Week 8 Anti-Hypertensives Flashcards
a1 antagonists
Tamsulosin, Prazosin
Tamsulosin, Prazosin
a1 antagonists
Used to treat:
Tamsulosin: BPH, bladder outlet obstruction, Prazosin: HTN (not 1t line)
MOA:
-prevents activation of a1 receptors (some found on peripheral vascular smooth muscle (arteries), some found in bladder/ urethra
AE:
- first dose phenomenon: orthostatic hypotension (common)
- reflex tachycardia (rare)
- sexual dysfunction
- rebound HTN if rx stopped suddenly
Beta blockers
Selective: metoprolol
Non selective: carvedilol (post MI, heart failure), labetalol (pregnancy), propranolol
Metoprolol, carvedilol, labetalol, propranolol
Beta blockers
Used to treat:
- HTN (not 1st line)
- glaucoma, heart failure, dysrhythmias, angina, migraines, anxiety
MOA:
- B1: primarily found on heart, also kidneys and eyes
- B2: lungs, uterine smooth muscle, liver, skeletal muscle
AE:
B1 blockade:
-bradycardia –> decreased CO
-masks s/s of hypoglycemia (tachycardia, anxiety, tremors)
-sexual dysfunction (libidio, ED, vaginal dryness)
-can cross BBB - CNS changes- depression, sleep disturbances, decreased libidio
-constipation
Non selective B2 blockade:
- bronchoconstriction
- prevent glycogenolysis in liver (prevents bodies countermeasure to hypoglycemia)
Boxed warning for all beta blockers: ischemic heart disease
-sudden stoppage can increase risk for MI/ angina. taper down
Nursing considerations:
- concern for worsening heart failure: pt should immediately report a weight gain of 2lb or more in 1 day or 5lb or more in 1 week, weigh daily
- notify provider of SOB, edema, fatigue, weight gain
a2 agonists
Clonidine “idine”, Methyldopa
clonidine + methldopa
a2 agonist
Used to treat:
- both: HTN
- clonidine: ADHD, pain management (epidurals), withdrawal
- methyldopa: used for HTN in pregnancy
MOA:
-stimulate a2 receptors centrally- found in brainstem (vasomotor center) –> decreased sympathetic outflow and decreased peripheral resistance presynaptically
AE:
- drowsiness/ CNS depressant (avoid mental alertness activities until it diminishes)
- dry mouth
- rebound HTN (if stopped suddenly after chronic use)
- orthostatic hypotension
- bradycardia (rare) (lowers output of the brain, slowing brain down)
Nursing considerations:
-educate about CNS depression- avoid alcohol
Admin:
-Clonidine as tablet: used daily and prn
-Clonidine as once weekly patch
Rotate sites, Hairless part of body, Intact skin, Clean with soap and water (not alcohol)
ACE Inhibitors
Captopril, Lisinopril
Captopril, Lisinopril
ACE Inhibitors “pril”
Used to treat:
- HTN: especially in patients with DM, CKD- protects kidneys from proteins
- Heart failure
- Post Mi (prevent remodeling)
MOA:
- prevents ACE from converting angiotensin I to angiotensin II
- -> decreased aldosterone release, decreased vasoconstriction, decreases preload and afterload (SVR)
AE:
- hyperkalemia : lowered aldosterone –> salt + water loss + potassium retention
- chronic, non productive cough (bradykinin retention)
- angioedema: eyelids, lips, tongue (bradykinin retention)
- boxed warning: drugs that work on RAAS can cause injury/ death to developing fetus. Class C in 1st trimester, class D in 2nd/3rd trimester.
- first dose orthostatic hypotension
Drug-drug interactions
- Hyperkalemia: sudden death in geriatrics with ACE -I and sulfamethoxazole trimethoprim (bactrim)
- additive hypotension effect (especially with diuretics)
- lithium- body views it as sodium- can accumulate, toxicity
- COX inhibitors/ NSAIDs ibuprofen, naproxen- use can decrease effectiveness, increase risk for AKI
Angiotensin II receptor blockers (ARBS)
Losartan “sartans”
Losartan
Angiotensin II receptor blockers (ARBS)
Used to treat:
- same as ACE-I
- HTN, post MI, heart failure
MOA: -Block the binding of angiotensin II --> Decreased aldosterone release Decrease vasoconstriction Decreased preload and after load
Adverse effects:
- Angioedema, cough, hyperkalemia
- Fetal harm, first dose orthostatic hypotension
- Kidney injury, sexual dysfunction
Drug drug:
-lithium accumulates, NSAIDs
Direct Renin Inhibitor
Aliskiren
Aliskiren
Direct Renin inhibitor
Used to treat:
-Same as ACE I: HTN, Post MI, Heart failure
MOA:
-blockade of the conversion of angiotensinogen to angiotensin I
AE:
Angioedema, cough, hyperkalemia
Fetal harm, first dose orthostatic hypotension
Kidney injury, sexual dysfunction
Drug Drug
-Lithium accumulates, careful with NSAIDs
DHP Calcium Channel Blockers
Amlodipine, Nifedipine “dipine”
Amlodipine, Nifedipine
DHP Calcium Channel Blockers
Used to treat:
-HTN (also in pregnancy)
-stable angina (preventative)
Nifedipine- tocolytic (delay premature labor)
MOA:
-block Ca channels in vascular smooth muscle (dilation of peripheral and coronary arteries), minimal to no myocardial tissue (minimal effect on HR)
AE:
- reflex tachycardia due to drop in BP- dangerous in unstable angina/ MI, counteract with beta blocker
- orthostatic hypotension
- sexual dysfunction
- peripheral edema, dose dependent
- no grapefruit juice
Thiazides (diuretic)
Hydrochlorothiazide (HCTZ)
