemia
