Hypertension Meds

Question 1

What are the categories of anti-hypertensive meds?

Answer 1

• ACE Inhibitors
• Angiotensin II Receptor Blockers (ARBs)
• Beta Blockers
• Calcium Channel Blockers (CCBs)

Question 2

What is ACE?

Answer 2

ACE – angiotensin-converting enzyme

• decreased BP and blood flow to kidneys leads to release of renin
• renin is converted to angiotensin I
• ACE is needed to convert angiotensin I to angiotensin II
• Angiotensin II is a powerful vasoconstrictor
• Angiotensin II also initiates aldosterone secretion
• vasoconstriction → increased PVR → increased BP

Question 3

What is the function of aldosterone?

Answer 3

holds on to sodium, gets rid of potassium

• increases blood volume

Question 4

How do ACE Inhibitors work?

Answer 4

Lower blood pressure by:

• Blocking conversion of angiotensin 1 to angiotensin 2
• Suppressing release of aldosterone
  
  • sodium is not reabsorbed, and blood volume won’t increase
• Increasing release of bradykinins which cause vasodilation
  
  • bradykinins are present with the inflammatory process
• vasodilation → decreased PVR → decreased BP

Question 5

What do ACE Inhibitors protect?

Answer 5

Have protective effect on the heart and kidneys.

Question 6

List some types of ACE inhibitors.

Answer 6

• Captopril
• Lisinopril
• Enalapril

(pril)

Question 7

ACE Inhibitors obvious side effects?

Answer 7

• Hypotension
• Orthostatic hypotension, especially after the 1st dose.
• Potential increase in potassium – direct result of effect on aldosterone (higher range of normal potassium or hyperkalemia)

Question 8

ACE Inhibitors unusual or life-threatening side effects?

Answer 8

• Dry, nonproductive cough
  
  • Persistent dry cough is secondary to accumulation of bradykinins
• Most serious adverse effect is angioedema- strong vascular reaction involving inflammation of submucosal tissues which can progress to anaphylaxis.
  
  • Swelling around lips, eyes, throat, and other body regions
  • Can lead to airway closure
  • Usually develops within hours/days

Question 9

What is a black box warning for ACE Inhibitors?

Answer 9

• All ACE inhibitors have detrimental effects on the unborn fetus and neonate
  
  • Category C- 1st trimester
  • Category D – 2nd and 3rd trimester

Question 10

What are ARBs?

Answer 10

• Angiotensin II is blocked at the receptor site (receptor located on arterial smooth muscle)
  
  • vasodilation → decreased PVR → decreased BP
• Equally effective as ACE-I
• Cardioprotective in same way as ACE-I

Question 11

What are some types of ARBs?

Answer 11

• Losartan
• Irbesartan

(sartan)

Question 12

ARBs obvious side effects?

Answer 12

• Hypotension
• Orthostatic hypotension
• Increase in potassium – direct result of effect on aldosterone (higher range of normal potassium or hyperkalemia)

Question 13

What is a black box warning for ARBs?

Answer 13

• All ARBs have detrimental effects on the unborn fetus and neonate
  
  • Category C- 1st trimester
  • Category D – 2nd and 3rd trimester

Question 14

How do ARBs compare with ACE-I?

Answer 14

• ARBs doesn’t cause cough like ACE-Inhibitors will.
  
  • There have been reports of angioedema but very low incidence.
  • Note: Even though rare, you still need to assess for it and teach your patients about it.

Question 15

Where are Beta Receptors located?

Answer 15

Beta receptors are primarily located in the heart and the lungs.

• Beta 1 receptors are primarily located in the heart (you have ONE heart)
• Beta 2 receptors are primarily located in the lungs (you have 2 lungs).

Question 16

What happens when the two types of Beta Receptors are activated?

Answer 16

• Beta 1- results in an increase in the pulse rate and contractility (increase in stroke volume and cardiac output).
• Beta 2 - Stimulation of beta-2 receptors in the lungs causes bronchodilation.

Question 17

Beta Blocker special note?

