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Pharmacology > Antihypertensive Drugs > Flashcards

Antihypertensive Drugs Flashcards

1
Q

Types of hypertension

A

Unknown cause

  • Essential, idiopathic, or primary hypertension
  • 90% of cases

Known cause

  • Secondary hypertension
  • 10% of cases
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2
Q

Lifestyle implications

A
  • Obesity
  • Physical exercise
  • Salt intake
  • Increased potassium intake
  • Dietary habits including fat intake
  • Alcohol
  • Smoking
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3
Q

BP Treatment Target

A

General population
- <140/90

High risk (CV, non-DM CKD)
- < 120/NA

Diabetes
- <130/80

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4
Q

Categories for Antihypertensive Drugs

A
  • Angiotensin converting enzyme (ACE) inhibitors
  • Angiotensin II receptor blockers (ARBs)
  • Calcium channel blockers (CCBs)
  • Diuretics
  • B-adrenoceptor blockers
  • Vasodilators
  • Adrenergic agents
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5
Q

ACE Inhibitors

A
  • Captopril (Capoten)
  • Shortest half-life of the “prils”
  • Safe and effective drugs
  • First-line agents for HF and hypertension
  • Often combined with a thiazide diuretic or calcium channel blocker

Other meds

  • enalapril (vasotec)
  • lisinopril, and quinapril
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6
Q

ACE Inhibitors - Indications

A

Hypertension
- Drugs of choice for diabetic patients

HF (either alone or in combination with diuretics or other agents)
- Drug of choice in hypertensive clients with heart failure

Slows progression of left ventricular remodelling after MI

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7
Q

ACE Inhibitors - Mechanism of Action

A
  • Prevents Ang II vasoconstriction (reduces peripheral resistance and afterload)
  • Prevents aldosterone release (reduces salt and water reabsorption)
  • Prevents the breakdown of bradykinin (therefore blood pressure continues to lower)
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8
Q

ACE Inhibitors - Adverse Effects

A
  • Fatigue
  • Headache
  • Impaired taste
  • Dizziness
  • Mood changes
  • Possible hyperkalemia
  • Dry, nonproductive cough which reverses when therapy is stopped

First dose hypotensive effect may occur

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9
Q

ACE Inhibitors - Interactions

A

K supplements and K-sparing diuretics

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10
Q

When should you not use ACE Inhibitors?

A

In pregnancy

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11
Q

ARB - Drugs

A

*Losartan (Cozaar)
Valsartan (Diovan)

Generally not combined with ACEIs - similar in composition

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12
Q

ARB - Mechanism of Action

A

Block receptors that angiotensin II activates

- Blocks vasoconstriction and blocks release of aldosterone

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13
Q

ARB - Indicaitons

A

Hypertension
Adjunctive agent for HF treatment
May be used alone or with others like diuretics

Used mostly in clients who can’t tolerate ACE inhibitors

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14
Q

What should you not use ARB drugs?

A

In pregnancy

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15
Q

What can calcium channel blockers be used to treat?

A

*Hypertension
Angina
Dysrhythmias

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16
Q

What are 3 example of CCB’s?

A

Benzothiazepines (cardiac and vascular)
-*Diltiazem

Phenylalkylamines (cardiac and vascular)
- Verapamil

Dihydropyridines (vascular selective)
- Amlodipine

17
Q

What effect do CCB’s have on cardiac muscles?

A

It alters electrical activity of cardiac muscle cells by blocking Ca channels

18
Q

What effect do CCB’s have on vascular muscles?

A

It causes relaxation and decreased peripheral resistance (decreased blood pressure)

19
Q

What are the 2 main adverse effects of Verapamil/Diltiazem?

A
  1. Cardiovascular
    - Hypotension, flushing, peripheral edema
  2. Gastrointestinal
    - *Constipation, nausea
20
Q

How does the DHP’s adverse effects differ from Verapamil/Diltiazem?

A

There is very little constipation, palpitations and tachycardia

21
Q

How do Thiazide Diuretics influence the heart?

A

Decreases preload, cardiac output, and total peripheral resistance

Overall decreased workload for heart and decreased BP

22
Q

What is an example of a Thiazide Diuretics?

A

Hydrochlorothiazide

23
Q

What is a possible adverse effect of Thiazide Diuretics?

A

Hypokalemia

24
Q

What are the 4 adrenoceptor subtypes?

A

a1
a2
B1
B2

25
Q

Where and how does the B-adrenergic receptor blockers (antagonists) function?
What is an example?

A

Metoprolol (Lopressor) B1- selective

Acts primarily in the heart

B1 blockade to prevent norepinephrine/epinephrine action. This leads to reduces heart rate and stroke volume

26
Q

When should you use B-adrenoceptor blockers? (4)

A
  1. Hypertension
  2. HF
  3. Angina
  4. Dysrhythmias
27
Q

When should you avoid using B-adrenoceptor blockers?

A

In patients with asthma

28
Q

Where do Dual a1 and B-receptor blockers act?

A

In the periphery at heart and blood vessels

29
Q

Which receptor blocker reduces heart rate?

A

B1-receptor blockade

30
Q

Which receptor causes vasodilation?

What is an example?

A

a1-receptor blockade

Prazosin (Minipres)

Blocks NE contraction fo blood vessels

31
Q

Which adrenoceptor acs centrally?
What is an example?
Does it increase or decrease blood pressure?

A

a2-adrenoceptor agonists

Methyldopa

Decreased blood pressure

32
Q

Which adrenoceptor acts peripherally?

When should it be used?

A

a1-adrenoceptor antagonists

For relief of symptoms of benign prostatic hypertrophy (BPH) and hypertension (not 1st line)

33
Q

When should Methyldopa be used?

A

1st line therapy for hypertension in pregnancy

34
Q

What are adverse effects for a receptors?

A
  • *Orthostatic hypotension
  • Dry mouth
  • Drowsiness
  • Sedation
  • Constipation

Less common:

  • Headaches
  • Nausea
  • Rash etc
35
Q

When should you use vasodilators and what are two examples?

A

*Hydralazine (Apresoline)
For hypertension

Sodium nitroprusside (Nipride)

  • IV sodium nitroprusside and diazoxide are reserved for the management
36
Q

What are the adverse effects for Hydralazine?

A

*Tachycardia

Dizziness, headache, anxiety, diarrhea, anemia, edema etc

37
Q

What are the adverse effects for Sodium nitroprusside?

A

*Hypotension

Bradycardia, cyanide toxicity

38
Q

What is important to keep in mind for client care?

A

Do not stop drugs abruptly! May cause rebound hypertensive crisis and stroke

Avoid smoking, and high sodium diets

Change positions slowly to avoid syncope from postural hypotension

Pharmacology (29 decks)

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