hypertension Flashcards
diuretics effect _______
preload (of Stroke Volume, of Cardiac Output)
diuretics cause volume depletion and work with pulmonary edema as it relates to ________
HF
thiazides have some ________ of peripheral arterioles
vasodilation
diuretics are the most commonly prescribed _____
antihypertensive (probably not used in HF)
BB MOA & therapeutic effect
inhibit cardiac response to sympathetic nerve stimulation
HR, CO, BP reduced
for BB, watch for _____ symptoms if decontractility is excessive
HF
common adverse effects of BB
bradycardia
masks hypoglycemic shock
not effective for African Americans
hold BB for BP <____ or HR<____
BP < 100
HR < 60
and contact prescriber
sudden discontinuation of BB can result in
worsening angina or MI
selective BB effect the
heart
blocks receptors in cardiac tissue
BB pts with wheezing or history of lung disease will be on _____ instead of ______
will be on selective instead of nonselective
3 selective BB
Metoprolol
Atenolol
Esmomol
Metoprolol
selective BB
treats HTN, angina
slows HR, decreases CO, reduces BP, decreases MI severity
Atenolol
selective BB
slows sinus node HR decreasing CO and BP, decreases myocardial oxygen demand
Esmolol
selective BB
rapid, short term control of ventricular rate in SVT, a fib, tachycardia, HTN
slows sinus HR, decreases CO, reduces BP
nonselective BBs effect the
heart and lungs (decrease HR, constrict bronchials)
may induce bronchospasm
3 nonselective BB
Labetalol
Propranolol
Sotalol
Labetalol
nonselective BB
treat HTN, may decrease effectiveness of selective BBs
Propranolol
nonselective BB
treats angina, HTN, migraines
Sotalol
nonselective BB
treats ventricular arrhythmias and a fib
BB are the
LOLs
Beta blockers
ACEIs are the
PRILs
Angiotensin-converting enzyme inhibitors
ACEI MOA & therapeutic effect
disrupts the RAAS system (renin-angiotensin-aldosterone system hormones controls BP, fluid and electrolytes), reducing BP, preserves CO and increases renal blood flow
reduces preload (effects sodium and water retention, and venous tone) and afterload (reduces SVR through circulating regulators and local regulators)
can help reduce the work of the heart in HF
which HTN meds do not work well for African Americans?
BB
ACEI (unless combined with diuretic)
ARB alone
About 1/3 of patients develop a cough from
ACEIs
SVR
systemic vascular resistance
ACEI side effects
angioedema (swelling of face, eyes, lips, tongue, diffilty breathing)
may cause fetal harm
hyperkalemia
hypotension
monitor for nephrotoxicity/too much perfusion = elevated creatinine and s/s of renal failure
Lisinopril
ACEI (ACE Inhibitor)
treats HTN in adults and kids 6yo and older, acute MI within 24 hrs to improve survival
adjunctive therapy to reduce s/s of systolic HF
ARBs ar the
SARTANs
Angiotensin II Receptor Blockers
ARB MOA & therapeutic effect
directly antagonizes angiotensin II receptors, blocks vasoconstrictor, aldosterone-secreting effects of angiotensin II, inhibiting binding of antiotensin II to ATj receptors
produces vasodilation, decreases peripheral resistance, decreases BP, helps work of heart in HF, effects afterload and preload
Valsartan
ARB
treats HTN alone or combo, treats HF, reduce mortality in high risk pts (left ventricular failure/dysfunction) following MI
ARB side effects
tachycardia
GI
watch kidneys
hyperkalemia
NEVER TAKE AN ARB WITH
ACEI
hypotension, hyperkalemia, renal impairment
CCB stands for
calcium channel blockers
CCB MOA and therapeutic effect
inhibit movement of calcium ions across cell membranes
helps with HR & rhythm, reduces contractillity, effects systemic vascular resistance (afterload), reduces vascular tone, dilates coronary arteries & peripheral arteries/arterioles, decreases total peripheral vascular resistance and BP by vasodilation
CCB are ideal for
first or second line drug therapy for HTN
effective in African American pts
CCB adverse effects
hypotension
syncope
edema
bradycardia
do not injest ____ with CCBs
grapefruit juice
Amlodipine
CCP, dihydropyridine, vasodilator
helps reduce afterload (HTN, angina, HF)
a1-b are
alpha 1 adrenergic blocking agents
the ZOSINs
a1-b MOA and therapeudic effects
selectively blocks alpha 1 adrenergic receptors, decreasing peripheral vascular resistance
used for HTN and urinary obstruction secondary to BPH
produces vasodilation, decreases vascular resistance and BP, effect CO and SVR, affect venous and arterial tones
a1-b side effects
bradycardia
peripheral edema
headach
Doxazosin
a1-b
treats HTN alone or combo, also treats urinary outflow obstruction
relaxes smooth muscle of bladder and prostate, reducing BPH (benign prostatic hyperplasia) s/s
Centrally acting alpha 2 agonists MOA and therapeutic effects
reduces sympathetic outflow from CNS, reduces HR and SVR, causes drop in both systolic and diastolic BP
adjunctive, used only in combo with other antihypertensives
reduces peripheral resistance, decreases BP, HR, produces analgesia
Clonidine
centrally acting alpha 2 agonist
adjunctive, used only in combos for HTN
also used for ADHD and refractory cancer pain
off label used for opiate and nicotine withdrawl, hot flashes, Tourettes
Direct vasodilators effect
Systemic Vascular Resistance
Direct vasodilators MOA and therapeutic effects
relaxes arterial smooth muscle, reducing SVR
decreases BP and systemic vascular resistance
Direct vasodilator side effects
dizziness
orthostatic hypotension
tachycardia
fever
chills
joint and muscle pain
skin eruptions
Hydralazine
direct vasodilator
used for stage 2 HTN (moderate to severe), renal disease HTN, toxemia of pregnancy
Nitroprusside sodium
direct vasodilator
very strong, potent IV titratable drug, short action, for HTN crises, HG hemodynamics (reduce left ventricular end-diastolic pressure, pulmonary capillary pressure, peripheral vscular resistance, and mean arterial BP)
used when immediate reduction of preload or afterload is needed
preferred antihypertensive for pts with acute pulmonary edema
