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Pharm Exam 3 > Antihypertensives > Flashcards

Antihypertensives Flashcards

1
Q

Normal BP

A

less than 120/80

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2
Q

Elevated BP

A

SBP between 120-129 and DBP less than 80

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3
Q

HTN Stage 1

A

SBP between 130-139 or DBP between 80-89

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4
Q

HTN Stage 2

A

SBP greater than or equal to 140 or diastolic greater than or equal to 90

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5
Q

HTN Urgency

A

180/120 without s/s of end-organ damage

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6
Q

HTN Emergency

A

HTN with s/s of end-organ damage (malignant, accelerated)

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7
Q

Result of HTN (diseases)

A
  1. HF
  2. CAD/ACS
  3. AMS
  4. CVA
  5. RF
  6. PVD
  7. papilledema
  8. preeclampsia
  9. eclampsia
  10. aortic aneurism/dissection
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8
Q

ways the body increases BP in chronological order (5)

A
  1. Norep, Epi (CNS/PNS/adrenal) => tachycardia, vasoconstriction
  2. Angiotensinogen (liver) + renin (kidney)=> angiotensin I
  3. Angiotensin I + ACE (epithelium) = angiotensin II (vasoconstriction)
  4. Angiotensin II => aldosterone (adrenal) => fluid retention
  5. ADH (hypothalamus) => fluid retention
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9
Q

diuretics side effects

A
  • prevent renal reabsorption of fluid => diuresis and natriuresis => decreased IV volume
  • “diuretic contraction” = increased concentration of blood content that are not excreted in urine (blood cells, glucose, uric acid, lipids = electrolyte imbalances)
  • decreased BP = orthostatic hypotension, dizziness, syncope, FALL
    = poor renal perfusion => AKI
    = tachycardia (reflex tachy too)
    = hypovolemia SO assess for edema and assess pt’s wt daily
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10
Q

diuretics electrolyte imbalance side effects

A
  • hypokalemia
  • hypomagnesemia
  • hyponatremia
  • metabolic acidosis
  • hyperglycemia
  • hyperuricemia
  • hyperlipidemia

LOW: K, Mg, Na, bicarb
HIGH: Ca, BG, uric acid, LDL

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11
Q

diuretics hypokalemia s/s and nursing (3)

A
  1. K+ replacement always should be considered along with diet high in K+ (exception?)
  2. Monitor for S/S (AMS, ileus, N/V, weakness, respiratory arrest, ventricular dysrhythmia)
  3. Dysrhythmia (check Hx., place on cardiac monitor and treat as indicated)
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12
Q

diuretics hypomagnesemia nursing (3)

A
  1. Monitor for S/S (dysrhythmia, weakness, tremor, muscle twitching)
  2. Dysrhythmia (check Hx., place on cardiac monitor and treat as indicated)
  3. Report low Mg level to provider and replace (PO/IV)
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13
Q

diuretics hyponatremia s/s and nursing (1)

A
  1. Monitor for S/S (muscle cramps, weakness, brain herniation, AMS, seizure, coma)
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14
Q

diuretics metabolic acidosis nursing (2)

A
  1. Monitor for low Bicarb on the ABG

2. Caution: patient with respiratory disorders are at higher risk of acidosis

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15
Q

diuretics hyperglycemia nursing (1)

A
  1. Monitor BG more closely in patients with diabetes (higher risk of hyperglycemia)
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16
Q

diuretics hyperuricemia nursing (2)

A
  1. Monitor uric acid levels

2. Caution in gout patients (assess history)

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17
Q

diuretics hyperlipidemia nursing (3)

A
  1. Caution in patient with hyperlipidemia (review Hx)
  2. Higher risk of atherosclerosis complications (angina, CVA, etc.)
  3. Monitor lipid panel
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18
Q

Nursing with diuretics (5)

A
  1. Assess ability to use the urinal/BSC in 30 minutes after taking
  2. Adherence
    • build rapport to understand the root cause of non-adherence
    • avoid taking potassium supplement while skipping the diuretic dose = hyperkalemia & fluid overload!! you can skip the dose but then ALSO skip your potassium
  3. Take diuretics earlier in the day rather than close to bedtime
  4. Keep a log of BP & daily weight
  5. Contraindications:
    • Hypovolemia, pregnancy, lactation, anuria (oliguria - low level of urine)
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19
Q

thiazides and thiazide-like diuretics drugs (3) and routes

A 
PO (IV only chlorothiazide)
Thiazides:
1. chlorothiazide - PO/IV
2. hydrochlorothiazide (aka HCTZ) - PO
Thiazide-like:
1. *metolazone*, chlortalidone, indapamide
- Give it an hour before Loop
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20
Q

loop diuretics - furosemide, bumetanide, torsemide general

A

Strongest and safest diuretics
renal vasodilator
- All diuretics cause AKI due to loss of blood volume/lower BP (lower renal perfusion)
- only diuretic that may be used in CKD and AKI

