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Mod 5- BP Agents Flashcards

1
Q

What type of blood pressure medications can be used in children?

A
  1. mild diuretics
  2. calcium channel blockers
  3. Beta- Blockers- ADE possible
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2
Q

What type of blood pressure medications should NOT be used in children

A

Angiotensin receptor blockers (ARBs) and Angiotensin- converting enzymes (ACEs) b/c no established safety

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3
Q

What should be done first for a child before putting them on blood pressure medication?

A

Lifestyle changes like weight loss and increasing activity

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4
Q

What are signs of high BP that adults should report to their provider?

A

headache, vision changes, nose bleeds, & ringing in the ears

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5
Q

What alpha and beta blocker blood pressure medication can be used during pregnancy?

A

Labetalol if the benefit outweighs the risk

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6
Q

Why shouldn’t an older adult crush or chew a sustained release or extended release blood pressure medication?

A

They could have a toxic overdose d/t it being released too quickly into the system

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7
Q

What would we monitor for an older adult on blood pressure medications?

A

kidney/ liver functions- impaired metabolism and excretions
safety- fall precautions, dehydration
drug/ drug interactions including herbal remedies

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8
Q

What are the 4 steps for management of hyper tension

A
  1. Lifestyle modifications- lose weight, smoking cessation, moderate alcohol, reduce salt, increase activity
  2. inadequate response- add drug
  3. inadequate response- changing drug or adding another for combination
  4. Inadequate response- 2nd or 3rd agent or diuretic added if not already on
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9
Q

What is the suffix for ACE inhibitors?

A 
They end in "-pril" 
Benazepril 
Captopril 
Enalapril 
Lisinopril 
Ramipril
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10
Q

What is the action of ACE Inhibitors?

A

Block ACE from converting Angiotensin I to angiotensin II. This leading to a decease is blood pressure, aldosterone production, and small increase in serum potassium along with sodium and fluid loss

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11
Q

When are ACE inhibitors indicated?

A

treatment of hypertension, congestive HF, diabetic nephropathy, L ventricular dysfunction following an MI

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12
Q

Contraindications/ Cautions for ACE inhibitors?

A

Allergies
impaired renal function
pregnancy & lactation
Caution: CHF

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13
Q

ADE of ACE Inhibitors

A

Same as symptoms of having low BP, GI irritation, renal insufficiency, Cough (30% of people)

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14
Q

Drug/ Drug interactions of ACE Inhibitors

A

Allopurinol which is a gout medication

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15
Q

What is a side effect of abruptly stopping an ACE Inhibitor?

A

Rebound hypertension

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16
Q

When would ACE inhibitors be administered in relation to food?

A

On an empty stomach 1 hour before or 2 hours after meals

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17
Q

What is the ending suffix for Angiotensin II receptor Blockers?

A 
"-sartan" 
candesartan 
irbesartan 
losartan 
olmesartan 
telmisartan 
valsartan
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18
Q

What is the action of Angiotensin II Receptor Blockers?

A

Selectively bind with angiotensin II receptors in the vascular smooth muscle and in the adrenal cortex to block vasoconstriction and release of aldosterone

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19
Q

Contraindications/ cautions for Angiotensin II Receptor blockers?

A

Allergy, pregnancy, lactation

Cautions: hepatic or renal dysfunction, and hypovolemia

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20
Q

ADE of Angiotensin II Receptor blockers

A

BP becomes too low
CNS: H/A, dizziness, syncope, weakness
GI Complaints
skin: rash or dry

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21
Q

Drug/ Drug interactions with Angiotensin II Receptor blockers

A

phenobarbital

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22
Q

What would you assess for a pt taking Angiotensin II Receptor blockers

A

Impaired kidney function, salt/ volume depletion/ HF or anything that could lead to hypovolemia

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23
Q

What labs do you assess for a pt taking Angiotensin II Receptor blockers

A

Renal and liver function tests

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24
Q

When should you administer Angiotensin II Receptor blockers in regard to food?

