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CDM 1 > HTN 2 Drugs 3 > Flashcards

HTN 2 Drugs 3 Flashcards

1
Q

α-2 agonists, α-1 blockers, βblockers will effect the

A

Sympathetic nervous system

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2
Q

Pathophysiology:
Peripheral vascular resistance is due to Increased sympathetic
activity leads to

A

Stimulation of adrenal glands to release epinephrine (adrenaline)and norepinephrine (noradrenaline)

Causes constriction/contraction of smooth muscle arterioles get smaller increase resistance/pressure

Decreased perfusion to organ systems (i.e. kidney)

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3
Q

Agonist Alpha1 vs. Alpha2

A

Alpha1
Vasoconstriction (and reflex bradycardia)
Bladder sphincter contraction (means go to bathroom)
Reduced lipolysis

Alpha2
Decrease pre-synaptic NE release (reduced sympathetic outflow)

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4
Q

Alpha1-blockers MOA

A

: Selectively block α1-receptors on smooth muscle cells of peripheral vasculature

BP = CO X PVR
• Lower BP via vasodilation, ↓ PVR
• ↓ standing BP > supine BP (orthostasis) –> When we stand up the B.p go down and we feel dizzy

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5
Q

_____ blockers predominantly lower blood pressure that causes orthostatic hypotension supine BP (orthostasis)

A

Alpha 1

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6
Q

Alpha1 -blockers are

A

Doxazosin (Cardura) 1 – 8 Daily

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7
Q

Apha 1 blocker (doxazosin)leads to

A

less contraction of bladder leads to person have to go less to bathroom

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8
Q

Prazosin is only used for

A

nightmares

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9
Q

Clinical Considerations: of Alpha 1 blocker

A

Alpha 1 blocker is the last line therapy because they do not have long term effects,

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10
Q

Alpha-blocker help pt with

A

BPH (benefits: improves urine flow and decrease frequency) and decrease HR at the same time

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11
Q

ADEs: of Alpha 1 blocker

A 
Orthostatic hypotension 
• First dose syncope (occurs 1-3 hrs after first dose)
• Dizziness
• Reflex tachycardia
• Peripheral edema
• Sexual dysfunction
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12
Q

Alpha2 Agonists MOA:

A

Stimulate α2 pre-synaptic receptors in the brain
• ↑ inhibitory neuron activity
• ↓ sympathetic outflow

P = CO x decrease PVR

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13
Q

Alpha2 Agonists lower B.P VIA

A

lowering the PVR

Clonidine: can lower HR, CO
Methyldopa: less effect on HR, CO

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14
Q

Alpha2 Agonists: are

A 
Clonidine (Catapress) 0.1 – 0.8 BID
Clonidine patch (Catapres – TTS) 0.1 – 0.3 Weekly
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15
Q

Clonidine path will reduce

A

potential side effects due to long acting

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16
Q

If pt taking multiple B.p medications and it is not helping

A

add clonidine as the last line

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17
Q

iF WE ABRUPTLY stop clonidine oral

A

there will be rebound HTN so tell pt not to stop taking right away

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18
Q

Possible indications: of alpha 2 agonist

A 
Resistant HTN (clonidine)
Pregnancy (methyldopa)
19
Q

The adverse effect of Alpha 2 agonist (clonidine) are

A

Significant CNS adverse effects: impaired concentration, nightmares, vertigo
(methyldopa), sedation, drowsiness, fatigue
• Orthostatic hypotension
• Dry mouth
• Depression (clonidine)
• Abrupt discontinuation of clonidine → rebound HTN (less so in TTS vs. PO)

20
Q

β1 vs. β2 When we stimulate

A

β1 –> Heart
•Increase heart rate
•Increase renin secretion

β2  --> Lungs & Periphery
•Smooth muscle relaxation (bronchioles)
•Peripheral vasodilation
•Skeletal muscle stimulation (tremors)
•Glycogenolysis & gluconeogenesis
21
Q

Beta-Blockers (BB): MOA

A

: Competitively inhibit catecholamine neurotransmitters at
• β1 (cardiac) receptors
• β2 (smooth muscle/lungs) receptors

