Antihypertensives and Heart Failure Medications Flashcards
List the classes of blood pressure medications (7 main categories).
- Which category has sub-categories (will be marked with asterisk)
Remember acronym!
- Diuretics (already covered in first lecture of the module)
- Adrenergic drugs*
- Angiotensin - converting enzyme (ACE) inhibitors
- Angiotensin II receptor blockers (ARBs)
- Calcium channel blockers (CCBs)
- Vasodilators
- Direct renin inhibitors
Acronym: “Dat A-A-Ass Can Verberate D***”
List the Adrenergic drug subcategories (4 main categories).
- include with the categories if the drug acts centrally or peripherally.
- Alpha 2 receptor agonists (central)
- Alpha 1 receptor blockers (peripheral)
- Beta receptor blockers (peripheral)
- Combination alpha 1 and beta receptor blockers (peripheral)
Central = brain
Peripheral = heart & vessels
Clonidine
- Class?
- Acts centrally or peripherally?
- How does it work to decrease BP? (2)
- Side effects?
- Nursing considerations?
Alpha-2 Adrenergic Receptor stimulators
Works centrally in the brain
Decreases BP by:
- stimulating alpha II adrenergic receptors which decreases norepinephrine production, in turn, decreasing BP
- stimulating alpha II adrenergic receptors in the kidneys which reduces renin activity and vasodilates blood vessels (renin vasoconstricts vessels)
Side effects:
*Pretty significant (usually not a first-line medication)
- Orthostatic hypotension (sudden drop in BP with change in positions i.e., standing, sitting)
- fatigue
- dizziness
Nursing considerations:
- Change positions slowly d/t risk of fainting or falling
- First-dose “syncope” can occur (loss of consciousness) –> should be lying or sitting for first dose
- Can not suddenly stop taking (can lead to severe rebound hypertension)
- Should check BP before administering (could be too low to safely give medication)
Methyldopa
- Class? Sub-class?
- Acts centrally or peripherally?
- How does it work to decrease BP? (2)
- Side effects?
- Nursing considerations?
*For what type of patient is this medication used?
Alpha-2 Adrenergic Receptor stimulators
Works centrally in the brain
Decreases BP by:
- stimulating alpha II adrenergic receptors which decreases norepinephrine production, in turn, decreasing BP
- stimulating alpha II adrenergic receptors in the kidneys which reduces renin activity and vasodilates blood vessels (renin vasoconstricts vessels)
Side effects:
*Pretty significant (usually not a first-line medication)
- Orthostatic hypotension (sudden drop in BP with change in positions i.e., standing, sitting)
- fatigue
- dizziness
Nursing considerations:
- Change positions slowly d/t risk of fainting or falling
- First-dose “syncope” can occur (loss of consciousness) –> should be lying or sitting for first dose
- Can not suddenly stop taking (can lead to severe rebound hypertension)
- Should check BP before administering (could be too low to safely give medication)
*Usually given to PREGNANT patients –> category B
Doxazosin
- Class? Sub-class?
- Acts centrally or peripherally?
- How does it work to decrease BP?
- Side effects?
- Nursing considerations?
Peripherally acting alpha I blocker
Acts peripherally on the blood vessels
Decreases BP by: Blocking alpha I adrenergic receptors from the effects of norepinephrine in the blood vessels –> this dilates the arteries + veins, reducing peripheral vascular resistance and lowering BP
Side effects:
- Dizziness
- Orthostatic hypotension (sudden drop in BP with position changes)
- Bradycardia (slow HR)
Nursing considerations:
- Can’t stop medication suddenly –> can experience rebound hypertension
- Should change positions slowly d/t dizziness
- Check BP before administering medication (could be too low to safely administer)
Prazosin
- Class? Sub-class?
- Acts centrally or peripherally?
- How does it work to decrease BP?
- Side effects?
- Nursing considerations?
