Pharmacology - Chapter 46 - Drugs for Hypertension

Question 1

Treatment for Hypertension must continue for ___

Answer 1

Lifetime.

Question 2

Drug therapy for hypertension does/does not cure hypertension, it only ___ the symptoms.

Answer 2

Does not cure/only reduces.

Question 3

Hypertension - what is it? (Numbers.)

Answer 3

A systolic blood pressure > 140 mm Hg and a diastolic blood pressure > 90 mm Hg. (Stage 1 is 140-159 and 90-99 and Stage 2 is >160 and >100.)

Question 4

What is the biggest type of hypertension?

Answer 4

1 Primary (Essential) Hypertension.

Question 5

Primary Hypertension - has an identifiable cause. T/F?

Answer 5

False - it does not!

Question 6

Primary Hypertension affects about ___ % of adults (ages 25-74)

Answer 6

20%.

Question 7

Secondary Hypertension - does it have an identifiable cause?

Answer 7

Yes!

Question 8

What are some causes of secondary hypertension?

Answer 8

Chronic renal failure, renovascular disease, coarction (narrowing of aorta), Primary aldosteronism, pheochromocytoma (tumor of chromaffin tissue) and oral contraceptive-induced.

Question 9

What is the objective of hypertensive therapy?

Answer 9

Treating hypertension to reduce morbidity and morality without decreasing the quality of life with the drugs employed.

Question 10

Selecting Treatment - determined by ___ __ and the presence of __ ___ ___.

Answer 10

Blood pressure and the presence of target organ damage.

Question 11

What is the 1st step in selection of treatment for hypertension?

Answer 11

Evaluate patient for major cardiovascular risk factors, clinical cardiovascular disease (CCD) and target organ damage (TOD.)

Question 12

What are some lifestyle changes to manage hypertension?

Answer 12

Lose weigh, reduce sodium intake, reduce alcohol, exercise, stop smoking, and take potassium/calcium.

Question 13

Arterial Pressure = ?

Answer 13

Cardiac output x peripheral resistance!

Question 14

What are the two systems that regulate blood pressure?

Answer 14

The Sympathetic Baroreceptor Reflex and the Renin-Angiotensin System.

Question 15

How does the Sympathetic Baroreceptor Reflex work?

Answer 15

The receptors are in the aortic arch and the carotid sinus. When BP is low, impulses are sent along the sympathetic nerves to stimulate heart and blood vessels. BP is elevated by stimulation of beta 1 receptors in heart. causing increased cardiac output. When BP is restored, the sympathetic stimulation stops.

Question 16

What are the 11 Sites of Drug Action for Antihypertensive Drugs?!

Answer 16

Brainstem, Sympathetic Ganglia, Adrenergic Terminals, Beta-Adrenergic Receptors of the Heart, Alpha-adrenergic receptors of blood vessels, Vascular Smooth Muscle, Renal Tubules, Beta 1 receptors of the juxtaglomerular cells, angiotensin converting enzyme, angiotensin 2 receptors, aldosteron receptor.

Question 17

Thiazide and related diuretics (HCTZ, Furoesmide) - can be used as antiphypertensives. T/F?

Answer 17

True!

Question 18

What do the thiazides and related diuretics do?

Answer 18

reduce blood volume and reduce arterial resistance.

Question 19

What are the adverse effects of thiazides and these other diruetics?

Answer 19

Hypokalemia, Dehydration, Hyperglycemia, and Hyperuricemia

Question 20

Adrenergic Antagonists (or antagonists)..what do they do?

Answer 20

They suppress the influence of sympathetic nervous system on the heart, blood vessels, and other structures.

Question 21

Initial Drug Selection of Anti-hypertensives - based on the presence or absence of…

Answer 21

comorbid conditions (pathological states in addition to hypertension.)

Question 22

For patients with no comorbid conditions, the preferred drugs for initial therapy are ___ and ___ ____.

Answer 22

Diuretics and Beta Blockers.

Question 23

For patients with comorbid conditions, preferred treatment depends on…

Answer 23

what the comorbid condition is.

Question 24

When using two or more drugs to treat hypertension, each drug should come from…

Answer 24

a different class.

Question 25

Step-Down Therapy - def

Answer 25

after BP has been controlled for one year, attempt should be made to reduce dosages and number of drugs in therapeutic regimen.

Question 26

African Americans - ___ % higher rate of death from whites than heart disease, __ % higher rate from stroke, and ___ % from hypertension related end-stage renal disease.

Answer 26

African Americans - 50%, 80%, 320%

Question 27

Hypertension is most common complication of…(Hint - Babies!)

Answer 27

Pregnancy!

Question 28

What is the drug of choice for hypertension in pregnancy?

Answer 28

Methyldopa, because it has no effect on uteroplacental hemodynamics or fetal hemodynamics, and it does not affect fetus or neonates.

Question 29

If the Diastolic Blood Pressure is above 120, it is a ___ ___.

Answer 29

Hypertensive Emergency.

Question 30

What drugs are used for a hypertensive emergency?

Answer 30

Sodium Nitroprusside, Nifedipine, Labetalol, Diazoxide, Trimethaphan.

Question 31

What is involved in the pre-administration assessment for nursing (with these drugs.)

Answer 31

Thegoal is to prevent long term sequelae of hypertension (heart disease, kidney disease, blindness, stroke.) You need baseline data, like BP, ECG, complete urinalysis, hemoglobin and hematocrit, blood levels of Na+, K+, Ca++, creatinine, glucose, uric acid, triglycerides, and cholesterol.
Also, implement lifestyle changes, promote compliance, and keep evaluating!