Chap 22 Antihypertensive Drugs

Question 1

AdrenergicDrugs:interactions

Answer 1

Can cause additive CNS depression
with alcohol, benzodiazepines,
opioids

Question 2

Peripherally Acting Alpha1 Blockers

Answer 2

Doxazosin, prazosin, and
terazosin
◦ Block alpha1-adrenergic receptors
◦ When alpha1-adrenergic receptors
are blocked, BP is decreased.
◦ Dilate arteries and veins
◦ Alpha1 blockers also increase
urinary flow rates and decrease
outflow obstruction by preventing
smooth muscle contractions in the
bladder neck and urethra.
◦ Use: benign prostatic hyperplasia
(BPH*

Question 3

Beta
Blockers

Answer 3

Propranolol, metoprolol, and atenolol
◦ Reduction of the heart rate through
beta1 receptor blockade
◦ Cause reduced secretion of renin
◦ Long-term use causes reduced
peripheral vascular resistance.

Question 4

Beta Blockers site of action 1H 2L

Answer 4

Beta-1 = 1 heart
Beta-2 = 2 lungs

Question 5

Adrenoceptors: vasomotor fxn AC-BD

Answer 5

Alpha=Constrict
Beta=Dilate

Question 6

Beta Blockers: B1 selective vs. B1-B2Nonselective
A->N O->Z

Answer 6

A through N B1 selective: Acebutalol, Atenolol, Esmolol, Metoprolol

O through Z: B1, B2 non-selective: Pindolol, Propanalol, Timolol

Question 7

Angiotensin-Converting 
Enzyme (ACE) Inhibitors

Answer 7

Large group of safe and effective drugs
Currently are 10 ACE inhibitors
Often used as first-line drugs for HF and hypertension
May be combined with a thiazide diuretic or CCB

Question 8

Angiotensin-Converting 
Enzyme (ACE) Inhibitors

Answer 8

Captopril (Capoten)
Benazepril (Lotensin)
Enalapril (Vasotec)
Fosinopril (Monopril)
Lisinopril (Prinivil)
Moexipril (Univasc)
Perindopril (Aceon)
Quinapril (Accupril)
Ramipril (Altace)
Trandolapril (Mavik)

Question 9

ACE Inhibitors: 
Mechanism of Action

Answer 9

Inhibit ACE inhibit an enzyme

ACE: converts angiotensin I (AI) (formed through the action of renin) to angiotensin II (AII)

A II: potent vasoconstrictors that induce aldosterone secretion by the adrenal glands

Aldosterone: stimulates sodium and water resorption, which can raise BP

Renin-angiotensin-aldosterone system (R-A-A)

ACE inhibitors thus lower BP.

Question 10

Cardio Protective and Renal Protective Effects

Answer 10

ACE inhibitors decrease SVR (a measure of afterload) and preload.
Used to prevent complications after MI
ACE inhibitors have been shown to decrease morbidity and mortality in patients with HF.
*ACE inhibitors: reduce glomerular filtration pressure *
Standard therapy for diabetic patients to prevent the progression of diabetic nephropathy

Question 11

ACE Inhibitors: Adverse Effects

Answer 11

Dry, nonproductive cough, which reverses when therapy is stopped

Note: First-dose hypotensive effect may occur.

Question 12

CAPTOPRIL

Answer 12

*Cough
*Angioedema
*Potassium Excess
Taste Changes
*Orthostatic Hypotension
Pressure Drop
Renal Failure/Rash
Indomethacin Inhibition
Leukopenia

Question 13

ACE drug Interactions

Answer 13

NSAIDs
Lithium*
Potassium sparing diuretics*
Other antihypertensives

Question 14

Ace Inhibitors Interactions & Precautions

Answer 14

Drug interactions:
NSAIDS(decrease BP control)*
Diuretics ( excessive hypotensive effect)*
Potassium supplement (increased rick of hyperkalemia)*
Lithium ( increased lithium serum levels)*

Precautions
“first dose effect” severe hyptoension, remain in bed for 3-4 days to prevent falls
obtain BP before giving, hold if hypo
change positions slowly due to orthostatic
monitor liver and kidney fxn

Question 15

Captopril (Capoten) Uses

Answer 15

Uses: prevention of ventricular remodeling after MI; reduce the risk of HF after MI
Shortest half-life
Must be administered multiple times throughout the day
Captopril and Lisinopril are not prodrugs

