Antihypertensives

Question 1

african americans do not respond well to what antihypertensives

Answer 1

beta blockers and ACE inhibitors (needs diuretic)

Question 2

which antihypertensive drugs are effective for african americans

Answer 2

alpha1 blockers and CCBs

Question 3

nonpharm control of hypertension

Answer 3

stress-reduction, exercise, salt restriction, decrease alcohol, and smoking cessation

Question 4

promote sodium depletion which decreases extracellular fluid volume

given as first-line drugs for treating mild hypertension

Answer 4

diuretics

Question 5

many antihypertensive drugs cause fluid retention and are often administered in combination with ___

Answer 5

diuretics

Question 6

____ diuretics are not recommended for pts with renal insufficiency

Answer 6

thiazide

check BUN and creatinine
creatinine clearance (<30 mL/min)

Question 7

5 groups of Sympatholytics (Sympathetic Depressants)

Answer 7

1) beta-adrenergic blockers
2) centrally acting alpha2 agonists
3) alpha-adrenergic blockers
4) adrenergic neuron blockers
5) alpha1 and beta1 adrenergic blockers

Question 8

used as antianginals and antidysrhythmics

reduce HR, contractility, and renin release; the hypotensive response is greater in pts with higher renin lvls

Answer 8

beta-adrenergic blockers

Question 9

Cardioselective beta blockers are preferred bc they act on beta1 rather than beta2 (could cause bronchoconstriction)

Answer 9

AB BEAM

Question 10

side effects of beta blockers

Answer 10

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)

Question 11

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

Answer 11

centrally acting alpha2 agonists (methyldopa (LFTs) , clonidine, guanabenz, and guanfacine)

do not give with beta blockers or heart block/bradycardia

Question 12

___ may be ordered with methyldopa or clonidine to decrease sodium and water retention (edema)

Answer 12

diuretics

Question 13

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

Answer 13

methyldopa

Question 14

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

Answer 14

alpha-adrenergic blockers

-azosin (prazosin, doxazosin, terazosin)

Question 15

side effects of alpha adrenergic blockers

Answer 15

orthostatic hypotension, faintness, lightheadedness, increased HR, drowsiness, nasal congestion, edema, and weight gain

give with diuretic

Question 16

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

Answer 16

adrenergic neuron blockers (peripherally acting sympatholytics)

reserpine

Question 17

side effects of reserpine

Answer 17

orthostatic hypotension, vivid dreams, nightmares, and suicidal ideation; sodium and water retention

may be taken alone or with a diuretic

Question 18

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

Answer 18

alpha1-beta1 adrenergic blockers (labetalol, carvedilol)

labetalol can be given when breastfeeding

Question 19

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

Answer 19

direct-acting arteriolar vasodilators

Question 20

name 3 direct-acting arteriolar vasodilators

Answer 20

moderate to severe HTN: hydralazine, minoxidil

acute hypertensive emergency: nitroprusside

may be prescribed with beta blockers to counteract reflex tachycardia

Question 21

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

Answer 21

angiotensin-converting enzyme inhibitors (ACE inhibitors)

-pril

DO NOT GIVE IN PREGNANCY (reduce placental BF)
OR
WITH SPIRONOLACTONE

Question 22

ACE inhibitor side effects

Answer 22

constant, irritated cough
hyperkalemia
hypotension
ANGIOEDEMA
N/V/D, HA, dizziness, fatigue, insomnia, tachycardia

Question 23

similar to ACE inhibitors; block angiotensin II from the angiotensin I receptors found in many tissues

cause vasodilation and decrease peripheral resistance

Answer 23

ARBs
-sartan

do not cause irritating cough

Question 24

renin inhibitor for treating HTN, which binds with renin and causes a reduction of angiotensin I, II, and aldosterone

Answer 24

direct renin inhibitors

aliskiren

Question 25

free calcium increases muscle contractility, peripheral resistance, and BP

these block the calcium channel in the vascular smooth muscle, promoting vasodilation

Answer 25

CCBs

verapamil, diltiazem, and -pine

NO GRAPEFRUIT JUICE