Antihypertensives

Question 0

Treatment of hypertension

Answer 0

●Step 1 – life style modification
●Step 2 – introduction to medications
●Step 3 and 4 include increasing or adding medications until desired BP is met

Question 1

Controls of hypertension

Answer 1

●Sympathetic nervous system

●Renal system

●Endocrine system

●Vascular endothelium

Question 2

Sympathetic nervous system antihypertensives

Answer 2

●Alpha and Beta1 receptor sites
●Alpha Adrenergic blockers
●Beta1 Adrenergic blockers

Question 3

Alpha adrenergic blockers

Answer 3

●Blocks arteriole vasoconstriction

Question 4

Alpha adrenergic blocker therapeutic uses

Answer 4

●Blocks vasoconstriction
●Especially good with lowering DBP
●Uses include benign prostate hypertrophy

Question 5

Alpha adrenergic blocker contraindications

Answer 5

●Hypotension
●Tachycardia (caution)
●Pregnancy
●Hypersensitivity (as in all meds)

Question 6

alpha adrenergic agent blocker adverse effects

Answer 6

●First dose phenomenon
●Effects from vasodilatation
●Flushing, headache, dizziness
●GI effects (think of blocking SNS)
●N/V/D dry mouth
●Other effects of blocking SNS
●Confusion, weakness, fatigue, urinary frequency, bronchospasm, sexual dysfunction

Question 7

Alpha blockers teaching and implications

Answer 7

●Slow position change, watch for first dose
●Watch for weight gain (renin)
●Be careful of situations which cause vasodilatation
●2 weeks to see therapeutic results

Question 8

Beta blockers

Answer 8

●CO is reduced, thus reducing BP
●Decreases cardiac oxygen demand
●Used for cardiac arrhythmias, antianginals
●First line drugs

Question 9

Beta blockers contraindications

Answer 9

●Ischemic heart disease
●Systolic heart failure
●Hypotension
●Asthma and COPD (extreme caution)
●Diabetes (caution)
●Some dysrhythmias

Question 10

Beta blockers adverse reactions

Answer 10

●Hypotension (orthostatic)
●Bradycardia  (tachycardia with alpha)
●Bronchoconstriction
●Hypoglycemia
●Fatigue/weakness
●GI upset (increased motility)
●Think about the parasympathetic unchecked

Question 11

Beta blocker teaching points

Answer 11

●Evenly dose around the clock
●Report GI or sexual adverse effects
●Report breathing difficulties
●Report signs/symptoms heart failure
●Do not discontinue abruptly
●Monitor for orthostatic hypotension, change positions slowly
●Avoid alcohol, sedatives

Question 12

Calcium channel blockers

Answer 12

●Action on Calcium channels
●Used for:
    Hypertension
    Angina
    Peripheral vascular diseases
    arrhythmias (atrial) (verapamil)

Question 13

Calcium channel blocker contraindications

Answer 13

●Heart block, sick sinus syndrome
●Patients with severe LV dysfunction
●Pregnancy or lactation
●Hepatic or renal failure

Question 14

Calcium channel blocker adverse reactions

Answer 14

●Bradycardia
●Depressed heart function
●Peripheral edema
●Hypotension
●CNS symptoms include:
●Dizziness, light-headedness, headache, fatigue
●Hepatic damage

Question 15

Calcium channel blocker implications

Answer 15

●Watch for cardiac symptoms:
Weight gain, bradycardia
●Hepatic damage (Lab values?)  ALT, AST
●Monitor first dose carefully
●Do not discontinue abruptly
●Do not crush/break extended release
●Avoid grapefruit
●Space out with BB

Question 16

Angiotensin Converting Enzyme Inhibitor

Answer 16

●ACEI work in the RAAS, reducing BP through PVR and CO
●Widely used, often first line with certain diseases
●“Pril” medications

Question 17

Renal control in BP

Answer 17

●Kidneys control Na+ and H2O excretion
●Remember water follows Na+
●Increased extracellular fluid will increase venous return = SV = CO = BP

Question 18

Angiotensin Converting Enzyme Inhibitor

Therapeutic uses

Answer 18

●Hypertension
●Given after AMI for remodeling
●Gives renal protection for DM patients
●Treatment of CHF and LV dysfunction

Question 19

Angiotensin Converting Enzyme Inhibitor

Contraindications

Answer 19

●Renal stenosis
●Pregnancy or lactation
●Caution with CHF
●Hyperkalemia (caution)

Question 20

Angiotensin Converting Enzyme Inhibitor

Adverse effects

Answer 20

●Dry cough**
●Hypotension, headache, tachycardia, palpitations
● First dose syncope
●Anaphylaxis
●Hyperkalemia **
●Dry mouth, N/V/D abd. pain

Question 21

Angiotensin Converting Enzyme Inhibitor

Implications

Answer 21

●Decrease chance of first dose syncope
●Avoid OTC stimulants, NSAIDS
●Watch for renal and liver function tests

Question 22

ATII (ARB)

Answer 22

●Second generation of ACEI
●Blocks angiotensin II receptor sites
●Decreases PVR
●Takes 3 to 6 weeks for full effect
●Great for patients who cannot tolerate ACEI
●“sartan” medications

Question 23

ATII (ARB)

Contraindications

Answer 23

●Hypersensitivity to medications
●Pregnancy or lactation
●Caution with renal or liver dysfunction

Question 24

ATII (ARB)

Adverse effects

Answer 24

●Tolerated better than ACEI, similar effects
●Headache, dizziness, hypotension
●Weakness
●Dry mouth, N/V/D
●No dry cough or life threatening reaction as seen in ACEI

Question 25

ATII (ARB)

Implications

Answer 25

●First dose phenomenon
●Teach the importance of dosing
●Watch renal and liver enzyme values
●Teach patients how to cope with minor adverse effects

Question 26

Direct vasodilators

Answer 26

●Treatment of moderate to severe hypertension
●Reduces PVR and CO (preload and afterload)
●Never used as first line treatment of HTN
●Many adverse effects
●Monitoring labs

Question 27

Prehypertension values

Answer 27

120-139/80-89

Question 28

Stage1 hypertension values

Answer 28

140-159/90-99

Question 29

Stage2 hypertension values

Answer 29

160 or higher/ 100 or higher