Antihypertensives Flashcards
Beta-blockers ex
-olol: acebutolol, atenolol, nadolol, metoprolol, propranolol, pindolol, esmolol
Beta blockers MOA
Decrease hearts excitability, decrease cardiac workload and oxygen consumption, and provide membrane stabilizing effects that contribute to other antiarrhythmic drug activity
Beta blockers indications
Hypertension, angina, heart failure, cardiac arrhythmia, migraine, glaucoma, prevent myocardial reinfarction
Beta blockers, must monitor
Heart rate
Beta blocker side effects
Can mask signs of hypoglycemia, prevent epinephrine release, fast heart rate, sweating (diaphoresis), dizzy, headache, nausea, vomiting, diarrhea, bronchospasm, elderly at greater risk of side effects
Beta-blockers restrictions
Not for ppl with heart blocks or asthma, hypotension, emphysema, sinus bradycardia
Ace inhibitors ex
-pril: lisinopril, enalapril, quinapril, ramipril
Ace inhibitors MOA
Work on lung and inhibit angiotensin 1 from converting into angiotensin 2, sodium and water aren’t retained
Ace inhibitors side effects
Dry cough (general throat irritation), hypotension, hyperkalemia, first dose effect
ARB’s use
Will get switched to these if ace inhibitors cause cough or other negative side effects
ARB’s ex
-sartan: losartan, candesartan, Valsartan, olmesartan
ARB’s side effects
Angioedema (painless swelling in lips), not for use during pregnancy, renal artery stenosis (narrowing of blood vessels that give blood to kidneys)
CCB’s dihydropyridines ex and MOA
Work on blood vessels, -dipine: nifedipine, felodipine, amlodipine
CCB’s phenylalkylamines MOA and ex
Work on heart, verapmil
CCB’s Benzothiazepines ex and MOA
Work on heart, diltiazem (HR control)
CCB’s side effects
Swelling in lower limbs, constipation
Loop diuretics fact
Very powerful diuretics, and if mineral loss side effects are an issue, switch to thiazide diuretics
Loop diuretics ex
-semide: furosemide, torsemide, bumetanide, ethacrynic acid (can give to ppl with sulfa allergy)
Loop diuretics concerns
Loops lose everything (esp. calcium and potassium)
Loop diuretics look out for
Ototoxicity and tinnitus
Betaxolol indications
Glaucoma
Timolol indication
Glaucoma
Beta blockers precautions
Diabetes, thyrotoxicosis, peptic ulcer
Beta blockers interactions
Antidepressants increase effect of beta blocker and cause bradycardia, NSAIDs decrease effect of beta blocker, loop diuretics increase risk of hypotension, clonidine increases risk of paradoxical hypertensive effect, cimetidine increases bet blocker serum levels and risk of toxicity, lidocaine increases beta blocker serum levels and risk of toxicity
Blood pressure
Force of blood against artery walls
Hypertension
High blood pressure that stays elevated over time
Hypertensive emergency
Extremely high blood pressure that must be lowered immediately to prevent damage to target organs
Hyponatremia
Low blood sodium level
Isolated systolic hypertension
systolic blood pressure over 140, with diastolic blood pressure under 90
Lumen
The space or opening within an artery
Prehypertension
Systolic blood pressure between 120 and 139 or diastolic between 80 and 89
Primary hypertension
Hypertension that has no known cause, aka essential or idiopathic hypertension
Antihypertensives MOA
Vasodilation, which creates and increase in the lumen of the arterial blood vessels
Secondary hypertension
Hypertension with a known cause , such as kidney disease
Vasodilation
Increase in the diameter of the blood vessels, that, when widespread, results in a drop in blood pressure
CCBs general MOA
Inhibit the movement of calcium ions across cell membranes and arterial muscle cells, which means there is less calcium available for the transmission of nerve impulses, so blood vessels are relaxed
ARBs MOA
Block the binding of angiotensin 2 at various receptor sites in the vascular smooth muscle and adrenal gland
Primary treatment for heart failure
Antihypertensives, most frequently, ACE inhibitors, ARBs, diuretics, and beta blockers
Nitroprusside use
Hypertensive emergency, given IV
Antihypertensives elderly consideration
Fainting and falling due to orthostatic hypotension
General antihypertensive side effects
Fatigue, depression, dizziness, headache, syncope, upper respiratory infections, cough, abdominal pain, nausea, diarrhea, constipation, gastric irritation, and anorexia, rash, pruritus, dry mouth, tachycardia, hypotension, proteinuria, neutropenia
ACE inhibitors contraindications
Impaired renal function, salt or volume depletion, bilateral stenosis, angioedema, pregnancy (cat C in 1st trimester and cat D in and and 3rd trimesters) and lactation
ARBs contraindications
Impaired renal function, salt or volume depletion, bilateral stenosis, angioedema, pregnancy (cat
C in 1st trimester and cat D in 2nd and 3rd trimester), and lactation
CCBs contraindications
Sick sinus syndrome, 2nd or 3rd degree AV block (except with a functioning pacemaker), hypotension, ventricular dysfunction, or cardiogenic shock
Antihypertensives precautions
Renal or hepatic impairment, electrolyte imbalances, lactation , pregnancy, elderly
CCBs precautions
Heart failure, renal or hepatic impairment, pregnancy (cat C), lactation
ACE inhibitors precautions
Sodium depletion, hypovolemia, coronary or cerebrovascular insufficiency, and in people on diuretics or dialysis
ARBs precautions
Renal or hepatic dysfunction, hypovolemia, volume or salt depletion, people taking high doses of diuretics
ACE inhibitors interactions
NSAIDs reduce effects of ACE inhibitors, higher risk of allergic reaction to allopurinol, increased or decreased plasma digoxin levels, increased effects of loop diuretics, increased serum lithium levels (possible toxicity), hypoglycemic agents and insulin increase risk of hypoglycemia, and elevated potassium serum level with potassium sparing diuretics
Antihypertensives general interactions
MAOIs, antihistamines and sympathomimetic bronchodilators decrease effects of antihypertensives
Enalapril interactions
Rifampin decreases enalapril effects
CCBs interactions
Cimetidine and ranitidine increase CCB effect, increased effects and toxicity of theophylline, increased risk for digoxin toxicity, rifampin decreases CCB effect
Losartan interactions
Fluconazole increases side effects, indomethacin decreases effects of losartan
Centrally anti adrenergic drugs antihypertensive ex
Clonidine, guanabenz, guanfacine, methyldopa
Peripherally acting anti adrenergic drugs antihypertensive ex
Doxazosin, prazosin, reserpine, terazosin,
Alpha/beta adrenergic blocking drugs antihypertensive ex
Carvedilol, labetalol
Direct renin inhibitors ex
Aliskiren
Selective aldosterone receptor antagonists ex
Eplerenone