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21
Q

aldosterone receptor blocker; K-sparing diuretics drugs - spironolactone, eplerenone, triamterene, amiloride MOA and route

A

PO, Weakest diuretics

MOA: blocks the action of aldosterone => K retention, water, Na, bicarb excretion

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22
Q

drugs that block the heart and BV (sympatholytic drugs) (3)

A
  • beta-blockers
  • alpha2 agonist
  • diuretics
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23
Q

drugs that affect only the BVs (5)

A
  • direct acting vasodilators
  • alpha-1 blockers
  • ACEi
  • ARB
  • CCB
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24
Q

beta-blockers (-lol) drugs and route

A

IV/PO

  1. propranolol**
  2. nadolol
  3. timolol
  4. metoprolol**
  5. atenolol**
  6. esmolol
  7. carvedilol**
  8. labetalol**
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25
Q

alpha-2 agonist - methyldopa, clonidine, guafacine - MOA

A

MOA: decreased sympathetic stimulation

—->decreased HR, decreased CO, vasodilation (decreased peripheral resistance)

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26
Q

antihypertensives drugs (2) and route

A

IV/PO

  1. hydralazine
  2. minoxidil
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27
Q

alpha-1 blocker drugs (5)

A

For HTN & BPH:

  1. prazosin
  2. terazosin
  3. doxazosin

ONLY for BPH:

  1. tamsulosin
  2. silodosin
28
Q

ACE inhibitors (-pril) drugs (5)

A
  1. benzepril
  2. captopril
  3. lisinopril
  4. enalapril
  5. enalaprilat
29
Q

angiotensin receptor blockers (ARBs) MOA

A

block the receptor site of angiotensin II

  • —> very similar to ACEi but not as effective
  • —> prevents vasoconstriction = low BP
  • —> tachycardia (reflex)
30
Q

what are the 2 types of calcium channel blockers (ccb’s)

A
  1. -dipine: specific to vasculature, used for HTN

2. verapamil & diltiazem: used for tachy-dysrhythmia

31
Q

vasculature CCBs drugs (2) and route

A

IV/PO (specific to vasculature)

  1. amlodipine
  2. nifedipine
32
Q

managing symptomatic w/ drugs for hypotension & orthostatic hypotension (4)

A
  1. IV fluid - crystalloid (NS) or colloid volume expander (albumin) if edematous
  2. midodrine PO/IV - if the pt is at risk of hypervolemia or after hemodialysis
    - MOA: alpha1 agonist = vasoconstriction
    - SE: urinary retention (BPH), supine HTN (HTN associated with lying supine, check BP & administer while pt is in supine position)
    - Contraindications: AKI

FOR HYPOVOLEMIC SHOCK (EMERGENCY)

  • emergency drugs, used for shock and cardiopulmonary resuscitation
    3. vasopressin = ADH
    4. dobutamine (beta1 agonist)
33
Q

drug groups for HTN

A
  1. diuretics
  2. beta blockers
  3. alpha2 agonists
  4. direct acting vasodilators
  5. alpha1 blockers
  6. ACEi
  7. ARB
  8. CCB
34
Q

drug groups for hypotension

A
  1. crystalloid IV
  2. colloid IV
  3. alpha1 agonist
  4. emergency medicines
35
Q

loop diuretics - furosemide, bumetanide, torsemide routes

A

IV/PO/IM

36
Q

loop diuretics - furosemide, bumetanide, torsemide nursing

A
  • DILUTE & very slow IVP to avoid tinnitus

- –> ototoxicity

37
Q

aldosterone receptor blocker; K-sparing diuretics drugs - spironolactone, eplerenone, triamterene, amiloride secondary indication (2)

A
  1. With other diuretics to balance potassium

2. Treatment of adult acne (MOA: anti-androgenic effect)

38
Q

aldosterone receptor blocker; K-sparing diuretics drugs - spironolactone, eplerenone, triamterene, amiloride nursing (4)

A

Diet:
- avoid high potassium foods (oranges, grapefruit, potatoes, bananas, dried fruits)

Monitor HYPERkalemia:

  • Place on heart monitor (dysrhythmia)
  • —>Bradycardia/cardiac arrest, peaked T (cardiac monitor)
  • Monitor for paresthesia, abd/muscle cramps, weakness, fatigue
  • avoid with ACEi, ARB
39
Q

aldosterone receptor blocker; K-sparing diuretics drugs - spironolactone, eplerenone, triamterene, amiloride adverse affects (1)

A
  • Anti-androgenic effect
  • —>male (impotence, gynecomastia)
  • —>female (deepened voice, irregular menstrual cycles)
40
Q

beta-blockers (-lol) MOA (3)

