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Pharmacotherapeutics > Week 8- Drugs affecting BP > Flashcards

Week 8- Drugs affecting BP Flashcards

1
Q

What elements determine blood pressure?

A
  • HR
  • SV
  • TPR
    (total peripheral resistance)
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2
Q

Why does hypertension increase your risk of CAD?

A
  • Thickening of heart muscle (becomes less efficient, less coordinated, and leads to failure
  • Increased pressure
  • Increased workload
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3
Q

Hypertension is a major risk factor for what?

A
  • CAD and cardiac death
  • stroke
  • Renal failure
  • Loss of vision
  • Dementia
  • Erectile dysfunction
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4
Q

What situations can cause hypotension?

A
  • Heart muscle is damaged and unable to pump effectively
  • Severe blood loss, volume drops dramatically
  • Extreme stress when body’s levels of norepinephrine are depleted (unable to respond to stimuli)
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5
Q

What are the 2 classifications for hypertension?

A
  • UNKNOWN CAUSE 90%(idiopathic or primary hypertension)
  • KNOWN CAUSE 10%
    (secondary hypertension)
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6
Q

What is masked hypertension?

A

Patient’s BP is less than 140/90 mm Hg in a medical setting but is hypertensive at home

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7
Q

What is white coat hypertension?

A

Patient’s BP is less than 140/90 mm Hg at home but is hypertensive in a medical setting

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8
Q

What are the non-modifiable risk factors of hypertension?

A 
Age (rigidity of blood vessels)
Gender
Ethnic Background (African decent)
Family History
Medication Use
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9
Q

What are the modifiable risk factors of hypertension?

A 
Smoking
Obesity
Poor dietary habits
High sodium intake
Sedentary lifestyle
High alcohol consumption
High stress
Medication
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10
Q

What are the symptoms of hypertension?

A
  • no symtoms

- severe hypertension may present with headaches

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11
Q

When should hypertension be treated?

A
  • at 140/90 mm Hg
  • at 130/80 mm Hg in those with diabetes
  • at 150/90 for those 80+
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12
Q

How is hypertension treated?

A
  • combination of drugs and lifestyle
  • regular follow up to ensure correct drug amounts
  • focus on adherence
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13
Q

What classifies you as having normal BP or being hypertensive?

A
  • Normal
    120/80-129/89
  • High Normal
    130/85-139/89
  • Hypertension greater than or equal to 140/90
    -Hypertension (age 80+) greater than or equal to 150/90
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14
Q

In what order are antihypertensives tried?

A

Try in following order

  • thiazide
  • ACEI
  • ARB
  • Long-acting CCB
  • Beta-blockers
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15
Q

What kind of lifestyle modifications should be made?

A
  • Healthy eating
  • Regular physical activity
  • Weight loss (waist circumference/BMI)
  • Moderation in alcohol consumption (no more than 2 drinks per day)
  • reduce dietary sodium
  • stress reduction
  • smoking cessation
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16
Q

What diet recommendations are given?

A
  • FRESH fruits and vegetable, low fat dairy, dietary and soluble FIBRE, plant protein
  • LOW in SATURATED FAT, CHOLESTEROL and Na (less than 2300mg/day)
  • Dietary POTASSIUM; Daily dietary intake greater than 80mmol
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17
Q

What are the physical activity recommendations?

A

FITT (frequency, intensity, time, type)

Frequeny: 4-7 days per week in addition to normal daily activity
Intensity: Moderate
Time: 30-60 min (you can split it up)
Type: Cardiorespiratory activity (walking jogging, cycling, non-competitive swimming)

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18
Q

What is the recommendation for weight loss?

A
  • BMI over 25, encourage weight reduction (healthy btw 18.5-24.9kg/m2)
  • Waist circumference: Men less than 102 cm and women less than 88cm
    (Measure just above iliac crest)
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19
Q

What are the alcohol intake recommendations?

A

0-2 standard drink/day
Men: 14 per week
Women: 9 per week

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20
Q

What does DASH stand for?

A

dietary approaches to stop hypertension

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21
Q

What are diuretics?

A

decrease sodium levels and blood volume

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22
Q

What are beta-blockers?

A

leads to a decrease in HR and strength of contraction; cause vasodilatation

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23
Q

What are ACEI?

