Pharm Exam 2 and 3 Hypertension and Heart Failure Flashcards
What are the uses for hypertonic solutions?
Move fluid from inside the cell to out
hyponatremia or hypoglycemia
digoxin therapeutic levels
.5-2ng/ml
Hydralazine (apresoline)
action
dosing
Uses
Adverse effects
antihypertensive, vasodilator
3-4 times a day
moderate to severe HTN, off label, HTN emergencies and heart failure with reduced ejection fraction
flushing, headache, GI issues
When are thiazides not effective?
When urine flow is scant
What factors affect electrolyte absorption?
concentration gradients
binding proteins
contents of the GI tract
pH of intestinal content
medications
surgical removal of GI tract
What qualifies as high BP
> 80mmHg diastolic
130mmHg systolic
Mechanism of action of crystalloid solutions?
Small molecules flow across semipermeable membranes allowing transfer from the bloodstream into cells.
For lifestyle modifications, what is the ideal amount of daily sodium?
1500mg or less.
Uses for D5W
should not be used alone to treate low fluid volume
resuscitation
increased ICP
hypernatremia
Causes of hypokalemia
decreased dietary potassium
shift from ECF into cells
increased excretion
what are the two types of calcium channel blockers?
DHP (vascular selective) and Non-DHP (myocardial selective)
What is the most common loop diuretic?
Furosemide (Lasix)
How do diuretics work?
block sodium and chloride reabsorption
What are the four types of IV solutions?
crystalloids, colloids, isotonic, and hypertonic
digoxin pharmacokinetics
rapid absorption and wide distrubution
lipophilic
rapid onset
Adverse effects of mannitol
edema, headache, N/V, and fluid/electrolyte imbalance
What effects on the heart does Digoxin have?
strengthens contraction, slows heart rate and conduction velocity
Hyponatremia causes
Too much water from excessive ADH release, excess water intake, or decreased Na intake
Too much salt being lost from thiazide diuretics and salt wasting renal disease
Uses for .9% NaCl
treat low extracellular fluid from fluid loss
shock, mild hyponatremia, metabolic acidosis, and hypercalcemia
Uses for digoxin
congestive heart failure: improves contractility
arrhythmias: slows conduction velocity through SA node and the refractory period at the AV nodes, decrease HR
Who should not be given lactated ringers?
People who cannot metabolize lactate like liver disease or lactic acidosis
Which electrolytes are higher inside the cell?
potassium, magnesium, and phosphate
Effects of Beta 2 blocking
bronchoconstriction, vasoconstriction, and inhibits glycogenolysis
Adverse effects of furosemide?
OTOXICITY
decreased sodium, potassium, chloride, calcium, and magnesium
dehydration
Hypotension due to loss of BV and relaxation of venous smooth muscle
hyperglycemia
hyperuricemia (uric acid)
disrupts lipid metabolism and reduces HDL, increases LDL and triglycerides
Therapeutic uses for spironolactone (potassium-sparing)
Hypertension
Edema
heart failure
primary hyperaldosteronism
PMS
PCOS
acne in women
What are the adverse effects of thiazides?
increased renal excretion of sodium, chloride, potassium, and water
elevate levels of uric acid and glucose
hyponatremia treament
treat cause, reduce water intake, Na tabs
treatement of digoxin toxicity
temporary pacemaker and digibind
Are the adverse effects of sudden stoppage of beta blockers?
hypertensive crisis
bronchodialation
rebound tachycardia
hypoglycemia
What are calcium channel blockers effective for treating?
HTN and symptoms of angina
treatment for hyperkalemia
potassium removal
Kayexalate
Uses for lactated ringer’s
fluid replacement for burn patients, acute blood loss or hypovolemia
Adverse effects of spironolactone
increased potassium
tumors
endocrine effects
Lisinopril- type of drug
absorption
onset/peak
duration
excretion
dosing
ACEi
good absorption
onset in 60 min/peak 6 hours
24 hour duration
kidneys
daily
Which electrolytes are higher outside the cell?
sodium, chloride, bicarbonate ions
Hypernatremia causes
More salt than water-dehydration
Loss of more water than salt-hyperventilation, diabetes insipidus (not enough ADH), prolonged diarrhea/vomiting
Causes of hyperkalemia
increased IV intake, shift from cells to ECF, and decreased excretion
Mechanism of action of colloid solutions?
Remain in blood and increases fluid in blood.
Symptoms of hyperkalemia
!ascending muscle weakness and dysrhythmias and cardiac arrest
intestinal cramping, diarrhea, finger and lips tingling
hydrochlorothiazide drug interactions
digoxin
intensifies hypertensive medications
lithium
NSAIDS
ototoxic drugs
mechanism of action for mannitol (osmotic diuretic)
promotes diuresis by creating osmotic forces within the lumen of the nephron
Digoxin toxicity signs and potassium component
early: anorexia, nausea, double vision, yellow vision, halos around objects
late: arrhythmias, AV or complete heart block
Must keep potassium above 3.2 or cardiotoxicity occurs.
What are the four anatomical locations BP drugs work on?
heart, blood vessels, CNS, and PNS
Hypernatremia treatment
treat cause, IV d5W (dextrose), increase water intake
What is the location of action for hydrochlorothiazide?
proximal section of the distal convoluted tubule
What is the onset for furosemide?