Peripherally acting Alpha-1 blocker
Acts peripherally on the blood vessels
Decreases BP by: Blocking alpha I adrenergic receptors from the effects of norepinephrine in the blood vessels –> this dilates the arteries + veins, reducing peripheral vascular resistance and lowering BP
Side effects:
- Dizziness
- Orthostatic hypotension (sudden drop in BP with position changes)
- Bradycardia (slow HR)
Nursing considerations:
- Can’t stop medication suddenly –> can experience rebound hypertension
- Should change positions slowly d/t dizziness
- Check BP before administering medication (could be too low to safely administer)
Terazosin
- Class? Sub-class?
- Acts centrally or peripherally?
- How does it work to decrease BP?
- Side effects?
- Nursing considerations?
Peripherally acting alpha I blocker
Acts peripherally on the blood vessels
Decreases BP by: Blocking alpha I adrenergic receptors from the effects of norepinephrine in the blood vessels –> this dilates the arteries + veins, reducing peripheral vascular resistance and lowering BP
Side effects:
- Dizziness
- Orthostatic hypotension (sudden drop in BP with position changes)
- Bradycardia (slow HR)
Nursing considerations:
- Can’t stop medication suddenly –> can experience rebound hypertension
- Should change positions slowly d/t dizziness
- Check BP before administering medication (could be too low to safely administer)
Metoprolol
- Class? Sub-class?
- Acts centrally or peripherally?
- Selective or non-selective?
- How does it decrease BP?
- Side effects?
- Nursing considerations?
*How does it treat HF (when used for that)?
Beta-blocker
selective
Acts peripherally on the heart
Decreases BP by:
1. blocking beta II receptors in the heart which reduces HR
2. stimulates alpha II adrenergic receptors in the kidneys which reduces renin activity and allows for vasodilation
Side effects:
- Bradycardia (slow HR)
- Dizziness
Nursing considerations:
- check BP AND PULSE (HR)
- can’t stop suddenly (can cause rebound hypertension)
*Treats HF by:
1. Decreasing after-load i.e., decreased resistance the heart has to pump against by lowering BP
2. Increasing contractility i.e., helping the heart beat stronger
Atenolol
- Class? Sub-class?
- Acts centrally or peripherally?
- Selective or non-selective?
- How does it decrease BP?
- Side effects?
- Nursing considerations?
Beta-blocker
selective
Acts peripherally on the heart
Decreases BP by:
1. blocking beta II receptors in the heart which reduces HR
2. stimulates alpha II adrenergic receptors in the kidneys which reduces renin activity and allows for vasodilation
Side effects:
- Bradycardia (slow HR)
- Dizziness
Nursing considerations:
- check BP AND PULSE (HR)
- can’t stop suddenly (can cause rebound hypertension)
Propranolol
- Class? Sub-class?
- Acts centrally or peripherally?
- Selective or non-selective?
- How does it decrease BP?
- Side effects?
- Nursing considerations?
- Contraindications?
Beta-blocker
non-selective
Acts peripherally on the heart
Decreases BP by:
1. blocking beta II receptors in the heart which reduces HR
2. stimulates alpha II adrenergic receptors in the kidneys which reduces renin activity and allows for vasodilation
Side effects:
- Bradycardia (slow HR)
- Dizziness
Nursing considerations:
- check BP AND PULSE (HR)
- can’t stop suddenly (can cause rebound hypertension)
Contraindications:
- Albuterol for asthma –> can decrease effectives; narrowing the airways and possibility of bronchospasm, worsening the condition of breathing
Labetalol
- Class? Sub-class?
- Acts centrally or peripherally?
- How does it decrease BP?
- Side effects?
- Nursing considerations?
Dual-action alpha I and beta receptor blocker
Works in the periphery on the heart and blood vessels
Decreases BP by:
1. targeting alpha - I receptors to dilate the heart and blood vessels
- targeting beta receptors to decrease HR
Side effects:
- Bradycardia (slow HR)
- Dizziness
- Orthostatic hypotension
- Erectile dysfunction
Nursing considerations:
- Take BP and PULSE
- can’t stop taking suddenly (can cause rebound hypertension)
Carvedilol
- Class? Sub-class?
- Acts centrally or peripherally?
- How does it decrease BP?
