The Cardiovascular System (Hypertension) Flashcards
What are the 4 main categories of Antihypertensive Meds?
RAAS Suppressants + Calcium Channel Blockers + Sympatholytics (Anti-Adrenergic Meds) + Direct-Acting Vasodilators
What can cause Kidney Damage, Left-Sided HF, and increase the risk for Cerebrovascular Accidents / Stroke?
Acute or Chronic Hypertension
What are the 4 types of RAAS Suppressors?
Angiotensin-Converting Enzyme Inhibitors (ACE Inhibitors)
Angiotensin II Receptor Blockers (ARBs)
Aldosterone Antagonists
Direct Renin Inhibitors
What do ACE Inhibitors treat?
HTN, Diabetic Neuropathy + Left Ventricular Dysfunction caused by an MI
What is the prototype med for ACE Inhibitors?
Captopril
What are the meds that fall into the ACE Inhibitor class of med?
Captopril + Enalapril + Enalaprilat + Fosinopril + Lisinopril + Benazepril + Moexipril + Perindopril + Quinapril + Ramilpril + Trandolapril
What is Enalaprilat?
The IV form of Enalapril
How do ACE Inhibitors produce their Anti-Hypertensive effect?
Blocking Angiotensin II
What things happen after ACE Inhibitors are administered?
Arteriolar Vasodilation occurs
Increased excretion of Sodium + Water
Retention of Potassium
So Renin is an Enzyme, are Angiotensin I and Angiotensin II also enzymes?
No, they’re both Hormones
What 3 substances does the RAAS use to regulate the BP + Salt & Water Absorption?
Renin + Angiotensin I + Angiotensin II
What is Angiotensin secreted from?
The Liver
What’s the difference between Angiotensin I and Angiotensin II?
After Angiotensin I is released by the liver, it gets broken down into smaller pieces. One of the smaller parts that Angiotensin I is broken up into is Angiotensin II
What is the order in which the secretions of the RAAS are secreted that can make Hypertension occur in the first place?
Renin splits Angiotensinogen into —> Angiotensin I —> Angiotensin II —> Aldosterone & ADH —> Vasopressin
What’s the Pharmacological Action of ACE Inhibitors?
Preventing Angiotensin I from being converted to Angiotensin II
What are the Adverse Effects / Side Effects of ACE Inhibitors?
Common Adverse Effects:
Severe Hypotension + Rash
Uncommon Adverse Effects:
Hyperkalemia + Neutropenia + Angioedema
Common Side Effects:
Metallic Taste in mouth + Dry, Nonproductive Cough
What is Neutropenia?
Decreased WBC Count
What labs need to be monitored when taking ACE Inhibitors?
WBC Count + Potassium Level
What does Neutropenia leave the pt at risk for?
Infection
What is Angioedema?
A potentially life-threatening condition. It’s when your Mouth and Throat become Swollen
What causes the cough when taking ACE Inhibitors?
Increased Bradykinin Level
What causes the Angioedema when taking ACE Inhibitors?
Increase of ACE
What is ACE also called?
Kinase 2
What causes an increased Bradykinin level when taking an ACE Inhibitor?
Kinase 2 isn’t available to break it down
What is the Safety Alert for ACE Inhibitors?
Whenever a dry, unrelenting cough occurs, inform the provider so that they can decide whether or not to continue the medication with an Antitussive
The longer you have a dry cough while taking an ACE Inhibitor, the harder it can be to be rid of it after discontinuing the med.
True or false?
True
What should the dosages be like overtime for ACE Inhibitors in order to avoid Hypotension?
Start with a low dose, gradually increase
How many doses of an ACE Inhibitor does it take before Severe Hypotension can occur?
Just one dose
In what groups of pt’s is Severe Hypotension the most common when taking ACE Inhibitors?
Pt’s who’re taking Diuretics + Pt’s who’re on a Low-Sodium Diet
When is the risk for Hypotension at its greatest when taking an ACE Inhibitor?
After administering it for the first time
What can be used to treat Severe Angioedema?
IV Epinephrine
How often should the pt’s WBC Count be checked when taking an ACE Inhibitor?
Q 2 Weeks when starting to taking it, then Periodically
How should ACE Inhibitors always be administered?
PO
How often should ACE Inhibitors be taken for HTN?
2-3x Daily
How often should ACE Inhibitors be taken for HF?
3x Daily
What should the pt do if they start to feel Lightheaded after the first dose of an ACE Inhibitor?
Lay on the bed Supine
What signs of Hyperkalemia should be relayed to the provider while taking ACE Inhibitors?
Sore Throat + Palpitations + Weakness + Muscle Weakness + Other Signs of Infection
When should Females not take an ACE Inhibitor?
When Pregnant or Breast Feeding
What are Teratogenic Effects?
