Antihypertensives Flashcards
1
Q
What are the stats of HTN?
A
- 1 in 3 ppl in the world have HTN
- 72 Million over 20 yrs old have HTN
- Only 72% are aware they have HTN
- 277,000 U.S. deaths in 2004
- 3 Times more deadly for African-Americans
2
Q
What other effects can HTN have?
A
- MI
- CVA
- HF
- Kidney disease
3
Q
Normal Regulation of BP
A
- Arterial Blood Pressure = Cardiac Output X Systemic Vascular resistance
- CO = HR x Stroke vol.
- Systemic vascular resistance is affected by radius of vessel
4
Q
Controls of HTN
A
- Sypmathetic Nervous System
- Renal System
- Endocrine System
- Vascular Endothelium
5
Q
Tx of HTN
A
- Lifestyle Modifications
- Intro to medication
a. Increase or adding medications until desired BP is met.
6
Q
What are the forest camps?
A
- Adrenergic blockers
- Calcium Channel Blockers
- ACE Inhibitors
- Direct Vasodilators
- Diuretics
7
Q
Sympathetic Nervous System
A
- Alpha & Beta receptor sites:
a. Alpha Adrenergic Blockers
b. Beta1 Adrenergic Blockers
8
Q
Adrenergic Receptors
A
- Alpha 1&2: Arterial constriction/Pupil dilation
GI smooth muscle relaxation - Beta 1: Increased HR/Contractility/Automaticity/Conduction
- Beta 2: Bronchodilation/Arteriol Constriction/Glycogenolysis
9
Q
Alpha Adrenergic Receptors
A
- Blocks arteriole vasoconstriction
- Clinically not the first choice to Tx HTN
- Great @ lowering DBP
- Tx BPH
10
Q
Alpha Adrenergic Receptor Contraindication
A
- Hypotension*
- Pregnancy*
- Tachycardia
- Hypersensativity
11
Q
Alpha Adrenergic Receptor Rx Interaction
A
- Antacids* 1 hr
2. Alcohol- Increase Hypotension
12
Q
Alpha Adrenergic Adverse Eeffects
A
- First Dose Phenomenon*
- Vasodilation=Flushing, Headache, Dizziness
- Dry mouth
13
Q
Alpha Adrenergic RN Implication/Teaching
A
- Slow position change*
- Watch for 1st dose*
- 2 Weeks needed to see therapeutic results*
- Watch for wt gain
14
Q
Name 1 Alpha Blocker
A
- Cardura
15
Q
Name 2 Beta Blockers
A
- propanolol
2. atenolol
16
Q
Beta Blocker Info
A
- CO is reduced=Reducing BP*
- Decreased 02 demand
- Used for cardiac arrhythmias & angina
- 1st line Rx
17
Q
Beta Blocker Contraindication
A
- Ischemic Heart Disease*
- Systolic Heart Failure*
- Hypotension*
- Asthma*
- COPD*
- Diabetes
18
Q
Beta Blocker Rx Interactions
A
- Adrenergic Agonist
- Insulin/Oral Antidiabetic Agent
- Alcohol
- Antacids
- NSAID’s
19
Q
Beta Blocker Adverse Reaction
A
- Hypotension (Orthostatic)*
- Bradycardia*
- Bronchoconstriction*
- Hypoglycemia*
- PNS response
20
Q
Beta Blockers RN Implication/Teaching
A
- Do not DC Abruptly*
- Monitor BP for Orthostatic Hypotension, Change position slowly*
- Watch BP, HR, RR- HR <60=hold*
- Report breathing difficulty*
21
Q
Name 3 Calcium Channel Blockers
A
- nifedipine (Procardia)
- diltiazem (Cardizem)
- verapamil
22
Q
CCB Info
A
- Actions on Ca+ channel
- Used for
a. HTN
b. Angina
c. Peripheral Vascular Disease
23
Q
CCB Contraindication
A
- Heart Block*
- Pregnancy*
- Hepatic/Renal Failure*
- pt c LV dysfunction
24
Q
CCB Rx Interaction
A
- Ca+ & Vitamin D
- Beta Blockers
- Digoxin
- Cyclosporin
- Grapefruit juice
25
CCB Adverse Effects
1. Bradycardia*
2. Depressed Heart Function*
3. Peripheral Edema*
4. Hypotension
5. Dizziness
6. Hepatic Damage
26
CCB RN Implication/Teaching
1. Watch for
a. wt gain
b. bradycardia
2. Watch hepatic values- ALT, AST
3. Do not DC abruptly
4. Avoid grapefruit
27
ACEI Info
1. Works in the RAAS, reducing BP via PVR & CO-HRxSV
2. Widely used, often first line c certain diseases
3. "Pril" medication
28
Name 2 ACEI & 1 A2RA*
1. enalapril (Vasotec)
2. lisinopril (Prinivil)
3. losartan (Cozaar)*
29
ACEI Info
1. Renal Control*
2. Kidneys Control Na+ & H20 excretion*
3. Renin-->Angiotensin-->Aldosterone Ssystem*
4. Water follows Na+
5. Increased ECF will Increase Venous Return=SV=CO=BP
6. Prostoglandins vasodilate (renal & systemic)
30
ACEI Indication
1. HTN*
2. CHF & LV dysfunction
3. Gives renal protection for DM pt
31
ACEI Contraindication
1. Renal Stenosis*
2. Pregnancy*
3. CHF
4. Hyperkalemia
32
ACEI Rx Interaction
1. Antacids
2. NSAID's
3. Alcohol
4. Nitrates
5. K+
6. Digoxin (Lithium)
33
ACEI Adverse Effects
1. Dry cough**
2. Hyperkalemia
3. 1st Dose syncope
4. Hypotension
5. Headache
6. Tachycardia/Palpitations
7. Dry mouth
34
ACEI RN Implication/Teaching
1. Avoid OTC, NSAID's**
2. Watch for renal/hepatic functions test
3. Watch electrolytes:
a. Na+
b. K+
c. Ca++
35
A2RA Info
1. 2nd Gen ACEI
2. Block angiotensin 2 receptor site*
3. Decrease PVR*
4. Takes 3-6 weeks for full effect
5. Great for pt that cannot tolerate ACEI
6. "Sartan"
36
Name 1 A2RA
1. Losartan (cozaar)
37
A2RA Contraindication
1. Pregnancy
2. Renal/Liver dysfunction
3. Hypersensativity
38
A2RA Rx Interaction
Phenobarbital
39
A2RA Adverse Effect
1. No dry cough
2. Tolerated better than ACEI
3. Headache/Weakness
40
A2RA RN Implication/Teaching
1. 1st dose phenomenon
2. Watch renal/liver enzyme values
3. Teach pt how to cope c minor effects
41
Direct vasodilators
1. Tx of moderate to severe HTN
2. Reduces PVR & CO (Preload & afterload)
3. Never used as 1st line Tx of HTN
4. Monitor labs
42
CO x SVR = BP
Cardiac output x systemic vascular resistance
43
Cardiac output equation
HR x SV = CO
44
3 primary factors controlling BP
1. Cardiac output
2. Peripheral resistance
3. Blood volume
45
Advantage of using 2 anti hypertensives
1. Fewer side effects
| 2. Better pt adherence
