Antihypertensives Flashcards
What is the Formula for BP?
Cardiac output (CO) x Systemic Vascular Resistance (SVR) = BP
In what Global population is hypertension most prevalent?
In Africa and middle , low income nations
Who is at greater risk of developing Hypertension?
individuals of Black, Indigenous, or South Asian heritage
What is the Goal of Antihypertensive drugs?
To reduce renal and cardiac morbidity; reduce BP to below 140/90
What BP should a person with Diabetes be aiming for?
< 130/80
What do the PSNS and SNS stimulate?
PSNS: glands, smooth muscle, cardiac muscle
SNS: heart, blood vessels, skeletal muscle
What are the categories of Antihypertensive drugs?
adrenergic drugs
ACE inhibitors
ARBs
Calcium channel blockers
diuretics
Direct renin inhibitors
vasodilators
List the Five Subcategories of Adrenergic drugs and where they act in the body
Adrenergic neuron blockers (central and peripheral)
α2-Receptor agonists (central)
α1-Receptor blockers (peripheral)
β-Receptor blockers (peripheral)
Combination α1- and β-receptor blockers (peripheral)
What are the indications of Adrenergic Drugs
management of hypertension
glaucoma
Menopausal flushing
severe heart failure when combined with other drugs
What are the contraindication of Adrenergic drugs?
allergy
acute heart failure
depression
severe liver or kidney disease
What are the adverse effects of Adrenergic Drugs
brady cardia
orthostatic/ post exercise hypotension
edema
dry mouth
when pt is taking alpha blockers
MoA of centrally Acting Adrenergic drugs
stimulates α2-adrenergic receptors which decreases outgoing stimulation resulting in a lack of norepinephrine causing reduced BP
What is the MoA of Peripherally Acting α1-Blockers
This drug will block α1 adrenergic receptors which will decrease blood pressure because when these receptors are blocked it causes vasodilation
What is the MoA of Beta Blockers?
They create a blockade on beta 1 receptors which in turn reduces HR; reduces the amount of renin produced
What is the MoA of Dual-Action α1- and β-Receptor Blockers?
Dual antihypertensive effects of reduction in heart rate (β1-receptor blockade) and vasodilation (α1-receptor blockade)
What is the MoA of ACE inhibitors?
Angiotensin converting enzyme (ACE) inhibitors inhibit ACE which is responsible for converting angiotensin I to angiotensin II which is a vasoconstrictor. breakdown vasodilating substances in the body; slows the progression of LV hypertrophy
What are the Indications of ACE inhibitors?
Hypertension
Heart failure
Renal protection
What are the Contraindications of ACE inhibitors?
allergy
angioedema
potassium levels of 5mmol/L or higher as the drug may cause hyperkalemia
declining kidney function
lactating women
What are the Adverse Effects of ACE inhibitors?
fatigue, dizziness, mood changes, a significant decline in BP on first dose, may cause acute kidney failure, angioedema
How do you manage a ACE inhibitor overdose?
Give IV fluid to expand blood volume; use hemodialysis to remove the ACE inhibitor drug
List the ACE inhibitor drug you need to know for the Exam
ALL END IN PRIL
Captopril
Enalapril
Perindopril
Ramipril
What are the Pharmacokinetics of Captopril?
Route: PO
OsA: 15 mins
Peak: 1-2 hrs
HL: 2hrs
DoA: 2-6hrs
What are the Pharmacokinetics of Enalapril?
Route: PO; OsA: 1 hr; Peak:4-6 hrs; HL: 2 hrs; DoA: 12-12 hrs
Route: IV; OsA: 15 mins; Peak: 1-4 hrs; HL: 2 hrs; DoA; 4-6 hrs
a 1/4 reduction from PO to IV
How do ACE inhibitors protect the Heart?
decrease the SVR
prevent complications after MI
prevents Left ventricle hypertrophy (enlargement)
How do ACE inhibitors Protect the Kidneys?
Decrease GFR
reduce proteinuria
What is the MoA of Angiotensin II Receptor blockers?
block the binding of Angiotensin II to type 1 angiotensin II receptors which blocks the secretion of aldosterone and vasoconstriction
What are the indications of ARBs?
Hypertension
Adjective drug for HF
with other drugs such as diuretics
What are the Contraindications of ARBs?
allergy
pregnancy, lactation
kidney dysfunction
What are the Adverse effects of ARBs?
URTIs
headaches
dizzy
insomnia
heartburn
back pain
What ARB drugs do you need to know for the exam?
ALL END IN SARTAN
Losartan
Telmisartan
What are the Pharmacokinetics of Losartan?
Route: PO
OsA: 1hr
Peak: 6 hrs
HL:6-9 hrs
DoA: 24 hrs
What is the MoA of Calcium channel blockers (CCB)?
Block calcium from binding to its receptors which causes vasodilation due to smooth muscle relaxation
What are the indications for CCB
Primary hypertension
angina
dysrhythmias
Is a common first line therapy drug for people with Hypertension
What are the CCB drugs you need to know for the Exam?
Amlodipine
What is the MoA of Diuretics?
These drugs decreases the work load of the heart by decreasing plasma and extracellular fluid volumes
What class of diuretics are most commonly used for hypertension?
Thiazides specifically hydrochlorothiazide
What is the MoA of Vasodilators?
Cause vasodilation via stimulation of arterial and venous smooth muscle
What are the indications for Vasodilators?
Treatment of hypertension
recently used in hair regeneration
What are the Contraindications of Vasodilators?
allergy
head injury
Acute MI
What are the Adverse effects of Vasodilators?
Dizziness.
Dry cough (with ACE inhibitors).
Edema (fluid retention).
Fatigue.
Headaches.
Joint pain.
Heart palpitations or rapid heartbeat ( tachycardia ).
Nausea and vomiting
what are Some nursing implications for Antihypertensive drugs?
Always monitor HR and BP
monitor lab values
always asses for contraindications and interactions
patient education on meds and what to do if symptoms worsen (hypo or hyper), and healthy living
Monitor serum creatinine and potassium levels when pt is taking ACE inhibitors