A

drugs that block the conversion of angiotensin 1 into angiotensin 2; angiotensin 2 receptor blocker; blocking effects of angiotensin on blood vessels

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24
Q

What are calcium channel blockers?

A

Relaxes muscle contraction or other autonomic blockers

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25
Q

What are ARBs?

A

drugs that block vasoconstriction and release aldosterone

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26
Q

What are the drugs that control blood pressure?

A 
diuretics
BB
ACEI
CCB
ARB
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27
Q

What is the first line treatment for diabetics with hypertension?

A

ACEI

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28
Q

What is the action of ACEI?

A
  • blocks ACE from converting of angiotensin1 to angiotensin 2
  • this leads to a decrease in BP, a decrease in aldosterone production, small increase in serum potassium and sodium, and fluid loss
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29
Q

What are ACEI indicated for?

A
  • hypertension (first line for diabetic hypertension)
  • CHF
  • Diabetic nephropathy
  • Left ventricle dysfunction after MI
  • reduction of proteinuria and slowing progression of renal impairment
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30
Q

What are the pharmacokinetics of ACEI?

A

Well absorbed, widely distributed, metabolized in the liver, and excreted in the urine and feces

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31
Q

What are the contraindications of ACEI?

A
  • allergy
  • impaired renal function
  • pregnancy and lactation
  • cautioned for CHF
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32
Q

What are the adverse effects of ACEI?

A
  • Related to the effects of vasodilatation and alterations in blood flow
  • GI irritation
  • Renal insufficiency
  • Cough (may cause sleep disturbance)
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33
Q

What are the drug to drug interactions for ACEI?

A

Alloperinol

ask about NSAIDS

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34
Q

What do ACEI end in?

A
  • pril
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35
Q

What is the prototype for ACEI and what route is it given?

A

Captopril

  • PO
  • (onset 15m and peak 30-90m)
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36
Q

What does ACE stand for?

A

angiotensin converting enzyme

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37
Q

What are ARBs?

A

Angiotensin 2 Receptor Blockers

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38
Q

What are ARBs indicated for?

A
  • hypertension
  • adjunct for HF (such as diuretics)
  • used primarily for those who cannot tolerate ACEI
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39
Q

Can ARBs be used with diuretics?

A
  • yes
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40
Q

What are ARB contraindications?

A
  • allergy
  • pregnancy and lactation
  • cautioned for renal and hepatic dysfunction and hypovolemia
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41
Q

What are the adverse effects of ARBs?

A

Headache, dizziness, syncope, weakness
GI complaints
Skin rash or dry skin

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42
Q

What do ARBs end in?

A

-artan

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43
Q

What are ARB drug interactions?

A

Phenobarbital

44
Q

What is syncope?

A

loss of consciousness due to BP falling

45
Q

What is the prototype for ARBs?

A

Losartan

46
Q

What is the action of calcium channel blockers (CCB)?

A
  • Inhibits the movement of calcium ions across the membranes of cardiac and arterial muscle cells
  • depressing the impulse and leading to slowed conduction, decreased myocardial contractility, and dilation of arterioles
  • thus lowering BP and decreases myocardial oxygen consumption
47
Q

What are CCB indicated for?

A
  • treatment of ESSENTIAL HYPERTENSION in the extended release form
  • effective for angina
  • can be used for migraines
48
Q

When are CCB contraindicated?

A
  • allergy
  • heart block or sick sinus syndrome
  • renal and hepatic dysfunction
  • pregnancy and lactation
49
Q

What are the adverse effects of CCB?

A
  • Related to effects on CO
  • GI
  • CV
50
Q

What is the drug interaction with CCB?

A

Cyclosporine

51
Q

What do CCB end in?

A
  • dipine

mostly however prototype is Diltiazem

52
Q

What is the prototype for CCB?

A

Diltiazem

53
Q

What are BABA?

A

Beta-Adrenargic Blocker Agents

54
Q

What do beta-adrenargic blockers do?

A
  • competitively block beta-receptors in the SNS (in the heart and juxtaglomular apparatus of the nephron)
55
Q

What are beta-adrenargic blockers indicated for?

A 
Treatment of CV problems
- hypertension
- angina
- migraines
Prevention of reinfarction after MI
56
Q

Why are beta-adrenargic blockers not often used?

