Antihypertensives Flashcards
Cardiovascular disease (CVD) is usually managed with
with exercise, diet, stress management and a variety of pharmacological and surgical approaches
CVS provides the body’s cells with
nutrients and removes their metabolic waste efficiently
The response to heightened tissue demands is to:
Increase BP
Increase HR
Redirect blood flow to prioritize tissues under stress
***These responses are normal but are intended to be short-term immediate reactions
Cardiovascular medications:
Anti-hypertensives
Drugs to manage heart failure and angina
Drugs that interfere with coagulation
Drugs to treat respiratory conditions
Bronchodilators
Inhaled steroids
Antihistamines
Decongestants
BP = CO x TPR
CO: cardiac output is the volume of blood the heart pumps per minute. Reflects the pumping strength of the heart, its rate and rhythm, and the volume of blood returned to the heart
TPR: all the elements that create resistance to the flow of blood. Most important factor is blood vessel diameters in the systemic and pulmonary circulations
Average BP is
120/80 mm Hg
Hypertension – AKA the silent killer
140/90 mm Hg
Average normal resting heart rate is
70-72 beats per minute
Within physiological limits, the faster the heart beats
the more blood it can pump
A rapid HR reduces the time frame in which the heart wall itself can
be perfused with fresh blood
When drugs are used in the treatment of CVD, they are often directed at managing
BP or strengthening heart function, or BOTH
CVD Medications are grouped by function:
Improve heart function Increase blood vessel diameter Alter blood coagulation mechanisms Reduce blood volume Lower blood lipid levels (reduce blood vessel blockage)
Sites of action for cardiovascular medications
CNS-Alpha-2 agonists
Kidneys- Diuretics
Heart-Beta blockers/
Alpha-1 antagonists/
Calcium channel blockers
BOTH-Angiotensin-
converting enzyme
inhibitors (ACE-i)Drugs that Improve Heart Function
BETA BLOCKERS
Cardiac Glycosides
Betablockers
metoprolol, atenolol, propranol, lavetolol
Betablockers act on
beta-adrenergic receptors located on the surface of the heart
receptors are normally activated when sympathetic neurotransmitters like _________
are released during stress
adrenaline
adrenaline when activated increase _____ _____ and ______as part of ‘flight or fight’
response
heart’s rate and force of contraction
unnecessary or chronic stimulation of the beta receptors
begin to weaken the heart from overstress and reduce perfusion
Cardiac Glycosides
commonly called digitalis (Digoxin)
- derived from a number of naturally occurring plants such as foxglove
Drugs that Improve ↑ blood vessel diameter
Vasodilators
Alpha receptor Drugs
Ca+ Channel Blockers
Angiotensin Converting Enzyme(ACE) Inhibitor
Angiotensin Converting Enzyme(ACE) Inhibitor
lisinopri l(Zestril), captopril (Copoten), enalapril (Vasotec)
Ca+ Channel Blockers
verapamil (Isoptin), nifedipine (Procardia), ditiazem
Alpha receptor Drugs
Alpha-1 receptor antagonist (Prazosin, doxazosin) and Alpha-2-receptor Agonist (Clonidine)
Vasodilators
Nitroglycerine vasodilators belong to a group of drugs that are chemically related to nitrates
nitroglycerine can be administered through a wide variety of routes
IV,
transdermally (patch, cream), sublingually, and via oral spray
other anti-anginal drugs that have similar mechanisms of action to antihypertensives
includes calcium-channel blockers and beta-blockers
nitroglycerine almost complete first-pass metabolism, so never given
orally (swallowed)
but may be sublingually, and via oral spray
Alpha 1 and 2 receptor found in
the CNS and the smooth muscle of blood vessel walls
- alpha-1 receptors located on vascular smooth muscle cells
- alpha-2 receptors found in synapses in the autonomic nervous system
the alpha receptors respond to sympathetic NT epinephrine and norepinephrine to
alter
blood vessel tone
- alpha-1 receptor activation has a direct effect to produce vasoconstriction
- alpha-2 receptor activation results in a decrease in sympathetic impulses leaving the
