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NURS 251 (Pharmacology 1) > Antihypertensive Drugs > Flashcards

Antihypertensive Drugs Flashcards

1
Q

stWhat is the equation for blood pressure?

A

Cardiac output x Systemic vascular resistance

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2
Q

What is a high normal BP

A

130-139 mm Hg/ 85-89 mm Hg

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3
Q

What are the 3 different types of hypertension

A

Essential hypertension: Sudden/spontaneous
Secondary hypertension: Caused by another condition
Malignant hypertension: Above 180/120, a medical emergency

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4
Q

What is the goal of antihypertensive therapy?

A

Reduction of cardiovascular and renal morbidity
Achieve pressure <140/90
<130/80 for diabetics

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5
Q

What does the parasympathetic NS stimulate

A

Smooth muscle, cardiac muscle, glands

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6
Q

What are the 7 categories of antihypertensive drugs?

A

Adrenergic drugs
Angiotensin-converting enzyme inhibitors
Angiotensin II receptor blockers (ARBs)
Calcium channel blockers
Diuretics
Vasodilators
Direct renin inhibitors

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6
Q

What does the sympathetic NS stimulate

A

Heart, blood vessels and skeletal muscle

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7
Q

What are the 5 subcategories of adrenergic drugs

A

Adrenergic neuron blockers (central and peripheral)
A2 receptor agonists ( central)
A1 receptor blockers (peripheral)
Beta receptor blockers (peripheral)
Combo a1 and B receptor blockers (peripheral)

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8
Q

Name an A2 receptor agonist and what does it do.

A

Clonidine is an A2 receptor agonist. Stimulates A2 adrenergic receptors in the brain which decreases sympathetic outflow in the CNS and norepinephrine production. Also reduces renin in kidneys (makes angiotensin 1)

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9
Q

Name a A1 receptor blocker and what does it do

A

Doxazosin
Blocks a1 adrenergic receptors which dilates arteries and veins resulting in decreased BP
Also increases urinary flow rates by preventing smooth muscle contraction in the bladder neck and urethra so there’s no blockage/resistance

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10
Q

What is doxazosin also used to treat?

A

BPH

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11
Q

Name 3 beta blockers and what do they do?

A

Propranolol, metoprolol, atenolol
Reduces HR and secretion of renin (makes angiotensin I)

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12
Q

What does long term use of beta blockers cause?

A

Reduced Peripheral vascular resistance

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13
Q

Name a dual-action a1 and beta receptor blocker and what does it do?

A

Labetalol
Reduces HR and is a vasodilator

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14
Q

What are the indications for adrenergic antihypertensives?

A

HTN, Glaucoma, BPH, Severe heart failure when used with cardiac glycosides and diuretics, menopausal flushing

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15
Q

What are adverse effects of adrenergic drugs

A

Orthostatic hypotension
Dry mouth
Drowsiness, sedation
Constipation
Depression
Edema
Sexual dysfunction
Bradycardia
Headaches
Sleep disturbances
Rash
Palpitations

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16
Q

Why are a2 receptor agonists (clonidine) not typically used as a first line of antihypertensive drugs?

A

High incidence of unwanted adverse effects (orthostatic hypotension, fatigue, dizziness)
Only used adjunctly with other antihypertensives when other drugs fail

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17
Q

What is nebivolol HCL, what does it do and what is a nursing consideration?

A

Beta blocker
Blocks beta receptors which causes vasodilation resulting in a decrease in Systemic vascular resistance
Do not stop abruptly, taper out over 2 weeks

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18
Q

What is used as a first line antihypertensive and why?

A

ACE inhibitors
Safe and very effective

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19
Q

What is the suffix for ACE inhibitors?

A

“pril”

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20
Q

Name 4 ACE inhibitors

A

Captopril
Enalapril
Perindopril
Ramipril

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21
Q

What is the MOA of ACE inhibitors

A

Blocks ACE which converts angiotensin 1 to angiotensin 2.
Angiotensin 2 is a potent vasoconstrictor
Prevents breakdown of bradykinin which is a vasodilator

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22
Q

What else can ACE inhibitors treat

A

Decrease SVR and preload (left ventricle volume)
Can stop progression of left ventricular hypertrophy

23
Q

What are the indications for ACE inhibitors

A

HTN, HF, Slow progression of Left ventricular hypertrophy after myocardial infarction
Renal protection for diabetes

24
Q

What are prodrugs

A

Prodrugs are inactive when administered and must be metabolized by the liver into an active form

25
Q

How are captopril and lisinopril different from other ACE inhibitors

A

They can be used if a patient has liver dysfunction, unlike others that are prodrugs

26
Q

How do ACE inhibitors treat HF

A

Prevent sodium and water reabsorption by inhibiting aldosterone secretion
Diuretic so decreases blood volume returning to the heart
Decreases preload
Decreases work required of the heart

27
Q

How do ACE inhibitors provide renal protective effects?