22
Q

Different types of Beta-blockers

A

– Non-selective (β1 and β2 activity)
– Cardioselective (β1 activity only)
– Some w/ β2 agonist properties
– Others are mixed α1/ β

23
Q

Non-selective Beta1/Beta2 Blockers MOA

A

antagonists of β1/ β2receptors

24
Q

Non-selective Beta1/Beta2 are

A

PropranololPropranolol (Inderal) 160 - 480 BID
Propranolol long-acting (Inderal LA) 80 – 320 Daily

25
Q

Clinical Considerations: of Non-selective Beta1/Beta2 (PROPRANOLOL)

A

Avoid in pts with reactive airways disease, caution for blocking hypoglycemia sx
(except sweating)

Avoid in pt with hypoglycemia
Avoid in pt with Asthma blocking that smooth muscle will be harmful and can cause asthma

26
Q

someone with uncontrolled hyperthyroidism ______ will help them.

A

Beta-blockers

27
Q

Additional indications / clinical use of Propranolol

A 
Angina, 
post-MI CV event prevention, 
atrial fibrillation, atrial flutter, 
supraventricular arrhythmias, migraine prophylaxis, 
tremors

These agents improve these disease states.

28
Q

Beta1 Selective Blockers are

A 
Atenolol (Tenormin)                       25 – 100 Daily
Metoprolol succinate (Toprol XL) 50 – 400 Daily - BID
Metoprolol tartrate (Lopressor)    50 – 200 BID
29
Q

Beta1 Selective BlockersMOA

A

β1
-selective antagonists (cardioselective)
• Limited effect on pulmonary function & peripheral vessels
• Preferred in pts with bronchospastic airway disease requiring a BB
• Selectivity lost at higher doses

30
Q

Additional clinical indications/use in clinical practice of B1 selective

A 
Angina
Post MI CV event prevention
Migraine prophylaxis
Heart failure
Atrial fibrillation
Atrial flutter
31
Q

Mixed Alpha1/Beta Blockers MOA

A

Mixed α1/β-blockers
• Less effect on HR and CO than pure β-blockers
• Additional effect on TPR (α1 blocker)

32
Q

Mixed Alpha1/Beta Blockers are

A

Carvedilol (Coreg CR) 20 – 80 Daily

Labetalol (Normodyne) 200 – 800 BID

33
Q

Clinical Considerations of A1/B blockers

A

Carvedilol: Mortality benefit in heart failure, after stabilized

Labetalol: Increased safety data in pregnancy, hypertensive emergency (IV)

34
Q

Beta Blockers & ACC/AHA Guidelines are

A

BB NOT recommended as first-line for uncomplicated HTN

35
Q

Beta-blockers are reserved for

A

Reserve for patients with hypertension plus compelling co-existing
a condition that would benefit from a beta-blocker:
• Heart Failure –> Prevent heart attack and reduce risk and decrease hospitalization
• Post-MI
• Angina

36
Q

Beta-Blockers clinical considerations

A

Abrupt discontinuation can cause rebound HTN (taper over 1-2 weeks)

Caution in asthma/COPD, especially with nonselective agents

37
Q

pt with Asthma and COPD should avoid

A

Beta blockers

38
Q

ADE of Beta-blocker is

A

Bronchospasm; worsening of pre-existing asthma
• Bradycardia
• Fatigue, exercise intolerance, ↓ AV nodal conduction
• Insomnia, sleep disturbances, sexual dysfunction
• Masked signs and symptoms of hypoglycemia (except sweating)
• Cold hands, feet

39
Q

Contraindications: of Beta blocker

A

avoid in pt with Sinoatrial or atrioventricular (AV) node dysfunction
Decompensated HF
Severe bronchospastic disease

40
Q

Avoid Beta-blockers with

A

Non-DHP CCBs –> Verapamil and diltiazem because they reduce blood pressure significantly.

41
Q

The agents that block B1 selectively, At higher doses

A

their selectivity loss and will have blockade on B2 receptor and they will have shortness of breath.

42
Q

Monitoring with BB is

A

BP
• HR
• BG if have diabetes
• Signs and symptoms of asthma/COPD

43
Q

B1 prevent

A

Prevent tremor and migraine

CDM 1 (15 decks)

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