vasomotor centre resulting in peripheral vasodilation
Ca+ Channel Blockers commonly used to treat
high blood pressure by exerting their effects by influencing smooth
muscle tone in blood vessel walls
Angiotensin Converting Enzyme(ACE) Inhibitor
produces vasodilation by interrupting
the activities of one of the enzymes in the renin-angiotensin system (this system plays a role in long-term blood pressure control )
Drugs that Improve
alter blood coagulation mechanisms- there are 3 categories of drugs used in the treatment of CVD that influence blood
coagulation
anticoagulants (affect blood clotting)
- antithrombotics (inhibit thrombosis by altering how platelets adhere together)
- thrombolytics (break down clots and thrombi that have already formed)
- blood coagulation is a necessary process to stop
bleeding
- too much clot formation- can lead to thrombosis which can obstruct the blood
vessel
- inadequate clot formation- can lead to excessive bleeding
- anticoagulants (affect blood clotting)
- antithrombotics (inhibit thrombosis by altering how platelets adhere together)
- thrombolytics (break down clots and thrombi that have already formed)
Anticoagulants -Heparin (administered parenterally), coumadin- warfarin (admin orally)
Antithrombotic -(asprin, persantin)
Thrombolytics -(streptokinase, tPA)
Drugs that Improve ↓ blood volume
Diurectics -hydrochlorothiazide (Diuril), furosemide
Drugs that Improve
↓ blood lipid levels (↓BV blockage)
- Bile acid sequestrants
- Nicotineic acid
- Fibric acid derivatives
- HMG Co A reductase inhibitors
Beta blockers: metoprolol (lopressor), atenolol, propranolol (Inderal), labetalol MoA
Hypertension: reduce cardiac output, therefore reducing blood pressure Ischemic heart disease: reduced heart rate and cardiac output reduce the workload of the heart Heart Failure: some beta blockers reduce peripheral resistance and workload of the heart
Beta blockers: metoprolol (lopressor), atenolol, propranolol (Inderal), labetalol Adverse Effects
GI: nausea and diarrhea Resp: bronchospasm (mostly asthmatics or COPD) Cardio: hypotension, heart failure, orthostatic hypotension, bradycardia Endocrine: hypoglycemia, especially in diabetics CNS: fatigue, dizziness, depression
Beta blockers: metoprolol (lopressor), atenolol, propranolol (Inderal), labetalol Massage Therapy Guidelines
Massage: postural hypotension. May not tolerate lying down. May cause peripheral edema Hydrotherapy: systemic treatments pose a high risk of hypotension, dizziness, falls. Beware of increasing cardiac workload Exercise: beta blockers notorious for causing fatigue during exercise
CARDIAC GLYCOSIDES
(Digoxin) MoA
Heart failure: reduces heart rate, but increases strength of contraction of the heart
CARDIAC GLYCOSIDES
(Digoxin) Adverse Effects
Toxicity: fatigue, nausea, vomiting, visual disturbances, HA, bradycardia-EMERGENCY.
Cardio: bradycardia ,hypotension
CARDIAC GLYCOSIDES
(Digoxin) Massage Therapy
Guidelines
dysrhythmias are common side effects. Be aware of dyspnea, angina symptoms while working Hydrotherapy: see general guidelines for heart failure
VASODILATORS
(Nitroglycerine) MoA
Angina: vasodilation of coronary arteries improves blood flow to heart; vasodilation of veins and systemic arteries decrease preload and afterload (decreases workload of the heart)
VASODILATORS
(Nitroglycerine) Adverse Effects
Hypotension
Headache
VASODILATORS
(Nitroglycerine) Massage Therapy
Guidelines
Considerations as for
clients with ischemic
heart disease
ALPHA RECEPTOR DRUGS- Alpha-2-receptor
agonist
(clonidine) MoA
Hypertension: acts
on the CNS to cause
peripheral vasodilation
ALPHA RECEPTOR DRUGS- Alpha-2-receptor
agonist
(clonidine) Adverse Effects
CNS: fatigue, drowsiness, sedation Cardio: orthostatic hypotension, hypotension
ALPHA RECEPTOR DRUGS- Alpha-2-receptor
agonist
(clonidine) Massage Therapy
Guidelines
Massage: postural hypotension Hydrotherapy: systemic heat treatments increase risk of hypotension and syncope
