Quiz 1 Antihypertensive MOA and counseling points

Question 1

Atenolol

Answer 1

General Mechanism of Action: Atenolol is a cardio selective beta-adrenergic that decreases AV nodal conduction in supra-ventricular tachycardias and blockade of catecholamine-induced dysrhythmias

Key patient counseling points: Take on an empty stomach. Avoid abrupt discontinuation; exacerbations of angina may occur. Report signs/symptoms of bradycardia, hypotension, heart failure, or exacerbation of angina with initial dosing and dose changes. May cause dizziness or drowsiness. Diabetic patients to carefully follow blood sugar levels as β-blockers may mask symptoms of hypoglycemia. Drug may cause sexual side effects, fatigue, and depression.

Question 2

Metoprolol

Answer 2

General Mechanism of Action: Metoprolol is a cardio selective beta-adrenergic blocker used in arrhythmias, HTN, angina pectoris, and heart failure. It is also effective in decreasing post-MI mortality.

Key patient counseling points: Take on an empty stomach and avoid alcohol. Avoid abrupt discontinuation, exacerbations of angina may occur. Instruct patients to report signs/symptoms of hypotension, heart failure, or exacerbation of angina with initial dosing and dose changes. Advise diabetic patients to carefully follow blood sugar levels as beta-blockers may mask symptoms of hypoglycemia.

Question 3

Nebivolol

Answer 3

General Mechanism of Action: Nebivolol is a long-acting B1-adrenoceptor antagonist without intrinsic sympathomimetic activities. The mechanism of action of the antihypertensive response of nebivolol Is not fully understood. Possible mechanisms include decreased HR, decreased myocardial contractility and vasodilation, and decreased peripheral vascular resistance.

Key patient counseling points: Report signs/symptoms of hypotension, worsening heart failure, or bronchospastic disease. Diabetic patients should carefully monitor blood sugar levels as beta-blockers may mask symptoms of hypoglycemia. Do not discontinue drug abruptly, as this may cause rebound angina or, in some cases, AMI.

Question 4

Propanolol

Answer 4

General Mechanism of Action: Propranolol is a nonselective β-adrenergic blocker that competitively blocks β1 and β2 receptors, thereby preventing β-adrenergic stimulation. The mechanism of its antihypertensive and anti-migraine effects is not completely understood.

Key patient counseling points: Take immediate-release tablets on an empty stomach; ER can be taken with or without food but consistently. Avoid alcohol. Avoid abrupt discontinuation; exacerbations of angina may occur. Report signs/symptoms of hypotension, CHF, or exacerbation of angina with initial dosing and dose changes. This medicine may cause dizziness. Diabetic patients should carefully follow blood glucose as beta-blockers may mask symptoms of hypoglycemia.

Question 5

Carvedilol

Answer 5

General Mechanism of Action: Carvedilol is a selective alpha1 and nonselective beta-adrenergic blocker that can decrease AV nodal conduction in supra-ventricular tachycardias and blockade of catecholamine-induced dysrhythmia.

Key patient counseling points: Take carvedilol with food or milk. Report signs/symptoms of heart failure, bradyarrhythmias, bronchospasm, hypotension, syncope, or exacerbation of angina with initial dosing and dose changes. Avoid abrupt discontinuation, may cause rebound HTN. Avoid driving, using machinery, or doing anything else that could be dangerous if not alert. Diabetic patients should carefully follow blood sugar levels as beta-blockers may mask symptoms of hypoglycemia.

Question 6

Labetalol

Answer 6

General Mechanism of Action: Carvedilol is a selective alpha1 and nonselective beta-adrenergic blocker that can decrease AV nodal conduction in supra-ventricular tachycardias and blockade of catecholamine-induced dysrhythmia.

Key patient counseling points: Report signs/symptoms of hypotension with initial dosing and dose changes. Avoid alcohol while taking drug. May cause dizziness. Instruct patient to rise slowly from a sitting/supine position, as labetalol may cause orthostatic hypotension. Report signs/symptoms of bronchospasm, slow HR, hepatotoxicity, or syncope. Advise diabetic patients to carefully follow blood sugar levels as beta-blockers may mask symptoms of hypoglycemia. Advise patients against sudden discontinuation of drug as this may cause rebound HTN.

Question 7

Clonidine

Answer 7

General Mechanism of Action: Clonidine simulates presynaptic alpha2-adrenergic receptors and blocks postsynaptic alpha2-adrenergic receptors in the CNS by activating inhibitory neurons to decrease sympathetic outflow. Clonidine is not a complete agonist, so some of its effects might result from antagonist actions at presynaptic alpha-receptors. These actions reduce peripheral vascular resistance, renal vascular resistance, HR, and BP.