A

Reduce glomerular filtration pressure
Reduce proteinuria
Prevents progression of diabetic nephropathy

28
Q

What are adverse effects of ACE inhibitors?

A

Fatigue, dizziness, headache, impaired taste, mood changes, Dry, nonproductive cough that reverses when therapy is stopped.
Angioedema
First dose hypotension
Possible hyperkalemia

29
Q

Which ACE inhibitor has the shortest half life and needs to be given the most often? How many times must be administered?

A

Captopril. 3 to 4 times a day

30
Q

Enalapril is the only ACE inhibitor available in _____ and ____ forms

A

Oral and IV

31
Q

What is the suffix for ARBs

A

“sartan”

32
Q

Name 2 ARBs

A

Losartan
Telmisartan

33
Q

What is the MOA for ARBs

A

Selectively block the binding of angiotensin 2 to to angiotensin 2 receptors in vascular smooth muscle and adrenal glands
Blocks vasoconstriction and the secretion of aldosterone

34
Q

What is difference between ACE inhibitors and ARBs

A

Both well tolerated and effective
ARBs do not cause a cough

35
Q

________ are better tolerated than ____________ and are associated with lower mortality after MI

A

ARBS, ACE inhibitors

36
Q

T/F: ARBs are as effective as ACE inhibitors in treating HF and protecting the kidneys

A

False

37
Q

What are the indications for ARBs

A

HTN
Adjunctive drugs for the treatment of HF

38
Q

What are the adverse effects of ARBs

A

Upper respiratory infections, headaches, dizziness, inability to sleep, diarrhea, dyspnea, heartburn, nasal congestion, back pain, fatigue

39
Q

T/F: Hyperkalemia is more likely to occur with ARBs than ACE inhibitors

A

False; It is less likely

40
Q

What are the contraindications with losartan

A

Breastfeeding women
Used with caution in patients with renal or hepatic dysfunction or renal artery stenosis

41
Q

How do Calcium channel blockers decrease HTN ?

A

Cause smooth muscle relaxation by blocking the binding of calcium to its receptors, thereby preventing contractions.
Decreases peripheral smooth muscle tone, SVR and BP

42
Q

What are the indications for Calcium channel blockers

A

Angina
HTN
Antidysrhythmias
Migraines
Raynaud’s disease
Cerebral artery spasm prevention

43
Q

Name a calcium channel blocker

A

Amlodipine

44
Q

How do diuretics lower BP

A

Decrease plasma and ECF volumes.
Decreases preload, cardiac output and total peripheral resistance
Overall decreases heart workload and BP

45
Q

What is the common diuretic used to treat HTN

A

Hydroclorthiazide

46
Q

Name a vasodilator

A

Sodium nitroprusside

47
Q

What is the MOA of vasodilators?

A

Direct vasodilation of arteries and/or veins
Decreases SVR

48
Q

What are the indications for Vasodilators

A

HTN
Hypertensive emergencies

49
Q

What are the adverse effects sodium nitroprusside

A

Bradycardia, decreased platelet aggregation, rash, hypothyroidism, Hypotension, Methemoglobinemia, Cyanide toxicity

50
Q

What are the contraindications of sodium nitroprusside?

A

Allergy, Severe HF, Known inadequate cerebral perfusion

51
Q

What is a general rule regarding patients BP and administering an antihypertensive

A

If apical HR <60 or systolic BP <90, hold meds and contact physician

52
Q

Teach patients to______ to avoid syncope from postural hypotension.

A

Change positions slowly

53
Q

What is a consideration for male patients on these drugs?

A

Impotence is an expected effect

54
Q

Why shouldn’t antihypertensives be stopped abruptly

A

Can cause rebound hypertensive crisis which could lead to a stroke

NURS 251 (Pharmacology 1) (20 decks)

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