A
  • decrease HR (negative chronotrope)
  • decrease excitability (negative dromotrope)
  • decrease BP
41
Q

beta-blockers (-lol) indication and secondary uses

A

Indication: angina/MI, dysrhythmia, HTN, HF

—->secondary uses: glaucoma, migraine

42
Q

beta-blockers (-lol) side effects

A
  • even selective beta-blockers become nonselective at high dose (blocking beta2 and bronchospasms)
  • —> monitor breath sounds (for worsening or new wheezing)
  • bradycardia, hypotension, dysrhythmia (FALL)
  • —>monitor trend of HR, BP, cardiac rhythm
  • —>postural hypotension and FALL (Nursing: lie down if feeling dizzy, avoid sudden changes of position)
  • —>impotence, decreased libido (build rapport and discuss factors that may affect adherence)
43
Q

beta-blockers (-lol) contraindications (4)

A
  • bradycardia, hypotension (call provider and hold for HR less than 60 or SBP less than 90)
  • asthma, COPD (bc bronchospasm is a possible side effect!)
44
Q

beta-blockers (-lol) nursing (3)

A
  • masks hypoglycemia s/s (palpitation) so monitor DM pt’s BG for asymptomatic hypoglycemia)
  • avoid stopping abruptly, wean off over 1-2 weeks
  • at home keep a log HR/BP and associated s/s
45
Q

alpha-2 agonist - methyldopa, clonidine, guafacine side effects

A
  • sodium/water retention (use with diuretics & monitor daily wt and edema)
  • bradycardia
  • orthostatic hypotension, dizziness, FALL
  • impotence, decreased libido
46
Q

alpha-2 agonist drugs (3)

A
  1. methyldopa
  2. clonidine
  3. guafacine
47
Q

alpha-2 agonist - methyldopa, clonidine, guafacine contraindications (2)

A
  • pregnancy, lactation
48
Q

alpha-2 agonist - secondary uses of clonidine

A
  • Cancer pain
  • ADHD
  • opioid withdrawal
  • migraine
  • menopause flushing
49
Q

alpha-2 agonist secondary uses of brimonidine & apraclonidine (1)

A

for eye drops for glaucoma

50
Q

antihypertensives - hydralazine** and minoxidil - MOA

A

MOA: direct-acting vasodilator

51
Q

antihypertensives - hydralazine** and minoxidil - side effects

A
  • Less blood pressure in kidney => fluid/Na retention (combine with diuretics)
  • increased permeability with arteriodilation (edema, nasal congestion, HA) combine with diuretic
  • Orthostatic hypotension (FALL)
  • tachycardia (reflex) (patient reports palpitation)
52
Q

antihypertensives - hydralazine** and minoxidil - indications

A

quick management of acute HTN, preeclampsia

53
Q

antihypertensives - hydralazine** and minoxidil - contraindications

A

RF, concurrently with sildenafil

54
Q

alpha1 blocker - prazosin, terazosin, doxazosin, tamsulosin, silodosin - MOA

A

vasodilator (decreased peripheral resistance), relaxing prostate

55
Q

alpha1 blocker - prazosin, terazosin, doxazosin, tamsulosin, silodosin - side effects

A
  • orthostatic hypotension (FALL)
  • sodium/water retention (use with diuretics & monitor daily wt & edema)
  • tachycardia (reflex)
  • erectile dysfunction
56
Q

ACE inhibitors (-pril) MOA

A

MOA: angiotensin-converting enzyme inhibitor - prevent angiotensin II formation -> decreased peripheral resistance and afterload

57
Q

ACE inhibitors (-pril) indication

A

Indication: HTN & HF

58
Q

ACE inhibitors (-pril) contraindication

A

PAAK: pregnancy, allergy, AKI pts (but helpful to CKD pts), K increases

59
Q

ACE inhibitors (-pril) side effects and adverse effects

A
  • increases bradykinin (inflammatory mediator) = dry hacking cough, angioedema
  • AKI, HYPERkalemia (monitor K, dysrhythmia, paresthesia, weakness, cramps)
  • orthostatic hypotension, tachycardia (reflex), dizziness, fall (change position slowly, lie down if dizzy)
60
Q

angiotensin receptor blockers (ARBs) indications

A

HTN & HF

61
Q

angiotensin receptor blockers (ARBs) contraindications

A

PAAK: pregnancy, allergy, AKI pts (but helpful to CKD pts), K increases

62
Q

angiotensin receptor blockers (ARBs) side effects

A
  • AKI, hyperkalemia (monitor K, dysrhythmia, paresthesia, weakness, cramps)
  • orthostatic hypotension, tachycardia (reflex), dizziness, FALL (change position slowly, lie down if dizzy)
63
Q

calcium channel blockers (ccb’s) indication

A
  • angina

- HTN

64
Q

calcium channel blockers (ccb’s) side effects

A
  • peripheral edema –> nursing: daily wt and I/Os
  • decreased BP
    = tachycardia reflex
    = FALL
    = monitor renal panel for AKI
65
Q

calcium channel blockers (ccb’s) MOA

A

systemic vasodilation = decreased BP

—-> if SBP less than 90 = call the provider and hold drug

Pharm Exam 3 (9 decks)

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