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1 Pharmacology > CV - anti-hypertensive > Flashcards

CV - anti-hypertensive Flashcards

1
Q

4 categories for anti-hypertensive

A

1 RAAS
2 Sympathetic Nervous System Drugs (mostly adrenergic blockers)
3 Ca-channel blockers
4 Direct Acting VasoDilators

*A,B,C,D’s

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2
Q

types of RAAS

[the A’s]

A

1 ACE inhibitors***
2 ARBS
3 Aldosterone Antagonist
4 Aliskiren (indirect renin inhibitors)

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3
Q

angiotensin-converting enzyme [ACE]

A
  • 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
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4
Q

ACE inhibitors [-pril]

drug names

A

ends in -pril

lisinopril
captopril
enalapril
benazepril
enalaprilat (for IV)
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5
Q

ACE inhibitors [-pril]

MOA

A
  • vasodilation (mostly arteriole)
  • excrete Na + H2O
  • retain K+
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6
Q

ACE inhibitors [-pril]

Tx

A

HTN
post MI
HF
stroke/MI prevention

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7
Q

ACE inhibitors [-pril]

AE

A 
hyper-K
1st dose hypotension
dry cough
angioedema
dysgeusia
neutropenia
SJS
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8
Q

ACE inhibitors [-pril]

CI

A

cat D
liver disease
bilateral renal artery stenosis

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9
Q

ACE inhibitors [-pril]

RN

A
  • fall risk

- bradykinin buildup

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10
Q

If a patient taking ACE inhibitors [-pril] acquires a dry cough, ask if they are taking any new medications

A

might be a sign of bradykinin buildup

  • nonallergice angioedema
  • s/e of ACE inhibitors
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11
Q

be careful with the first dose of ACE inhibitors [-pril] due to

A

first dose hypotension, check BP before giving

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12
Q

ARBS stands for…

A

angiotensin receptor blockers

  • Ang-II is a powerful vasoconstrictor
  • stimulates the release of aldosterone
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13
Q

ARBS [-sartan]

drug names

A

losartan
valsartan
olmesartan
irbesartan

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14
Q

ARBS [-sartan]

MOA

A

used to slow diabetic retinopathy

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15
Q

ARBS [-sartan]

A/E

A

similar to ACE except no bradykinin buildup

—no dry cough, no angioedema

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16
Q

ARBS [-sartan]

CI

A
  • BL renal artery stenosis

- only 1 kidney

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17
Q

ARBS [-sartan]

RN/teaching

A
  • can interact w lithium

- rise slowly from sitting position

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18
Q

aldosterone antagonist

drug names

A

spironolactone
eplerenone
triamterene

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19
Q

spironolactone, eplerenone, triamterene [aldosterone antagonist]
MOA

A

excrete Na + H2O

reabsorp K

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20
Q

spironolactone, eplerenone, triamterene [aldosterone antagonist]
Tx

A 
HTN
diuretic
CHF
hypo-K
polycystic ovarian syndrome [POS]
acne
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21
Q

spironolactone, eplerenone, triamterene [aldosterone antagonist]
A/E

A
  • hyper-K: cramps, muscle twitching, paresthesia
  • flu-like symptoms
  • endocrine changes: menstrual irreg, deep voice, hirsutism, impotence
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22
Q

spironolactone, eplerenone, triamterene [aldosterone antagonist]
CI

A
  • DM w microalbuminuria

- kidney problems

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23
Q

spironolactone, eplerenone, triamterene [aldosterone antagonist]
RN

A
  • monitor liver + kidney test
  • take in morning
  • dont drink grapefruit juice
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24
Q

which of the aldosterone antagonists has the highest incidence of endocrine changes?

A

spironolactone

-may cause menstrual irregularities, deep voice, hirsutism, and impotence

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25
Q

Direct Renin Inhibitors

drug name

A

Alisketron

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26
Q

Alisketron [renin inhibitor]

MOA

A

stops the whole RAAS process

-stops cleavage of angiotensin

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27
Q

Alisketron [renin inhibitor]

Tx

A

HTN

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28
Q

Alisketron [renin inhibitor]

AE

A 
hyper-K
dry cough
angioedema
abdominal pain
rash
diarrhea
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29
Q

Alisketron [renin inhibitor]

CI

A

cat D

-lactating

30
Q

Alisketron [renin inhibitor]

RN teaching

A
  • NO HIGH FAT MEALS (reduces absorption)
  • take at the same time each day
  • onset is 2 weeks
31
Q

Sympatholytic

categories

A

1 alpha-adrenergic blockers

2 beta-adrenergic blockers

32
Q

alpha-adrenergic blockers

drug names

A

prazosin
doxazosin
terazosin
tamsulosin

33
Q

a-adrenergic blockers [-osin]

MOA

A
  • peripheral vasodilation

- -blocks adrenaline which leads to vasodilation + relaxation of smooth muscles

34
Q

a-adrenergic blockers [-osin]

Tx

A

HTN

BPH (urgency, frequency, dysuria)

35
Q

a-adrenergic blockers [-osin]

A/E

A
  • 1st dose hypotension

- reflex tachycardia

36
Q

a-adrenergic blockers [-osin]

CI

A

caution w…

  • angina pectoris
  • renal insufficiency
  • sildenafil
  • NTG
37
Q

a-adrenergic blockers [-osin]

