Antihypertensive drugs, tx of angina pectoris, arrhythmias and CHF

Question 1

How do antihypertensive drugs work?

Answer 1

work by affecting cardiac output, total peripheral resistance or both

Question 2

Which category of hypertension is attributed to an abnormality in the body and treatment focuses on correcting the abnormality, and which one has no clear cause? Which one is more common?

Answer 2

secondary, primary, primary is more common

Question 3

What are the possible causes of essential HTN?

Answer 3

diet, stress, genetic predisposition, cigarette smoking, alcohol abuse, obesity

Question 4

What happens as BP increases with HTN?

Answer 4

changes in peripheral vasculature lead to vessels becoming less compliant and resistance increases

Question 5

HTN is associated with metabolic abnormalities that are known together as metabolic syndrome, what are the characteristics? (4)

Answer 5

impaired glucose metabolism, hyperinsulinemia, dyslipidemia, abdominal obesity

Question 6

What are the drugs used to treat HTN? (5)

Answer 6

diuretics, sympatholytics, vasodilators, drugs that inhibit renin-angiotensin system, calcium-channel blockers

Question 7

Which drugs are used to treat HTN because they increase renal excretion of water and sodium which decreased fluid volume in the vascular system?

Answer 7

diuretics

Question 8

What is something you have to be aware of when a patient is on diuretics?

Answer 8

it gets rid of sodium and potassium so pt needs to be taking potassium supplements or checking potassium levels to make sure they aren’t too low-> lead to arrhythmias and no energy

Question 9

What are the diuretics (3) and which one is the most potent, least

Answer 9

thiazide (needs good kidney function), loop (most potent), potassium sparing (least potent)

Question 10

What problem can fluid depletion cause in diuretics in response to decreased blood volume?

Answer 10

decrease in blood volume may cause an increase in cardiac output and peripheral vascular resistance due to activation of the baroreceptor reflex

Question 11

Beta blockers, alpha blockers, presynaptic adrenergic inhibitors, and centrally acting agonists are all types of which drug?

Answer 11

sympatholytic

Question 12

Which sympatholytic drug help decrease HR and myocardial contraction force and reduce HTN because they decrease cardiac output and slow down the HR?

Answer 12

beta blockers

Question 13

What do most beta blockers tend to end with?

Answer 13

-lol

Question 14

What are side effects to be aware of in beta blockers?

Answer 14

nonselective can cause bronchoconstriction in pts with asthma, orthostatic hypotension, excessive HR depression

Question 15

What sympatholytic drugs block the alpha-1 adrenergic receptors on smooth mm which promotes a decrease in vascular resistance, and these drugs also improve blood lipid profiles (decreased trigylcerides and total cholesterol)?

Answer 15

alpha blockers

Question 16

What are some adverse effects of alpha blockers to be aware of?

Answer 16

reflex tachycardia (lead to compensatory increase in HR), orthostatic hypotension, increase in cardiac disease and CHF

Question 17

Which sympatholytics inhibit the release of norepinephrine from the presynaptic terminals which decreases sympathetic excitation of the heart and peripheral vasculature resulting in decreased BP?

Answer 17

presynaptic adrenergic inhibitors

Question 18

Which sympatholytics inhibit sympathetic discharge from the brainstem by acting on central receptors which causes a decrease in cardiovascular stimulation and BP?

Answer 18

centrally acting agents

Question 19

Which antihypertensive drug inhibit the enzyme that allows angiotensin I to convert to angiotensin II which causes vasodilation and decrease in BP, what do they tend to end with?

Answer 19

ACE inhibitors. -pril (part of the renin-angiotensin system inhibitors)

Question 20

Which antihypertensive drug block the actual recept where angiotensin II would bind to allow vasoconstriction to occur, leading to end result of vasodilation and decrease in BP, what do they tend to end with?

Answer 20

ARBs (angiotensin II receptor blockers), -tan

Question 21

Why might someone opt to use an ARB rather than an ACE inhibitor?

Answer 21

to avoid the persistent dry cough side effect of ace inhibitors

Question 22

What drugs block calcium entry into the vascular smooth mm cells which blocks contractile process leading to vasodilation and decreased vascular resistance? What were they developed to treat?

Answer 22

calcium channel blockers, treat angina pectoris, cardiac arrhythmias and hypertension

Question 23

Which drugs are recommended for pts in stage I hypertension (140-159/90-99)?

Answer 23

thiazide diuretic, calcium channel blocker, ACE inhibitor or ARB

Question 24

How many drugs are recommended for treating stage II hypertension (>159/>99)?

Answer 24

2 drugs, so thiazide diuretic or calcium channel blocker is combined with either an ACE inhibitor or an ARB

Question 25

What are the main HTN concerns for PTs?

Answer 25

orthostatic hypotension, beta blockers cause blunted HR response so RPE should be used

Question 26

What drugs are used to treat angina pectoris?

Answer 26

organic nitrates, beta blockers, calcium channel blockers

Question 27

How do organic nitrates work?

Answer 27

decrease cardiac preload and afterload which decreases the amount of work the heart must do so the myocardial oxygen demand decreases

Question 28

___ is the best route for administration of nitroglycerin

Answer 28

sublingual

Question 29

What anticoagulant drug is stronger than aspirin and used in angina pectoris as it is usually associated with some coronary artery occlusion?

Answer 29

plavix

Question 30

What drug may be used in the acute phase of unstable angina to prevent clot formation?

Answer 30

heparin

Question 31

Which drugs tend to be the first drugs used in the long term management of stable angina, how about for acute episodes?

Answer 31

beta blockers, nitroglycerin

Question 32

Which drugs are most effect for variant angina?

Answer 32

calcium channel blockers

Question 33

Which medication is essential to prevent unstable angina from progressing into a MI?

Answer 33

anticoagulant and antiplatelet therapy (ACE inhibitors and statin drugs are also used)

Question 34

What are concerns for PT in regards to angina pectoris medications?

Answer 34

ensure pt has nitroglycerin with them during session, blunted HR responses, risk for hypotension

Question 35

What are the 4 classes of arrhythmic drugs?

Answer 35

class 1: sodium channel blockers
class 2: beta blockers
class 3: drugs that prolong repolarization
class 4: calcium channel blockers

Question 36

What is the most common side effect to be aware of in sodium channel blockers?

Answer 36

pro-arrhythmic effect (increase arrhythmias)

Question 37

What is the most widely used antiarrhythmic drug?

Answer 37

amiodarone

Question 38

Which drugs are very useful in treating a-fib as they decease the rate of SA node discharge and inhibit conduction velocity through the AV node?

Answer 38

calcium channel blockers

Question 39

What are things a PT should be aware of when treating a pt on antiarrhythmic drugs?

Answer 39

be aware of cardiotoxic drug effects (faintness and dizziness), increased arrhythmias and hypotension so pulse rate should be taken for full 60 seconds

Question 40

What are the 2 primary goals of drugs that are used for CHF?

Answer 40

improve myocardial contraction force (inotropic agents), decrease cardiac workload

Question 41

What drug helps improve pumping action of the heart and increases exercise tolerance and cardiac output at rest and exercise?

Answer 41

digitalis

Question 42

What is an adverse side effect to be aware of with digitalis?

Answer 42

digitalis toxicity- GI distress, CNS disturbances, abnormalities in cardiac function, more toxic-> v-fib and then death