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Pharmacology Made Easy ATI > The Cardiovascular System (Hypertension) > Flashcards

The Cardiovascular System (Hypertension) Flashcards

1
Q

What are the 4 main categories of Antihypertensive Meds?

A

RAAS Suppressants + Calcium Channel Blockers + Sympatholytics (Anti-Adrenergic Meds) + Direct-Acting Vasodilators

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2
Q

What can cause Kidney Damage, Left-Sided HF, and increase the risk for Cerebrovascular Accidents / Stroke?

A

Acute or Chronic Hypertension

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3
Q

What are the 4 types of RAAS Suppressors?

A

Angiotensin-Converting Enzyme Inhibitors (ACE Inhibitors)

Angiotensin II Receptor Blockers (ARBs)

Aldosterone Antagonists

Direct Renin Inhibitors

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4
Q

What do ACE Inhibitors treat?

A

HTN, Diabetic Neuropathy + Left Ventricular Dysfunction caused by an MI

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5
Q

What is the prototype med for ACE Inhibitors?

A

Captopril

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6
Q

What are the meds that fall into the ACE Inhibitor class of med?

A

Captopril + Enalapril + Enalaprilat + Fosinopril + Lisinopril + Benazepril + Moexipril + Perindopril + Quinapril + Ramilpril + Trandolapril

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7
Q

What is Enalaprilat?

A

The IV form of Enalapril

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8
Q

How do ACE Inhibitors produce their Anti-Hypertensive effect?

A

Blocking Angiotensin II

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9
Q

What things happen after ACE Inhibitors are administered?

A

Arteriolar Vasodilation occurs
Increased excretion of Sodium + Water
Retention of Potassium

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10
Q

So Renin is an Enzyme, are Angiotensin I and Angiotensin II also enzymes?

A

No, they’re both Hormones

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11
Q

What 3 substances does the RAAS use to regulate the BP + Salt & Water Absorption?

A

Renin + Angiotensin I + Angiotensin II

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12
Q

What is Angiotensin secreted from?

A

The Liver

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13
Q

What’s the difference between Angiotensin I and Angiotensin II?

A

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

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14
Q

What is the order in which the secretions of the RAAS are secreted that can make Hypertension occur in the first place?

A

Renin splits Angiotensinogen into —> Angiotensin I —> Angiotensin II —> Aldosterone & ADH —> Vasopressin

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15
Q

What’s the Pharmacological Action of ACE Inhibitors?

A

Preventing Angiotensin I from being converted to Angiotensin II

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16
Q

What are the Adverse Effects / Side Effects of ACE Inhibitors?

A

Common Adverse Effects:
Severe Hypotension + Rash

Uncommon Adverse Effects:
Hyperkalemia + Neutropenia + Angioedema

Common Side Effects:
Metallic Taste in mouth + Dry, Nonproductive Cough

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17
Q

What is Neutropenia?

A

Decreased WBC Count

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18
Q

What labs need to be monitored when taking ACE Inhibitors?

A

WBC Count + Potassium Level

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19
Q

What does Neutropenia leave the pt at risk for?

A

Infection

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20
Q

What is Angioedema?

A

A potentially life-threatening condition. It’s when your Mouth and Throat become Swollen

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21
Q

What causes the cough when taking ACE Inhibitors?

A

Increased Bradykinin Level

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22
Q

What causes the Angioedema when taking ACE Inhibitors?

A

Increase of ACE

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23
Q

What is ACE also called?

A

Kinase 2

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24
Q

What causes an increased Bradykinin level when taking an ACE Inhibitor?

A

Kinase 2 isn’t available to break it down

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25
Q

What is the Safety Alert for ACE Inhibitors?

A

Whenever a dry, unrelenting cough occurs, inform the provider so that they can decide whether or not to continue the medication with an Antitussive

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26
Q

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?

A

True

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27
Q

What should the dosages be like overtime for ACE Inhibitors in order to avoid Hypotension?

A

Start with a low dose, gradually increase

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28
Q

How many doses of an ACE Inhibitor does it take before Severe Hypotension can occur?

A

Just one dose

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29
Q

In what groups of pt’s is Severe Hypotension the most common when taking ACE Inhibitors?

A

Pt’s who’re taking Diuretics + Pt’s who’re on a Low-Sodium Diet

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30
Q

When is the risk for Hypotension at its greatest when taking an ACE Inhibitor?

A

After administering it for the first time

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31
Q

What can be used to treat Severe Angioedema?

A

IV Epinephrine

32
Q

How often should the pt’s WBC Count be checked when taking an ACE Inhibitor?

A

Q 2 Weeks when starting to taking it, then Periodically

33
Q

How should ACE Inhibitors always be administered?

A

PO

34
Q

How often should ACE Inhibitors be taken for HTN?

A

2-3x Daily

35
Q

How often should ACE Inhibitors be taken for HF?

A

3x Daily

36
Q

What should the pt do if they start to feel Lightheaded after the first dose of an ACE Inhibitor?

A

Lay on the bed Supine

37
Q

What signs of Hyperkalemia should be relayed to the provider while taking ACE Inhibitors?

A

Sore Throat + Palpitations + Weakness + Muscle Weakness + Other Signs of Infection

38
Q

When should Females not take an ACE Inhibitor?

A

When Pregnant or Breast Feeding

39
Q

What are Teratogenic Effects?

