CV - anti-hypertensive Flashcards
4 categories for anti-hypertensive
1 RAAS
2 Sympathetic Nervous System Drugs (mostly adrenergic blockers)
3 Ca-channel blockers
4 Direct Acting VasoDilators
*A,B,C,D’s
types of RAAS
[the A’s]
1 ACE inhibitors***
2 ARBS
3 Aldosterone Antagonist
4 Aliskiren (indirect renin inhibitors)
angiotensin-converting enzyme [ACE]
- ACE converts angiotensin I to II
- ang-II is a potent vasoconstrictor
- ang-II stimulates the release of aldosterone
- aldosterone incr the reabsorption of Na + H2O in exchange for the secretion of K
ACE inhibitors [-pril]
drug names
ends in -pril
lisinopril captopril enalapril benazepril enalaprilat (for IV)
ACE inhibitors [-pril]
MOA
- vasodilation (mostly arteriole)
- excrete Na + H2O
- retain K+
ACE inhibitors [-pril]
Tx
HTN
post MI
HF
stroke/MI prevention
ACE inhibitors [-pril]
AE
hyper-K 1st dose hypotension dry cough angioedema dysgeusia neutropenia SJS
ACE inhibitors [-pril]
CI
cat D
liver disease
bilateral renal artery stenosis
ACE inhibitors [-pril]
RN
- fall risk
- bradykinin buildup
If a patient taking ACE inhibitors [-pril] acquires a dry cough, ask if they are taking any new medications
might be a sign of bradykinin buildup
- nonallergice angioedema
- s/e of ACE inhibitors
be careful with the first dose of ACE inhibitors [-pril] due to
first dose hypotension, check BP before giving
ARBS stands for…
angiotensin receptor blockers
- Ang-II is a powerful vasoconstrictor
- stimulates the release of aldosterone
ARBS [-sartan]
drug names
losartan
valsartan
olmesartan
irbesartan
ARBS [-sartan]
MOA
used to slow diabetic retinopathy
ARBS [-sartan]
A/E
similar to ACE except no bradykinin buildup
—no dry cough, no angioedema
ARBS [-sartan]
CI
- BL renal artery stenosis
- only 1 kidney
ARBS [-sartan]
RN/teaching
- can interact w lithium
- rise slowly from sitting position
aldosterone antagonist
drug names
spironolactone
eplerenone
triamterene
spironolactone, eplerenone, triamterene [aldosterone antagonist]
MOA
excrete Na + H2O
reabsorp K
spironolactone, eplerenone, triamterene [aldosterone antagonist]
Tx
HTN diuretic CHF hypo-K polycystic ovarian syndrome [POS] acne
spironolactone, eplerenone, triamterene [aldosterone antagonist]
A/E
- hyper-K: cramps, muscle twitching, paresthesia
- flu-like symptoms
- endocrine changes: menstrual irreg, deep voice, hirsutism, impotence
spironolactone, eplerenone, triamterene [aldosterone antagonist]
CI
- DM w microalbuminuria
- kidney problems
spironolactone, eplerenone, triamterene [aldosterone antagonist]
RN
- monitor liver + kidney test
- take in morning
- dont drink grapefruit juice
which of the aldosterone antagonists has the highest incidence of endocrine changes?
spironolactone
-may cause menstrual irregularities, deep voice, hirsutism, and impotence
Direct Renin Inhibitors
drug name
Alisketron
Alisketron [renin inhibitor]
MOA
stops the whole RAAS process
-stops cleavage of angiotensin
Alisketron [renin inhibitor]
Tx
HTN
Alisketron [renin inhibitor]
AE
hyper-K dry cough angioedema abdominal pain rash diarrhea
Alisketron [renin inhibitor]
CI
cat D
-lactating
Alisketron [renin inhibitor]
RN teaching
- NO HIGH FAT MEALS (reduces absorption)
- take at the same time each day
- onset is 2 weeks
Sympatholytic
categories
1 alpha-adrenergic blockers
2 beta-adrenergic blockers
alpha-adrenergic blockers
drug names
prazosin
doxazosin
terazosin
tamsulosin
a-adrenergic blockers [-osin]
MOA
- peripheral vasodilation
- -blocks adrenaline which leads to vasodilation + relaxation of smooth muscles
a-adrenergic blockers [-osin]
Tx
HTN
BPH (urgency, frequency, dysuria)
a-adrenergic blockers [-osin]
A/E
- 1st dose hypotension
- reflex tachycardia
a-adrenergic blockers [-osin]
CI
caution w…
- angina pectoris
- renal insufficiency
- sildenafil
- NTG
a-adrenergic blockers [-osin]
RN teaching
- start med at night
- monitor BP for 2-6hr after initiation of Tx
