Pharmacological Therapy of Hypertension Flashcards
1
Q
Non-pharmacological treatment of hypertension
A
- moderate alcohol consumption
- weight reduction
- sodium restriction
- exercise
- smoking cessation
- Stress reduction
2
Q
Risk Factors for Hypertension
A
Develops slowly as a silent disease
- diet
- exercise
- age
- smoking
- genetic factors
3
Q
How does moderate activity improve BP
A
- increasing the strength of the contractility of the heart
- can pump more effectively so the heart rate can slow down
- reduces workload of the heart
- gives your heart time to refill
4
Q
Blood pressure is effected by three factors;
A
`1. cardiac output
2. volume
3. peripheral resistance
pharmacotherapy for HTN focuses on reducing one or more of these factors
5
Q
complications for hypertension
A
- ventricular hypertrophy
- angina, MI, CVA, peripheral vascular disease
- heart failure
- kidney failure
- blindness
6
Q
Guidelines for management of hypertension
A
- first approach is to modify lifestyle changes
- if pressure does not change, drugs are added to reduce pressure (diuretics, ACE inhibitors, angiotensin II receptor blockers, calcium channel blockers, beta-blockers)
7
Q
Pharmacotherapy of Hypertension
A
- goal of therapy is to reduce morbidity and mortality
- individualized to patients risk factors, comorbid medical conditions, and degree of pressure elevation
- if patient does not respond to mono-therapy, more drugs may be added to the regimen including vasodilators, alpha 2 antagonists.
8
Q
Diuretics:
- indication
- mechanism of action
- adverse effects
A
- hypertension, heart failure
- reduce blood volume, lowering pressure
- hyponatremia, hypokalemia, hypovolemia, nocturia
9
Q
Monitor for Diuretics
A
- vital signs
- weight I&Os
- Electrolyte levels
10
Q
Calcium channel blockers; 3 categories
A
- Arteriole selective drugs (nifedipine)
- relax arterial smooth muscle
- indicated for hypertension, angina, Raynauds - cardioselective drugs (diltiazam)
- decrease heart rate and force of contraction
- indicated for hypertension, angina, arterial dysrhythmias - non-selective drugs (verapamil)
- affect arterial smooth muscle and heart
- indicated for hypertension, angina, certain dysrhythmias
11
Q
Adverse effects of Calcium Channel Blockers
A
- dizziness, flushing, hypotension, reflex tachycardia, peripheral edema, dysrhythmias, exacerbation of heart failure
12
Q
Prototype Drug CCB: Nifedipine
- therapeutic effect
- adverse effects
- serious adverse effects
A
- hypertension, chronic stable or variant angina
- hypotension/flushing dizziness/peripheral edema
- hepatotoxicity/paradoxical angina/severe hypotension/exacerbation of heart failure/confusion
13
Q
ACE inhibitors
- indications
- mechanism of action
- adverse effects of ACE inhibitors
A
- hypertension/heart failure
- reduce production of angiotensin II (promotes vasodilation, reducing peripheral resistance and blood pressure/reduces secretion of ADH and aldosterone, increasing urine output, decreasing blood volume, and decreasing blood pressure/enhances effects of diuretics)
- persistent cough from bradykinin. /postural hypotension/hyperkalemia/angioedema
14
Q
Angiotensin II Receptor Blockers
- indication
- mechanism of action
- Adverse effects
A
- hypertension/heart failure
- inhibit effects of angiotensin II, producing similar antihypertensive effects to ACE inhibitors
- orthostatic hypotension, hypotension/first-dose phenomenon/dizziness/headache/hyperkalemia
15
Q
Beta1-Blockers
- indications
- mechanisms of action
- Adverse effects
A
- hypertension, dysrhythmias, angina
- block beta1 receptors - decreased CO. Can be non-specific as well and block beta2 and/or alpha1 receptors
- Bradycardia/dysrhythmia/Hypotension/Bronchospasm/Hypoglycemia (inhibit normal signs of hypoglycemia) Inhibit the release of glucose from the liver
16
Q
Alpha1 adrenergic antagonists
- indications
- mechanisms of action
- adverse effects
A
- hypertension
- block alpha1 receptors - vasodilation
- orthostatic palpitations/dizziness/headache/flushing/nausea/vomiting
17
Q
Direct-Acting Vasodilators
- indications
- mechanism of action
- adverse effects
A
- hypertension
- Relax arterial smooth muscle directly casing vasodilation
- Hypotension/Peripheral edema/Dizziness/headache
18
Q
Prototype Drug: direct-acting vasodilator
- Hydralazine
1. therapeutic effects and uses
2. mechanisms of action
3. adverse effects
4. serious adverse effects
A
- moderate to severe hypertension/hypertensive emergencies/acute heart failure
- causes peripheral vasodilation of arterioles, reducing peripheral resistance and pressure
- hypotension/tachycardia/headache/flushing/diarrhea/nausea/orthostatic hypotension
- Lupus-like syndrome/blood dyscrasias
19
Q
Management of Hypertensive Emergency
A
- life-threatening condition present when diastolic pressure over 120 mmHg
- fast-acting direct vasodilators such as Nitroprusside sodium are used
- mechanism of action
(donates nitric oxide, a direct vasodilator) - adverse effects (hypotension/flushing/dizziness/headache)