A

Give w/out regard to meals but give w/ food if GI distress occurs

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25
T/F you should alert the surgeon a pt is on BP medication
TRUE
26
What special precautions should a female on Angiotensin II Receptor blockers take?
use of barrier contraceptives and making sure not pregnant before starting
27
Prototype for Angiotensin II Receptor blockers
Losartan
28
Prototype for ACE Inhibitors
Captopril
29
What is the Renin Inhibitor medication?
aliskiren
30
What is the action of Renin Inhibitors?
Directly inhibits renin, leading to decreased plasma renin activity and inhibiting the conversion of angiotensinogen to angiotensin I
31
Contraindications of Renin Inhibitors
pregnancy & lactation
32
ADE of Renin Inhibitors
Risk of hyperkalemia
33
Drug/ Drug interactions of Renin Inhibitors
Furosemide, Ace Inhibitors *increase in drug effects and decrease of furosemide actions
34
What is the suffix for Calcium Channel Blockers + 2 other different medications?
``` "-dipine" Amlodipine Felodipine Nifedipine -Diltiazem -Verapamil ```
35
What is the action for Calcium Channel Blockers?
inhibit movement of calcium ions across membranes of cardiac and arterial muscles, depressing the impulse - SLOW conduction, DECREASED contractility, DILATION of arterioles which lowers DP and decreases myocardial o2 consumption
36
What is another action of Calcium Channel Blockers?
Decreases BP, cardiac work load, and myocardial o2 consumption
37
What are Calcium Channel Blockers indicated for?
Hypertension
38
Contraindication for Calcium Channel Blockers
allergy, pregnancy & lactation, Renal/ hepatic dysfunction, heart block or sick sinus syndrome b/c low HR combined can be bradycardic and inadequate perfusion
39
ADE of Calcium Channel Blockers
R/t effects on cardiac output CNS effects GI symptoms Cardiovascular symptoms
40
Drug/ Drug interactions of Calcium Channel Blockers
cyclosporine leads to an increased toxicity risk
41
Drug/ food interactions of Calcium Channel Blockers
Grapefruit juice
42
Prototype for Calcium Channel Blockers
Diltiazem
43
What are the Vasodilator medications?
Hydralazine Minoxidil Nitroprusside
44
What are the actions of vasodilators?
act directly on vascular smooth muscle to cause muscle relaxation, leading to vasodilation, and drop in BP
45
What are vasodilators indicated for?
Severe hypertension- mostly used for severe/ malignant hypertension or hypertensive emergencies
46
Contraindications and cautions for vasodilators
allergy, pregnancy, lactation Caution: conditions exacerbated by decreased blood pressure- peripheral vascular disease, CAD, CHF, cerebral insufficiency or tachycardia
47
ADE of vasodilators
related to changes in BP- CNS, reflexive tachycardia, GI upset
48
What is a specific adverse effect associated with Nitroprusside?
cyanide toxicity- pink/ cherry red skin, headache, dizziness, tachycardia
49
Drug/ Drug interactions for vasodilators
based on ea individual drug- see drug guide
50
What labs would you assess for Vasodilators?
renal & hepatic function, blood glucose for diabetics b/c effect on part of kidneys will decrease blood glucose
51
Why would you assess for a drop in volume for a pt on vasodilators?
because it can lead to hypotension
52
What is the prototype for Vasodilators?
Nitroprusside- causes maintenance of controlled hypotension during anesthesia
53
What is the action of diuretics?
Increase excretion of sodium and water from the kidney to lower blood pressure
54
What are two thiazide and thiazide like diuretics?
chlorothiazide | hydrochlorothiazide
55
What are 2 potassium sparing diuretics?
spironolactone | triamterene
56
What are the blockers that work in the sympathetic nervous system?
1. Beta- blockers 2. Alpha-adrenergic blockers 3. Alpha1 blockers 4. Alpha2- agonists 5. Alpha & Beta Blockers
57
What is the suffix of Beta-Blockers?
"-olol" atenolol metoprolol propanolol