- change positions slowly
beta blocker pneumonic
blocks adrenergic reception
- vasodilatn>lower BP + lower HR
- neg - ino, chrono, dromo
beta-adrenergic blockers
subcategories + drug names
B1: betaxolol, esmolol, atenolol, metoprolol
Non-selective [B1+B2]: propanolol, sotalol
beta-adrenergic blockers [LOL]
MOA
- blocks adrenergic reception
- vasodilation to lower BP
- lowers HR
- [-] ino, chrono, dromo
beta-adrenergic blockers [LOL]
Tx
- HTN
- arrythmia
- stage fright
- HF
- MI/angina
- migraine
- pheochromocytoma
- glaucoma
- longevity
beta-adren blockrs
cardio-selective drugs
AE
- bradicardia
- hypotension
- decr CO
- bronchoconstriction
- AV block
- OH
- rebound
- excitation
- glycogenolysis is inhibited (risk of hypoglycemia in DM pt)
beta-adrenergic blockers [LOL]
AE
NSBB’s in clients who have asthma, COPD, HF, DM
-AV blocks + sinus brady
beta-adrenergic blockers [LOL]
RN teaching
- get HR + BP before admin + daily basis
- will mask s/s of hypoglycemia
- taper off 1-2 wks
- monitor for worsening HF: wt gain, SOB, edema, fatigue
- ETOH incr hypotensive effects
beta-adrenergic blockers
Tx
a lot HTN arrhythmias stage fright HF MI angina migraines pheochromocy
beta-adrenergic blockers
RN
.-will mask hypoglycemia
- taper over 1-2 wks
- monitor worsening of HF (wt gain,
inotropic, chronotropic, dromotropic
ino: contractivity
chrono: HR
dromo: speed of conDuctivity
inotropic
chronotropic
dromotropic
effects
I=contractn
+=hard squueze
-=weaker
C=HR
+=incr HR
-=decr HR
D=flow of electricity
+=incr speed
-=decr
all beta blockers are _____ on inotropic, chronotropic, + dromotropic effects
negative
hold beta-blockers if BP is
below 90 systolic
mixed a/b adrenergic antagonist
drug names
carvedilol
lavetalol
centrally acting alpha2 agonist
drug name + MOA
CLONIDINE
-triggers feedback in the brain to decrease sympathetic outflow
Ca-channel blockers
drug names
verapamil diltiazem amlodipine nicardipine nifedipine
Clonidine [a2-agonist]
A/E
- drowsy
- xerostomia
- rebound HTN w sudden DC
clonidine is give via
patch
-rotated Q7days
CI- scleroderma, opening, wound, cuts
Ca-channel blockers
drug names
verapamil diltiazem amlodipine nicardipine nifedipine
Ca-channel blockers [verapamil, diltiazem +dipine]
MOA
blocks Ca inflow to cell
Ca-channel blockers [verapamil, diltiazem +dipine]
Tx
- HTN
- raynaud’s phenomenon
- angina
- neuro-prevent vasospasm
- anti-dysrhythmic
Nifedipine [Ca-channel blockers]
AE
- OH
- reflex tachycardia
- acute toxicity
Verapamil + Diltiazem [Ca-channel blockers]
AE
-OH
-peripheral edema
acute toxicity: decr HR, decr BP, AV block
Verapamil + Diltiazem [Ca-channel blockers]
RN/teaching
- daily weights
- diuretic for periph edema
all Ca-channel blockers Ca-channel blockers [verapamil, diltiazem +dipine]
AE
gingival hyperplasia
all Ca-channel blockers Ca-channel blockers [verapamil, diltiazem +dipine]
interactions
- increases digoxin level leading to toxicity
- no grapefruit juice
- withhold if pulse<50, SBP<90
all Ca-channel blockers Ca-channel blockers [verapamil, diltiazem +dipine]
RN teaching
.-for IV, keep the pt on a monitor
-can combine w beta blocker to prevent reflex tachy
direct-acting vasodilators
drug names
nitroprusside IV, IVP (a nitrate)
nitroprusside [direct-acting v-dilator]
MOA
direct vasodilation of arteries + veins
-incr CO, HR, + fluid retention
nitroprusside [direct-acting v-dilator]
Tx
hypertensive crisis
nitroprusside [direct-acting v-dilator]
AE
excellent hypotension
*cyanide poisoning (thiocyanate toxicity)
HR changes
ECG changes
nitroprusside [direct-acting v-dilator]
RN teaching
- admin no longer than 3 days
- needs a dedicated line to avoid bolus incompatibility
- —do not admin w other meds
- discard bottle after 24hr
- IV is sensitive to light
- –glass bottle in brown bag
- keep client supine during admin
- *color is faint brown
cyanide poisoning antidotes
hydrocobalmin [B12]
amyl [Na] nitrate
Na thiosulfate
