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pharm > Antihypertensives > Flashcards

Antihypertensives Flashcards

1
Q

high normal blood pressure value

A

130/85-139/89 mm Hg

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2
Q

Essential hypertension

A

Multifactor (does not have a reason), Idiopathic/primary, 90-95% of the cases

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3
Q

Secondary Hypertension

A

There is a reason for hypertension, 5-10% of cases

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4
Q

Examples of secondary hypertension causes

A

pheochromocytoma, pre-eclampsia, renal artery disease, sleep apnea, thyroid disease, or parathyroid disease

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5
Q

Malignant hypertension

A

High blood pressure with a sudden onset,BP above 180/120, medical emergency

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6
Q

Goals of antihypertensive therapy

A

Reduction of cardiovascular and renal morbidity and to achieve BP of less than 140/90, Being cautious with elders

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7
Q

BP value when hypertensive and diabetic

A

<130/80

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8
Q

BP value when hypertensive and chronic Kidney disease

A

<140/90

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9
Q

Adrenergic drugs (5 subcategories)

A

Adrenergic neuron blockers (CNS and PNS)
a2 receptor agonists (central)
a1 receptor blockers (peripheral)
B Receptor blockers (peripheral )
Combo a1 and B receptors (peripheral)

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10
Q

Clonidine MOA

A
  • Centrally acting adrenergic drugs
  • Stimulates a2 adrenergic receptors in the brain reducing renin activity in the kidneys, decreases the sympathetic outflow from the CNS, decreases Norepinephrine production
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11
Q

Doxazosin MOA

A
  • Peripherally acting a1 blockers. blocked a1 adrenergic receptors lead to lower BP
  • Prevents smooth muscle contraction in the bladder and urethra leading to increased urinary flow and less obstruction (used for benign prostatic hyperplasia)
  • Dilatates both arterial and venous
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12
Q

propranolol, metoprolol and atenolol MOA

A
  • B blockers
  • Reduction of the HR through the B1 receptor blockade causing reduction of secretion of renin
  • Long term use causes reduced peripheral vascular resistance
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13
Q

Labetalol

A
  • Dual action a1 and B receptors blockers
  • A1 blockage cause vasodilation
  • B1 blockage cause HR reduction
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14
Q

Adrenergic Drugs: indication

A
  • Treat hypertension, Glaucoma, BPH (doxazosin), Heart failure management when used with cardiac glycosides and diuretics, Menopausal flushing (clonidine)
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15
Q

adrenergics drugs most common adverse effects

A

Orthostatic hypotension, Bradycardia with reflex of tachycardia, dry mouth, drowsiness, sedation, constipation, depression, edema, sexual dysfunction

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16
Q

adrenergic drugs: other adverse effects

A

Headaches, sleep disturbances, nausea, rash, cardiac disturbances

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17
Q

Clonidine and methyldopa(not red)

A

-a2 adrenergic receptor stimulators
- Used to treat hypertension after other drugs have failed, used in conjunction with other antihypertensive

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18
Q

Nebivolol Hydrochloride MOA

A
  • Used for hypertension and heart failure
  • Blocks B1 receptors and produces vasodilatation decreasing systemic vascular resistance
  • Improves sexual function
  • Do not stop abruptly; must be taped over 1-2 wks
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19
Q

Angiotensin-Converting Enzyme (ACE) Inhibitors

A
  • First line drugs for HF and hypertension and may be combined with thiazide diuretic or calcium channel blocker
  • Cardiovascular drugs of choice for patients with diabetes and hypertensive patients with HF
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20
Q

ACE inhibitors drugs (in red, 4)

A

Captopril, Enalapril, perindopril, Ramipril

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21
Q

ACE inhibitors MOA

A

-Inhibits ACE which stops the creation of angiotensin II which is a vasoconstrictor and causes aldosterone secretion from the adrenal glands
- Prevents breakdown of vasodilating substance of bradykinin
- Stops progression of left ventricular hypertrophy

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22
Q

ACE inhibitors Indications

A

Hypertension, HF, slow progression of left ventricular hypertrophy after myocardial infarction, renal protective effects in patients with diabetes

23
Q

Prodrug vs Non prodrug

A

Prodrugs are inactive when administered and are only active when metabolized by the liver. Nonprodrugs do not need the liver to be activated

24
Q

Primary effects of ACE inhibitors

A

Helps the heart and the kidneys by reducing the BP by decreasing the SVR. Also helps heart failure by preventing sodium and water reabsorption, Decreases blood volume return to heart and preload of the heart

25
Q

Cardioprotective effects of ACE inhibitor

A
  • Decreases SVR (measure of afterload) and preload
  • Decreases morbidity and mortality in patients with HF
  • Helps fix the damage of an Myocardial infraction(heart attack) in the left ventricular
26
Q

