Hypertension Part 2 Flashcards
What are the categories of Antihypertensive medications?
- ACEIs
- ARBs
- Alpha Blockers
- Beta Blockers
- CCBs
- Diuretics
- Peripheral Vasodilators
- DRIs
How can ACEIs be identified?
They all end in “pril”
What system do ACEIs act on?
Renin Angiotensin System
How do ACEIs lower BP?
By inhibiting the enzyme in your body that normally produces Angiotensin II from producing it
How does Angiotensin II normally effect BP?
It narrows the blood vessels which raises BP
It releases hormones that raise BP
How does Angiotensin II normally effect the heart?
forces your heart to work harder
How does Angiotensin II normally effect the heart?
forces your heart to work harder
When taking ACEI what occurs?
Angiotensin II is not produced so the veins and arteries relax
What is the result of the relaxed veins and arteries after taking ACEIs?
Lower BP
How else do ACEIs help the body?
- Improve oxygen
2. Decrease remodeling
Is remodeling in the heart good?
No
When would a persons heart have remodeling occur?
Patient has MI causing the walls to thin out and/or balloon d/t damage
What is the first treatment used to prevent remodeling of the heart muscle in a person who has suffered heart damage d/t MI?
ACEI
When choosing weather to use an ACEI or another antihypertensive medication what factor is important to consider?
It is renal protective
Considering ACEIs relation to renal system, which patients would ACEIs be the best option?
Would you prescribe ACEIs even if the patient didn’t have HTN?
If these patients had a hard time tolerating ACEIs would you still prescribe them?
What would you prescribe to a patient having a hard time tolerating ACEIs?
Why would you prescribe this to a patient having a hard time tolerating ACEIs?
- Diabetics
- Yes
- Yes
- A low dose ACEI (even if only a 1/2 or 1/4 of the smallest 5mg tablet)
- It is renal protective
What is one major difference between the effects of ACEI and ARBs?
- ACEIs effect an area of the respiratory system which often results in a cough as a side effect
- ARBs do NOT effect this area of the respiratory system resulting in NO side effect of coughing
How can ARBs be identified?
They all end in “sartan”
What system do ARBs act on?
Renin Angiotensin System
How do ARBs lower BP?
They block the action of the chemical Angiotensin II
How does Angiotensin normally effect BP?
It narrows the blood vessels which increases BP
How does Angiotensin normally effect the heart?
forces the heart to work harder
How do ARBs block the action of Angiotensin II?
They block Angiotensin II receptors
What is the result when ARBs are used to block Angiotensin II receptors?
Veins and arteries to dilate
What are the results once the veins and arteries have dilated d/t ARBs blocking Angiotensin II receptors?
- Lower BP
2. Less stress on the heart
What are Alpha Blockers mainly used for?
BPH
What does BPH stand for?
Benign prostatic Hypertrophy
What is BPH?
Enlarged prostate gland
What else are Alpha Blockers used to treat? (other than BPH)
BP control
What effect do Alpha Blockers have on BP?
mild effect on BP control
How do Alpha blockers work to lower BP?
They block a hormone that delivers signals through nerve cells
What hormone do alpha blockers block to lower BP?
norepinephrine
What does the hormone norepinephrine normally cause to happen to effect BP?
It sends signals through nerve cells that tell the body’s smaller arteries and veins wall muscles to tighten
What occurs when Alpha Blockers cause norepinephrine to be blocked?
The vessels remain open and relaxed
What occurs once Alpha Blockers block norepinephrine and vessels remain open and relaxed?
- improves blood flow
2. lowers BP
Do alpha blockers cause muscles other than those of the smaller arteries and veins walls to relax?
Yes
When alpha blockers cause the relaxation of other muscles (other than those of the smaller arteries and veins walls) what other action can occur?
urine flow improves
What condition can be treated by improved urine flow?
BPH
Are alpha blockers alone (not in combination with another drug) commonly prescribed for BP control?
No
What other condition can alpha blockers be used to treat? (other than HTN and BPH)
Alpha blockers will only work for this condition if what circumstance is met?
- HF
2. Must be used in combination with a specific beta blocker
What is the generic name and brand name for the beta blocker used in combination with an alpha blocker to treat HF?
carvedilol (Coreg)
What are Beta Blockers primarily used for?
