Antihypertensives Flashcards
Sympatholytics
- Beta-adrenergic blockers
- Centrally acting alpha2 agonists
- Alpha-adrenergic blockers
- Alpha1 - and beta1 - adrenergic blockers
End in *olol
beta blockers
A-M are cardiac selective (beta1)
N-Z are non-selective (both)
Beta blocker w/ intended responses are to reduce cardiac output by diminishing SNS response; reduce HR, decrease strength of contractions, decrease BP
Used to treat hypertension, stable angina, dysrhythmias (e.g., SVT), migraines, glaucoma, anxiety
metoprolol (Lopressor)
Side effects of beta blockers
- Decreased HR (bradycardia)
- Decreased BP (hypotension); orthostatic hypotension
- Bronchospasm (asthma and COPD patients can’t have nonselective beta blockers)
- Other: dizziness, depression, fatigue, erectile dysfunction
Do NOT stop taking beta blockers because it can cause
rebound hypertension
Life Span Considerations for beta blockers
Pediatric:
* Not researched
* Consult pediatric cardiologist
Pregnancy and breastfeeding:
* Category C; not recommended unless absolutely necessary
* Excreted in breast milk
Older adults:
* More sensitive to effects; usually prescribed lower dosages
* Can cause mental confusion
* May significantly decrease tolerance to cold
Centrally-acting Alpha2 agonist that decreases sympathetic response; stimulate alpha2 receptors, which decreases sympathetic activity, decreases cardiac output, decreases epi, norepi, and renin release
clonidine (Catapres)
Side effects of clonidine
drowsiness, dry mouth, dizziness, bradycardia, edema (can cause sodium and water retention)
End in *zosin
AKA alpha adrenergic blockers
Dilates peripheral blood vessels and used to treat HTN
Alpha blockers
Ex: prazosin
Side effects of alpha blockers
Ex: prazosin
orthostatic hypotension, nausea, nasal congestion caused by vasodilation, edema, weight gain
Can alpha blockers be given with drugs for erectile dysfunction?
No, may result in profound hypotension
Combine effects of alpha blockers and beta blockers
Intended responses same as beta blockers, with slightly
different mechanism
Alpha1-Beta1 blockers
Ex: carvedilol (Coreg)
Act directly on peripheral arteries causing them to
dilate; leads to lower BP and decreased heart workload
Direct vasodilators
Ex: hydralazine
Side effects of direct vasodilators
tachycardia and hypernatremia
Adverse reactions of direct vasodilators
- Stevens-Johnson syndrome
- Report sustained increase in pulse >20 beats/min to prescriber immediately
Is hydralazine safe to use in pregnancy and breastfeeding?
yes
End in *pril
Vasodilation of blood vessels, diuresis, lowered blood pressure, decreased workload of heart.
Used to treat HTN, HF, and post MI to limit damage to myocardium
ACE Inhibitors
Ex: enalopril (Vasotec)
Side effects of ACEi
persistent dry cough, dizziness, postural hypotension, N/V, tachycardia, hyperkalemia, angioedema (life-threatening swelling of face, tongue, lips, larynx), renal failure, fatigue
Contraindications for ACEi
- Pregnancy (risk of fetal renal damage; tetratogenic)
- Potassium-sparing diuretics
- Salt substitutes that contain potassium
African American adults & older adults may not respond to ACEi monotherapy
End in *sartan
Intended responses are the same as ACEi; better tolerated
Used to treat HTN, diabetic nephropathy, HF
Angiotensin II Receptor Blockers (ARBs)
Ex: valsartan (Diovan)
Side effects of ARBs
Dizziness, hypotension, hyperkalemia
Block calcium from entering muscle cells of heart and arteries; decrease strength in heart contractions; relax vascular smooth muscle (vasodilation of coronary arteries)
Calcium Channel Blockers (CCBs)
Ex: nifedipine (Procardia) and diltiazem (Cardizem)
Two subtypes of CCBs
dihydropyridines—prototype nifedipine (-pines)
non-dihydropyridines—prototype diltiazem
What is the difference between the two?
dihydropyridines are non-specific
more effect of vasodilation
less effect on heart function
non-dihydropyridine are cardiac specific
less effect on vasodilation
more effect on heart function
CCBs side effects
constipation, nausea, headache, flushing, rash, edema (legs), hypotension, drowsiness, dizziness, bradycardia
CCBs adverse reactions
dysrhythmia, worsening heart failure (with verapamil and diltiazem), Stevens Johnson syndrome
Important pt teaching for CCBs
-Monitor vitals for bradycardia & hypotension
-Monitor for s/sx of HF: dyspnea, weight gain, and edema
-Teach pt to avoid grapefruit juice
-Teach pt to eat high fiber diet and have good oral hygiene