Key patient counseling points: Avoid alcohol, CNS depressants. Use caution with driving and other tasks requiring alertness. May cause nausea, vomiting, insomnia, constipation, fatigue, or dry mouth. Swallow extended-release tablet whole. Apply patch to hairless area of intact skin on upper outer arm or chest; rotate patch location. If patch loosens during the 7-d wearing, secure adhesive cover. Report signs/symptoms of hypotension, exacerbation of angina peripheral edema, fatigue, hypotension, or hepatic dysfunction with initial dosing and dose changes. Avoid abrupt discontinuation to avoid rebound HTN.

Question 8

Prazosin

Answer 8

General Mechanism of Action: Prazosin inhibits the postsynaptic alpha1-adrenoceptors. This inhibition blocks the vasoconstriction effect of catecholamines on the vessels, leading to peripheral blood vessel dilation through blood vessel constriction by adrenergic receptor activation, epinephrine and norepinephrine normally try to increase blood pressure

Key patient counseling points: Do not take more or less of it or take it more often than prescribed by your doctor.

Your doctor will probably start you on a low dose of prazosin and gradually increase your dose.

Prazosin controls high blood pressure but does not cure it. Continue to take prazosin even if you feel well. Do not stop taking prazosin without talking to your doctor.

Take this medication by mouth with or without food, usually two or three times daily or as directed by your doctor. If stomach upset occurs, take with food or milk. The dosage is based on your age, medical condition and response to therapy.

Question 9

Amlodipine

Answer 9

General Mechanism of Action: Amlodipine is a long-acting dihydropyridine calcium-channel bloacking drug with potent arterial and coronary vasodilating properties

Key patient counseling points: Instruct patient to report signs/symptoms of hypotension or exacerbation of angina with initial dosing and dose changes. Avoid alcohol while taking drug. Report signs/symptoms of peripheral edema, fatigue, hypotension, or hepatic dysfunction. This medicine may cause dizziness. Avoid activities that could be dangerous if dizziness occurs at initiation of therapy. Dizziness may be worse if too much water is lost from the body due to excessive sweating, diarrhea, or vomiting.

Question 10

Nifedipine

Answer 10

General Mechanism of Action: Nifedipine is a calcium ion influx inhibitor that selectively inhibits the transmembrane influx of calcium ions into cardiac muscle and smooth muscle. Nifedipine does not alter serum calcium concentrations.

Key patient counseling points: Take Adalat CC on an empty stomach. Report signs/symptoms of hypotension, exacerbation of angina, peripheral edema, fatigue, or hypotension. Avoid sudden discontinuation of drug as this may cause rebound HTN. May cause dizziness; avoid driving or using hazardous machinery until effects are known. Avoid grapefruit juice. May see tablet or shell of dosage form in stool.

Question 11

Hydralazine

Answer 11

General Mechanism of Action: Hydralazine is a vasodilator that reduces total peripheral resistance by direct action on vascular smooth muscle, with an effect greater on arterioles than on veins.

Key patient counseling points: Patient should not drink alcohol while taking drug. Advise patient against sudden discontinuation of drug as this may cause rebound HTN. This medicine may cause dizziness. Patient should report chest pain, palpitations, signs/symptoms of tachyarrhythmia, hypotension, agranulocytosis, systemic lupus erythematosus, or hepatotoxicity.

Question 12

Chlorthalidone

Answer 12

General Mechanism of Action: Chlorthalidone increases sodium and chloride excretion by interfering with their reabsorption in the cortical-diluting segment of the nephron.

Key patient counseling points: Take in the morning with food. Instruct patient to report signs/symptoms of dyspnea, hypotension, gout, or heart failure. Avoid alcohol (may cause hypotension) and NSAIDs (may decrease effectiveness). This medicine may cause dizziness or blurred vision. Avoid driving, using machinery, or doing anything else that could be dangerous if not alert.

Question 13

Furosemide

Answer 13

General Mechanism of Action: Furosemide is a loop diuretic that is actively secreted via the nonspecific organic acid transport system into the lumen of the thick ascending limb of Henle’s loop, where it decreases sodium reabsorption by competing for the chloride sites on the Na+ -K+ -2Cl- cotransporter

Key patient counseling points: Avoid alcohol and NSAIDs. Increased risk of sun-sensitivity; use sunscreen and avoid tanning. Avoid activities requiring coordination until drug effects are realized, as drug may cause dizziness, vertigo, or blurred vision. Report signs/symptoms of hypotension, decreased urine output, or ototoxicity; severe skin reactions. Eat high-potassium foods, as directed by health-care professional.