ALPHA RECEPTOR DRUGS-Alpha-1-receptor
antagonist
( Prazosin,
doxazosin) MoA
Hypertension: vasodilation and reduces the force of contraction of the heart Angina: reduces the workload of the heart by reducing contractility
ALPHA RECEPTOR DRUGS-Alpha-1-receptor
antagonist
( Prazosin,
doxazosin) Adverse Effects
Cardio: edema, bradycardia, congestive heart failure, hypotension, dizziness
ALPHA RECEPTOR DRUGS-Alpha-1-receptor antagonist ( Prazosin, doxazosin) Massage Therapy Guidelines
Massage: postural hypotension-take care when changing positions. Peripheral edema-poorly treated with massage Hydrotherapy: systemic heat treatments increase risk of hypotension and syncope
Calcium Channel
Blockers: verapamil
(Isoptin), nifedipine
(Procardia), ditiazem MoA
Hypertension: vasodilation and reduces the force of contraction of the heart Angina: reduces the workload of the heart by reducing contractility
Calcium Channel
Blockers: verapamil
(Isoptin), nifedipine
(Procardia), ditiazem Adverse Effects
Cardio: edema, bradycardia, congestive heart failure, hypotension, dizziness
Calcium Channel Blockers: verapamil (Isoptin), nifedipine (Procardia), ditiazem Massage Therapy Guidelines
Massage: postural hypotension, peripheral edema Hydrotherapy: systemic heat treatments increase risk of hypotension and syncope
ACE Inhibitors: lisinopril
(Zestril), captopril
(Copoten), enalapril
(Vasotec) MoA
Hypertension: vasodilation and reduces blood volume, due to reduced angiotensin II formation
ACE Inhibitors: lisinopril
(Zestril), captopril
(Copoten), enalapril
(Vasotec) Adverse Effects
Cardio: dizziness,
hypotension
Resp: cough
Fluids: hyperkalemia
ACE Inhibitors: lisinopril (Zestril), captopril (Copoten), enalapril (Vasotec) Massage Therapy Guidelines
hypotension-take care when changing position. May not tolerate prone position Hydrotherapy: see calcium channel blockers
Anticoagulants: Heparin (administered parenterally), coumadin- warfarin (administered orally) MoA
Heparin: activation of antithrombin III and decreased activity of thrombin Coumadin (warfarin): antagonizes vitamin K, needed for clotting factors II, IV, IX, and X
Anticoagulants: Heparin (administered parenterally), coumadin- warfarin (administered orally) Adverse Effects
Cardio: hemorrhage, ecchymosis Note: Coumadin levels can be altered by a wide range of food and drugs, resulting in under or overdose
Anticoagulants: Heparin (administered parenterally), coumadin- warfarin (administered orally) Massage Guidelines
Massage: these agents are much more likely to cause hematomas or eccymoses with deep work. Light modalities are necessary
Antithrombotics prevent or impair
platelet aggregation reduce the risk of dangerous thrombus
formation —> ANTIPLATELET DRUGS
Antithrombotics used in prevention of
arterial thrombosis, especially in the coronary and cerebral arteries
thrombi develop as a result of platelet activation with the presence of
thromboxane A2
causing platelets to aggregate
thrombi typically comprises of
aggregated platelets, entrapped red blood cells, and fibrin
platelets are important in controlling bleeding but thrombi can be dangerous if
they obstruct
blood vessels
aspirin: inhibits
the formation of thromboxanes
single dose of aspirin can inhibit platelet aggregation for up to
a week
a platelets lifespan is only 6-10 days, so aspirin can inactivate platelets for
most or
all of their short lifespan
Thrombolytics
promote disintegration of
clots and thrombi that have already formed
disintegration of clots and thrombi depends on the presence of
plasmin (enzyme responsible for breaking down fibrin
mesh)
any drug that increases plasmin formation has the potential to be used to
promote clot and
thrombus dissolution
streptokinase: drug that is an enzyme that combines with plasminogen to form a
plasminogen-streptokinase complex which facilitates plasmin formation
thrombolytics (tPA) are used in the treatment of
arterial and venous thrombi, after strokes and
heart attacks, and to clear IV catheters and other such devices