- Side effects?
- Nursing considerations?
Dual-action alpha I and beta receptor blocker
Works in the periphery on the heart and blood vessels
Decreases BP by:
1. targeting alpha - I receptors to dilate the heart and blood vessels
- targeting beta receptors to decrease HR
Side effects:
- Bradycardia (slow HR)
- Dizziness
- Orthostatic hypotension
- Erectile dysfunction
Nursing considerations:
- Take BP and PULSE
- can’t stop taking suddenly (can cause rebound hypertension)
Captopril
- Class?
- How does it decrease BP?
- Side effects?
- Contraindications?
Angiotensin - converting enzyme inhibitor drug (ACE inhibitor)
Decreases BP by:
- Inhibiting ACE enzyme which is responsible for converting angiotensin I into II, causing vasoconstriction and aldosterone secretion (reabsorption of sodium and water)
- Dilates heart vessels
- Promotes diuresis to lower blood volume
Side effects:
- Dry cough –> can be put on different medication if this becomes too much for pt to handle
- Hyperkalemia (high potassium) –> can effect electrical activity of the heart if too high
- Fatigue
- Dizziness
Nursing considerations:
- Monitor potassium (K+) levels
- Take BP before administering
Contraindications:
- Spironolactone (potassium sparing diuretic) –> can lead to hyperkalemia
- Potassium supplement –> hyperkalemia
- Lithium –> toxicity
- Pregnant or breastfeeding patient –> can be toxic to fetus
*Treats HF by:
1. Decreasing pre-load and after-load
Enalapril
- Class?
- How does it decrease BP?
- Side effects?
- Contraindications?
Angiotensin - converting enzyme inhibitor drug (ACE inhibitor)
Decreases BP by:
- Inhibiting ACE enzyme which is responsible for converting angiotensin I into II, causing vasoconstriction and aldosterone secretion (reabsorption of sodium and water)
- Dilates heart vessels
- Promotes diuresis to lower blood volume
Side effects:
- Dry cough –> can be put on different medication if this becomes too much for pt to handle
- Hyperkalemia (high potassium) –> can effect electrical activity of the heart if too high
- Fatigue
- Dizziness
Nursing considerations:
- Monitor potassium (K+) levels
- Take BP before administering
Contraindications:
- Spironolactone (potassium sparing diuretic) –> can lead to hyperkalemia
- Potassium supplement –> hyperkalemia
- Lithium –> toxicity
- Pregnant or breastfeeding patient –> can be toxic to fetus
*Treats HF by:
1. Decreasing pre-load and after-load
Fosinopril
- Class?
- How does it decrease BP?
- Side effects?
- Contraindications?
Angiotensin - converting enzyme inhibitor drug (ACE inhibitor)
Decreases BP by:
- Inhibiting ACE enzyme which is responsible for converting angiotensin I into II, causing vasoconstriction and aldosterone secretion (reabsorption of sodium and water)
- Dilates heart vessels
- Promotes diuresis to lower blood volume
Side effects:
- Dry cough –> can be put on different medication if this becomes too much for pt to handle
- Hyperkalemia (high potassium) –> can effect electrical activity of the heart if too high
- Fatigue
- Dizziness
Nursing considerations:
- Monitor potassium (K+) levels
- Take BP before administering
Contraindications:
- Spironolactone (potassium sparing diuretic) –> can lead to hyperkalemia
- Potassium supplement –> hyperkalemia
- Lithium –> toxicity
- Pregnant or breastfeeding patient –> can be toxic to fetus
*Treats HF by:
1. Decreasing pre-load and after-load
Lisinopril
- Class?
- How does it decrease BP?
- Side effects?
- Contraindications?
*How does it treat HF (when used for that)?
