Cardiovascular Meds: hypertension Flashcards
State the ranges of systolic pressure and diastolic pressure in normal BP
SP: less than 120
DP: less than 80
State the ranges of systolic pressure and diastolic pressure in elevated BP.
SP: 120-129
DP: less than 80
State the ranges of systolic pressure and diastolic pressure in hypertension stage 1
SP: 130-139
DP: 80 - 89
State the ranges of systolic pressure and diastolic pressure in hypertension stage 2
SP: greater than 140
DP: greater than 90
State the ranges of systolic pressure and diastolic pressure in hypertension crisis
SP: greater than 180
DP: greater than 120
List 7 drug classes used in the treatment of hypertension
- ACE (angiotensin-converting enzyme) inhibitor “pril”
- Angiotensin II receptor blocker “tan”
- Beta-adrenergic blockers “olol”
- Ca channel blockers “pine”
- Sympatholytic drugs (other than beta blockers)
- Direct vasodilators
- Selective aldosterone-receptor antagonists
Describe the 5 key players in maintaining blood pressure
- arterioles
- baroreceptors (sensory nerves in carotid sinuses and aortic arch)
- medulla oblangata
- EPI and NE from adrenal medulla
- RAAS system
Name 4 examples of ACE inhibitors
Benazepril
Captopril
Enalapril
Lisinopril
List 5 indications of ACE inhibitors
- hypertension
- left ventricle systolic problem
- after acute MI
- diabetic/non-diabetic nephropathy
- diabetic retinopathy
Identify the 6 side effects of ACE inhibitors (acronym ACE)
TOP 3
1. Angioedema
2. Cough
3. Elevated potassium
- orthostatic hypotension (especially with the first dose!!)
- headache and fatigue (hypertension meds in general make patients tired)
- transient elevation of BUN and creatinine and proteinuria
Recognize 1 contraindication of ACE inhibitors
do not use ACE inhibitors in pregnancy!
Name 4 examples of ARBs
Olmesartan
Telmisartan
Irbesartan
Losartan
Specify 5 indications of ARBs
All types of ARBs can treat hypertension.
In addition,
- irbesartan & losartan for diabetic nephropathy
- losartan for diabetic retinopathy
- losartan for reducing the risk of stroke (when patients have high BP with LV hypertrophy)
- valsartan for post-MI
- telmisartan for patients who are 55+, cannot tolerate ACE inhibitors, and have cardiovascular risk
Identify 2 side effects of ARBs
- angioedema
- lower risk of cough than ACE inhibitors
no elevated K+
Recognize 1 contraindication of ARBs
Do not use in pregnancy!
Name an example of direct renin inhibitors
aliskiren
Specify 3 adverse effects of direct renin inhibitors
Same as ACE inhibitors
Name an example of selective aldosterone antagonists and compare it with spironolactone
The example is eplerenone.
Eplerenone only binds to aldosterone receptors, while spironolactone (potassium-sparing diuretic) binds to aldosterone + other hormone receptors
Specify 1 adverse effects of selective aldosterone antagonists
Hyperkalemia
Describe the mechanism of action of calcium channel blockers (CCBs)
CCBs prevent Ca ions crossing myocardial cell membranes and vascular smooth muscle cells
–> increase vasodilation & slow HR
Classify CCBs into 2 groups based on their effects and list examples in each group
The Dihydropyridines family acts primarily on arterioles at therapeutic levels. The D’s family always end in “pine”
Amlodipine, Felodipine, Nifedipine, Nicardipine, Nimodipine, Nisoldipine
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Diltiazem and verapamil are two meds that act on arterioles AND the heart
Specify 4 effects of CCBs in the blood vessels and heart
- vasodilation
- slow HR
- decrease afterload (arterioles constrict less!)
- Nimodipine is a special CCB –> treat cerebral vasospasm
Recognize the 3 indications of CCBs.
Analyze the role of CCBs in preventing angina.
- hypertension
- arrhythmia / RVR (rapid ventricular rate)
- long term prevention of angina
(CCBs dilate coronary arteries and bring down HR)
Identify 5 side effects of CCBs
- Headache
- Dizziness and weakness
- Bradycardia and heart block
- Palpitations and arrhythmias
- Orthostatic hypotension
Identify the location of beta-1 receptors and beta-2 receptors
beta-1 receptors: heart
–> HR, conduction velocity, and FOC go up when stimulated
beta-2 receptors: lungs
–> bronchi will dilate
Name 4 examples of beta-adrenergic blockers
Non-selective (work both Beta 1 and 2)
labetalol, propranolol
Selective
atenolol, metoprolol
Why do you want a patient with asthma to be on a selective beta blocker?
It minimizes the need to bronchodilate and having that response blocked.
Beta blockers and breathing problems are bad news!!!
List 4 cardiovascular indications of beta blockers
What is a non-cardiovascular indications of beta blockers
- chest pain and after MI
- hypertension
- cardiomyopathy
- supraventricular arrhythmias
**anxiety
Identify 4 side effects of beta blockers
- Hypotension
- Bronchospasm (Breathing problems & BBs are Bad news)
- nausea/vomiting
- Impotence
Recount 3 points to teach patients about beta blockers, especially focusing on patients with asthma and diabetes
Asthmatic patients: notify HCP of any shortness of breath
Diabetic patients: BB will block the tachycardiac response to low blood sugar and block the body’s normal response to transform stored glucagon to glu in the liver –> monitor blood sugar level
Check the patient’s pulse before taking BB. Hold medication if pulse is less than 60
