HTN Flashcards
Stage 1 HTN reading
130-139/ 80-89
What is the pathophysiology of HTN
An increase in after load affects stroke volume which in turn raises the blood pressure
digoxin and nifedipine (procardia xl) together interacts how together
Nifedipine affects the absorption of digoxin and can increase the risk of digoxin toxicity.
Decrease sympathetic impulses from the CNS to the heart and arterioles, causing vasodilation. Is the mechanism of action of what drugs
Alpha, agonists
Drugs whose mechanism of action
Inhibit sympathetic activation in arterioles, causing vasodilation are called what
Alpha, blockers
Drugs with a mechanism of action that
Act on the smooth muscle of arterioles, causing vasodilation are called what
Direct vasodilators
Drugs with a mechanism of action that
Decreaso the heart rate and myocardial contractility.
reducing cardiac output are called what?
Beta blockers
Drugs with a mechanism of action that
Block calcium ion channeis in artorial
smooth muscie
causing
vasodilation are called what?
Calcium channel blockers
Drugs with a mechanism of action that
Prevents angiotensin
Il from reaching its receptors, causing vasodilation are called what
Angiotensin receptor blockers
Drugs with a mechanism of action that
Block formation of angiotensin Il, causing vasodilation, and block aldosterone secretion, decreasing fluid volume. Are called what?
ACE inhibitors
Drugs that increase urine output and decrease fluid volume are called what
Diuretics.
Elevated blood pressure level
120-129/ less than 80
Htn stage 2 levels
140 and above/ 90 and above
First line drugs for hypertension
ACE inhibitors
Angiotensin receptor blockers (arbs)
Calcium channel blockers
Thiazide diuretics
Second line drugs for hypertension
Alpha 1- adrenergic blocker
Aloha2- adrenergic agonists
Beta-adrenergic blockers
Centrally acting alpha and beta blockers
Direct-acting vasodilators
Direct renin inhibitors
Peripherally acting adrenergic neuron blockers
What herbal hypertension remedy should be discontinued if patient is taking an anticoagulant drug.
Grape seed extract
Increased risk of bleeding
Common adverse effect of ACE inhibitors that is usually minor
Persistent cough
From accumulation of bradykinin.
Most serious adverse effect of ACE inhibitors that usually would develop within hours or days after beginning treatment with drug. (Although late onset has been reported months or years after therapy starts)
Angioedema
Swelling around the lips, eyes, throat and other body regions.
Concurrent use of ACE inhibitor, ARB, or renin inhibitor is or is not recommended for HTN patients
Not. It can be harmful and low effectiveness
Losartan (cozaar)
Is what type of drug
- pregnancy category?
Angiotensin 2 receptor blocker (ARB)
- pregnancy category D (do not use)
Nifedipine (adalat cc, procardia xl) is what class do drug
- what special administration alert needs to be considered with this drug
Calcium channel blocker
- do not administer immediate release formulations if an impending MI is suspected or within 2 weeks following a confirmed MI.
What drug drug interaction needs to be monitored if a patient is taking nifedipine
Digoxin toxicity
Beta blockers should be used with caution in what kind of patients and why?
Asthma or HF because it slows heart rate and causes brochoconstriction
Alpha1 adrenergic blockers main side effects
Orthostatic hypotension, dizziness, nausea, nervousness and fatigue.
Doxazosin is what kind of drug
Alpha 1- adrenergic blocker
To prevent the adverse effect of reflex tachycardia when administering a direct vasodilator, what can be done?
Concurrent administration of a beta adrenergic blocker like propranolol
Hydralazine is what class of drug
And has what contraindications
Direct acting vasodilator.
Contraindications for:
Patients with angina, or rheumatic mitral valve heart disease.
Patients with lupus as it worsens symptoms
What is the BP level of a hypertensive emergency
Greater than 180/ greater than 120
What are the 3 primary factors controlling blood pressure
Cardiac output, peripheral resistance, and blood volume
Heart failure can be caused or accelerated by what conditions
Coronary artery disease
Mitral stenosis
Myocardial infarction
Chronic htn
Diabetes mellitus
Dyslipidemia
Thyroid disorders
What is an inotropic effect?
A change in contractility of the heart
Drugs that increase contractility are called what
Examples?
Positive inotropic agents
Epinephrine, norepinephrine, thyroid hormone, dopamine.
Drugs that decrease contractility are called what?
Examples
Negative inotropic agents
Quinidine, beta adrenergic atangonists (propranolol)
A patient is at high risk for developing HF but without structural heart disease or symptoms. What stage is this and how to treat
Stage A
Lifestyle modifications
Comorbidities treated. (Diabetes, htn, dislipidemia)
A patient has structural evidence of heart disease (such as previous MI or valvular disease) but no symptoms. What stage is this and how to treat.
Stage B
Continued lifestyle modifications and treat comorbidities. Treat with ACE or ARB. Added beta blockers for patients with prior HF symptoms or MI hx.
Patient has structural evidence of heart disease with symptoms of fatigue, fluid retention or Dyspnea. What stage and how to treat.
Stage C
Lifestyle mods
ACE or ARBs
Add a beta blocker to control symptoms or isosorbide, dinitrate with hydralazine, digoxin, aldosterone antagonists.
Diuretics if fluid retention is evident.
Patient has structural evidence of heart disease with symptoms at rest or during minimal exertion despite optimal medical therapy. What stage. How to treat.
Stage D,
Continue lifestyle mods
Tx may include ivabradine, IV diuretics, dopamine, dobutamine, I’v nitroglycerins, nitroprusside, nesiritide, or phosphodiesterase inhibitors.
What drug
Decreases cardiac workload by slowing the heart rate (B1) and decreasing blood pressure (a1)
(Example: carvedilol)
Adrenergic blockers
What drugs
Increase cardiac output by increasing the force of myocardial contraction
(Example: digoxin)
Cardiac glycosides
What drugs Increase cardiac output by increasing the force of myocardial contraction
(Example: milrinone)
Phosphodliesterase inhibitors
What drugs Increase cardiac output by lowering blood pressure and decreasing blood volume
(Example: lisinopril)
ACE inhibitors and angiotensin receptor blockers.
What drugs Decrease cardiac workload by dilating vessels and reducing preload (Example: isosorbide dinitrate with hydralazine)
Vasodilators
What drugs Increase cardiac output by reducing fluid volume and decreasing blood pressure
(Example: furosemide)
Diuretics.
All patients with HF and those at high risk for HF should receive what drug
ACE inhibitor
Lisinopril (prinivil, zestril) is what class of drug
Black box warning?
Ace inhibitor
Fetal injury or death. Pregnancy contraindication
A patient prescribed Lisinopril is discussing how they plan on using salt substitutes to help with their HF. What patient education do you need to address
Lisinopril can cause hyperkalemia which is a serious electrolyte imbalance and salt substitutes are generally potassium based, so they should be avoided while taking this med.
What is the one potassium sparing diuretic that is useful in the treatment of heart failure
Spironolactone
What 3 beta blockers are approved for treatment of HF
Bisoprolol (Zebeta)
Carvedilol (coreg)
Metoprolol extended release (toprol xl)
How are beta blockers administered for HF
And why do we not start give too fast or too much
Low initial doses
1/10-1/20 of target dose. Then doubled every 2-4 weeks until optimal dose is reached.
They can worsen HF if too fast or too much
What does Ivabradine (corlanor) do
It slows ion currents across the sa node which slows heart rate, reducing myocardial oxygen demand.
What class of drug is Metoprolol
What black box warning
Beta-1 adrenergic blocker
Abrupt withdrawal may exacerbate angina or cause mi.
