Antihypertensive drugs Flashcards
What is the equation for CO?
SV*HR=CO
What is stroke volume measure?
Force of contraction
What is the biggest determinant of peripheral resistance (PR)?
Radius of the lumen or vessel
What are the 2 equations for MAP?
MAP=(CO)(PR)
MAP=(SV)(HR)(PR)
What drugs effect CO?
Beta blockers
What drugs effect PR?
Alpha blockers
What does inotrope mean?
Force of contraction
What does chronotrope mean?
Effect on HR
What is considered high BP?
Anything >120/80
True or false: any drug or disease that increases the sympathetic system can cause HTN?
True
True or false: aldosterone secreting tumor can cause hypotension?
False, it causes hypertension because Aldosterone increases blood volume
How many cases of HTN are idiopathic?
90%
What is two other name for idiopathetic HTN?
Essential HTN
primary HTN
Why is HTN called a silent killer?
Because no Sx show until damage is done
How can HTN damage your heart?
Increased BP causes heart to work harder to eject blood into peripheral
How does HTN damage your vessels?
High BP in vessels damages endo cells and lead to atherosclerosis and thrombi
How can an aneurysm in vessels be caused by HTN?
HTN weakens vessel walls
How can HTN damage kidneys?
Increased pressure in glomerulus can damage its ability to filter blood
What commonly seen in urine when the kidney glomerulus is damaged?
Protein in urine(proteinuria)
How does HTN damage eyes?
HTN damages retinal vessels and causes them to leak into virtuous humor
What gender is more likely to get HTN?
Males
What ethnicity is more likely to get HTN?
African American
How does genetics and aging effect HTN?
Increase age=risk
HTN runs in families
How does smoking cause a risk for HTN?
Smoking increases the sympathetic system and damages endo cells
What does DASH diet stand for? What type of diet does it include?
Dietary Approached to Stop HTN
Low salt, sweets and fats
More fruit and veggies
What are 4 things that can decrease HTN risk?
Stop smoking
Exercise
Relaxation techniques
DASH diet
Why does a DASH diet help decrease BP?
DASH diet is high in K+ which hyperpolarizes SM which causes vasodilation
What happens to Na+ levels when body is hypokalemic?
Na+ retention increases
at what BP is lifestyle modifications used to Tx HTN?
120-140 systolic BP
What controls the long term regulation of BP?
RAAS
ADH mechanism
ANH mechanism
What 2 things being decreased will cause renin to be released?
Decreased BP
Decreased Na+
What cells measure BP in glomerulus?
Juxtaglomerulosa cells
What cells in the glomerulus measure Na+ levels?
Macula densa cells
What part of the nephron is closely associated with the afferent arteriol?
DCT
What enzyme changes Angiotensinogen into angiotensin 1?
Renin
What enzyme changes AT-1 into AT-2?
ACE
What effect does ACE have on Bradykinin?
It breaks down bradykinin
What are the 4 things that AT-2 does?
Vasoconstriction
Increase ADH
Increase Aldosterone
Increase salt appetite and thirst
What is the receptor for AT-2? Where are they found?
AT-1 receptor
Kidneys and heart
What does ACEI stand for?
Angiotensin converting enzyme inhibitors
What does ARBs stand for?
Angiotensin receptor blocker
What are the 3 types of drugs used to inhibit the RAAS?
ACEI
ARBs
renin inhibitors
What are the 3 things that bradykinin causes?
Endothelial retraction
Vasodilation
Dry cough d/t bronchoconstriction
What DO ACEI drugs end in?
-pril
What do ACEI come from?
Venom of Pit vipers
What are the indications for ACEIs?
HTN
Preserving kidney function
What is benazepril(Lotensin)?
ACEI
What is Captopril(Capten)?
ACEI
What is Enalapril(Vasotec)?
ACEI
What is Lisinopril(Prinivil)?
ACEI
What is Quinipril(Accupril)?
ACEI
What is Ramipril(Altace)?
ACEI
Where are the most amount of AT-1 receptor found?
Efferent arteriol
Why can having DM lead to glomerular damage and eventually proteinuria?
DM increases levels of AT-2 which binds to efferent arteriol and causes massive vasoconstriction. The blood gets backed up and eventually leaks protein into urine
What causes the posterior pituitary to release ADH?
Increase in osmolarity concentration
Decrease in BP
What is the contraindication for ACEI and ARBs? What can they cause?
Pregnancy
Infant renal failure
Congenital malformations(cleft pallet)
Death
What are the ADR of ACEI and ARBs?
Dry cough
Hyperkalemia
Why can ACEI and ARB cause a ADR of hyperkalemia?
