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pnm- pharm > week 5- Antihypertensive Drugs > Flashcards

week 5- Antihypertensive Drugs Flashcards

1
Q

b-blockers and ACE inhibitors hve been found in canada to be more effective in lowering

A

BP in whites than in blacks

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2
Q

CCB and diuretics have been shown to be more effective in

A

black pnts than whites

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3
Q

hypertension in the elderly population

A

often presents as elevation of systolic blood pressure in the older adult population

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4
Q

Common adverse effect in anithypertensive drugs

A

is sexual dysfunction in male pnts

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5
Q

all antihypertensive drugs with the exeption of diuretics

A

have some vasodilation action.

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6
Q

centrally acting a2 adrenergic drugs

A

act by modifying the function of the SNS.

the end resulting in reduced BP

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7
Q

STAGES OF HYPERTENSION

A

1.Normal
2. Pre-hypertension
3. Stage 1 hypertension
BP 140-159/90-99 1st line of drug therapy
4. Stage 2 hypertension
BP >160/>100 introduction of 2nd drug therapy

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8
Q

Classification of BP

A

1.Unknown cause
Referred to as essential, idiopathic, or primary hypertension makes up for 90% of the cases
Known cause
2.Secondary hypertension (renal disease, artery disease, eclampsia in pregnancy)
10% of the cases

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9
Q

Antihypertensive Agents: Categories

A 
Adrenergic agents
Angiotensin converting enzyme (ACEi’s) inhibitors
Angiotensin II receptor blockers (ARBs)
Calcium channel blockers (CCBs)
Diuretics
Vasodilators
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10
Q

Beta and Alpha Receptors

A

Beta1 Receptors:
- stimulate the heart

Beta 2 and Alpha Receptors:
- stimulate the blood vessels (smooth muscle)

Agonist:
- a drug that binds and stimulates the activity of the receptor

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11
Q

Mechanism of Action-Adrenergic agents

A

Work centrally by blocking nor-epinephrine (stimulant neurotransmitter) in the brain thereby decreasing blood pressure

Work peripherally to lower systemic vascular resistance which causes relaxation and dilatation of the smooth muscles thereby decreasing blood pressure

Work directly on the heart muscle, mainly the left ventricle which decreases the force to eject blood through the ventricle

Works directly on the kidneys by increasing diuresis thereby decreasing plasma volume resulting in lowered blood pressure

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12
Q

Adrenergic Agents: Alpha Receptors

A

Prazosin (Minipress)
Clonidine (Catapres)
Methyldopa (Aldomet) – drug of choice for hypertension in pregnancy

These agents cause vasodilation of the peripheral arteries and veins therefore reducing peripheral vascular resistance which decreases blood pressure

Also reduces systemic and pulmonary venous pressure thereby increasing cardiac output

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13
Q

*** The first dose of Minipress (Prazosin) should be given

A

laying down or sitting as it causes extreme dilation of the peripheral arteries resulting in dizziness, lightheaded with the possibility of fainting (syncope

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14
Q

Adrenergic Agents: Beta-blockers

A 
Propranolol (Inderal)
Atenolol (Tenormin)
Metoprolol 
Bisoprolol
Timolol
Sotolol

These agents act peripherally
They REDUCE heart rate due to the beta receptor blockade
DECREASE myocardial contractility and conduction
Some have a dual action on both alpha and beta receptors

Mainly used in the treatment of hypertension
Used for glaucoma
Used for benign prostate hypertrophy (BPH) as it relaxes the smooth muscles
Widely used, more effective in the elderly population and especially for those resistant to ACE inhibitors

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15
Q

Adrenergic Agents: Beta-blockers SIDE EFFECTS

A

Most serious side effect is peripheral pooling of blood (due to relaxation of smooth muscles) which causes orthostatic hypotension

These agents should never be stopped abruptly as they will cause rebound hypertension patients need to be weaned

Use cautiously with asthmatic or COPD patients can cause bronchospasm

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16
Q

Angiotensin converting enzyme (ACEi’s) inhibitors

A

Ramipril (Altace)
Enalapril (Vasotec)
Captopril (Capoten)
Lisinopril (Zestril)

Large group of safe and effective drugs
Often used as first-line agents for heart failure and hypertension
Inhibits angiotensin converting enzyme which is a potent vasoconstrictor

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17
Q

ACE Inhibitors: Indications

A

Hypertension
HF (either alone or in combination with diuretics or other agents)
Slows progression of left ventricular hypertrophy after an MI (cardio-protective)
Renal protective effects in patients with diabetes
– Drug of choice in hypertensive patients with HF

Prevents left ventricular dilation and dysfunction after an MI
Decreased further risk of heart failure (reduces work load for the heart)

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18
Q

ACE INHIBITOR EFFECTS

A

**Biggest draw back and side effect is that they cause a persistent dry, nonproductive cough, which reverses when therapy is stopped

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19
Q

THERE are ___ ace inhibiotrs aailable

A

10

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20
Q

captopril

A

has the shortest half-life and therefore must be dosed more freq

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21
Q

captopril and lisinopril are the only two acei’s that are not

A

prodrugs (a drug that is inactive in its admined form and must be biotransformed in the liver to its active form in order tb effective

