Antihypertensives

Question 1

Organ damage from hypertension

Answer 1

Cerebrovascular disease
Hypertensive retinopathy
Left ventricular dysfunction
Left ventricular hypertrophy
Coronary artery disease (MI, angina, CHF)
Chronic Kidney Disease
Peripheral artery disease

Question 2

BP target for high risk

Answer 2

Less than 120 systolic

Question 3

BP target for general population

Answer 3

Less than 140 systolic and 90 diastolic

Question 4

Target BP for diabetics

Answer 4

Less than 130 systolic and 80 diastolic

Question 5

Antihypertensive drug categories

Answer 5

•Angiotensin converting enzyme inhibitors (ACE inhibitors)

•Angiotensin II receptor blockers (ARBs)

•Calcium Channel Blockers (CCB)

•Diuretics

•B-adrenoreceptor blockers

•Vasodilators

•Adrenergic agents

Question 6

ACE Inhibitors

Answer 6

•First line treatment for HF and hypertension
•Often combined with thiazide diuretic or calcium channel blocker
•Nagging cough

DRUGS: end in “pril”
Capropril: shortest half-life
Enalapril (vasotec): Available oral and parenteral

Question 7

ACE inhibitor indications

Answer 7

Hypertension

Heart failure

Renal protective effects in diabetes

Question 8

ACE Inhibitor mechanism of action

Answer 8

•Prevents conversion of angiotensin I to angiotensin II
•Reduces peripheral resistance (afterload)
•Prevents Aldosterone release, thus reducing salt/water reabsorption
•Prevents breakdown of bradykinin which causes vasodilation

Question 9

ACE inhibitor adverse effects and interactions

Answer 9

•Nagging dry cough
•Hypotension
•Possible hyperkalemia

Interactions/CI
•K-sparing diuretics
•Contraindicated during pregnancy

Question 10

Angiotensin II receptor blockers (ARBs)

Answer 10

•Similar to ACE
•Does NOT cause dry cough
•Angiotensin II receptor antagonist. blocks receptors that ang II activates.
•Blocks ang II mediated vasoconstriction
•Blocks release of aldosterone
•Drug names end in “sartan”

DRUGS:
Losartan

Question 11

ARBS indications

Answer 11

•Hypertension
•Heart failure

•Used with or without other agents: CCBs, Diuretics.

Alternative for those who can’t handle ACE inhibitors

contraindicated in pregnancy

Question 12

Calcium Channel Blockers (CCBs)

Answer 12

•For hypertension, angina, dysthymias
•Block cardiac muscle Ca channel
•Alters electrical activity of cardiac muscle cells at SA and AV nodes and cardiac muscle
•Vascular: inhibits Ca entry into arteriolar vascular smooth muscle cells, causing relaxation
•Decreased peripheral resistance

DRUGS:
•Benzothiazepines (cardiac/vascular): Diltiazem
•Phenylalkamines (cardiac/vascular): Verapamil
•Dihydropyridines -DHPs-Vascular selective): Amlodipine, nifedipine

Question 13

CCB: Diltiazem

Answer 13

Cardiac & vascular

Question 14

CCB: Verapamil

Answer 14

Cardiac & vascular

Question 15

CCB: Dihydropyridines (DHPs)

Answer 15

Vascular selective.
Cause muscle cells to relax

Drugs end in “pine”

Amlodipine
Nifedipine

Question 16

Verapimil and Diltiazem Adverse Effects

Answer 16

Cardiovascular: hypotension, flushing, peripheral edema

GI: Constipation, nausea

Question 17

DHPs (amlodipine, nifedipine) Adverse effects

Answer 17

Cardiovascular: hypotension, palpitations, tachycardia, flushing, peripheral edema

GI: Very little constipation

Question 18

Thiazide and Thiazide-like Diuretics

Answer 18

•Decrease plasma and extracellular fluid
•Decreased preload, decreased cardiac output, decreased total peripheral resistance
•First line Tx in hypertension

DRUGS
hydrochlorothiazide
-Risk for hypokalemia, digoxin interaction
-Longer-acting thiazide preferred over short/acting

Question 19

Beta-Adrenergic Blockers (Beta blockers)

Answer 19

•Act in periphery, mainly heart
•Blocks epinephrine/norepinephrine action on receptors in heart
•Decreases force of heart muscle contraction and decreases heart rate
•Not indicated as first-line for age over 60

DRUGS: end in “lol”
Metaprolol: B1-selective

Question 20

B-Blocker Indications and considerations

Answer 20

Hypertension
HF
Angina
Dysrhythmia

•Intolerance to exercise
•Avoided in asthma patients

Question 21

If hypertension not controlled, or there are adverse effects, other classes of antihypertensive drugs may be combined, such as..

Answer 21

Alpha blockers or centrally acting agents

Question 22

Centrally acting a2 receptor agonists

Answer 22

•Stimulate a2 receptors in brainstem
•Norepinephrine release decreased
•Sympathetic NS outflow decreased
•Vasodilation: decreased BP

Indications:
•Tx of hypertension, alone or with other drugs
•Used after other agents have failed, or used in combo with other drugs

DRUGS:
Methyldopa: First line for HPTN in pregnancy

Question 23

Adverse Effects of Adrenergic Agents (a-receptors)

Answer 23

Most common:
•Dry mouth
•Drowsiness/sedation
•Constipation

High incidence of orthostatic hypotension

Question 24

Client implications

Answer 24

•Drugs should not be stopped abruptly as this can cause a rebound hypertensive crisis (stroke risk)
•Clients should avoid smoking, avoid eating foods high in sodium.
•Change positions slowly to avoid syncope and postural hypotension
•Avoid aggravating low blood pressure (hot tubs, baths, hot weather, prolonged sitting/standing, intense exercise, alcohol)

Question 25

beta blockers end with what?

Answer 25

“lol”

Question 26

ACE inhibitor drug names end in?

Answer 26

“Pril”

Question 27

ARB drugs end in?

Answer 27

“sartan”

Question 28

DHP calcium channel blockers end in?

Answer 28

“pine”