Angiotensin - converting enzyme inhibitor drug (ACE inhibitor)
Decreases BP by:
- Inhibiting ACE enzyme which is responsible for converting angiotensin I into II, causing vasoconstriction and aldosterone secretion (reabsorption of sodium and water)
- Dilates heart vessels
- Promotes diuresis to lower blood volume
Side effects:
- Dry cough –> can be put on different medication if this becomes too much for pt to handle
- Hyperkalemia (high potassium) –> can effect electrical activity of the heart if too high
- Fatigue
- Dizziness
Nursing considerations:
- Monitor potassium (K+) levels
- Take BP before administering
Contraindications:
- Spironolactone (potassium sparing diuretic) –> can lead to hyperkalemia
- Potassium supplement –> hyperkalemia
- Lithium –> toxicity
- Pregnant or breastfeeding patients –> can be toxic to fetus
*Treats HF by:
1. Decreasing pre-load and after-load
Losartan
- Class?
- How does it decrease BP?
- Side effects?
- Nursing considerations?
- Contraindications?
Angiotensin II Receptor Blockers
Decreases BP by:
- Blocking angiotensin II from binding to receptors –> vasodilation (angiotensin binding causes vasoconstriction + aldosterone secretion)
- Blocks aldosterone secretion –> promotes excretion of sodium + water
How ARBs are different from ACEs:
- more selective for smooth muscles –> don’t cause cough
- don’t have same issues with hyperkalemia
Side effects:
- Chest pain
- Fatigue
- Weakness
- Diarrhea
Nursing considerations:
- Check BP
- Change positions slowly
- Can’t stop taking suddenly –> can cause rebound hypertension.
Contraindications:
- Pregnant or breastfeeding patients –> can be toxic to fetus (do pregnancy test before prescribing)
Valsartan
- Class?
- How does it decrease BP?
- Side effects?
- Nursing considerations?
- Contraindications?
*How does it treat HF (when used for that)?
Class = Angiotensin II Receptor Blockers
Decreases BP by:
- Blocking angiotensin II from binding to receptors –> vasodilation (angiotensin binding causes vasoconstriction + aldosterone secretion)
- Blocks aldosterone secretion –> promotes excretion of sodium + water
How ARBs are different from ACEs:
- more selective for smooth muscles –> don’t cause cough
- don’t have same issues with hyperkalemia
Side effects:
- Chest pain
- Fatigue
- Weakness
- Diarrhea
Nursing considerations:
- Check BP
- Change positions slowly
- Can’t stop taking suddenly –> can cause rebound hypertension.
Contraindications:
- Pregnant or breastfeeding patients –> can be toxic to fetus (do pregnancy test before prescribing)
*Treats HF by:
1. Decreasing after-load i.e., decreasing resistance the heart has to pump against by lowering BP
Irbesartan
- Class?
- How does it decrease BP?
- Side effects?
- Nursing considerations?
- Contraindications?
Class = Angiotensin II Receptor Blockers
Decreases BP by:
- Blocking angiotensin II from binding to receptors –> vasodilation (angiotensin binding causes vasoconstriction + aldosterone secretion)
- Blocks aldosterone secretion –> promotes excretion of sodium + water
How ARBs are different from ACEs:
- more selective for smooth muscles –> don’t cause cough
- don’t have same issues with hyperkalemia
Side effects:
- Chest pain
- Fatigue
- Weakness
- Diarrhea
Nursing considerations:
- Check BP
- Change positions slowly
- Can’t stop taking suddenly –> can cause rebound hypertension.
Contraindications:
- Pregnant or breastfeeding patients –> can be toxic to fetus (do pregnancy test before prescribing)
Candesartan
- Class?
- How does it decrease BP?
- Side effects?
- Nursing considerations?
- Contraindications?
Class = Angiotensin II Receptor Blockers
Decreases BP by:
- Blocking angiotensin II from binding to receptors –> vasodilation (angiotensin binding causes vasoconstriction + aldosterone secretion)
- Blocks aldosterone secretion –> promotes excretion of sodium + water
How ARBs are different from ACEs:
- more selective for smooth muscles –> don’t cause cough
- don’t have same issues with hyperkalemia
Side effects:
- Chest pain
- Fatigue
- Weakness
- Diarrhea
Nursing considerations:
- Check BP
- Change positions slowly
- Can’t stop taking suddenly –> can cause rebound hypertension.