22
Q

acei’s and pregos

A

category C and D

23
Q

many ACEI’S are combined with either a

A

diuretic or a CCB

24
Q

THEY have a protective effect on the kidneys because

A

they reduce glomerular filtration pressure

25
Q

Angiotensin II receptor blockers (ARBs)

A

Losartan (Cozaar, Hyzaar)
Valsartan (Diovan)
Candesartan (Atacand)
Telmisartan (Micardis)

Known as (A-II blockers, or ARBs)
Newer class of antihypertensive
Well tolerated

Do not cause a dry cough (as with the ACEi’s) therefore better tolerated

26
Q

Angiotensin II Receptor Blockers: Indications

A

Hypertension
Adjunctive agents for the treatment of HF
May be used alone or with other agents such as diuretics
Used primarily in patients who cannot tolerate ACE inhibitors

27
Q

aIIrblockersalso decrease SVR

A

(measure of afterload)

28
Q

Calcium Channel Blockers

A

Diltiazem (Cardizem, Dilacor)
Verapamil (Calan, Isoptin)
Amlodipine (Norvasc)
Nifedipine

Known as (CCB)
Causes smooth muscle relaxation by blocking the binding of calcium to its receptors thereby preventing muscle contraction (effective for hypertension and angina)
This causes decreased peripheral smooth muscle tone and decreased systemic vascular resistance
RESULT: decreased blood pressure

29
Q

Calcium Channel Blockers INDICATIONS

A

Angina
Hypertension
Dysrhythmias
Migraine headaches (d/t vasodilatation effect, CCB’s prevent cerebral artery spasms)
Raynaud’s disease (constriction of peripheral vessels causing cyanosis, CCB cause a vasodilatation effect)

30
Q

Diuretics

A

Hydrochlorothiazide
Indapamide
Lasix

Decreases extracellular fluid volumes

Results: Decreased preload , Decreased cardiac outpuT, Decreased total peripheral resistance

Overall effect: Decreased workload of the heart, and decreased blood pressure

31
Q

Lasix

A

(potent diuretic agent for immediate use to induce diuresis)

32
Q

Vasodilators

A 
Nitroglycerine 
Diazoxide
Minoxidil 
Sodium Nitroprusside (IV for hypertensive 	emergencies)
Hydralazine

Act directly on arteriole smooth muscle which causes relaxation resulting in dilatation

Reduces SVR (systemic vascular resistance)

33
Q

Side Effects

A 
Headaches
Facial flushing
Dizziness
Diaphoresis 
Lethargy
34
Q

Instruct patients that these drugs should not be stopped abruptly because this may cause a

A

rebound hypertensive crisis, and perhaps lead to stroke or MI

35
Q

Reflex tachycardia—

A

when a drug is given to lower blood pressure the Baroreceptors respond by trying to return the pressure to its original high level. Baroreceptors respond by increasing heart rate—causes reflex tachycardia

36
Q
  1. Beta receptors stimulate _
A

the heart

37
Q
  1. Alpha receptors stimulate __
A

smooth muscle and blood vessels.

38
Q
  1. Prazosin (Minipress) is a(n) _
A

a-adernergic agent__ with special precautions to monitor for ___dizziness___, _lighthea ness_____, ___orthostatic hypertension which can lead to ___syncope____, therefore the first dose should always be given __sitting ____ or ___laying down_______.

39
Q
  1. methadopa___.
A

Antihypertensive drug of choice for pregnancy is

40
Q
  1. The blockade of beta receptors leads t
A

TO dcrease in heart rate and cardiac conduction and leads to lower BP

41
Q
  1. These drugs are used for glaucoma, hypertension, and benign prostate hypertrophy _____
A

beta-blockers_______.

42
Q
  1. Most serious side effect of beta blockers is ____
A

peripheral pooing____ which causes ____hypotension________.

43
Q

A persistent dry, non-productive cough is classically seen with

A

ACE inhibiters _.

44
Q
  1. These drugs are known to be cardio protective after and M I __
A

ACE HIBITORS __.

45
Q
  1. Effective drugs for the treatment of migraine headaches and Raynaud’s Disease are ___
A

CCB___.

46
Q
  1. These drugs are generally the first line of antihypertensive drugs to be used for stage 1 hypertension ____
A

DIRECTICS, HYDROCHOLOR.. __.

47
Q
  1. An effective drug for the treatment of emergency hypertension is
A

__SODIUM NITROPRESSIDE__.

48
Q
  1. __MINOXILDIL____
A

is used for hair loss.

49
Q
  1. Antihypertensive drugs should not be stopped abruptly because they can lead to _____
A

REBOUND HYPERTENSION_______ putting the patient at risk for __STROKE ____ and __HEART ATTACK______.

50
Q
  1. Symptoms of shortness of breath, difficulty breathing, peripheral swelling, chest pain with palpitations need to be reported immediately because the patient could be experiencing symptoms of __
A

CONGESTIVE HEART FAILURE___ and may necessitate the need to be treated with __LASIX___ which is a potent __LOOP-DIURETIC ___ effective for immediate diuresis.

pnm- pharm (19 decks)

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