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HLSC 220 Pharmacotherapeutics for Health Professionals 💊 > Antihypertensive Drugs - Ch 21, 47-50 > Flashcards

Antihypertensive Drugs - Ch 21, 47-50 Flashcards

1
Q

What are 90% of hypertension cases?

A

Unknown cause (idiopathic)
Aka Essential or primary hypertension

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2
Q

What are 10% of hypertension cases?

A

Known cause
-Secondary hypertension

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3
Q

What can hypertension lead to?

A

Cerebrovascular disease
Hypertensive retinopathy
Left ventricular dysfunction
Left ventricular hypertrophy
Coronary artery disease
Chronic kidney disease
Peripheral artery disease

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4
Q

What are some benefits of treating hypertension?

A

Decreased heart failure by 50%
Decreased stroke by 38%
Decreased heart attack by 15%
Decreased death ny 10%

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5
Q

What are some lifestyle considerations that contribute to hypertension?

A

Obesity
Physical exercise
Salt intake
Increase potassium intake
Dietary habits including fat intake
Alcohol
Smoking

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6
Q

What blood pressure needs hypertension treatment in the general population?

A

<140/90

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7
Q

What blood pressure needs hypertension treatment in high risk populations (e.g, CV disease, Non-DM CKD)?

A

≤120/NA

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8
Q

What blood pressure needs hypertension treatment in diabetics?

A

<130/80

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9
Q

What are the categories of antihypertensive drugs?

A

Angiotensin converting enzyme (ACE) inhibitors
Angiotensin II receptor blockers (ARBs)
Calcium channel blockers (CCBs)
Diuretics
B-adrenoreceptor blockers
Vasodilators
Adrenergic agents

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10
Q

What are ACE inhibitors?

A

Large grouo of safe and effective drugs
Often used as first-line agents in heart failure and hypertension

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11
Q

What are ACE inhibiotrs often combined with?

A

Thiazide diuretic or calcium channel blocker

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12
Q

Examples of ACE inhibitors?

A

Captopril (Capoten)
Enalapril (Vasotec)
Lisinopril and quinapril

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13
Q

What is unique about Captopril?

A

Shortest half-life of the prils

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14
Q

How is Enalapril (Vasotec) administered?

A

Oral
Parenteral

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15
Q

What is unique about lisinopril and quinapril?

A

Newer agents, long half lives, once-aday administration

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16
Q

Why would patients with diabetes and hypertension want to use ACEIs?

A

ACEIS have renal protective effects in diabetics

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17
Q

Why are ACEIs used to treat heart failure?

A

Slows progression of left ventricular remodelling after an MI

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18
Q

What is the mechanism of action of ACEIs?

A
  • Prevents angitensin II vasoconstriction, which reduces peripheral resistance (afterload)

-Prevents aldosterone release, which reduces salt and water reabsorption

-Prevents the breakdown of bradykinin

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19
Q

What adverse effects are associated with ACEIs?

A

Dry, nonproductive cough
First-dose hypotensive effect may occur
Possible hyperkalemia

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20
Q

What drugs do ACE inhibitors have interactions with?

A

Potassium (K) supplements and K-sparing diuretics

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21
Q

When is ACEIs use contraindicated?

A

Pregnancy

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22
Q

ARBs are similar to ACEIs, but not identical, what are some differences?

A

Don’t cause a dry cough
-Not combined with ACEIs normally

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23
Q

Examples of ARBs?

A

Losartan (cozaar)
Valsartan (Diovan)

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24
Q

What is the mechanism of action of ARBs?

A

Angiotensin II receptor antagonist
-Block receptors that Ang II activates

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25
Q

What are the effects of ARBs when they block receptors than Ang II activates?

A

Blocks Ang-II mediated vasoconstriction
Blocks release of aldosterone

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26
Q

ARBs may be used alone, or with what other agents?

A

CCB
Diuretics

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27
Q

Angiotensin II receptor blockers (ARBs) are alternatives to what?

A

ACE inhibitors

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28
Q

When is ARB use contraindicated?

A

Pregnancy

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29
Q

What are calcium channel blockers used for?

A

Hypertension
Angina
Dysrhythmias

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30
Q

What are the kinds of calcium channel blockers?

A

Benzothiazepines (cardciac + vascular)
Phenylalkamines (cardiac + vascular)
Dihydropyridines - DHPs (vascular selective)

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31
Q

Examples of Benzothiazepines?

A

Diltiazem (Cardizem)

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32
Q

Example of Phenylalkamines?

A

Verapamil

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33
Q

Examples of Dihydropyridines - DHPs?

A

Amlodipine, nifedipine, nimodipine

34
Q

What is the effect of CCBs on cardiac muscle?

A

Block cardiac muscle Ca channels which alters electrical activity of cardiac muscle (SA, AV nodes and muscle)

35
Q

What is the effect of CCBs on vascular muscle?

A

Inhibits Ca entry into arteriolar vascular smooth muscle cells which causes relaxation and decreased peripheral resistance (lowers BP)

36
Q

Adverse effects: CCBs - Verapamil/Diltiazem?

A

Cardiovascular: Hypotension, dizziness, flushing, peripheral edema

Gastrointestinal: Constipation, nausea

Other: Rash, demititis

37
Q

Adverse effects: CCBs - DHPs?

A

Cardiovascualr: Hypotension, dizziness, palpitations, tachycardia, flushing, peripheral edema

Gastrointestinal: Little constipation

Other: Rash, demititis

38
Q

What is the mechanism of action of thiazide diuretics for hypertension treatment?

A

Decrease the plasma and extracellular fluid volumes which decreases preload and cardiac output, and decreases total peripheral resistance

Decreased herat workload = decreased BP

39
Q

What is the first line drug in guidelines for hypertension?