Answer 17

• There is not a complete “blocking” of action at the receptor site.
• There is a DECREASE in the activity at the receptor site.

Question 18

How do Beta Blockers work?

Answer 18

• Decreases heart rate and contractility → decreased cardiac output → decreased systemic blood pressure
• Blocks B1 receptors in the JGA which inhibits secretion of renin and formation of angiotensin.
• Also used for angina, arrhythmias, and migraines

Question 19

What are some types of Beta Blockers?

Answer 19

• Metoprolol
• Propranolol
• Atenolol

(lol)

Question 20

What do non-specific Beta Blockers affect?

Answer 20

• Will affect Beta 1 AND Beta 2 receptors.
  
  • These drugs will have Beta 1 AND Beta 2 side effects.

Question 21

What do specific Beta Blockers affect?

Answer 21

• Beta specific drugs will only affect the Beta 1 OR Beta 2 receptors.
  
  • Beta 1 drugs will only have Beta 1 side effects.
  • Beta 2 drugs will only have Beta 2 side effects.

Question 22

Beta blockers obvious side effects?

Answer 22

• Hypotension
• Orthostatic hypotension
• Decreased heart rate
• Bronchiole constriction
• Used with caution in patients with respiratory disorders/injury and heart failure.

Question 23

Beta blockers not so obvious side effects?

Answer 23

• Abrupt cessation and result in rebound hypertension, angina and MI
• Doses should be tapered over several weeks.
• Decreased libido and erectile dysfunction.

Question 24

What can happen with larger doses of Beta Blockers?

Answer 24

Can also have fatigue and activity intolerance at high doses

• ↓ HR → ↓ CO
• ↓ CO → ↓ O2 to the tissue, which is why they feel fatigued

Question 25

What is a Calcium Channel?

Answer 25

• Muscle contraction is regulated by calcium
• One of the functions of calcium is to enter channels in the muscles to initiate contraction.

Question 26

How do Calcium Channel Blockers work?

Answer 26

• CC blockers will “block” calcium from entering the cardiac and smooth muscle cell resulting in limited contraction.
  
  • Relaxes cardiac muscle – decreased heart rate
  • Relaxes smooth muscle – vasodilation → decreased PVR → decreased blood pressure.
• Used to treat hypertension, angina, and dysrhythmias

Question 27

What are the two categories of Calcium Channel Blockers?

Answer 27

• Non-dihydropyridines
  
  • Act primarily on the heart (decreased heart rate and contractility) with less effect (vasodilation) on the blood vessels
• Dihydropyridines
  
  • Act primarily on the vascular smooth muscle with little direct effect on the myocardium.

Question 28

List some types of Calcium Channel Blockers.

Answer 28

• Verapamil - Non-dihydro
• Dilitiazem - Non-dihydro
• Amlodipine - Dihydro
• Felodipine - Dihydro
• Nifedipine - Dihydro

she won’t ask if each drug is dihydro or non-dihydro; just a fun fact!

Question 29

What is something you should know about Calcium Channel Blockers side effects?

Answer 29

• The dihydropyridines and the non-dihydropyridines have effects on the blood vessels AND the heart.
• However, the effects and side effects will be more prevalent based on the type of CCB.

Question 30

What side effects should you assess for regarding non-specific CCB?

Answer 30

• assess for effects on the heart and blood vessels
• assess for side effects like hypotension and palpitations

Question 31

Calcium Channel Blockers obvious side effects?

Answer 31

• Hypotension
• Orthostatic hypotension
• Pulmonary edema
• Edema of lower extremities
• Headache
• Dizziness
• Fatigue
• Weakness

Question 32

Calcium Channel Blockers not so obvious side effects?

Answer 32

Do not abruptly stop taking CCBs or it may result in reflex tachycardia.

• Patients may abruptly stop taking the med because CCBs can cause erectile dysfunction

Question 33

What are some additional drugs used to treat hypertention?

Answer 33

• Diuretics
• Direct Vasodilators
• Alpha Agonists
• Alpha Adrenergic Blockers
• Renin Inhibitors