Question 14

Hydrochlorothiazide

Answer 14

General Mechanism of Action: Thiazides increase sodium and chloride excretion by interfering with their reabsorption in the cortical diluting segment of the nephron.

Key patient counseling points: May be taken with or without food. Take early in the day to avoid nocturia, even if taken more than once/d (eg, bid administration at 8 AM and 2 PM). May cause dizziness. Report signs/symptoms of hypotension. Eat high-potassium foods during therapy. Avoid alcohol and using NSAIDs.

Question 15

Spironolactone

Answer 15

General Mechanism of Action: Spironolactone is a steroidal competitive aldosterone antagonist that acts from the interstitial side of the distal and collecting tubular epithelium to block sodium-potassium exchange, producing a delayed and mild diuresis. The diuretic effect is maximal in states of hyperaldosteronism. Excretion of sodium and chloride excretion is increased; excretion of potassium and magnesium is decreased. Spironolactone has mild antihypertensive activity and has demonstrated a beneficial effect in NYHA class III and IV heart failure.

Key patient counseling points: May cause dizziness. Avoid driving, using machinery, or doing anything else that could be dangerous if not alert. Report signs/symptoms of hyperkalemia (muscle weakness, fatigue, bradycardia) and hyponatremia (confusion, dry mouth, thirst, weakness, hypotension, decreased urination). Avoid potassium supplements, foods/salt substitutes that are high in potassium. Avoid alcohol and NSAIDs.

Question 16

Triamterene-HCTZ

Answer 16

General Mechanism of Action: Triamterene acts directly from the distal tubular lumen on active sodium exchange for potassium and hydrogen, producing a mild diuresis that is independent of aldosterone concentration. Antihypertensive activity is inconsistent and less pronounced than with thiazides or spironolactone. Hydrochlorothiazide is a thiazide diuretic that increases sodium and chloride excretion by interfering with their reabsorption in the cortical diluting segment of the nephron; a mild diuresis of slightly concentrated urine results.

Key patient counseling points: May cause dizziness. Rise slowly from a sitting or lying position to avoid dizziness. Avoid foods that are high in potassium, potassium supplements, or potassium-containing salt substitutes. Avoid alcohol and NSAIDs. May cause photosensitivity; use sunscreen. Use with caution in patients with sulfonamide allergy.

Question 17

Irbesartan

Answer 17

General Mechanism of Action: Irbesartan is a selective, reversible, competitive antagonist of angiotensin II receptor (AT1), which is responsible for the physiologic effects of angiotensin II including vasoconstriction, aldosterone secretion, sympathetic outflow, and stimulation of renal sodium reabsorption.

Key patient counseling points: Seek medical attention if angioedema (swelling of the face, eyes, lips, tongue, or throat), excessive fluid loss (vomiting, diarrhea, or excessive perspiration), hyperkalemia (confusion, body weakness, uneven heartbeat, or numbness/tingling in hands or feet), reduction in urination, jaundice, or skin rash occurs. Avoid pregnancy. Avoid abrupt discontinuation. Use potassium supplements or salt substitutes only under medical supervision. This medicine may cause dizziness. Avoid alcohol or driving.

Question 18

Losartan

Answer 18

General Mechanism of Action: Losartan is a selective, reversible, competitive antagonist of the angiotensin II receptor (AT1), which is responsible for the physiologic effects of angiotensin II including vasoconstriction, aldosterone secretion, sympathetic outflow, and stimulation of renal sodium reabsorption.

Key patient counseling points: Avoid pregnancy. Avoid sudden discontinuation; rebound HTN can occur. Use potassium supplements or salt substitutes only under medical supervision. May cause dizziness that may worsen if dehydrated. Seek medical attention if angioedema, excessive fluid loss, hyperkalemia, reduction in urination, or jaundice occurs.