What are they NOT primarily used for?
- CAD or HF
2. HTN
Are beta blockers a large or small category of medications?
large
What are Beta blockers, also known as?
beta-adrenergic blocking agents
How do Beta blockers lower BP?
By blocking the effects of a hormone
What hormone do Beta blockers block the effects of?
epinephrine
What is epinephrine also known as?
adrenaline
What results when beta blockers are used to treat and the effects of epinephrine become blocked?
- Veins and arteries dilate
- Lower HR
- Heart beats with less force
What results when the veins and arteries dilate, the HR lowers, and the heart beats with less force after the effects of epinephrine are blocked by beta blockers?
- Improved blood flow
2. Lower BP
Is there any category of Antihypertensive medication other than Beta Blockers that lowers both BP and HR?
No
When considering when to give beta blockers:
If patients HR is 70 what do you do?
- Do not give
OR - Start with low dose and titrate up watching HR
How do Beta Blockers work on the body?
They inhibit the sympathetic activation of Beta-adrenergic receptors
How are Beta 1 and Beta 2 different from each other?
Beta 1 and Beta 2 receptors are found in different places in the body
What are the two general categories of Beta Blockers?
- Non Specific Beta Blockers
2. Selective Beta Blockers
What do Non Specific Beta Blockers do?
Blocks all Beta receptor sites
What do Selective Beta Blockers do?
Will target either Beta 1 OR Beta 2 receptor sites
What is an example of a Non Specific Beta Blocker?
propranolol (Inderal)
Is propranolol (Inderal) a new or old medication?
Old
Is propranolol (Inderal) a commonly used medication?
Why?
- No
2. Because it is not a specific Beta Blocker
What is an example of a Selective Beta Blocker?
metoprolol (Lopressor)
What is an example of a group of Selective Beta Blockers?
Cardioselective blockers
What do Cardioselective blockers do?
Primarily block Beta 1 receptors in the heart
What is the result of Cardioselective blockers blocking Beta 1 receptors in the heart?
Decreased:
- heart rate
- cardiac contractility
- cardiac workload
- AVN conduction
What receptor does metoprolol (Lopressor) selectively block?
Beta 2 selective
Are Non Specific Beta Blockers or Selective Beta Blockers better medications to prescribe as treatment?
Selective Beta Blockers
What type of Beta Blocker should be ordered for a patient with asthma?
Selective Beta Blockers
Why are Selective Beta Blockers ordered for patients with asthma?
If the Beta Blocker is non specific it will inhibit all Beta receptors including those in the respiratory tract.
What can occur when patients with asthma (or any respiratory issue) experience their Beta receptors in the respiratory tract are inhibited?
Bronchospasm or other life threatening complications
What are CCBs mainly used to treat?
HTN
How do CCBs help HTN?
Lower BP
How do CCBs lower BP?
By preventing calcium from entering the cells of your heart and arteries
What does calcium cause the cardiac and artery cells to do normally?
Contract with more intensity
When CCBs block calcium from entering the cardiac and artery cells what occurs?
Blood vessels relax and open
What occurs when CCBs cause blood vessels relax and open?
BP lowers
Other than HTN what other conditions are CCBs used to treat?
- Angina
- Arrhythmia
- Raynaud’s Disease
- Migraines
- Cardiomyopathy
- Esophageal Spasm
How do CCBs help in treatment of Angina?
They reduce Angina
Other than CCBs what medication is also used in the treatment of angina?
Nitroglycerin
How does Nitroglycerin help in treatment of Angina?
It reduces Angina
What is the physiology behind how CCBs work?
- They cause a significant reduction in afterload
2. And little effect on preload
What are commonly used CCBs? (generic name, Brand name)
- amlodipine (Norvasc)
2. diltiazem (Cardizem)
What is amlodipine (Norvasc) most commonly used to treat?
HTN
What is diltiazem (Cardizem) most commonly used to treat?
Arrhythmia
Although diltiazem (Cardizem) is most commonly used to treat Arrhythmia, is it ever used to treat HTN?
Yes
What is the most common condition treated with Diuretics?
HTN
What are Diuretics also known as?
water pills
Which Diuretics are mainly used to treat HTN?
Thiazides and related diuretics
How do Diuretics lower BP?