RN teaching

A
  • start med at night
  • monitor BP for 2-6hr after initiation of Tx
  • change positions slowly
38
Q

beta blocker pneumonic

A

blocks adrenergic reception

  • vasodilatn>lower BP + lower HR
  • neg - ino, chrono, dromo
39
Q

beta-adrenergic blockers

subcategories + drug names

A

B1: betaxolol, esmolol, atenolol, metoprolol

Non-selective [B1+B2]: propanolol, sotalol

40
Q

beta-adrenergic blockers [LOL]

MOA

A
  • blocks adrenergic reception
  • vasodilation to lower BP
  • lowers HR
  • [-] ino, chrono, dromo
41
Q

beta-adrenergic blockers [LOL]

Tx

A
  • HTN
  • arrythmia
  • stage fright
  • HF
  • MI/angina
  • migraine
  • pheochromocytoma
  • glaucoma
  • longevity
42
Q

beta-adren blockrs
cardio-selective drugs
AE

A
  • bradicardia
  • hypotension
  • decr CO
  • bronchoconstriction
  • AV block
  • OH
  • rebound
  • excitation
  • glycogenolysis is inhibited (risk of hypoglycemia in DM pt)
43
Q

beta-adrenergic blockers [LOL]

AE

A

NSBB’s in clients who have asthma, COPD, HF, DM

-AV blocks + sinus brady

44
Q

beta-adrenergic blockers [LOL]

RN teaching

A
  • 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
45
Q

beta-adrenergic blockers

Tx

A 
a lot
HTN
arrhythmias
stage fright
HF
MI
angina
migraines
pheochromocy
46
Q

beta-adrenergic blockers

RN

A

.-will mask hypoglycemia

  • taper over 1-2 wks
  • monitor worsening of HF (wt gain,
47
Q

inotropic, chronotropic, dromotropic

A

ino: contractivity
chrono: HR
dromo: speed of conDuctivity

48
Q

inotropic
chronotropic
dromotropic
effects

A

I=contractn
+=hard squueze
-=weaker

C=HR
+=incr HR
-=decr HR

D=flow of electricity
+=incr speed
-=decr

49
Q

all beta blockers are _____ on inotropic, chronotropic, + dromotropic effects

A

negative

50
Q

hold beta-blockers if BP is

A

below 90 systolic

51
Q

mixed a/b adrenergic antagonist

drug names

A

carvedilol

lavetalol

52
Q

centrally acting alpha2 agonist

drug name + MOA

A

CLONIDINE

-triggers feedback in the brain to decrease sympathetic outflow

53
Q

Ca-channel blockers

drug names

A 
verapamil
diltiazem
amlodipine
nicardipine
nifedipine
54
Q

Clonidine [a2-agonist]

A/E

A
  • drowsy
  • xerostomia
  • rebound HTN w sudden DC
55
Q

clonidine is give via

A

patch
-rotated Q7days
CI- scleroderma, opening, wound, cuts

56
Q

Ca-channel blockers

drug names

A 
verapamil
diltiazem
amlodipine
nicardipine
nifedipine
57
Q

Ca-channel blockers [verapamil, diltiazem +dipine]

MOA

A

blocks Ca inflow to cell

58
Q

Ca-channel blockers [verapamil, diltiazem +dipine]

Tx

A
  • HTN
  • raynaud’s phenomenon
  • angina
  • neuro-prevent vasospasm
  • anti-dysrhythmic
59
Q

Nifedipine [Ca-channel blockers]

AE

A
  • OH
  • reflex tachycardia
  • acute toxicity
60
Q

Verapamil + Diltiazem [Ca-channel blockers]

AE

A

-OH
-peripheral edema
acute toxicity: decr HR, decr BP, AV block

61
Q

Verapamil + Diltiazem [Ca-channel blockers]

RN/teaching

A
  • daily weights

- diuretic for periph edema

62
Q

all Ca-channel blockers Ca-channel blockers [verapamil, diltiazem +dipine]

AE

A

gingival hyperplasia

63
Q

all Ca-channel blockers Ca-channel blockers [verapamil, diltiazem +dipine]
interactions

A
  • increases digoxin level leading to toxicity
  • no grapefruit juice
  • withhold if pulse<50, SBP<90
64
Q

all Ca-channel blockers Ca-channel blockers [verapamil, diltiazem +dipine]
RN teaching

A

.-for IV, keep the pt on a monitor

-can combine w beta blocker to prevent reflex tachy

65
Q

direct-acting vasodilators

drug names

A

nitroprusside IV, IVP (a nitrate)

66
Q

nitroprusside [direct-acting v-dilator]

MOA

A

direct vasodilation of arteries + veins

-incr CO, HR, + fluid retention

67
Q

nitroprusside [direct-acting v-dilator]

Tx

A

hypertensive crisis

68
Q

nitroprusside [direct-acting v-dilator]

AE

A

excellent hypotension
*cyanide poisoning (thiocyanate toxicity)
HR changes
ECG changes

69
Q

nitroprusside [direct-acting v-dilator]

RN teaching

A
  • 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
70
Q

cyanide poisoning antidotes

A

hydrocobalmin [B12]
amyl [Na] nitrate
Na thiosulfate

1 Pharmacology (33 decks)

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