Question 19

Losartan-HCTZ

Answer 19

General Mechanism of Action: Selectively antagonizes angiotensin Ii receptors + inhibits covoluted tubule sodium and chloride reabsorption

Key patient counseling points: Seek medical attention of angioedema (swelling of the face, eyes, lips, tongue, or throat), excessive fluid loss (voiting, diarrhea, or excessive perspiration), hyperkalemia (confusion, body weakness, uneven heartbeat, or numbness/tingling in hands or feet), reduction in urination, jaundice, or skin rash occurs. Avoid pregnancy. Avoid abrupt discontinuation. Use potassium supplements or salt substitutes only under medical supervision. This medicine may cause dizziness. Avoid alcohol or driving

Question 20

Olmesartan

Answer 20

General Mechanism of Action: Olmesartan is a selective, reversible, competitive antagonist of the angiotensin II receptor (AT1)

Key patient counseling points: Avoid pregnancy. Use potassium supplements or salt substitutes only under medical supervision. May cause dizziness that may worsen if dehydrated. Seek care if angioedema, excessive fluid loss, hyperkalemia, reduction in urination, or jaundice occurs. May cause orthostatic hypotension.

Question 21

Valsartan

Answer 21

General Mechanism of Action: Valsartan is a selective, reversible, competitive antagonist of the angiotensin II receptor, which is responsible for the physiologic effects of angiotensin II, including vasoconstriction, aldosterone secretion, sympathetic outflow, and stimulation of renal sodium reabsorption.

Key patient counseling points: Do not discontinue abruptly. Use potassium supplements or salt substitutes only under medical supervision. This medicine may cause dizziness. Avoid driving, using machinery, or doing anything else that could be dangerous if not alert. Recommend avoiding alcohol and NSAIDs while taking this drug.

Question 22

Benazepril

Answer 22

General Mechanism of Action: Benazepril is a competitive ACE-I. It also reduces serum aldosterone, leading to decreased sodium retention, potentiates the vasodilator kallikrein–kinin system, and can alter prostanoid metabolism, inhibit the sympathetic nervous system, and inhibit the tissue renin-angiotensin system.

Key patient counseling points: Avoid pregnancy. Seek medical attention immediately if you experience any facial swelling. Most common adverse effect is dry cough. Use potassium supplements or salt substitutes only under medical supervision. May cause dizziness that may worsen if dehydrated. Take at the same time daily.

Question 23

Enalapril

Answer 23

General Mechanism of Action: Enalapril is a prodrug that is rapidly converted to its active metabolite, enalaprilat, a competitive ACEI. It reduces serum aldosterone, leading to decreased sodium retention, potentiates the vasodilator kallikrein–kinin system, and inhibits the sympathetic nervous system and tissue renin-angiotensin system. The net effect is reduction in total peripheral resistance and BP in hypertensive patients and reduction in elevated afterload in patients with heart failure.

Key patient counseling points: Use potassium supplements or salt substitutes only under medical supervision. Report signs/symptoms of angioedema. May cause dizziness that may worsen if dehydrated. Use caution rising from sitting or lying position, especially when initiating treatment.

Question 24

Lisinopril

Answer 24

General Mechanism of Action: Lisinopril is a competitive ACEI. It also reduces serum aldosterone, leading to decreased sodium retention, potentiates the vasodilator kallikrein–kinin system, and can alter prostanoid metabolism, inhibit the sympathetic nervous system, and inhibit the tissue renin-angiotensin system

Key patient counseling points: Avoid pregnancy. Use potassium supplements or salt substitutes only under medical supervision. May cause dizziness that may worsen if dehydrated.

Question 25

Lisinopril-HCTZ

Answer 25

General Mechanism of Action: Lisinopril is a competitive ACEI. It also reduces serum aldosterone, leading to decreased sodium retention, potentiates the vasodilator killikrein - kinin system, and can alter prostanoid metabolism, inhibit the sympathetic nervous system, and inhibit the tissue renin-angiotensin system

Key patient counseling points: Avoid pregnancy. May be taken with or without food. Take early in the day to avoid nocturia, even if taken more than once/d (eg, bid administration at 8 AM and 2 PM). May cause dizziness. Report signs/symptoms of hypotension. Eat high-potassium foods during therapy. Avoid alcohol and using NSAIDs.

Question 26

Rampiril

Answer 26

General Mechanism of Action: Ramipril is a competitive ACEI. It is also a prodrug for the more potent ACEI ramiprilat. ACEI prevents conversion of angiotensin I to angiotensin II (a vasoconstrictor). It also reduces serum aldosterone, leading to decreased sodium retention, potentiates the vasodilator kallikrein–kinin system, and inhibits the tissue renin-angiotensin system.

Key patient counseling points: Avoid pregnancy. Use potassium supplements or salt substitutes only under medical supervision. May cause dizziness that may worsen if dehydrated.