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Pharmacology > Chapter 25- Antihypertensive Drugs > Flashcards

Chapter 25- Antihypertensive Drugs Flashcards

1
Q

A1-Blockers

A

Drugs that primarily cause arterial and venous dilation through their action on peripheral sympathetic neurons.

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2
Q

Antihypertensive Drugs

A

Drugs used to treat hypertension

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3
Q

Cardiac output

A

The amount of blood ejected from the left ventricle, measured in litres per minute

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4
Q

Centrally acting adrenergic drugs

A

Drugs that modify the function of the sympathetic nervous system in the brain by stimulating a2-receptors, which has a reverse sympathetic effect causing a decrease in blood pressure.

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5
Q

Essential hypertension

A

An elevated systemic arterial pressure for which no cause can be found an which is often the only significant clinical finding; AKA primary or idiopathic hypertension

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6
Q

Ganglionic blocking drugs

A

Drugs that prevent nerves from responding to the action of acetylcholine by occupying the receptor sites for acetylcholine on sympathetic and parasympathetic nerve endings.

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7
Q

Hypertension/Risk factor for

A

A common, often asymptomatic disorder in which blood pressure persistently exceeds 140/90mmHG
Risk Factor for: Stroke, Heart failure, coronary artery disease, cardiovascular disease, kidney failure. “Silent Killer”

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8
Q

Idiopathic hypertension

A

Hypertension with no known primary cause

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9
Q

Nicotinic receptor

A

The receptor and site of action for acetylcholine in both the parasympathetic and sympathetic nervous system.

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10
Q

Orthostatic hypotension

A

A common adverse effect of adrenergic drugs involving a sudden drop in blood pressure when patients change position, especially when rising from a seated or horizontal position.

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11
Q

Prodrug

A

A drug that is inactive in its administered for and must be biotransformed in the liver to its active form.

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12
Q

Secondary hypertension

A

High blood pressure known to be associated with with a primary disease, such as kidney, pulmonary, endocrine, or vascular disease.

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13
Q

Ethnocultural considerations

A

White people: B-blockers and ACE inhibitors more effective.

Black people: Calcium channel blockers and diuretics more effective

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14
Q

Canadian Hypertension Education Program (CHEP)

A

Endorses: Home BP monitoring, ongoing routine assessment. Lifestyle modifications: Healthy diet, regular physical activity, reduction in dietary sodium, stress reduction.
Target to treat: Less than 140/90. Less than 130/80 in PTs with diabetes or chronic kidney disease

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15
Q

Normal BP

A

120/80-129/89

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16
Q

Prehypertension

A

130/85-139/89

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17
Q

Stage 1 hypertension

A

140/90-159/99

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18
Q

Stage 2 hypertension

A

160+/100+

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19
Q

Unknown cause

A

Essential/idiopathic/primary hypertension. Accounts for 90% of cases

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20
Q

Known cause

A

Secondary hypertension. Accounts for 10% of cases

21
Q

Masked hypertension

A

BP less than 140/90 in a medical setting but hypertensive at home

22
Q

White-coat hypertension

A

BP less than 140/90 at home but hypertensive in a medical setting

23
Q

PNS

A

Vasodilation of smooth muscle, cardiac muscle, glands

24
Q

SNS

A

Constriction of heart, blood vessels, skeletal muscle

25
Q

Adrenergic drugs

A

Prevent vasoconstriction.
Centrally and peripherally acting adrenergic neutron blockers
Centrally acting a2 receptor agonists
Peripherally acting a1 receptor blockers
Peripherally acting B receptor blockers (b1 blockers) both cardioselective(B1 receptors) and nonselective (both B1 and B2 receptors).
Peripherally acting dual a1 and B receptor blockers

26
Q

Adrenergic drugs Mech of Action

A

Centrally acting a2 receptor agonists: Stimulate a2 adrenergic receptors in the brain.
Decrease sympathetic outflow from the central nervous system.
Decrease norepinephrine production
Peripheral a1 blockers/antagonists: Block a1-adrenergic receptors ex) prazosin (Minipress)-Prevent vasoconstriction.
B-Blockers: Reduce BP by reducing HR. cause reduced secretion of renin. Cause reduced peripheral vascular resistance. Result in decreased BP
Dual-action a1 and B receptor blockers: ex) Labetalol and carvedilol. Decrease BP.

27
Q

Adrenergic Indications

A

Centrally acting a2 receptor agonists (brain): Usually used after other drugs have failed due to adverse effects.
Peripherally acting a1 receptor agonists: Treatment of hypertension. Relief symptoms of BPH, management of severe heart failure.