Aldosterone gets blocked
-aldosterone normally helps Na+ get reabsorbed back into the blood through a Na/K pump
What do ARB drugs usually end in?
-sartan
What is aliskiren(Tekturna)? What effects of the drug is it similar to?
A renin inhibitor
ACEIs and ARBs
What are the 3 different categories of diuretics?
Thiazides/thiazide-like drugs
K+ sparing drugs
Loop diuretics
What is hydrochlorothiazide(Hydrodiuril)? What does it cause?
Thiazide
Causes vasodilation of SM
What is chlorthalidone(Hygroton)? What does it cause?
Thiazide
Causes vasodilation of SM
When are K+ sparing drugs used?
When loss of K+ is a concern
When are loop diuretics used?
When there is reduced kidney function
What is the MOA of thiazides that causes vasodilation?
Thiazides open large conductance Ca2+ activated K+ channels, which hyperpolarizes the endo cells and cause vasodilation
What is clonidine(Catapress)? What receptor does it stimulate? What does it cause?
Central acting sympatholytic
Stimulates alpha 2 receptor
Decreases NE release which causes vasodilation
What do alpha blockers end in?
-osin
What part of MAP do alpha blockers effect?
Peripheral Resistance
What is doxazosin(Cardura)?
Alpha blocker
What is prazosin(Minipress)?
Alpha blocker
What is terazosin(Hytin)?
Alpha blocker
What organs do beta-blockers work on? What enzyme do they reduce the release of?
Act on heart and kidneys
Reduce release of renin
What is atenolol(Tenormin)?
Selective beta 1 blocker
What is metoprolol(Lopressor)?
Selective beta 1 blocker
What is esmolol(Brevibloc)?
Selective beta 1 blocker
What is bisoprolol(Morocor)?
Selective beta 1 blocker
What is propranolol(Inderal)? What is it contraindicated for?
beta 1 and 2 blocker
Contraindicated for asthmatic pt
What is carvedilol(Coreg)?
beta 1 and alpha 1 blocker
What is labetalol(Trandate)?
beta 1 and alpha 1 blocker
What are the 2 categories of Ca2+ channel blockers (CCB)? What do they cause?
Nondihydropyridine-
Decrease HR
negative inotrope effect
Vasodilation
Dihydropyridine-
Just vasodilation
What is diltiazem(Cardizem)?
Nondihyrdopyridine CCB
What is verapamil(Calan)?
Nondihyrdopyridine CCB
What is amlodipine(Notvasc)?
Dihyrdopyridine CCB
What is nicardipine(Cardene)?
Dihyrdopyridine CCB
What is nifedipine(Procardia)?
Dihyrdopyridine CCB
What effect does ANH have on blood volume? When is it released?
Released to kidneys to cause natriuresis to decrease BP
ANH is release when atria is stretch a lot
What is Nesiritide(Natrecor)? Route? Available in US?
Synthetic ANH
Given IV
no long available in USA
What is diazoxide(Hyperstat)? Route? When is it used?
Vaso and arteriolar dilator
Oral
Used in HTN emergencies
What is nitroprusside(Nitropress)? Route? When is it used?
Vaso and arteriolar dilator
IV infusion
Used in HTN emergencies
What is Epleronone(Inspra)? What does it block?
Selective aldosterone blocker
Blocks aldosterone receptor
What is endothelium? What does it cause?
Hormone released from endo cells that causes vasoconstriction
What is bosentan(Tracleer) MOA? Route? Indication?
Blocks receptors of hormone endothelin
Oral
Pulmonary HTN w/ severe HF
What are the lab values of a pt on an ACEI?
Increase serum creatinine levels
Increased serum K+ levels
If a pt is <60yo and has a BP >140/90 on two occasions? What type of therapy should be used?
Pharmacotherapy
If a pt is >60yo and has a BP >150/90 on two occasions? What type of therapy should be used?
Pharmacotherapy
If a pt is African American w/ HTN what drug classes are commonly used?
Thiazides and CCB
If a pt is DM w/ HTN, what type of drug classes are they likely to use?
ACEI or ARB +/- CCB or thiazide
What is the goal of using Medications for HTN pt <60yo? >60yo? DM pt?
<60yo= <140/90
>60yo= <150/90
DM pt= <130
What Hx should a nurse get from pt of PMHx?
Medications
Herbal medication Hx
What HR should HTN meds not be given?
<60HR
What can cause rebound HTN?
Abruptly discontinuing HTN medication
What is a ADR of antiHTN drugs?
Dizzinesss and syncope
