Antihypertensives Flashcards
african americans do not respond well to what antihypertensives
beta blockers and ACE inhibitors (needs diuretic)
which antihypertensive drugs are effective for african americans
alpha1 blockers and CCBs
nonpharm control of hypertension
stress-reduction, exercise, salt restriction, decrease alcohol, and smoking cessation
promote sodium depletion which decreases extracellular fluid volume
given as first-line drugs for treating mild hypertension
diuretics
many antihypertensive drugs cause fluid retention and are often administered in combination with ___
diuretics
____ diuretics are not recommended for pts with renal insufficiency
thiazide
check BUN and creatinine
creatinine clearance (<30 mL/min)
5 groups of Sympatholytics (Sympathetic Depressants)
1) beta-adrenergic blockers
2) centrally acting alpha2 agonists
3) alpha-adrenergic blockers
4) adrenergic neuron blockers
5) alpha1 and beta1 adrenergic blockers
used as antianginals and antidysrhythmics
reduce HR, contractility, and renin release; the hypotensive response is greater in pts with higher renin lvls
beta-adrenergic blockers
Cardioselective beta blockers are preferred bc they act on beta1 rather than beta2 (could cause bronchoconstriction)
AB BEAM
side effects of beta blockers
decreased HR, decrease BP, and nonselective bronchospasm
do not abruptly discontinue bc rebound hypertension
dizziness, insomnia, depression, fatigue, nightmares, and ED
noncardioselective inhibit liver’s ability to convert glycogen to glucose in response to hypoglycemia (caution in pts with diabetes)
decrease the sympathetic response from the brainstem to the peripheral vessels
decreases sympathetic activity; increases vagus activity; decreases cardiac output; and decreases serum epi, norepi, and renin
centrally acting alpha2 agonists (methyldopa (LFTs) , clonidine, guanabenz, and guanfacine)
do not give with beta blockers or heart block/bradycardia
___ may be ordered with methyldopa or clonidine to decrease sodium and water retention (edema)
diuretics
frequently used to treat chronic or pregnancy-induced hypertension; however, it crosses the placental barrier, and small amounts may enter the breast milk of a lactating pt
methyldopa
blocks the alpha-adrenergic receptors, resulting in vasodilation and decreased BP
help maintain renal BF
decrease VLDL and LDL; increase HDL
also used in treatment of BPH
alpha-adrenergic blockers
-azosin (prazosin, doxazosin, terazosin)
side effects of alpha adrenergic blockers
orthostatic hypotension, faintness, lightheadedness, increased HR, drowsiness, nasal congestion, edema, and weight gain
give with diuretic
potent antihypertensive drugs that block norepi release from the sympathetic nerve endings, causing a decrease in norepi release that results in a lowering of BP
a decrease occurs in both cardiac output and peripheral vascular resistance
adrenergic neuron blockers (peripherally acting sympatholytics)
reserpine
side effects of reserpine
orthostatic hypotension, vivid dreams, nightmares, and suicidal ideation; sodium and water retention
may be taken alone or with a diuretic
blocks alpha1 and beta1; blocking alpha1 receptor causes vasodilation, which decreases resistance to blood flow
effect on the alpha receptor is stronger than the effect on the beta receptor; BP lowered and HR is moderately decreased
alpha1-beta1 adrenergic blockers (labetalol, carvedilol)
labetalol can be given when breastfeeding
act by relaxing the smooth muscles of the blood vessels, mainly the arteries, causing vasodilation
BP decreases and sodium and water are retained (peripheral edema) can give diuretics
direct-acting arteriolar vasodilators
name 3 direct-acting arteriolar vasodilators
moderate to severe HTN: hydralazine, minoxidil
acute hypertensive emergency: nitroprusside
may be prescribed with beta blockers to counteract reflex tachycardia
inhibits the formation of angiotensin II (vasoconstrictor) and blocks the release of aldosterone (promotes sodium retention and potassium excretion)
when aldosterone is blocked, sodium is excreted along with water, and potassium is retained
angiotensin-converting enzyme inhibitors (ACE inhibitors)
-pril
DO NOT GIVE IN PREGNANCY (reduce placental BF)
OR
WITH SPIRONOLACTONE
ACE inhibitor side effects
constant, irritated cough
hyperkalemia
hypotension
ANGIOEDEMA
N/V/D, HA, dizziness, fatigue, insomnia, tachycardia
similar to ACE inhibitors; block angiotensin II from the angiotensin I receptors found in many tissues
cause vasodilation and decrease peripheral resistance
ARBs
-sartan
do not cause irritating cough
renin inhibitor for treating HTN, which binds with renin and causes a reduction of angiotensin I, II, and aldosterone
direct renin inhibitors
aliskiren
free calcium increases muscle contractility, peripheral resistance, and BP
these block the calcium channel in the vascular smooth muscle, promoting vasodilation
CCBs
verapamil, diltiazem, and -pine
NO GRAPEFRUIT JUICE