A

Things that can cause harm to a Fetus/Child because of exposures during pregnancy

40
Q

ACE Inhibitors should be taken with precaution in pt’s with-

A

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

41
Q

ACE Inhibitors are known to be less effective for what race? What adverse effect is at an increased risk of occurring with this race?

A

African Americans, Angioedema is at an increased risk

42
Q

What contraindication’s with ACE Inhibitors increases the pt’s risk for Hyperkalemia?

A

Potassium-Sparing Diuretics + Potassium Supplements + Potassium-Containing Salt Substitutes

43
Q

What meds increase the pt’s risk for Hypotension when taken with ACE Inhibitors?

A

Antihypertensive Meds

44
Q

What med decreases the body’s absorption of ACE Inhibitors?

A

NSAID’s

45
Q

Can ACE Inhibitors be taken with food?

A

Captopril can’t (The food will decrease the body’s absorption of the drug).

Most other ACE Inhibitors can be though.

46
Q

ACE Inhibitors need to be taken with caution when used with Lithium. Why?

A

They can cause Lithium Toxicity when taken together

47
Q

What do Angiotensin II Receptor Agonists (ARB’s) treat?

A

They all treat HTN.

Some treat HF.
Some prevent Migraines.

48
Q

What meds fall into the classification of ARB’s?

A

Losartan, Valsartan, Irbesartan, Candesartan, Azilsartan, Olmesartan, Telmisartan, Eprosartan

49
Q

What is the prototype med for ARB’s?

A

Losartan

50
Q

How do ARB’s produce their antihypertensive effect?

A

Blocking Angiotensin II Receptors

51
Q

Whenever Angiotensin II is unable to bind to receptors, what occurs in the body to cause a lower BP?

A

More Sodium and Water are excreted via the urine + Potassium Retention Occurs

52
Q

What’s the difference between ARB’s and ACE Inhibitors?

A

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)

53
Q

If a pt can’t take any ACE Inhibitors, what is your best alternative?

A

ARB’s

54
Q

Whenever ARB’s block Angiotensin II, what are they blocking it from doing?

A

From breaking down into ADH and Aldosterone

55
Q

What do hormones like Aldosterone and ADH cause the body to do?

A

Sodium + Water Retention
Potassium Excretion

(These things increase BP)

56
Q

What are the side effects of ARB’s?

A

Angioedema + Dizziness + Hypotension + Headache + Insomnia

57
Q

Between ARB’s and ACE Inhibitors, which one causes Angioedema more often?

A

ACE Inhibitors

58
Q

What should always be monitored before administering Losartan? Why?

A

BP, to avoid Severe Hypotension

59
Q

What should always be kept available and prepared in the cases that Severe Angioedema can occur?

What about Mild Angioedema?

A

Severe = IV Epinephrine

Mild = Dyphenhydramine

60
Q

How should Severe Hypotension be treated?

A

Expand the pt’s Blood Volume with IV Fluid Therapy

61
Q

When should ARB’s be immediately discontinued?

A

If Angioedema Occurs

62
Q

What adverse symptoms should be monitored for and reported if they occur while taking an ARB?

A

CNS Effects (Headache + Insomnia + Syncope + Dizziness)

63
Q

Which routes should be used when administering ARB’s?

A

PO only.
Take with/without food.

64
Q

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?

A

Start with Low Doses until the pt’s reaction to the med is determined.

65
Q

When taking ARB’s immediately report any swelling of-

A

The Eyes, Face, Mouth, or Throat

66
Q

Losartan can be taken if pregnant or breastfeeding.
True or false?

A

False

67
Q

What groups of people are ARB’s contraindicated for?

A

Pregnant/Lactating + Kids under 6 Y/O + Kids over 6 Y/O if they’ve got a low Creatinine Clearance

68
Q

ARB’s should be taken with caution if the pt is concurrently taking what meds? What disorders?

A

Diuretics

Hyperkalemia + Liver / Renal Disorders

69
Q

What med combos can Losartan be used with?

A

Thiazine Diuretics, Hydrochlorothiazide

70
Q

What can NSAID’s do if taken with ARB’s?

A

Decrease Effectiveness of ARB’s + Increase risk of Renal Complications

71
Q

What is the end goal of the Renin-Angiotensin Aldosterone System?

A

The production of Aldosterone

72
Q

What are Aldosterone Blockers used to treat?

A

HTN + Manifestations of HF following an MI

73
Q

What’s the prototype med for Aldosterone Antagonists?

A

Eplerenone (This is a category of drugs, Spironolactone is a member of this class)

74
Q

How do Aldosterone Antagonists exert their anti-hypertensive effect?

A

By blocking Aldosterone Receptors

This causes Sodium and Water Excretion + Potassium Retention

75
Q

What’s the primary adverse effect of Aldosterone Antagonists?

A

Hyperkalemia (Due to their Potassium-Sparing Effects)

76
Q

What are some signs of Hyperkalemia to look out for when giving Aldosterone Antagonists?

A

Palpitations + Muscle Twitching / Cramps + Weakness + Paresthesia in the Extremities + Slow Irregular HR + Hyperactive Bowel Sounds + Diarrhea

77
Q

What labs need monitored for pt’s at risk for Hyperkalemia?

A

Potassium + BUN + Creatinine

Pharmacology Made Easy ATI (45 decks)

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