Blood pressure medication

Question 1

Angiotensin converting enzyme (ACE) Inhibitor

Answer 1

Captopril

Question 2

Actions of captopril

Answer 2

Blocks ACE from converting angiotensin I to angiotensin II, leading to a decrease in blood pressure, decrease in aldosterone production, and a small increase in serum potassium levels, along with sodium and fluid loss.

Question 3

Indications for captopril

Answer 3

treatment of HTN, HF diabetic nephropathy and left ventricular dysfunction after an MI.

Question 4

pharmockinetics of captopril

Answer 4

Route- oral
Onset- 15 min
Peak 30-90 min
T1/2 2hrs; excreted in urine, widely distributed, well absorbed and metabolized in the liver.

Question 5

Adverse effects of captopril

Answer 5

tacycardia, MI, rash, pruritus, gastric irritation, aphthous ulcers (don’t eat gluten), peptic ulcers, dysgeusia, proteinuria, bone marrow suppression, cough.

Related to the effects of vasodilatation and alterations in blood flow.

Question 6

Contraindications and cautions for captorpil

Answer 6

Contra- allergies, impaired renal function, pregnancy and lactation.

Caution- CHF

Question 7

D-2-D for captorpil

Answer 7

allopurinol

Question 8

Angiotnesin II Receptor blockers

Answer 8

Losartan

Question 9

Actions of losartan

Answer 9

Selectively blocks the binding of angiotensin II to specific tissue receptors found in the vascular smooth muscle and adrenal glands; blocks the vasoconstriction and release of aldosterone associated with the renin- angiotensin- aldosterone system.

Question 10

Indications for losartan

Answer 10

Alone or as part of combination therapy for the treatment of hypertension; treatment of diabetic nephropathy with an elevated serum creatinine and proteinuria in pts with DM II and HTN.

Question 11

Pharmacokinetics for losartan

Answer 11

Route- oral
Onset- varies
Peak 1-3 h
Duration- 24h
T 1/2- 2h than 6-9 hrs; metabolized in the liver and excreted in urine and feces.

Question 12

Adverse effects for losartan

Answer 12

dizziness, HA, syncope, weakness, diarrhea, abdominal pain, symptoms of URTI, cough, back pain, fever, muscle weakness, hypotension. skin rash or dry skin
**(ARB will be given if ACE is causing a cough)

Question 13

C &C for losartan

Answer 13

Contra- allergy, pregnancy and lactation

caution- hepatic or renal dysfunction and hypovolemia

Question 14

D-2-D for losartan

Answer 14

phenobarbital

Question 15

Calcium Channel Blockers

Answer 15

Diltiazem

Question 16

Actions of diltiazem

Answer 16

inhibits the movement of calcium ions across the membranes of cardiac and arterial muscle cells, depressing the impulse ad leading to slowed conduction, decreased myocardial contractility and dilation of arterioles, which lowers blood pressure and decrease myocardial oxygen consumption.

Question 17

Indications for diltiazem

Answer 17

treatment of essential HTN in the extended-release form.

Question 18

Pharmacokinetics for diltiazem

Answer 18

Route- oral ER
Onset 30-60min
Peak 6-11 h
Duration- 12 h
T1/2- 5-7 hrs; metabolized in liver and excreted in urine. Well absorbed.

Question 19

Adverse effects for diltiazem

Answer 19

dizziness, LH, HA, peripheral edema, bradycardia, AV block, flushing nausea.
Related to effects on cardiac output. GI symptoms, Cardiovascular symptoms.

Question 20

C &C for diltiazem

Answer 20

Contra- allergy, heart block or sick sinus syndrome, renal or hepatic dysfunction, pregnancy and lactation.

Question 21

D-2-D for diltiazem

Answer 21

Cyclosporine

Question 22

Vasodilators

Answer 22

Nitroprusside (Nitropress)

Question 23

Actions for nitroprusside

Answer 23

acts directly on vascular smooth muscle to cause vasodilation and drop of BP; does not inhibit cardiovascular reflexes and tachycardia; renin release will occur.

Question 24

Indications for nitroprusside

Answer 24

Sever hypertension, maintenance of controlled hypotension during anesthesia, acute HF.

Question 25

Pharmacokinetics for nitroprusside

Answer 25

``` Route-IV Onset- 1-2 min Peak- Rapid Duration- 1-10min T1/2- 2 min; metabolized in the liver and excreted in urine. rapidly absorbed and widely distributed. ```

Question 26

Adverse effects of nitroprusside

Answer 26

Apprehension, HA, retrosternal pressure, palpiations, cyanide, toxicity, diaphoresis, N/V, abd pain, irritation at the injection site. **very potent and you need to worry about cyanide poisoning.

Question 27

C & C for nitroprusside

Answer 27

Caution- peripheral vascular disease, CAD, CHF, or tachycardia

Question 28

D-2-D for nitroprusside/ vasodialors

Answer 28

Based on individual drug

Question 29

Various vasodilators

Answer 29

Diazoxide (Hyperstat)- IV for hospitalized pts w/ severe HTN; increases blood glucose levels. Hydralazine (Apresoline)- Maintains increase renal blood flow. Minoxidil (Loniten)- Used only for sever and unresponsive HTN Nitroprusside (Nitropress)- used for HTN crisis; maintain hypotension during surgery

Question 30

Alpha-specific adrenergic agent

Answer 30

Midodrine

Question 31

Action of midodrine

Answer 31

Activates alpha-receptors in arteries and veins produce and increase in vascular tone and increase in blood pressure.

Question 32

Indications for midodrine

Answer 32

symptomatic treatment of orthostatic hypotension.

Question 33

Pharmacokinetics for midodrine

Answer 33

absorbed from GI tract, metabolized in the liver, and excreted in urine.

Question 34

C &C for midodrine

Answer 34

Contra- supine hypertension, CAD, pheochromcytoma, and urinary retention. Caution- pregnancy and lactation, visual problems

Question 35

Adverse effects of midodrine

Answer 35

related to stimulation of alpha-receptors

Question 36

D-2-D of midodrine

Answer 36

cardiac glycosides, beta blockers, alpha-adrenergic agents and corticosteroids.

Question 37

Beta blockers

Answer 37

Lead to a decrease in HR and strength of contraction as well as vasodilatation. Labetalol (Normodyne, Trandate)- blocks alpha and beta receptors to lower BP w/o tachycardia or decreased renin levels. other - carvediol (Coreg)- CHF and HTN guanadrel (Hylorel)- HTN if not responding to thiazide diuretics. guanethidine (Ismelin)- HTN and renal hypertension. Propanolol (Inderal)- blocks beta adrenergic receptors in SNS causing decreased HR, BP, decreased arrhythmias and decreased renin. AE- brady, CHF, arrhytmias, CVA, Pulmonary edema, impotence, fatigue, bronchospasm. C &C- allergy, brady, heart blocks, shock, CHF, bronchospams, COPD, asthma, Caution DM, hepatic dysfunction. D2D- clonidine, NSAIDS, epi, insulin Atenolol (Tenormin)- does not usually block beta 2- receptor sites including sympathetic bronchodilation. Used to treat HTN, angine and some cardiac arrhythmias in pts with COPD, asthma, rhinitis.

Question 38

Diuretic

Answer 38

Thiazide diuretics- Hydrochlorothiazide (HydroDIURIL). First line treatment for HTN. Actions- Inhibits reabsorption of Na and Cl in distal renal tubles increasing the excretion of Na, Cl and H2O. Decrease serum sodium levels and blood volume.