Drugs affecting blood pressure chapt 43 Flashcards
What do cardiac meds do
Increase/decrease cardiac output
Increase/decrease blood pressure
Regulate cardiac rhythm
Decrease cardiac chest pain
Goal is to restore physiologic balance
What is blood pressure
The force of blood against artery walls
Systolic pressure
Heart contracts
Diastolic pressure
Heart relaxes
What causes hypertension?
Increased SNS stimulation
Increased activity of renin-angiotensin-aldosterone system
Diet, lack of exercise, stress , sodium intake, weight, ETOH, smoking
White Coat Hypertension(HTN @ doctors office)
Genetic variances
What are age related causes of hypertension?
Decreased vasodilation
Plaque formation
What are the stages of hbp?
Prehypertension: 120-129/ elevated
Stage 1 hypertension: 130-139
Stage 2 hypertension: 140-159
Stage 2 hypertension/crisis higher than 160
Stepped Care Approach to Treating Hypertension
What is step 1?
Step 1: Lifestyle Modifications
Weight reduction
Smoking cessation
Moderation of alcohol intake
Reduction of salt in diet
Increase in aerobic physical activity
Stepped Care Approach to Treating Hypertension
What is step 2?
If inadequate response –> continue lifestyle modifications & add drug therapy
Diuretic (decreases serum sodium levels and blood volume)
ACE inhibitor (blocks the conversion of angiotensin I to angiotensin II)
Calcium-channel blocker (relaxes muscle contraction) or other autonomic blockers
Angiotensin II receptor blocker (blocks the effects of angiotensin on the blood vessel)
Stepped Care Approach to Treating Hypertension
What is step 3?
If inadequate response –> change dosage/ class or add additional medication
Stepped Care Approach to Treating Hypertension
What is step 4?
If inadequate response—> 2nd or 3rd agent or diuretic agent added
All of the previous measures are continued.
What are drug categories
**Angiotensin-converting enzyme inhibitors
**Angiotensin II receptor antagonists
**Vasodilators
Anti-arrhythmic
Anti-angina –> not primary use, but lowers BP
Diuretics
Sympathetic Nervous System Blockers
How does the renin-angiotensin- aldosterone system work
-Decrease in blood flow to kidneys kidneys secrete renin into circulation travels to liver
-Renin converts angiotensinogen to angiotensin I
-Angiotensin I converts to angiotensin II in lungs
Angiotensin II constricts blood vessels BP
-Angiotensin II also stimulates adrenals to secrete Aldosterone
Causes sodium & water retention
Increases blood volume
What are 2 drug categories that affect RAS
-Angiotensin-Converting Enzyme (ACE) Inhibitors
-Angiotension II Receptor Blockers (ARBs)
What are
-captopril (Capoten)
and
-enalapril (Vasotec)
Angiotensin-Converting Enzyme (ACE) Inhibitors
What are indications of
-captopril (Capoten)
and
-enalapril (Vasotec)
Angiotensin-Converting Enzyme (ACE) Inhibitors
HTN
What are therapeutic actions of
-captopril (Capoten)
and
-enalapril (Vasotec)
Angiotensin-Converting Enzyme (ACE) Inhibitors
Act in the lungs prevent ACE from converting Angiotensin I to Angiotensin II
a powerful vasoconstrictor and stimulator of aldosterone release (see Fig.43.3). This action leads to a decrease in BP and in aldosterone secretion with a resultant increase in serum potassium and a loss of serum sodium and fluid.
What are adverse effects of
-captopril (Capoten)
and
-enalapril (Vasotec)
Angiotensin-Converting Enzyme (ACE) Inhibitors
Hypotension, dizziness
Reflex tachycardia
GI issues
Irritating cough
pancytopenia (captopril)
What are contras of
-captopril (Capoten)
and
-enalapril (Vasotec)
Angiotensin-Converting Enzyme (ACE) Inhibitors
-Allergy
-contraindicated during pregnancy because of the potential for serious adverse effects on the fetus and during lactation because of potential decrease in milk production and effects on the neonate.
What to be cautious of when taking
-captopril (Capoten)
and
-enalapril (Vasotec)
Angiotensin-Converting Enzyme (ACE) Inhibitors
Impaired renal function; could be exacerbated by the effects of this drug in decreasing renal blood flow;
Salt/fluid depletion (*monitor weights
What are drug to drug interactions of when taking
-captopril (Capoten)
and
-enalapril (Vasotec)
Angiotensin-Converting Enzyme (ACE) Inhibitors
NSAIDs – decreases antiHTN effect
ACE INHIBITORS CAN NOT BE TAKEN WITH FOOD
What is losartan (Cozaar)?
Angiotension II Receptor Blockers (ARBs)
What are the therapeutic actions of losartan (Cozaar)?
Angiotension II Receptor Blockers (ARBs)Allows
Angiotensin II to be made but prevents body from responding to Angiotensin II –>
prevents vasoconstriction
aldosterone secretion
What are the indications of losartan (Cozaar)?
Angiotension II Receptor Blockers (ARBs)Allows
-hypertension,
-Slow renal dz in patients with HTN and type II diabetes
What are adverse effects of losartan (Cozaar)?
Angiotension II Receptor Blockers (ARBs)Allows
Hypotension, dizziness
GI issues
What are contras/cautions when taking losartan (Cozaar)
Angiotension II Receptor Blockers (ARBs)
-Impaired renal function
-Pregnancy
CAN be taken with food