Contraindications:
- Pregnant or breastfeeding patients –> can be toxic to fetus (do pregnancy test before prescribing)
What are ACEs and ARBs primarily used for?
First-line drugs for:
- Heart failure
- Hypertension
What are Calcium channel blocker’s primarily used for?
- Hypertension
- Angina (Chest pain)
Amlodipine
- Class?
- How does it decrease BP?
- Side effects?
- Nursing considerations?
- Contraindications?
Class = Calcium channel blocker
Decreases BP by: Blocking binding of calcium to calcium channels in the heart and blood vessels which promote smooth muscle relaxation
- decreases peripheral smooth muscle tone
- decreases BP
- decreases peripheral vascular resistance
Side effects:
- Hypotension (low BP)
- Peripheral edema –> vessels are dilated d/t smooth muscle relaxation which can allow for fluid to leak into surrounding tissue
Nursing considerations:
- Check BP
Contraindications:
- Grapefruit juice –> causes higher drug levels in the blood; causes BP to drop suddenly
Nifedipine
- Class?
- How does it decrease BP?
- Side effects?
- Nursing considerations?
- Contraindications?
Class = Calcium channel blocker
Decreases BP by: Blocking binding of calcium to calcium channels in the heart and blood vessels which promote smooth muscle relaxation
- decreases peripheral smooth muscle tone
- decreases BP
- decreases peripheral vascular resistance
Side effects:
- Hypotension (low BP)
- Peripheral edema –> vessels are dilated d/t smooth muscle relaxation which can allow for fluid to leak into surrounding tissue
Nursing considerations:
- Check BP
Contraindications:
- Grapefruit juice –> causes higher drug levels in the blood; causes BP to drop suddenly
Nimodipine
- Class?
- How does it decrease BP?
- Side effects?
- Nursing considerations?
- Contraindications?
- What is this medication SPECIFICALLY used for? (Hint: after what kind of emergency)
Class = Calcium channel blocker
Decreases BP by: Blocking binding of calcium to calcium channels in the heart and blood vessels which promote smooth muscle relaxation
- decreases peripheral smooth muscle tone
- decreases BP
- decreases peripheral vascular resistance
Side effects:
- Hypotension (low BP)
- Peripheral edema –> vessels are dilated d/t smooth muscle relaxation which can allow for fluid to leak into surrounding tissue
Nursing considerations:
- Check BP
Contraindications:
- Grapefruit juice –> causes higher drug levels in the blood; causes BP to drop suddenly
*Used specifically after a subarachnoid hemorrhage (bleeding in the space surrounding the brain) to prevent arteries in the brain from spasming
Hydralazine
- Class?
- How does it decrease BP?
- Side effects?
- Nursing considerations?
Class = Vasodilator
Decreases BP by: working directly to relax arterial and venous smooth muscle
- decreases peripheral vascular resistance
- decreases after-load
- promotes peripheral vasodilation
Side effects:
- Tachycardia (high HR)
- Headache
- Edema
Nursing considerations:
- monitor BP
Minoxidil
- Class?
- How does it decrease BP?
- Side effect(s)?
- Nursing considerations?
Class = Vasodilator
Decreases BP by: working directly to relax arterial and venous smooth muscle
- decreases peripheral vascular resistance
- decreases after-load
- promotes peripheral vasodilation
Side effect(s):
- Hair regrowth
Nursing considerations:
- Monitor BP
Nitroprusside
- Class?
- Given in what setting?
- How does it decrease BP?
- Side effects?
- Nursing considerations?
Class = Vasodilator
Usually only given in an ICU setting for hypertensive emergencies –> has rapid onset
*IV ONLY
Decreases BP by: working directly to relax arterial and venous smooth muscle
- decreases peripheral vascular resistance
- decreases after-load
- promotes peripheral vasodilation
Side effects:
- Bradycardia (low HR)
- Decreased platelet aggregation (blood clotting)
- Hypotension
Nursing considerations:
- Monitor BP through arterial line
HF is classified by __________ function.
- What does this impair?
