Hypertension

Question 1

Sympathetic Nervous system

heart rate & contractility

Answer 1

Beta Blockers-beta-adrenergic stimulation.
Decrease stroke volume and lower bp
Propanolol

Question 2

Calcium channel blockers

Answer 2

Block calcium into the myocardial cells or vascular smooth muscle
A descrease in conttractility, a descreased heart rate and vasoldilation
Ex: nifedipine (Procardia)

Question 3

Central acting drugs

Answer 3

decrease cardiac output and descrease peripheral resistance. These drugs affect the vasomotor center in the brain by limiting the sympathetic outflow to the heart
Ex: methyldopa (aldomet)

Question 4

Vascular tone

Answer 4

vasoldilators-alpha adrenergic reptor blockers cause direct vasodilation
Ex: Prazosin

Question 5

Vascular volume

Answer 5

Diuretics-decrease blood volume and sodium

The different types are classified by what anatomic site in the kidney tuble they exert influence

Question 6

Three kinds of diuretics

Answer 6

Thiazide diurectics
Loop diuretics
Potassium sparing diuretics

Question 7

Angiotensis converting Enzyme (ACE) inhibitors

Answer 7

inhibit conversion of angiotensis I into angiotensis II thereby decreasing arterial pressure
Ex: enalapril

Question 8

Angiotensin receptor blockers

Answer 8

valsartan

Question 9

Beta blockers

Answer 9

end in olol

Question 10

Angiotensis receptor blockers

Answer 10

end in “sartin”

Question 11

Calcium channel blockers

Answer 11

end in “pine”

Question 12

ACE inhibitors

Answer 12

end in “pril”

Question 13

beta blockers-Considered 4th line tx in uncomplicated HTN

Answer 13

negative ionotropic effect and used with extreme caution in patients with heart failure
These drugs are cardioselective
Avoid atenolol

Question 14

Beta blockers

Answer 14

Should be used for 2-3 years after a heart attack.

two most effective are: carvedilol and metoprolol ER

Question 15

Beta Blockers

Increase triglycerides

Answer 15

Beta 1 predominate in cardiac tissue
Beta 2 predominate in bronchial and vascular smooth muscle and the liver. Both affect bp and Beat 1 have reduced risk of bronchoconstriction

Question 16

B1 selective

Answer 16

Metoprolol (lopressor) and atenolol

Question 17

Non selective beta blockers

Answer 17

Timolol and Propanolol

Question 18

Calcium channel blockers

Answer 18

decreased myocardial contractility, slowed rate of ventricular contractions, coronary artery dilation, and reduced perpheral resistance. They block movement of calcium into the cell membranes of cardiac and smooth muscle

Question 19

Calcium channel blockers-2 types

Answer 19

dihydropyridines and the non-dihydropyridines

DHP is the largest catefgory

Question 20

CCBs- dihydropyridines

They do not affect the cardiac conduction system, and thus are not used for cardiac arythmias.

Answer 20

nifedipine, (Procardia), amlodipine (Norvasc)

Question 21

non-dihydropyridines-Used for hypertension and arrythmias

Answer 21

Verapermil (Calan) and dlitiazem (Cardiazem)

Question 22

Calcium channel blockers-DO NOT USE IN PATIENTS WITH HEART FAILURE. Cause reflex tacchycardia

Answer 22

Side effects-reflux tachcardia and peripheral edema. Work well with the african american population

Question 23

Thiazides-used as first choice for most

Answer 23

inhibit reabsorption in the distal tule. Depletes sodium and potassium-conserves calcium. Used for women with osteoporosis. Side effect of hypokalemia. EX: HCT

Question 24

Loop diurectics

Answer 24

Deplete sodium, potassium, magnesium and calcium in the distal tuble. Most efficient and reserved for those with severe hypertension.
Side effect of hypokalemia, Dangerous if you have heart disease. EX: furosemide (lasix)

Question 25

Potassium sparing diuretics

Answer 25

Inhibits sodium re-absorption in the collecting duct (as opposed to the distal tubule), sparing potassium. Side effect is most dangerous for clients on ACE inhibitors or those with diabetes or renal impairment Used in conjuction with thiazide diuretics to counter potassium loss. EX: spironolactone (aldactone)

Question 26

ACE inhibitors

Answer 26

perevent vasoconstriction of the renal vessles. they potentiate water and sodium loss and tend to spare potassium, making them very effective with a thiazide. Do not combine with potassium sparing for risk of hyperkalemia. ACE's potentiate BRADYKININ, a vasodilator which enhances insulin sensitivity. Exceelent choice for those with diabetes. In african americans ACEs and ARBs have smaller effects

Question 27

ACE-examples

Answer 27

Benzapril (Lotensin), Lisinopril

Question 28

Angiotensin Receptor Blockers (ARBs)

Answer 28

Many advantages of the ACEs only no cough. They work on AT2 receptors and lead to vasoconstriction., thirst, sodium reabsorption. Blocking the sites decreases vasoconstiction and sodium retention. Have not been studying or available for long. EX: Avapro

Question 29

Other hypertensives:

Answer 29

Direct vasodilators :hydralazine (Apresoline) Alpha Blockers: EX: doxazosin (cardura) Alpha 2 agonists: guanabenz (Wytensin)

Question 30

Take one hypertensive at night. Not the diuretic

Answer 30

If client is taking three or more, take one at night.

Question 31

JNC7-tx

Answer 31

Take diuretic first. if not effective add another agent. If the systolic b/p is>160 or diastolic > 100 two agents are needed

Question 32

ACEs twice as likely for cough in women than men

Answer 32

CCBs more pedal edema in women. Thiazides more likely to cause gou in men. African Americans do not respond well to ACEs but have increased respons to thiazide diuretics

Question 33

NSAIDS elevate blood pressure when combined with and ACE or ARB

Answer 33

NSAIDS can worsen heart failure

Question 34

Clients should be counseled not to use

Answer 34

devils claw, ginseng, goldenseal, black licorice, ma huang, squill or yohimbe

Question 35

While pregnant

Answer 35

bp is lower in the first half of pregnancy. and then increases at the 3rd trimester to pre-pregnancy levels by the end.

Question 36

ARB and ACE and direct rennin inhibitors (DRI's) are teratogenic

Answer 36

They are category C in first trimester and D for the remainder. Discontinue if taking. Diuretics and thiazides are contraindicated due to multiple adverse affecdts, decreased plasma volume expansion, reduced amniotic fluid, decreased placental perfusion. Only for pregnant women wit cardiac or renal disease.

Question 37

ALDOMET (methyldopa)

Answer 37

FDA category B is used the most . Labetalol is category C and used commonly as well.

Question 38

Beta blockers are the class of anti-hypertensives contraindicated with breastfeeding

Answer 38

Some have been studied like Metoprolol (Lopressor), Propranolol (inderal) and Methyldopa (aldomet) have low levels in breast milk and are considered safe.

Question 39

Harmful beta blockers while breastfeeding

Answer 39

Atenolol, acebutolol due to extensive secretion in the milk. Some ACE are considered safe in full term babies, but better not to risk.

Question 40

Calcium channel blockers resul in low breastmilk levels

Answer 40

Prescribe the most studied and safest.

Question 41

Terbutaline has a selective action on B2 receptors and was used as a drug to delay preterm labor

Answer 41

Due to side effects MgSO4 is currently the preferred drug

Question 42

Peripheral Alpha 1 blockers-end in azosin

Answer 42

slight decrease in T. Cholesterol, and LDL. Can reduce prostate size so seen given to older men.