58
What is the action of Beta-Blockers?
block vasoconstriction, decrease HR, decrease muscle contraction, tend to increase flow to kidneys leads to decrease in release of renin
59
What are the indications for Beta-Blockers?
hypertension, angina pectoris, tachyarrhythmias, migrane H/A, MI, glaucoma, HF, hyperthryroidism
60
Contraindications for Beta-Blockers
Heart failure, bradycardia, and heart block (type of arrhythmia)
61
Cautions for Beta-Blockers
pregnancy/ lactation renal/ hepatic dysfunction lunch disease- can lead to bronchospasm diabetes- masks low blood symptoms
62
ADE of Beta-Blockers
CNS- HA, Fatigue, diziness, CV- bradycardia hypotension Pulmonary- bronchospasm, laryngospasm, GU: decrease libido and impotence
63
Drug/ Drug interactions of Beta-Blockers
may antagonize therapeutic effects of broncho dilators | may alter requirements for insulin for diabetics
64
What would you assess prior to administering Beta-Blockers?
Apical pulse
65
Diabetics taking this should be taught to monitor glucose closely bc it can mask low blood symptoms
Beta-Blockers
66
Suffix of Alpha-adrenergic blockers
"-amine" - phenoxybenzamine - phentoalamine
67
Actions of Alpha-adrenergic blockers
inhibit post synaptic alpha adrenergic receptors, decreasing sympathetic tone in the vasculature and causing vasodilation
68
Indications of Alpha-adrenergic blockers
diagnose and manage episodes of pheochromocytoma- a benign adrenal gland tumor where too many hormones are released but helps w/ hypertension caused by it
69
ADE of Alpha-adrenergic blockers
reflex tachycardia
70
Suffix of Alpha1-blockers
"-azosin" doxazosin prazosin terazosin
71
Actions of Alpha1-blockers
blocks the postsynaptic alpha receptor sites leading to decreases in vascular tone and vasodilation
72
Indications for Alpha1-blockers
hypertension
73
ADE of Alpha1-blockers
reflex tachycardia
74
This sympathetic nervous system blocker isn't usually a 1st line medication but is used in combo
Alpha2-agonists
75
Alpha2-agonists medications
clonidine (most common) guanfacine methyldopa
76
What blocks all the receptors in the SNS?
Alpha- and Beta- Blockers
77
Indications for Alpha- and Beta- Blockers
hypertension
78
Alpha- and Beta- Blockers Medications
Carvedilol | Labetalol
79
Actions of antihypotensive agents
sympathomimetic drugs that stimulate the SNS to increase BP
80
What is the only way to administer most antihypotensive agents
IV ONLY
81
What are the suffixes of sympathetic adrenergic agonists or vasopressors?
``` "-amine" dobutamine dopamine "-rine" epinephrine ephedrine norepinephrine phenylephrine ```
82
What are the oral medications for BP raising/ orthostatic hypotension?
Mixodrine | droxidopa
83
Which antihypotensive would you NOT give to a bedridden pt and why?
midodrine or droxidopa d/t supine hypertension
84
Antihypotensive drug effects to monitor for
hypertension, dizziness, visual changes, HA, chills, urinary problems
85
Describe the RAAS System
1. BP Drops 2. SNS activates 3. Kidney juxtoglomerular cells release RENIN 4. Renin activates angiotensinoGEN-> angiotenin I 5. ACE converts angiotensin I to II 6. Angiotensin II constricts blood vessels & increase blood volume; helps kidney keep sodium and water 7. Adrenal cortex releases aldosterone to help kidney keep sodium & water 8. Pituitary gland releases ADH to help kidneys keep H2o
86
Describe the angel-tennis in tutu w/ receptor blocked (picmonic)
angiotensin II receptor blocks; playing the "spartans" end in "-sartan"
87
When are ARBs contraindicated (picmonic)
Pregnancy and renal artery stenosis (kidneys of stone) b/c they can cause renal failure
88
When are ARBs indicated (picmonic)
Hiker BP- hypertension
89
Action of Losartan (picmonic)
blocks angiotensin II receptor- blocks angel-tennis in (2) tutu receptor
90
What is a side effect of ARBs (picmonic)
angioedema

Pharm Exams (25 decks)

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