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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
alpha-2 agonist - methyldopa, clonidine, guafacine - MOA
MOA: decreased sympathetic stimulation | ---->decreased HR, decreased CO, vasodilation (decreased peripheral resistance)
26
antihypertensives drugs (2) and route
IV/PO 1. *hydralazine* 2. minoxidil
27
alpha-1 blocker drugs (5)
For HTN & BPH: 1. prazosin 2. terazosin 3. doxazosin ONLY for BPH: 1. tamsulosin 2. silodosin
28
ACE inhibitors (-pril) drugs (5)
1. benzepril 2. captopril 3. lisinopril 4. enalapril 5. enalaprilat
29
angiotensin receptor blockers (ARBs) MOA
block the receptor site of angiotensin II - ---> very similar to ACEi but not as effective - ---> prevents vasoconstriction = low BP - ---> tachycardia (reflex)
30
what are the 2 types of calcium channel blockers (ccb's)
1. -dipine: specific to vasculature, used for HTN | 2. verapamil & diltiazem: used for tachy-dysrhythmia
31
vasculature CCBs drugs (2) and route
IV/PO (specific to vasculature) 1. amlodipine 2. nifedipine
32
managing symptomatic w/ drugs for hypotension & orthostatic hypotension (4)
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
drug groups for HTN
1. diuretics 2. beta blockers 3. alpha2 agonists 4. direct acting vasodilators 5. alpha1 blockers 6. ACEi 7. ARB 8. CCB
34
drug groups for hypotension
1. crystalloid IV 2. colloid IV 3. alpha1 agonist 4. emergency medicines
35
loop diuretics - *furosemide*, *bumetanide*, torsemide routes
IV/PO/IM
36
loop diuretics - *furosemide*, *bumetanide*, torsemide nursing
- DILUTE & very slow IVP to avoid tinnitus | - --> ototoxicity
37
aldosterone receptor blocker; K-sparing diuretics drugs - *spironolactone*, eplerenone, triamterene, amiloride secondary indication (2)
1. With other diuretics to balance potassium | 2. Treatment of adult acne (MOA: anti-androgenic effect)
38
aldosterone receptor blocker; K-sparing diuretics drugs - *spironolactone*, eplerenone, triamterene, amiloride nursing (4)
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
aldosterone receptor blocker; K-sparing diuretics drugs - *spironolactone*, eplerenone, triamterene, amiloride adverse affects (1)
- Anti-androgenic effect - --->male (impotence, gynecomastia) - --->female (deepened voice, irregular menstrual cycles)
40
beta-blockers (-lol) MOA (3)
- decrease HR (negative chronotrope) - decrease excitability (negative dromotrope) - decrease BP
41
beta-blockers (-lol) indication and secondary uses
Indication: angina/MI, dysrhythmia, HTN, HF | ---->secondary uses: glaucoma, migraine
42
beta-blockers (-lol) side effects
- 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
beta-blockers (-lol) contraindications (4)
- 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
beta-blockers (-lol) nursing (3)
- 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
alpha-2 agonist - methyldopa, clonidine, guafacine side effects
- sodium/water retention (use with diuretics & monitor daily wt and edema) - bradycardia - orthostatic hypotension, dizziness, FALL - impotence, decreased libido
46
alpha-2 agonist drugs (3)
1. methyldopa 2. clonidine 3. guafacine
47
alpha-2 agonist - methyldopa, clonidine, guafacine contraindications (2)
- pregnancy, lactation
48
alpha-2 agonist - secondary uses of clonidine
- Cancer pain - ADHD - opioid withdrawal - migraine - menopause flushing
49
alpha-2 agonist secondary uses of brimonidine & apraclonidine (1)
for eye drops for glaucoma
50
antihypertensives - hydralazine** and minoxidil - MOA
MOA: direct-acting vasodilator
51
antihypertensives - hydralazine** and minoxidil - side effects
- 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
antihypertensives - hydralazine** and minoxidil - indications
quick management of acute HTN, preeclampsia
53
antihypertensives - hydralazine** and minoxidil - contraindications
RF, concurrently with sildenafil
54
alpha1 blocker - prazosin, terazosin, doxazosin, tamsulosin, silodosin - MOA
vasodilator (decreased peripheral resistance), relaxing prostate
55
alpha1 blocker - prazosin, terazosin, doxazosin, tamsulosin, silodosin - side effects
- orthostatic hypotension (FALL) - sodium/water retention (use with diuretics & monitor daily wt & edema) - tachycardia (reflex) - erectile dysfunction
56
ACE inhibitors (-pril) MOA
MOA: angiotensin-converting enzyme inhibitor - prevent angiotensin II formation -> decreased peripheral resistance and afterload
57
ACE inhibitors (-pril) indication
Indication: HTN & HF
58
ACE inhibitors (-pril) contraindication
PAAK: pregnancy, allergy, AKI pts (but helpful to CKD pts), K increases
59
ACE inhibitors (-pril) side effects and adverse effects
- 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
angiotensin receptor blockers (ARBs) indications
HTN & HF
61
angiotensin receptor blockers (ARBs) contraindications
PAAK: pregnancy, allergy, AKI pts (but helpful to CKD pts), K increases
62
angiotensin receptor blockers (ARBs) side effects
- AKI, hyperkalemia (monitor K, dysrhythmia, paresthesia, weakness, cramps) - orthostatic hypotension, tachycardia (reflex), dizziness, FALL (change position slowly, lie down if dizzy)
63
calcium channel blockers (ccb's) indication
- angina | - HTN
64
calcium channel blockers (ccb's) side effects
- peripheral edema --> nursing: daily wt and I/Os - decreased BP = tachycardia reflex = FALL = monitor renal panel for AKI
65
calcium channel blockers (ccb's) MOA
systemic vasodilation = decreased BP | ----> if SBP less than 90 = call the provider and hold drug

Pharm Exam 3 (9 decks)

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