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antihypertensives Flashcards

1
Q

two types of hypertension

A

1) primary hypertension
- unknown cause
- essential, idiopathic
- 90% of cases
2) secondary hypertension
- known cause
- 10% of cases

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2
Q

benefits of treating hypertension

A
  • lower risk of heart failure (50%)
  • lower risk of stroke (38%)
  • lower risk of heart attack (15%)
  • lower risk of death (10%)
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3
Q

hypertension target organ damage

A

no obvious symptoms
- cerebrovascular disease (stroke)
- hypertensive retinopathy
- left ventricular dysfunction
- left ventricular hypertrophy
- coronary artery disease
- chronic kidney disease
- peripheral artery disease

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4
Q

hypertension treatment

A

combination of medication and lifestyle change
- obesity
- physical exercise
- salt intake
- increase potassium intake
- dietary habits including fat intake
- alcohol
- smoking

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5
Q

BP treatment targets

A

general population: <140/90
high risk (CV disease, CKD): <120/NA
diabetics: <130/80

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6
Q

first line hypertensive drugs

A
  • angiotensin converting enzyme (ACE) inhibitors
  • angiotensin II receptor blockers ( ARBs)
  • calcium channel blockers (CCBs)
  • diuretics
  • b adrenoceptor blockers

single pill combinations recommended

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7
Q

other hypertensive drugs

A
  • vasodilators
  • adrenergic agents
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8
Q

ACE inhibitors

A

stop angiotensin I from becoming angiotensin II
- large group of safe and effective drugs
- often used at first line agents for HF and hypertension
- often combined with a thiazide diuretic or calcium channel blocker

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9
Q

RAAS system (renin angiotensin aldosterone system)

A

renin released into bloodstream by kidneys, acts on angiotensinogen from liver to become angiotensin I, in/around the lungs ACE enzyme converts angiotensin I –> angiotensin 2 which stimulates aldosterone secretion from adrenal glands. aldosterone increased HR and constricts arteries to increase BP

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10
Q

ACE inhibitor examples

A

-pril
captopril (short half life)
enalapril (PO or parenteral)
lisinopril and quinapril (longer half life)

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11
Q

ACE inhibitor indications

A

hypertension
- alone or with other agents (CCB, diuretics)
- renal protective effects in clients with diabetes

HF
- drug of choice in hypertensive clients with heart failure
- slows progression. of left ventricular remodelling after a MI

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12
Q

ACE inhibitor mechanism of action

A
  • prevents ang II vasoconstriction (reduces peripheral resistance - afterload)
  • prevents aldosterone release (reduce salt and water reabsorption)
  • prevent breakdown of bradykinin (enzyme in lungs broken down by ang 1 but ACE inhibitors keep bradykinin and triggers cough)
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13
Q

ACE inhibitors adverse effects

A
  • dry, nonproductive cough
  • first-dose hypotension may occur
  • possible hyperkalemia (stopping reabsorption of sodium)
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14
Q

ACE inhibitor interactions

A

k supplements and k sparing diuretics

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15
Q

ACE inhibitors contraindications

A

pregnancy

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16
Q

ARBs angiotensin 2 receptor blockers

A

similar to ACE
- no dry cough
- block receptor of angiotensin 2

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17
Q

ARBs examples

A
  • losartan
  • valsartan
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18
Q

ARBs mechanism of action

A

ang 2 receptor antagonist
- block receptors that ang 2 activates
- stops vasoconstriction
- blocks release of aldosterone

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19
Q
A
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19
Q

ARBs indications

A
  • hypertension
  • adjunctive agents for the treatment of HF
  • alternative for those who cannot tolerate ACE inhibitors
  • used alone or in combination
20
Q

ARBs contraindications

A

pregnancy

21
Q

calcium channel blockers indications

A
  • hypertension
  • angina
  • dysrhythmias

higher levels of calcium trigger heartbeat

22
Q

types of CCBs

A

1) work on cardiac muscle and vessels
- diltiazem
- verapamil
2) DHPs (dihydropyridines) - vascular selective
- amlodipine
- nifedipine
- nimodipine

22
Q

CCBs on cardiac muscle

A
  • block cardiac muscle Ca channels
  • alters electrical activity of cardiac muscle cells (SA, AV nodes and cardiac muscle)
  • diltiazem
  • verapamil
23
Q

CCBs on vascular muscle

A
  • inhibits Ca entry into arteriolar vascular smooth muscle cells (causes relaxation)
  • decreased peripheral resistance (decreased blood pressure)
  • decreased BP –> increased HR (compensation)
  • baroreceptor reflex detects decreased BP and then SNS is triggered to increase HR for compensations
  • happens more with DHP and less with verapamil and diltiazem because Ca channels blocked in cardiac muscle so the reflex for increased HR is less extreme
24
Q

verapamil/diltiazem adverse effects

A

cardiovascular
- hypotension (dizziness)
- flushing, peripheral edema

GI (calcium channels in GI tract, less peristaltic activity)
- constipation
- nausea

other
- rash
- dermatitis

25
Q

DHP adverse effects

A

cardiovascular
- hypotension (dizziness), palpitations, tachycardia
- flushing, peripheral edema