A

lots of adverse effects

57
Q

What are the contraindications and cautions for BABA?

A 
Contraindications
- Allergy
- Bradycardia, heart block, shock, or CHF
- COPD, asthma
Caution
- Diabetes, hepatic dysfunction
58
Q

What are the pharmacokinetics of BABA?

A

Absorbed in the GI tract and metabolized in the liver

59
Q

What are the adverse reactions of BABA

A
  • Fatigue, dizziness, depression, sleep disturbances
  • Bradycardia, heart block, hypotension
  • Bronchospasm
  • Nausea, vomiting, diarrhea
  • Decrease libido
  • Decreased exercise tolerance
60
Q

What are the drug interactions with beta-adrenergic blockers (BABA)

A
  • Clonidine
  • NSAIDS
  • Insulin or antidiabetic medications
61
Q

What do BABA typically end in?

A

-olol

62
Q

What is an off label use for BABA?

A
  • stage fright
  • migraines
  • alcohol withdrawal syndrome
  • supraventricular tachycardias
63
Q

What is the prototype for BABA?

A

Atenolol

64
Q

What are the 4 classes of diuretics?

A
  • Thiazide and Thiazide-like Diuretics
  • Loop Diuretics
  • Potassium-Sparing Diuretics
  • Osmotic Diuretics
65
Q

What do diuretic do?

A
  • work on the kidneys do decrease reabsorption of sodium, chloride, water and other substances; thus decrease the workload on the heart and decrease BP
66
Q

What are the indications of diuretics?

A
  • edema associated with CHF
  • acute pulmonary edema
  • HF
  • hypertension
  • Liver disease (including cirrhosis)
  • Renal disease
  • Conditions that cause hyperkalemia
67
Q

What do you do if the hypertension is not responding to the diuretic?

A

Try combo therapy with anti-hypertensive
- or -
Monotherapy with a different type of anti-hypertensive

68
Q

What is the action of thiazide and thiazide-like diuretics?

A

block chloride pump (keeps chloride and sodium in tubules)

69
Q

What are the indications of thiazide and thiazide-like diuretics?

A 
edema associated with
- CHF
- Liver disease
- Renal disease
(mono therapy or adjunct)
70
Q

What are the pharmacokinetics of thiazide and thiazide-like diuretics?

A

Well absorbed for the GI tract, metabolized in the liver and excreted in the urine.

71
Q

What are the contraindication and cautions of thiazide and thiazide-like diuretics?

A 
CONTRAINDICATION
- Allergy to thiazides or sulfonamides
- Fluid and electrolyte imbalances, and renal and liver disease
- Bipolar disorders
- Pregnancy and lactation
CAUTIONS
- Gout
- Systemic lupus
- Diabetes
- Hyperparathyroidism
72
Q

What are the adverse effects of thiazide and thiazide-like diuretics?

A
  • Related to interference with the normal regulatory mechanisms of the nephron
  • Hypokalemia
  • Decreased calcium excretion
  • Altered blood glucose levels
  • Urine will be slightly alkalinized (polyuria, noturia)
  • orthostatic hypotension
  • GI (nausea, vomiting, diarrhea, anorexia, dry mouth)
73
Q

What is hypokalemia?

A

Hypokalemia- less than 3.5 mmol/L of potassium in the blood
(common signs muscle cramping; can effect the heart muscle)
Normal 3.5-5 mmol/L

74
Q

What are the drug-to-drug interactions with thiazide and thiazide-like diuretics?

A
  • Cholestyramine or colestipol
  • Digoxin
  • Antidiabetic agents
75
Q

What is the thiazide diuretic prototype?

A

hydrochlorothiazide

- PO (onset 2h, peak 4-6h, duration 6-12h)

76
Q

Name some loop diuretics.

A

Furosemide (Lasix)
- Most commonly used; less powerful than new drugs; larger margin of safety for home use

Bumetanide (Bumex) and Torsemide (Demadex)
- New drugs; more powerful than Lasix

77
Q

Which loop diuretic is most commonly used and why?

A

Furosemide (Lasix)

- Most commonly used; less powerful than new drugs; larger margin of safety for home use

78
Q

Furosemide (Lasix) is the prototype for what drug type?