HF is classified by L ventricle function
This impairs the hearts ability to pump blood to various parts of the body (brain, heart (itself), and kidneys).
What is the left ventricular ejection fraction?
- what other component is important to LVEF?
- what is a “normal” LVEF value?
- what can happen in the body if the LVEF is below “normal” values?
The fraction of blood (volume) ejected in systole in relation to the volume of the blood in the ventricle at the end of diastole
- calculated as the volume difference between EDV (after filling) and ESV (after ejection)
Stroke volume is an important component to ejection fraction i.e., the volume of blood pumped out by the heart during each contraction
Normal LVEF value = 55-70%
- >50% = indicative of heart failure
Lower than “normal” LVEF can cause: Fluid that isn’t ejected to “back-up.”
- Pulmonary edema
- Shortness of breath r/t pulmonary edema
- Peripheral vascular edema
Define the different classes or “stages” of heart failure.
- Class I
- Class II
- Class III
- Class IV
Class I:
- no symptoms
- can perform daily activities with no limitations
Class II:
- mild symptoms
- occasional swelling
- mild exercise limitations/strenuous activity limitations
- no symptoms at rest
Class III:
- noticeable limitations in ability to exercise or perform strenuous activities
- relief from symptoms only at rest
Class IV:
- Unable to perform physical/strenuous activities
- Symptoms at rest (constant)
List the classes of HF drugs (7)
- some overlap with anti-hypertensive drugs.
- Diuretics (covered)
- ACE inhibitors (covered)
- Angiotensin II receptor blockers (covered)
- Beta blockers (covered)
- Phosphodiesterase inhibitors
- Amino-glycosides (Cardiac, not antibiotic)
- Vasodilators (covered)
What is the “goal” of heart failure (HF) therapy?
The “goal” of therapy is to optimize left ventricular ejection fraction (LVEF).
What is meant by “pre-load?”
What is meant by “after-load?”
- what effects after-load?
What is meant by contractility?
*Think of medications this way
Pre-load = how much blood goes into the heart i.e., how much blood the heart has to pump
After-load = resistance the heart has to pump against
- hypertension and vasoconstriction effects after-load
Contractility = strength of heart’s contraction
Milrinone
- Class?
- MOA? Route?
- How does it treat HF (pre-load, after-load, contractility)?
- In what setting is it used?
- short-term/long-term?
- side effects?
- nursing considerations?
Class = Phosphodiesterase Inhibitor
Inhibits phosphodiesterase to increase contractility and promote vasodilation (after-load)
Use:
- ICU setting
- IV only
- short-term use if not responding to other meds
*Why not long-term –> can only improve to a certain point and then results may bounce back in the other direction.
Side effects:
- Hypotension
- Cardiac side effects (ventricular tachycardia)
Nursing considerations:
- monitor for drop in BP
Lanoxin (Digoxin)
- Class?
- How does it treat HF?
- Side effects?
- Nursing considerations?
- Therapeutic range?
- Antidote for toxicity? When would you give it?
Class = cardiac glycosides
Treats HF by:
- increasing contractility (induces increase sodium which causes influx of calcium)
Side effects:
- Heart arrhythmias (EKG changes)
- Dropped HR (don’t give if HR below 60)
- Dizziness
- Abnormal vision (light halos)
- Headaches
Nursing considerations:
- Narrow therapeutic range (0.5 - 2 mg/mL) –> have to draw blood frequently
- Monitor HR
- Monitor EKG
Antidote = Digoxin immune fab
- Hyperkalemia (heart arrhythmias)
- Life threatening arrhythmia
- Life threatening digoxin overdose
Hydralazine/isosorbide dinitrate (BiDil)
Class = Direct Vasodilator
Treats HF by:
- dilating vasculature (after-load)
Side effects:
- Dizziness
- Headache
- Hypotension
- Reflex tachycardia (heart trying to maintain CO when standing)
Nursing implications:
- Monitor BP
- Monitor for orthostatic hypotension
Contraindications:
- Viagra (erectile dysfunction med) –> additive hypotension effects
- Cialis (erectile dysfunction med) –> hypotension effects