Question 16

Angiotensin II receptor blocker “sartan”

Answer 16

Losartan
Valsartan
Candesartan
Eprosartan
Olmesartan

Question 17

Losartan (Cozaar)

Answer 17

Beneficial in patients with hypertension and HF

Used with caution* in patients with renal or hepatic dysfunction and in patients with renal artery stenosis

Not safe for breastfeeding women and should not be used in pregnancy

Question 18

Losartan Mnemonic Side Effects

Answer 18

Low Blood Pressure
Other(Fatigue, Headache, Dizziness)
Swelling
Allergic Reaction
Raised Potassium
Teratogenic
Acute Kidney Injury
Nasal Congestion

Question 19

Calcium Channel Blockers:
Mechanism of Action

Answer 19

Primary use: HTN and angina

Cause smooth muscle relaxation by blocking the binding of calcium to its receptors, preventing muscle contraction

Results in:
Decreased peripheral smooth muscle tone
Decreased SVR
Decreased BP

Question 20

Calcium Channel Blockers:
Indications

Answer 20

Dihydropyridine* – Amlodipine, Nicardipine Nimodipine
Non-dihydropyridine* – Verapamil, Diltiazem
Angina
Hypertension: amlodipine (Norvasc)
Dysrhythmias
Migraine headaches
Raynaud’s disease
Prevent the cerebral artery spasms after subarachnoid hemorrhage: nimodipine

Question 21

Diuretics

Answer 21

First-line antihypertensives in the JNC 8 guidelines for the treatment of hypertension
Decrease* plasma and extracellular fluid volumes*
Results
Decreased preload
Decreased CO*
Decreased total peripheral resistance*
Overall effect
Decreased workload of the heart and decreased BP*
Thiazide* diuretics* are the most commonly* used diuretics for hypertension.*

Question 22

Vasodilators

Answer 22

Diazoxide (Hyperstat)
Hydralazine (Apresoline)
Minoxidil (Rogaine) - hair regrowth
Nitroprusside (Nitropress)

Question 23

Vasodilators: Indications

Answer 23

Treatment of hypertension
May be used in combination with other drugs
Sodium* nitroprusside* and IV* diazoxide* are reserved* for the management of hypertensive emergencies.

Question 24

Vasodilators Nursing Implications

Answer 24

Before beginning therapy, obtain a thorough health history and head-to-toe physical examination
Assess for contraindications to specific antihypertensive drugs.
Assess for conditions that require cautious use of these drugs.

Educate patients about the importance of not missing a dose and taking the medications exactly as prescribed.*
Instruct patients to check with their physicians for instructions on what to do if a dose is missed; patients should never double up on doses if a dose is missed.
Monitor BP during therapy; instruct patients to 
keep a journal of regular BP checks.

Instruct patients that these drugs should not be stopped abruptly because this may cause a rebound hypertensive crisis and perhaps lead to stroke.
Oral forms should be given with meals so that absorption is more gradual and effective.
Administer IV forms with extreme caution and use an IV pump.

Remind patients that medication is only part of therapy. Encourage patients to watch their diet, stress level, weight, and alcohol intake.
avoid smoking and eating foods high in sodium.
Encourage supervised exercise.

change positions slowly to avoid syncope from postural hypotension.
report unusual shortness of breath; difficulty breathing;* swelling* of the feet, ankles, face, or around the eyes; weight gain or loss; chest pain; palpitations; and excessive fatigue.

Male patients who take these drugs may not be aware that impotence is an expected effect, and this may influence compliance with drug therapy.
If patients are experiencing serious adverse effects or if they believe the dose or medication needs to be changed, they should contact their physicians immediately.

Hot tubs, showers, or baths; hot weather; prolonged sitting or standing; physical exercise; and alcohol ingestion may aggravate low BP, leading to fainting and injury; patients should sit or lie down until symptoms subside.
Patients should not take any other medications, including over-the-counter drugs, without first getting the approval of their physicians.

Educate patients about lifestyle changes that may be needed.
Weight loss
Stress management
Supervised exercise
Dietary measures
Monitor for adverse effects
(dizziness, orthostatic hypotension, fatigue) and for toxic effects.
Monitor for therapeutic effects