Chapter 25- Antihypertensive Drugs

Question 1

A1-Blockers

Answer 1

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

Question 2

Antihypertensive Drugs

Answer 2

Drugs used to treat hypertension

Question 3

Cardiac output

Answer 3

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

Question 4

Centrally acting adrenergic drugs

Answer 4

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.

Question 5

Essential hypertension

Answer 5

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

Question 6

Ganglionic blocking drugs

Answer 6

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

Question 7

Hypertension/Risk factor for

Answer 7

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”

Question 8

Idiopathic hypertension

Answer 8

Hypertension with no known primary cause

Question 9

Nicotinic receptor

Answer 9

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

Question 10

Orthostatic hypotension

Answer 10

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.

Question 11

Prodrug

Answer 11

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

Question 12

Secondary hypertension

Answer 12

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

Question 13

Ethnocultural considerations

Answer 13

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

Black people: Calcium channel blockers and diuretics more effective

Question 14

Canadian Hypertension Education Program (CHEP)

Answer 14

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

Question 15

Normal BP

Answer 15

120/80-129/89

Question 16

Prehypertension

Answer 16

130/85-139/89

Question 17

Stage 1 hypertension

Answer 17

140/90-159/99

Question 18

Stage 2 hypertension

Answer 18

160+/100+

Question 19

Unknown cause

Answer 19

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

Question 20

Known cause

Answer 20

Secondary hypertension. Accounts for 10% of cases

Question 21

Masked hypertension

Answer 21

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

Question 22

White-coat hypertension

Answer 22

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

Question 23

PNS

Answer 23

Vasodilation of smooth muscle, cardiac muscle, glands

Question 24

SNS

Answer 24

Constriction of heart, blood vessels, skeletal muscle

Question 25

Adrenergic drugs

Answer 25

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

Question 26

Adrenergic drugs Mech of Action

Answer 26

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.

Question 27

Adrenergic Indications

Answer 27

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.

Question 28

Adrenergic Contraindicatoins

Answer 28

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

Question 29

Adrenergic Adverse effects

Answer 29

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

Question 30

ACE inhibitors

Answer 30

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.

Question 31

ACE inhibitor Mech of Action

Answer 31

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!

Question 32

ACE Inhibitor Indications

Answer 32

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!!

Question 33

ACE Inhibitor Contraindications

Answer 33

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

Question 34

ACE Inhibitor Adverse Effects

Answer 34

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

Question 35

ACE Inhibitor Interactions

Answer 35

NSAIDS, Lithium, Potassium supplements

Question 36

Angiotension II Receptor Blockers (ARBs) Mech of Action

Answer 36

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)

Question 37

ARBs Indications

Answer 37

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

Question 38

ARBs Contraindications

Answer 38

Drug allergy, pregnancy, lactation

Question 39

ARBs Adverse Effects

Answer 39

Upper respiratory infections, headache, back pain, fatigue

Question 40

ARBs Interactions

Answer 40

cimetidine, phenobarbital, rifampin

Question 41

Calcium Channel Blockers Mech of Action

Answer 41

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

Question 42

Calcium Channel Blockers Indications

Answer 42

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

Question 43

Diuretics

Answer 43

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

Question 44

Thiazide Diuretics

Answer 44

First line antihypertensives in CHEP guidelines

Question 45

Vasodilators Mech of Action

Answer 45

Directly relax arteriolar and venous smooth muscle | Ex) sodium nitroprusside (Nipride) IV pump. HYPERTENSIVE EMERGENCIES

Question 46

Vasodilators Indications

Answer 46

Treat hypertension

Question 47

Vasodilators Contraindications

Answer 47

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

Question 48

Vasodilators Adverse Effects

Answer 48

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

Question 49

Nursing Implications

Answer 49

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