GI
- very little constipation

other
- rash, dermatitis

26
Q

thiazide and thiazide-like diuretics

A

decrease plasma and extracellular fluid volumes
- decreased preload (decreased cardiac output)
- decreased total peripheral resistance

decreased workload of heart and decreased BP

27
Q

diuretics examples

A
  • hydrochlorothiazide
  • chlorthalidone (thiazide- like, longer acting)

possible hypokalemia (digoxin interaction)

28
Q

recommended single pill combinations

A
  • ACEI + CCB
  • ACEI + diuretic
  • ARB + diuretic
  • ARB CCB
29
Q

adrenergic agents

A

not first line treatment
- 4 receptor subtypes: A1, A2, B1, B2

30
Q

when are beta blockers first line treatment

A

only first line treatment for people under 60
- used in specific situations (HF and hypertension)

31
Q

b blockers

A
  • antagonists
  • act on b1 receptors
  • block epi/NE action in heart
  • reduce HR (SA/AV node)
  • decrease FOC of cardiac muscle (reduce stroke volume

together reduce CO and help bring BP to normal

32
Q

b blocker examples

A
  • metoprolol (b1 selective)
  • atenolol (b1 selective)
  • propranolol (non selective)
33
Q

b blockers indications

A
  • hypertension
  • HF
  • angina
  • dysrhythmias
34
Q

adrenergic agents: dual a1 and b receptor blockers

A

dual a1 and b receptor blockers
- act in periphery at heart and blood vessels
- reduce heart rate (b1 receptor blockade)
- cause vasodilation (a1 receptor blockade)

ex: labetalol, carvedilol

35
Q

types of adrenergic agents

A
  • centrally acting a2 adrenoceptor agonists
  • peripherally acting a1 adrenoceptor antagonists (alpha 1 blocker allows for smooth muscle in vessels to relax dilate)

not first line treatment (alpha blockers or centrally acting agents often used in combination/ add on therapy)

36
Q

b blockers contraindications

A

avoided in patients with asthma
- b blocker is selective but may effect some bs receptors
- antagonist will not let the bronchi dilate

intolerance to exercise
- SNS increases HR and FOC when exercising to meet metabolic demands
- b blocker would not let SNS have the same effect on heart and CO wouldn’t be raised as much as needed

37
Q

centrally acting a2 receptor agoinst examples

A
  • methyldopa (1st line treatment pregnancy)
  • clonidine
37
Q

centrally acting a2 receptor agonists

A
  • stimulate a2 adrenergic receptors in brainstem/medulla oblongata (NE release is decreased)
  • SNS outflow from CNS is decreased
  • vasodilation (decrease blood pressure)

first line for pregnancy because they are safer

38
Q

centrally acting a2 receptor agonists

A
  • treatment of hypertension, either alone or with other agents
  • usually used after other agents have failed or in combination with other drugs (due to adverse effects like sedation and dry mouth)
39
Q

peripherally acting a1 adrenoceptor antagonists

A
  • prazosin
  • block a1 adrenergic receptors
  • block NE contraction of blood vessels
40
Q

peripherally acting a1 receptors antagonist indications

A
  • treatment of hypertension (not firstline)
  • relief of symptoms of BPH (benign prostatic hypertrophy)
  • management of severe HF when used with cardiac glycosides and diuretics
41
Q

a receptor agrenderic agent adverse effects

A
  • dry mouth
  • drowsiness
  • sedation
  • headaches
  • sleep disturbances
  • nausea
  • rash
  • cardiac disturbances (palpitations)
  • ORTHOSTATIC HYPOTENSION
42
Q

vasodilators mechanism of action

A

directly relax arteriolar smooth muscle
- peripheral vasodilation

43
Q

vasodilators indications

A
  • treatment of hypertension - maybe with other agents
44
Q

vasodilator examples

A
  • hydralazine
  • sodium nitroprusside - nitric oxide action (management of hypertensive emergencies)
45
Q

vasodilator adverse effects

A

hydralazine
- dizziness, headache, anxiety, TACHYCARDIA, n&v, diarrhea, anemia, dyspnea, edema, nasal congestion
sodium nitroprusside
- bradycardia, HYPOTENSION, possible cyanide toxicity

46
Q

client implications

A
  • drug shouldn’t be stopped too abruptly (rebound hypertension - lead to stroke)

clients should
- avoid smoking, eating foods high in sodium
- follow lifestyle recommendations
- change positions slowly to avoid postural hypotension

avoid aggravating low BP
- hot tub, shower, bath
- hot weather
- prolonged sitting/standing
- intense physical exercise
- alcohol ingestion

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