Chapter 26 Flashcards
Hydrochlorothiazide (Microzide) for HTN
Thiazide diuretic
10-20mm Hg bp drop
Decrease Na reabsorption in kidney, meaning more gets peed out. When Na peed out, water drawn to the Na is peed out too.
-*Administer early in day to prevent nocturia
AE:
- Electrolyte imbalances
- Gout
-Don’t give for gestational HTN
doxazosin (Cardura) for HTN
Alpha1-andrenergic blocker
Dilates arteries and veins- rapid fall in bp
- Monitor closely for mega hypotension/syncope 2-6 hours after first couple doses.
- First dose phenomenon
AE:
- Dizziness
- Hypotension
- Headache
- Orthostatic hypotension
lisinopril (Prinivil) for HTN
ACE inhibitor
2-3 weeks to reach effectiveness
Several months to return to normal
- Assess BP before admin
- Can give to 6+
- Lower doses older adults
AE:
- Cough
- Hypotension
- Hyperkalemia
Black box: Fetal injury and death using ACE inhibitors during pregnancy.
enalapril (Vasotec) for HTN
ACE inhibitor- blocks effects of angiotensin II
Decrease peripheral resistance/decrease blood volume
AE:
-Angioedema**
hydralazine (Apresoline) for HTN
Direct acting vasodilator
Dilates arterial smooth muscle, ignores veins
Tolerance develops
BiDil- combo with isosorbide dinitrate: used for HF in african americans due to increased response
AE:
- Abrupt withdrawal can cause HTN
- Patients often receive beta-adrenergic blocker to counteract reflex tachycardia
- Na/fluid retention
- Lupus like symptoms
Can’t give to patients with angina/lupus
nifedipine (Procardia) for HTN
Calcium channel blocker
Blocking calcium channels to
- Dilate coronary arteries
- Heart uses less O2
- CO increase
- BP down
- *Don’t use IR if MI suspected or within 2 weeks of one
- Don’t use IR for HTN
AE:
- Minor
- Rebound hypotension, discontinue gradually
Spironolactone (Aldactone) pharmacotherapy
Potassium sparing diuretic, aldosterone antagonist
Treat mild HTN
Reduce edema from CKD, liver disease
Slow HF
Can also treat hyperaldosteronism
Aldosterone inhibition increases renal Na excretion, which brings water with it.
- Give with food to inc. absorption
- Don’t give potassium supplements
AE:
-Hyperkalemia may develop (esp. if taking K+ supps/ACE inhibitors)
Black box: Found to cause tumors in animals, use only for specified indications
ACE inhibitor mechanism of action
Blocks conversion of angiotensin 1 to angiotensin 2- causes vasodilation adn blocks aldosterone which decreases fluid volume.
Diuretic mechanism of action
Increase urine output and decrease fluid volume
Beta blocker mechanism of action
Decrease HR and myocardial contractility, reduces CO
Alpha 2 agonist mechanism of action
Decrease sympathetic CNS impulses to heart and arterioles, causes vasodilation.
Alpha 1 blockers mechanism of action
Inhibit sympathetic activation in arterioles, causing vasodilation
Direct vasodilators mechanism of action
Act on smooth muscle of arterioles, causing vasodilation
Calcium channel blockers mechanism of action
Block calcium ion channels in arterial smooth muscle, causing vasodilation
Angiotensin receptor blockers mechanism of action
Prevent angiotensin II from reaching receptors- causes vasodilation