A

Diuretics

40
Q

Examples of thiazides/thiazide-like diurteics?

A

Hydrochlorothiazide (hyrodiuril)
Chlorthalidone (thiazide-like) -longer acting

41
Q

What can thiazide use possibly lead to?

A

Hypokalemia
Digoxin interation

42
Q

What kind of diuretics are preferred for HTN?

A

Longer acting over short acting

43
Q

Examples of longer-acting (thiazide-like) diuretics?

A

Clorthalidone, indapamide

44
Q

Examples of shorter-acting (thiazide) diuretics?

A

Hydrochlorothiazide

45
Q

What are some reccomended sungle pill combinations used to treat HTN?

A

ACEI + CCB
ACEI + diuretic
ARB + diuretic
ARB + CCB

46
Q

What are the 4 adrenoceptors subtypes?

A

α1
α2
β1
β2

47
Q

What are β-adrenoreceptor blockers?

A

β-adrenoreptor antagonists, β1-blockade
Act in the periphery, mainly heart
Block norepinephine/epinephrine action in heart

48
Q

What do beta-blockers reduce?

A

↓Heart rate
↓Force of heart muscle contraction
↓Stroke volume

49
Q

Examples of β-adrenoreceptor blockers?

A

Metoprolol (Lopressor)
Atenolol
Propanolol (Inderal)

50
Q

What kind of β-adrenoreceptor blockers are β1- selective?

A

Metoprolol
Atenolol

51
Q

What kind of β-adrenoreceptor blockers are non-selective?

A

Propanolol

52
Q

What are β-adrenoreceptor blockers used for?

A

Hypertension
Heart failure
Angina
Dysrhythmias

53
Q

What do β-adrenoreceptor blockers cause an intolerance to?

A

Excercise

54
Q

Who should avoid using β-adrenoreceptor blockers ?

A

Asthma patients

55
Q

What are dual α1 and β-receptor blockers?

A

Act in the periphery of heart and blood vesseels
Reduce heart rate
cause vasodilation

56
Q

What adrenergic recpetor is blocked to cause reduced heart rate?

A

β1-receptors

57
Q

What adrenergic receptor is blocked to cause vasodilation?

A

α1 receptors

58
Q

Examples of dual α1 and β-receptor blockers?

A

Labetalol
Carvedilol

59
Q

How do centrally acting α2 adrenoceptors interact with the body?

A

Agonists

60
Q

How do peripherally acting α1 adrenoceptors interact with the body?

A

Antagonists

61
Q

What do centrally acting α2-recepotor agonists do?

A

Stimulate α2-adrenergic receptors in the brainstem to reduce norepinephrine release,
decrease SNS outflow from CNS,
cause vasodilation (decrease BP)

62
Q

Examples of centrally acting α2-recepotor agonists?

A

Clonidine (Catapres)
Methyldopa

63
Q

What centrally acting α2-recepotor agonist is rarely used?

A

Clonidine (Catapres)

64
Q

What is the 1st line therapy for hypertension in pregnancy?

A

Methyldopa
-Pro-drug

65
Q

When are centrally acting α2-recepotor agonists usually used?

A

After other agents have failed or in combination with other drugs due to adverse effects

66
Q

Adverse effects associated with centrally acting α2-recepotor agonists?

A

Sedation
Dry mouth

67
Q

What do peripherally acting α1-recepotor antagonists do?

A

Block α1-adrenergic receptors
Block NE contraction of blood vessels

68
Q

Examples of peripherally acting α1-recepotor antagonists?

A

Prazosin (minipres)
Doxazosin
Terazosin

69
Q

Peripherally acting α1-recepotor antagonists provide relief of symptoms of what?

A

BPH - Benign prostatic hypertrophy

70
Q

Peripherally acting α1-recepotor antagonists are used in combination with what to treat severe HF?

A

Cardiac glycosides and diuretics

71
Q

what adverse effects are associated with α-receptor adrenergic agents?

A

Dry mouth
Sedation, drowsiness
Costipation
Headaches
Nausea
Cardiac disturbances (palpitations)
Sleep disturbances
rash

72
Q

α-receptors have a high indicence of what?

A

Orthostatic hypotension

73
Q

What is the mechanism of action of vasodilators?

A

Directly relax arteriolar smooth muscle (peripheral vasodilation)

74
Q

What are vasodilators used for?

A

Hypertension
-Soemtimes in combination with other drugs

75
Q

Examples of vasodilators?

A

Hydralazine (Apresoline)
diazoxide
minoxidil
Sodium nitroprusside (Nipride) (Nitirc oxide action)

76
Q

What vasodilators are administed IV in hypertensive emergencies?

A

IV Sodium nitroprusside and diazoxide

77
Q

What adverse effects are associated with hydralazine (vasodilator)?

A

Dizziness, headache, anxiety
Tachycardia
nausea and vomiting
diarrhea
anemia
dyspnea
edema
nasal congestion

78
Q

What adverse effects are associated with sodium nitroprusside (vasodilator)?

A

Bradycardia
Hypotension
Possible cyanide toxicity

79
Q

Why should antihypertensive drugs not be stopped abruptly?

A

May cause rebound hypertensive crisis and lead to stroke

80
Q

What should the nurse teach the patient if they are using antihypertensive drugs?

A

Avoid smoking
Avoid eating foods high in sodium e.g, tinned osups, packaged meals
Change lifestyle
Change positions slowly
Avoid aggravating low BP

81
Q

What aggravates low BP?

A

Hot tubs, showers, baths
Hot weather
Prolonged sitting or standing
Intense physical exercise
Alcohol ingestion

HLSC 220 Pharmacotherapeutics for Health Professionals 💊 (31 decks)

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