Things that can cause harm to a Fetus/Child because of exposures during pregnancy
ACE Inhibitors should be taken with precaution in pt’s with-
Decreased Renal Function + Bone Marrow Depression + An Autoimmune Disorder (Like Rheumatoid Arthritis) + The Elderly + Those who’ve got a history of Cerebrovascular Disease + HF + Hyperkalemia + Hyponatremia + Pt’s who’re taking Meds that cause Immunosuppression
ACE Inhibitors are known to be less effective for what race? What adverse effect is at an increased risk of occurring with this race?
African Americans, Angioedema is at an increased risk
What contraindication’s with ACE Inhibitors increases the pt’s risk for Hyperkalemia?
Potassium-Sparing Diuretics + Potassium Supplements + Potassium-Containing Salt Substitutes
What meds increase the pt’s risk for Hypotension when taken with ACE Inhibitors?
Antihypertensive Meds
What med decreases the body’s absorption of ACE Inhibitors?
NSAID’s
Can ACE Inhibitors be taken with food?
Captopril can’t (The food will decrease the body’s absorption of the drug).
Most other ACE Inhibitors can be though.
ACE Inhibitors need to be taken with caution when used with Lithium. Why?
They can cause Lithium Toxicity when taken together
What do Angiotensin II Receptor Agonists (ARB’s) treat?
They all treat HTN.
Some treat HF.
Some prevent Migraines.
What meds fall into the classification of ARB’s?
Losartan, Valsartan, Irbesartan, Candesartan, Azilsartan, Olmesartan, Telmisartan, Eprosartan
What is the prototype med for ARB’s?
Losartan
How do ARB’s produce their antihypertensive effect?
Blocking Angiotensin II Receptors
Whenever Angiotensin II is unable to bind to receptors, what occurs in the body to cause a lower BP?
More Sodium and Water are excreted via the urine + Potassium Retention Occurs
What’s the difference between ARB’s and ACE Inhibitors?
ARB’s are less able to protect from Acute Cardiovascular conditions (MI)
ARB’s don’t cause Cough or Hyperkalemia (Because of no increase in Bradykinins)
If a pt can’t take any ACE Inhibitors, what is your best alternative?
ARB’s
Whenever ARB’s block Angiotensin II, what are they blocking it from doing?
From breaking down into ADH and Aldosterone
What do hormones like Aldosterone and ADH cause the body to do?
Sodium + Water Retention
Potassium Excretion
(These things increase BP)
What are the side effects of ARB’s?
Angioedema + Dizziness + Hypotension + Headache + Insomnia
Between ARB’s and ACE Inhibitors, which one causes Angioedema more often?
ACE Inhibitors
What should always be monitored before administering Losartan? Why?
BP, to avoid Severe Hypotension
What should always be kept available and prepared in the cases that Severe Angioedema can occur?
What about Mild Angioedema?
Severe = IV Epinephrine
Mild = Dyphenhydramine
How should Severe Hypotension be treated?
Expand the pt’s Blood Volume with IV Fluid Therapy
When should ARB’s be immediately discontinued?
If Angioedema Occurs
What adverse symptoms should be monitored for and reported if they occur while taking an ARB?
CNS Effects (Headache + Insomnia + Syncope + Dizziness)
Which routes should be used when administering ARB’s?
PO only.
Take with/without food.
What should administration be expected to be like for people who are just starting to take ARB’s if they have Liver Failure or are taking a Diuretic?
Start with Low Doses until the pt’s reaction to the med is determined.
When taking ARB’s immediately report any swelling of-
The Eyes, Face, Mouth, or Throat
Losartan can be taken if pregnant or breastfeeding.
True or false?
False
What groups of people are ARB’s contraindicated for?
Pregnant/Lactating + Kids under 6 Y/O + Kids over 6 Y/O if they’ve got a low Creatinine Clearance
ARB’s should be taken with caution if the pt is concurrently taking what meds? What disorders?
Diuretics
Hyperkalemia + Liver / Renal Disorders
What med combos can Losartan be used with?
Thiazine Diuretics, Hydrochlorothiazide
What can NSAID’s do if taken with ARB’s?
Decrease Effectiveness of ARB’s + Increase risk of Renal Complications
What is the end goal of the Renin-Angiotensin Aldosterone System?
The production of Aldosterone
What are Aldosterone Blockers used to treat?
HTN + Manifestations of HF following an MI
What’s the prototype med for Aldosterone Antagonists?
Eplerenone (This is a category of drugs, Spironolactone is a member of this class)
How do Aldosterone Antagonists exert their anti-hypertensive effect?
By blocking Aldosterone Receptors
This causes Sodium and Water Excretion + Potassium Retention
What’s the primary adverse effect of Aldosterone Antagonists?
Hyperkalemia (Due to their Potassium-Sparing Effects)
What are some signs of Hyperkalemia to look out for when giving Aldosterone Antagonists?
Palpitations + Muscle Twitching / Cramps + Weakness + Paresthesia in the Extremities + Slow Irregular HR + Hyperactive Bowel Sounds + Diarrhea
What labs need monitored for pt’s at risk for Hyperkalemia?
Potassium + BUN + Creatinine