A

loop diuretics

79
Q

Hydrochlorothiazide is the prototype for what drug type?

A

thiazide and thiazide like diuretics

80
Q

What is the action of loop diuretics?

A

Block the chloride pump in the ascending loop of Henle

This causes reabsorption of sodium and chloride

81
Q

What are loop diuretics indicated for?

A 
Acute CHF
Acute pulmonary edema
Edema associated with CHF 
Edema associated with renal or liver disease
Hypertension
82
Q

What are the contraindications and cautions for loop diuretics?

A 
CONTRAINDICATIONS
- Allergy
- Electrolyte depletion
- Anuria (failure to produce urine)
- Severe renal failure
- Hepatic coma
- Pregnancy and lactation
CAUTIONS
- SLE, gout, and diabetes mellitus
83
Q

What are the adverse effects of loop diuretics?

A
  • Related to the imbalance in electrolytes and fluid
  • Hypokalemia
  • Alkalosis
  • Hypocalcemia
84
Q

What drugs interact with loop diuretics?

A
  • aminoglycosides or cisplatine
  • anticoagulation
  • Indomethacin, NSAIDS, saliylates
85
Q

What is the prototype of loop diuretics?

A

furosemide

86
Q

What is flurosemide the prototype of?

A

loop diuretics

87
Q

What routes can loop diuretics be given in?

A

PO, IV, IM

88
Q

What is the action of potassium sparing diuretics?

A
  • Cause a loss of sodium while retaining potassium

- Block the actions of aldosterone in the distal tubule

89
Q

What are the indications of potassium-sparing diuretics?

A
  • Adjuncts with thiazide or loop diuretics

- Patients who are at risk for hypokalemia

90
Q

What are the pharmokinetics of potassium sparing diuretics?

A
  • Well absorbed, protein bound, and widely distributed

- Metabolized in the liver and excreted in the urine

91
Q

What is hyperkalemia?

A

potassium over 5mmol/L

92
Q

What are the contraindications and cautions of potassium sparing diuretics?

A

Contraindications

  • Allergy
  • Hyperkalemia, renal disease, or anuria
  • Patients taking amiloride or triamterene

Cautions
- pregnancy and lactation

93
Q

What are the drug interactions with potassium sparing diuretics?

A

salicylates

94
Q

What are the adverse effects of potassium sparing diuretics?

A

hyperkalemia

95
Q

What is the prototype of potassium sparing diuretics?

A

spironolactone

96
Q

What is spironolactone the prototype of?

A

potassium sparing diuretics

97
Q

What is an off label use of potassium sparing diuretics?

A
  • acne
98
Q

How long have potassium sparing diuretics been around?

A

long time

99
Q

Are potassium sparing diuretics expensive?

A

no

100
Q

What nursing interventions are needed when patients are taking diuretics?

A

TEACHING

  • educate on the importance of not missing a dose and taking meds as prescribed
  • never double a dose if one was missed
  • keep a BP journal
  • change positions slowly
  • report changes in breathing, swelling, or excess fatigue
  • take oral form with meals
  • impotence is expected
  • dont change dose on own, contact doctor
  • be cautious with fluid loss (heat, activity, alcohol)
  • consult doc before taking OTC meds
101
Q

What does the nurse need to monitor?

A
  • adverse effects
  • BP
  • therapeutic effects
  • IV with extreme caution
    with IV pump
102
Q

What effects the adherence of patients?

A
  • healthcare giver advice
103
Q

What is the single most important modifiable factor?

A

adherence

104
Q

What are the 5 dimensions or factors that determine adherence (RNAO)?

A

Social economic factors- what people around you do, finance, etc
Health system factors- availability, if they don’t like HCP
Therapy-related factors- side effects
Patient-related factors- age, sex, education, income, where you live (urban vs rural)
Condition-related factor- severity of their disease or other diseases they have at the same time
-RNAO

105
Q

What are the CHEP 2013 strategies to improve patient adherence?

A
  • Tailoring pill-taking to fit patients’ daily habits
  • Simplifying medication regimens to once-daily dosing
  • Multidisciplinary team approach
  • Encouraging greater patient responsibility/autonomy in monitoring their blood pressure and adjusting their prescriptions
  • Educating patients and patients’ families about their disease/treatment regimens

Pharmacotherapeutics (7 decks)

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