Renal protective effects of ACE inhibitor

A
  • reduces GFR
  • Reduces protein in the urine (proteinuria)
  • Therapy for diabetic patients to prevent the progression of nephropathy
27
Q

ACe inhibitor Adverse effect

A

Fatigue, dizziness, headache, impaired taste, mood changes, first dose hypotensive effect, possible hyperkalemia, dry nonproductive cough (reverses when therapy is stopped), swelling and build up of fluid in deep layers of skin(angioedema)

28
Q

Captopril

A
  • Not a prodrug and are used if a patient has liver dysfunction unlike other ACE inhibitors
  • Prevents ventricular remodeling after Mi reducing the risk of HF and MI
  • shortest half life and must be administer 3-4 times a day
29
Q

Enalapril (vasotec)

A
  • Only ACE inhibitor in both PO and parenteral
  • enalaprilat (IV) does not need cardiac monitoring
  • Oral is a prodrug
  • improves patients chances of survival after MI and reduces incidence of HF
30
Q

Angiotensin II receptor blockers drugs (in red 2)

A

Iosartan(Cozaar), telmisartan (Micardis)

31
Q

Angiotensin II receptor blockers MOA

A

Block the vascular smooth muscles from constricting and stops the adrenal gland from secreting aldosterone. This is done by blocking the binding of angiotensin II to the angiotensin II receptors in these tissues.

32
Q

Similarities of ACE inhibitors and Angiotensin II receptor blockers

A
  • Both are well tolerated, Both treat hypertension equally
33
Q

Differences of ACE inhibitors and Angiotensin II receptor blockers(ARBs)

A
  • ARB: Do not produce cough, better tolerated and are associated with lower mortality after MI
  • ACE: May be more effective in treating heart failure and protecting kidneys
34
Q

ARBs indications

A

hypertension, adjunctive drugs for HF, may be used alone or with other drugs such as diuretics

35
Q

ARBs adverse effects

A

Upper respiratory infections and headaches (most common), Dizziness and inability to sleep, diarrhea, dyspnea, heartburn, nasal congestion, back pain, fatigue, hyperkalemia(less likely then ACE)

36
Q

Iosartan

A
  • Benefits patients with hypertension and heart failure
  • Cautious with patients with renal or hepatic dysfunction and in patients with renal artery stenosis
  • Do not take if breastfeeding
37
Q

Calcium channel blockers

A

-Used to treat hypertension and angina by causing smooth relaxation

38
Q

Calcium Channel blockers MOA

A

Causes a decreases peripheral smooth muscle tone, decrease SVR, and decrease BP by blocking the binding of the calcium to its receptor blocking contraction

39
Q

Calcium channel blockers Indications

A

Angina, hypertension (amlodipine), antidysrhythmics, migraine headaches, raynaud’s disease, cerebral spasms after subarachnoid hemorrhage(prevention)

40
Q

Diuretics

A

is the first line drug that
- Decreases plasma and extracellular fluid volumes resulting in a decrease preload, cardiac output, decreased total peripheral resistance
- leading to an overall decreased workload of the heart and decreased BP

41
Q

Hydrochlorothiazide

A

A thiazide diuretic that are mostly used for hypertension

42
Q

Vasodilators MOA

A

Directly relax arteriolar or venous smooth muscles allowing vasodilation resulting in a decreased SVR

43
Q

Vasodilators indications

A

Treatment of hypertension and can be used with other drugs.

44
Q

Sodium nitroprussid adverse effects: vasodialtor

A

bradycardia, decreased platelet aggregation, rash, hypothyroidism, hypotension, methemoglobinemia, and (rarely) cyanide toxicity

45
Q

Soduim nitroprusside

A

Used for severe hypertensive emergencies titrated through IV infusion

46
Q

Sodium contradiction

A

known hypersensitivity to the drug, severe HF, and known inadequate cerebral perfusion (especially during neurosurgical procedures)

47
Q

What does the apical heart rate parameters need to be

A

Above 60. If not medications need to be held

48
Q

What does the Systolic blood pressure parameters need to be

A

above 90. If not hold the medications

49
Q

Should patients stop drug abruptly? what happens if they do?

A

No it should not be stopped abruptly or it will lead to a hypertensive rebound and possible lead to a stroke

50
Q

Why should patients change positions slowly

A

To avoid syncope from postural hypotension

51
Q

antihypertensives and the effect on males

A

can lead to impotence(sexual dysfunction) and may influence compliance of the drug

52
Q

Effects of Hot tubs, showers, or baths; hot weather; prolonged sitting or standing; physical exercise; and alcohol ingestion

A

may aggravate low BP leading to fainting and injury. Patients should sit/lie down until symptoms subside

53
Q

When on ACE inhibitors, what lab values to monitor

A

can cause renal impairment which can be seen through creatinine values, can cause hyperkalimia (Potassium levels) can affect sodium levels

pharm (21 decks)

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