pharm hypertension Flashcards
primary hypertension
Essential (Primary) (90%): unknown cause
secondary hypertension
Secondary (10%): related to identifiable cause
(e.g., obesity, sleep apnea, excess sodium
intake, drug induced) in which treatment is
directed toward correcting the underlying cause
Gestational HTN
> 140/ > 90
After 20 weeks gestation
No proteinuria
medications that can cause HTN (Lock NESS causes HTN)
Estrogens
NSAIDs
Stimulants
Steroids
Primary Mechanisms to Control Blood Pressure - short and long term
Adrenergic nervous system or baroreceptor
reflex (brain): a rapid-acting system
Renin-angiotensin-aldosterone
mechanism: a long-acting system
Activation of a receptors leads to
smooth muscle
contraction
Activation of b2
receptors leads to (2nd is lungs)
smooth
muscle relaxation - lungs
Activation of b1
receptors leads to (what happens to the muscles?)
smooth
muscle contraction - (especially in heart)
b2 agonist used for
asthma
b1 antagonists (BETA BLOCKERS) used for what? And does it slow down or speed up heart? And what about contraction?
treatment of hypertension and angina (slow heart and
reduce force of contraction)
alpha 1 antogonist used for (only the big alpha will cure HTN)
lowering of the blood pressure (relaxation of smooth
muscle and dilation of the blood vessels)
Clonidine (Catapres®) - agonist to…(Clonidine agonizes over little alpha) AND what is it used for?
Agonist to the CNS alpha – 2 adrenergic receptors (relaxes
vascular smooth muscle) - severe pain for cancer used with opiates
Withdrawal HTN when taking with (when adriene is blocked she withdraws)
beta – adrenergic
blocking agents and abruptly discontinued
Prazosin (Minipress®) (the minipress blocks big Alpha)
Selectively blocks alpha1-adrenergic receptors, decreases
vascular sympathetic tone (dilates arterioles and veins)
minipress nursing implications - and limit dose to what? (minipress makes me dizzy)
First time usage has reported risk of syncope
w/sudden loss of consciousness. Limit dose to 1mg PO
at bedtime to start
Propranolol (Inderal®) - Competitively blocks what? And what does that do? (MJ just blocks beta, now he’s the alpha)
Competitively blocks beta adrenergic receptors in the heart
and juxtaglomerular apparatus decreasing the influence of
the sympathetic nervous system
Propranolol (Inderal®) getting off it…(MJ for 2 weeks)
Taper over 2 weeks if pt is to discontinue after long
term therapy
Calcium Channel Blockers - approved and non FDA approved for (Calcium helps with my hemmorage, but not with Raynaud)
approved - ▪ Subarachnoid hemorrhage
non approved - Raynaud’s phenomenon
Nifedipine (Adalat®) (Procardia®) side effects (nifty gingevitis)
Gingival hyperplasia
Nifedipine (Adalat®) (Procardia®) overdose antidote (glue is nifty during an overdose)
Antidote: Calcium gluconate (IV). ER tabs may not be chewed
Captopril (Capoten®) adverse effects (The captin is puffy and coughing)
- NON PRODUCTIVE cough
- Angioedema
Angiotensin II Receptor Blockers
(ARB’s) - examples (get a tan at Arby’s)
Includes losartan and valsartan
Losartan (Cozaar®)
Angiotensin II receptor blocker (ARB)
losartan adverse effects (loose the tan, loose the puffy cough with this one)
- Same as ACE inhibitors but does not cause
- Dry cough, angioedema
Vasodilators - Arteriolar dilators ex. (Art expands with hydra and hair)
hydralazine, minoxidil
Hydralazine (Apresoline®) precautions (hydros cause stroke, headache and I can’t pee)
Caution with CVAs (stroke), increased ICP (risk of ischemia) difficulty with micturation
Diuretics - what is recommended as firstline drug therapy? (Thia is always first)
*Thiazide diuretics
Hydrochlorothiazide
(HCTZ / HydroDIURIL®) peak (hydros only work for 4-6 hours)
Peaks 4-6 hours
Hydrochlorothiazide
(HCTZ / HydroDIURIL®) - dosing? (You don’t need hydro every day)
Not always a daily dose, help patients mark calendar
for 3 or 5 dose/week administration
Furosemide (Lasix®) - can still work when what occurs?
Renal Failure: Lasix works even when GFR is low
Blood Pressure Control precautions -dosing?
NEVER double up on doses if 1 is missed
vasodilators - Arteriolar and venous dilators (sodium on nitro works everywhere, veins and arteries)
sodium nitroprusside
propranolol - what does it do to 02 consumption by the heart? (MJ takes my O2)
Decreases cardiac O2 consumption
Activation of alpha and beta 1 receptors leads to
smooth muscle contraction
Activation of b2 receptors leads to (think asthma for beta 2)
smooth muscle relaxation - lungs
Activation of b1 receptors leads to
smooth muscle contraction - (especially in heart)
Agonists of the b2 receptors are used in the treatment of
asthma (relaxation of the smooth muscles of the bronchi)
Antagonists of the b1 receptors are used in the treatment of
hypertension and angina (slow heart and reduce force of contraction)
Antagonists of the a1 receptors are known to cause
lowering of the blood pressure (relaxation of smooth muscle and dilation of the blood vessels)
1
contracts
2
relaxes
clonidine and withdrawal?
Withdrawal HTN when taking with beta – adrenergic blocking agents and abruptly discontinued
clonidine side effects (the usual)
dry mouth, constipation, skin rash
minipress dosing (minipress, mini dose)
Limit dose to 1mg PO at bedtime to start
nifedipine is a (calcium is nifty)
CCB
if pt has diabetes, use which HTN med? (diabetics get Arby’s)
ARB first, then ACE inhibitor
Captopril (Capin’ is an ACE)
Ace inhibitor
Arby’s v. ACE (soda to sooth cough at Arbys)
no cough or edema with Arbs
hydralizine - rebound? (Hydros ALWAYS cause a rebound)
Do not discontinue abruptly – may cause a severe increase in BP
Antidysrhythmics classes
1 - 4
class 1 examples (Na is first)
(QUINIDINE, LIDOCAINE,FLECANIDE)
class 2 example (don’t be second class at the met)
METOPROLOL
class 3 example (Amor is my fav class, 3)
AMIODARONE
class 4 (try diazapam last, 4)
DILTIAZEM
Quinidine precautions (Quin and Gab don’t mix)
Tends to promote atrial emboli in afib
Amor treats what?
Recurrent V-Fib (or tach) - emergency
A-Fib (oral)
Amor side effects (blinded by love)
Corneal Microdeposits & Blindness
don’t mix digoxin with what drugs? (can’t pee, can you dig?)
Diuretics: Combine to lower K+
normal potassium levels
3.5 - 5