IV 5 mins
PO 60 mins
What is systolic hypertension caused by?
stiff aorta and arteries
What is the onset of hydrochlorothiazide?
4-6 hours
Calcium channel blocker actions
blocks calcium channels in vascular smooth muscle, lowers arterial pressure, and indirectly activates baroreceptor reflex (maintains BP).
Should furosemide be used in pregnancy?
Probably not
Hyponatremia symptoms (x<135mEq)
!seizures, coma, cerebral herniation
confusion
N/V
muscle weakness/fatigue
headaches
restless/irritable
Losartan (cozaar)
type of drug
half life
duration
metabolism
elimination
angiotension II receptor antagonists (ARB)
1.5-2 hours
24 hours
P450 to active metabolite
urine and feces
treatment for hypokalemia
potassium replacement (IV or oral)
Furosemide drug interactions
Digoxin
Ototoxic drug (aminoglycosides)
Potassium-sparing diuretics
Lithium
antihypertensive agents
NSAIDs
Therapeutic uses of mannitol
prophylaxis of renal failure
reduction of intracranial pressure
reduction of intraocular pressure
Adverse effects of lisinopril
bradykinin (dry cough)
!first dose hypotensive effect
hyperkalemia
angioedema
pregnancy harm crosses placenta/breast milk
Hypokalemia symptoms
!respiratory paralysis, bilateral muscle weakness, and dysrhythmias (sudden death)
abdominal distention and diminished bowel sounds
polyuria
spironolactone drug interactions
thiazide and loop diuretics
agents that raise potassium levels (ACEi)
What are the adverse effects of hydrochlorothiazide?
Decreased sodium, chloride, and potassium
Increased uric acid and glucose
Dehydration
Examples of isotonic solutions
.9% NaCl, lactated ringers, 5% dextrose in water, and ringer’s solution
What is the mechanism of action for spironolactone?
blocks aldosterone in the distal nephron, retains potassium, increased excretion of sodium
What are the four major categories of diuretics?
loop, thiazide, osmotic, and potassium sparing (non/aldosterone antagonists)
For lifestyle modifications, what is the ideal amount of daily potassium?
3500-5000 mg
Can mannitol be taken orally?
no
What are the effects of ACE inhibitors?
arteriolar and venous dilation, suppression of aldosterone release, and reduced cardiac remodeling.
Side effects of beta blockers
bradycardia
bronchioconstriction
CNS depression
hypotension
fatigue
sexual dysfunction
masks symptoms of hypoglycemia
Hypernatremia symptoms (x>145mEq/L)
!seizures, coma, cerebral hemorrhage
confusion, lethargy, thirst, weight gain, and increased BP
What are the therapeutic uses or hydrochlorothiazide?
essential hypertension, edema, diabetes insipidus
Cardiac glycoside
Digoxin
Name the 6 lines of heart failure medication?
- diuretics
- ACE inhibitors
- beta blockers
- digoxin if needed
- aldosterone antagonist
- vasodialators if angina is present
Nisoldipine (sular)
Type of CCB
Use
Dosing
Adverse effects
DHP CCB
HTN
daily
headache, peripheral edema, dizziness, pharyngitis
What percentage of hypertension is primary?
90%
What are the uses for furosemide?
pulmonary edema, edematous states, hypertension
What are the four types of beta blockers?
Atenolol- B1
Carvedilol- A1, B1,B2
Metoprolol- B1
Propranolol-B1, B2
Normal values for potassium?
3.5-5 mEq/L
Effects of B1 blocking
reduced HR, decreased contraction, suppresses impulse conduction and renin secretion
What is the mechanism of action of furosemide?
acts on ascending loop of Henle to block the reabsorption of Na+
What is the most effective diuretic?
furosemide
What is the normal range of sodium?
135-145 mEq/L
Colloid solution examples
albumin, dextrans, and hydroxyethyl starches
lisinopril drug interactions
diuretics, NSAIDS, and other HTN agents
What are the adverse effects of diuretics?
hypovolemia, acid-base imbalance, and electrolyte imbalance
which three types of drugs cause hyperkalemia?
potassium-sparing diuretics, ace inhibitors, and ARBS
does digoxin prolong life?
no
What enzyme does digoxin act on?
Na/K ATPase
What causes digoxin-induced ventricular dysrhythmias?
Decreased automaticity of the SA node, decreased impulse conduction through the AV node, spontaneous discharge of Purkinje fibers, and shortening of the effective refractory period in the ventricle muscle.
how do you manage digoxin induced dysrhythmias?
withdraw digoxin and K+ wasting diuretics
monitor serum K+
antidysrhythmic drug
Treatment with Digifab or activated charcoal
the therapeutic range of digoxin
.5-.8 ng/mL
ace inhibitors
lisinopril, captopril, enalapril
aldosterone antagonist
spironolactone
inotropics
digoxin
alpha and beta blockers
carvedilol
vasodilators
isosorbide and apresoline
human B natriuretic peptide
nesiritide IV only
verapamil- drug type
uses
side effects/contraindications
dosing/administration
calcium channel blocker
reduce heart rate, reduce AV conduction, reduce heart contractility
HTN for people with afib, angina, supraventricular tachycardia, and cluster headaches
constipation and not for nursing mothers
PO/IV