28
Q

Adrenergic Contraindicatoins

A

Drug Allergy, Acute heart failure, concurrent use of MAOIs, Severe depression, peptic ulcer, asthma, severe live or kidney disease

29
Q

Adrenergic Adverse effects

A

Dry mouth, sedation, drowsiness, constipation, headaches, palpitations. HIGH INCIDENCE OF ORTHOSTATIC HYPOTENSION

30
Q

ACE inhibitors

A

First line drugs for heart failure and hypertension. May be combined with thiazide diuretic or calcium channel blocker
Ex) enalapril (Vasotec)- prodrug. captopril and lisinopril- NOT prodrugs. Used if a PT has liver dysfunction.

31
Q

ACE inhibitor Mech of Action

A

Renin-angiotension-aldosterone system: Inhibits angiotension-converting enzyme so in the end prevents vasoconstriction. Aldosterone stimulates water and sodium resorption so there is an increase blood volume, increase preload, and increase BP- Do NOT want this!!!
ACE inhibitors block the angiotensin-converting enzyme, prevent the breakdown of vasodilating substance bradykinin. This decreases BP!

32
Q

ACE Inhibitor Indications

A

Hypertension, heart failure, to slow progression of left ventricular hypertrophy after a MI, renal protective effects in PTs with diabetes. DRUG OF CHOICE FOR DIABETIC PATIENTS!!

33
Q

ACE Inhibitor Contraindications

A

Drug allergy, lactating women, children, bilateral renal artery stenosis or hyperkalemia

34
Q

ACE Inhibitor Adverse Effects

A

Fatigue, headache, impaired taste, dizziness, Dry, Nonproductive cough-#1 reason why people don’t tolerate this drug. People with Asthma not given this drug

35
Q

ACE Inhibitor Interactions

A

NSAIDS, Lithium, Potassium supplements

36
Q

Angiotension II Receptor Blockers (ARBs) Mech of Action

A

People with asthma use this! Allow angiotensin 1 to be converted to angiotensin II but block the receptors that receive angiotensin II,
Block vasoconstriction and release of aldosterone.
ex) losartan potassium (Cozaar), irbesartan (Avapro)

37
Q

ARBs Indications

A

Treat hypertension, heart failure, may be used alone or with other drugs like diuretics, primarily used in PTs who cannot tolerate ACE inhibitors.

38
Q

ARBs Contraindications

A

Drug allergy, pregnancy, lactation

39
Q

ARBs Adverse Effects

A

Upper respiratory infections, headache, back pain, fatigue

40
Q

ARBs Interactions

A

cimetidine, phenobarbital, rifampin

41
Q

Calcium Channel Blockers Mech of Action

A

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

42
Q

Calcium Channel Blockers Indications

A

Angina, Migraine headaches, hypertension, dysrhythmias, Raynaud’s diease

43
Q

Diuretics

A

Decrease the plasma and extracellular fluid volumes which results in decreased preload, cardiac output, total peripheral resistance, for an overall effect of decreased workload of the heart and decreased BP

44
Q

Thiazide Diuretics

A

First line antihypertensives in CHEP guidelines

45
Q

Vasodilators Mech of Action

A

Directly relax arteriolar and venous smooth muscle

Ex) sodium nitroprusside (Nipride) IV pump. HYPERTENSIVE EMERGENCIES

46
Q

Vasodilators Indications

A

Treat hypertension

47
Q

Vasodilators Contraindications

A

Drug allergy, Hypotension, Cerebral edema, Head injury, MI, coronary artery disease

48
Q

Vasodilators Adverse Effects

A

hydralazine: dizziness

sodium nitroprusside: Bradycardia, hypotension, possible cyanide toxicity (rare)

49
Q

Nursing Implications

A

Before beginning a therapy: Obtain thorough head to toe assessment/health history.
Discuss importance of not missing a dose, should never never double up on doses, monitor BP, should not stop taking meds abruptly.
Oral forms should be given with meals so absorption is more gradual and effective.
Administer IV forms with extreme caution and use a pump.
Watch their diet, stress level, weight, alcohol intake, avoid smoking, and eating foods high in sodium
CHANGE POSITIONS SLOWLY!!!
Report unusual SOB, difficulty breathing, swelling of legs and feet.
Men can experience impotence
Hot tubs, showers, prolonged standing/sitting, may aggravate low BP and lead to fainting and injury.
PTs need to consult doctor before taking any OTC drugs.
Monitor for Adverse effects
Monitor for Therapeutic effects: BP less than 130/90 or 130/80 for diabetics and renal PTs

Pharmacology (17 decks)

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