Hypertension

Question 1

ACE (Angiotensin converting enzyme) Inhibitors

Answer 1

-Pril; Lisinopril

• Prevent ACE from converting angiotensin I to angiotensin II
• Decrease in BP, aldosterone secretion
• Loss of serum sodium and fluid
• Increase in serum potassium

Treats: hypertension, Heart failure

Contraindications: serious fetal abnormalities, NSAIDs (may decrease effects), potassium-sparing diuretics (hyperkalemia)

May cause: Steven-Johnson Syndrome, Hypoglycemia, dry-cough, angioedema, erectile dysfunction

Question 2

Angiotensin II Receptor Blockers (ARBs)

Answer 2

Losartan, valsartan

• Selectively bind w/ angiotensin II receptors
• Located in the smooth muscle of the blood vessels and in the adrenal cortex
• Block the BP raising effects of the RAAS

Treats: Hypertension

Contraindications: ACE Inhibitors (risk for renal dysfunction), pregnancy/breastfeeding, NSAIDs (renal impairment/decreased effects)

May cause: lithium toxicity, hyperkalemia

Question 3

Calcium-Channel Blockers

Answer 3

-zem; Diltiazem

• Inhibit the movement of calcium ions across membranes of myocardial and arterial muscle cells
• Depresses myocardial contractility
• Relaxes/dilates arteries
• decreases cardiac oxygen demand

Treats: Angina, hypertension, atrial fib

Contraindications: heart block, heart failure, acute MI, digoxin/theophylline (toxicity)

• Grapefruit increases serum toxicity of calcium-channel blockers

Question 4

Diuretics

Answer 4

-ide, -one; furosemide (loop), hydrochlorothiazide (thiazide), spironolactone (Potassium-sparing)

Loop diuretics:
- Blocks reabsorption of Na (sodium) in the kidneys
- increased excretion of water by the
kidneys

Potassium-Sparing diuretics:
- Blocks action of aldosterone reabsorption of Na (sodium) and water in the kidneys
- increased excretion of water by the kidneys

Thiazide Diuretics:
- Blocks reabsorption of Na (sodium) in the kidneys
- increases excretion of water
by the kidneys

Treats: pulmonary edema (decrease pressure), mild hypertension, heart failure

Contraindications: hypovolemia, systemic lupus, NSAIDs (decrease effects), licorice (hypokalemia), lithium toxicity, diabetes (monitor glucose levels)

Question 5

Beta-Blockers

Answer 5

-olol; labetalol (Alpha-Beta Blocker), carvedilol (Alpha-Nonselective Beta Blocker), metoprolol (Beta Blocker)

Beta Blocker:
- Block the beta 1 receptors (heart)
- Decreases heart rate and decrease the workload and oxygen need of the heart.

Alpha Non-selective Blocker:
- non-selective blocking of alpha and beta blockers

Alpha-Beta Blocker:
- Blocks Alpha and Beta receptors
- reduces vascular constriction

Treats: MI, hypertension

Contraindications: heart block, bradycardia, heart failure, COPD, NSAIDs (decrease effects), theophylline (has decreased effects), may cause Erectile dysfunction

Question 6

Alpha2-Agonists

Answer 6

clonidine

• Stimulate alpha-2 receptors located in the CNS
• Decrease in sympathetic nervous system activity
• Decrease in BP

Treat: hypertension

Contraindications: Caution if patient has severe coronary disease, cerebrovascular disease, MAOIs (hypertension, headache, fever), alcohol (increase effects)

Question 7

Cardiac Glycosides

Answer 7

Digoxin

• increases intracellular calcium
• allows more calcium to enter myocardial cells during depolarization
• causes increased force of myocardial contraction - increased cardiac output - increased renal perfusion
• slowed heart rate

Treats: heart failure, atrial flutter/ fibrillation

Contraindications: ventricular tachycardia/fibrillation, heart block, ACE/ARBs/Diuretics (risk of toxicity), St. John’s Wort (decrease levels/effects)