By promoting the excretion of sodium and H2O from the body
When using diuretics: Increased sodium in the circulation causes what to happen?
- H2O is pulled from blood
2. Less H2O in blood
When using diuretics:
Decreased sodium in circulation causes what to happen?
- H2O is used by blood
2. More H2O in blood
How do most Diuretics promote the excretion of sodium and H2O from the body?
Diuretics work on distal tubules to inhibit sodium absorption
When using diuretics:
What is the result of inhibiting sodium absorption by the distal tubules?
When sodium absorption decreases fluid absorption to decreases too
Why does fluid absorption decrease as a result of the sodium absorption decreasing?
- Decreased sodium absorption causes there to be increase in sodium in the circulation
- Sodium absorbs fluid (H2O) from circulation (blood) resulting in decreased fluid absorption by the body
What is the result of the fluid (H2O) is being absorbed by sodium and NOT the body?
The kidneys release the sodium containing fluid (H2O) into urine.
This process of increased production of urine by the kidneys to excrete excess sodium (that contains excess fluid) in the circulation is called what?
Diuresis
What is the result of Diuresis on the body?
Less fluid causes decreased amount of fluid in the veins and arteries
What is the result of decreased amount of fluid in the veins and arteries?
Less blood circulating for the heart to pump to the body
What is the result of having less blood circulating for the heart to pump to the body?
Less pressure in veins and arteries
What is the result of having less pressure in veins and arteries?
Lower BP
What other less used diuretics (less than thiazides and related diuretics) are used as antihypertensive medications?
- Loop Diuretics
2. Potassium-Sparing Diuretics
What are Loop Diuretics and Potassium-Sparing Diuretics most commonly used for (more than HTN)?
HF
What do Loop Diuretics work on to effect the body?
Ascending Loop of Henle
SEE PG 351 FOR MORE INFORMATION
What does DRI stand for?
Direct Renin Inhibitors
Are DRIs a new or old category of mediation?
New
What medications are DRIs related to?
- ACEIs
2. ARBs
What is the most common condition DRIs are used to treat?
HTN
How do DRIs lower BP?
By blocking the enzyme in your body that is necessary to produce Angiotensin II.
What does Angiotensin II normally cause to happen in the body?
Blood vessels to constrict
What is the result of the enzyme in your body that is necessary to produce Angiotensin II being blocked by DRIs?
Blood vessels relax and this decreases BP
What is the result of the relaxation of blood vessels due to decreased Angiotensin II availability?
Lower BP
Are DRIs used alone or together with other medicines to treat HTN?
Can be used alone or in combination
How is the DRIs processes within the renin angiotensin system that cause the blocking of the enzyme that normally produces Angiotensin II different from processes carried out by ACEIs within the renin angiotensin system?
- DRIs: directly block renin
2. ACEIs: work on angiotensin component
What is an example of a DRI?
aliskiren (Aliskiren)
Are DRIs commonly used to treat HTN?
No, not yet
What is one reason DRIs are not commonly used to treat HTN?
Expensive
What are peripheral vasodilators usually used to treat?
Resistance for PVD
Other than PVD what can peripheral vasodilators treat?
Resistance for HTN
When are peripheral vasodilators indicated to treat hypertension?
- When there is problems with peripheral vasodilation
2. NOT used to treat HTN broadly
Do NPs prescribe peripheral vasodilators often?
No, almost never
When may an NP prescribe peripheral vasodilators?
Why?
- When working with patients in prison.
2. This may be on the prisons formulary.
What is an example of peripheral vasodilators?
hydralazine (Apresoline)
Is hydralazine (Apresoline) an old or new drug?
Very old
What makes hydralazine (Apresoline) a difficult drug to prescribe?
Dosing frequency causes non compliance (2-4 times a day)
Teachers Example:
- When working in the hospital
- Patient is on a cardiac Cath
- They hadn’t taken their AM antihypertensive medication d/t NPO status for procedure
- One half hour after the patient returned from their procedure their BP increased to 180/20
What antihypertensive medications do you give?
Why is this medication indicated?
What would happen next after administering the medication?
What would be the nurses next action after administering the medication and monitoring for its effects?
Generally what are the outcomes for patients in similar situations?
- hydralazine (Apresoline)
- It works quickly and can be given IV
- BP would come down
- Give them their regular antihypertensive medications.
- They do well
