Week 9 - Antihypertensives Flashcards
Blood pressure
BP = CO X SVR
(SVR = systemic vascular resistance)
Hypertension types (3)
Essential hypertension
Secondary hypertension
Malignant hypertension
Essential hypertension
90-95% of cases
Idiopathic
Aka primary
Secondary
5-10% of cases
Most commonly due to RAD, sleep apnea, thyroid disease
Malignant hypertension
BP above 180/120
Medical emergency
Categories of antihypertensive drugs (7)
Adrenergic drugs
ACE inhibitors
Angiotensin 2 receptor blockers
Calcium channel blockers
Diuretics
Vasodilators
Direct renin inhibitors
Adrenergic drug (5 subclasses)
(My notes say dont worry about this much so yeah)
Adrenergic neuron blockers
A2 receptors agonists
A1 receptor blockers
Beta receptor blockers
Combo a1 and beta recoetros blockers
Adrenergic drugs suffix
Sin
Drug names end in SIN
Adrenergic drugs indications
All for hypertension
Glaucoma as well
Management of HF when used with cardiac glycosides and diuretics
Ex. Doxazosin, proposing
Adrenergic drugs adverse effects
Orthostatic hypotension
Also
- bradycardia
- dry mouth
- drowsiness
- constipation
Edema
ACE inhibitors facts
Large group of safe and effective drugs
Often first line use for hypertension
May be combined with thiazide diuretic or Ca channel blockers
ACE inhibitors suffix
PRIL
Ramipril, enalapril, perindopril
Ace inhibitors indications
Hypertension
HF
Used to slow left ventricular hyper trophy after MI
ACE inhibitors mechanism of action
Inhibit ACE haha
ACE converts a1 into a2
A2 is a vasoconstrictor that induces aldosterone
Aldosterone = water/salt absorption which raises BP
We dont want any of that shit
#InhibitACE
Primary effects of ACE inhibitors
Reduce BP by decreasing SVR
HF
- prevent sodium and water resorption
- decreases heart work because of less BP
Ace inhibitors renal effects
Reduce GFR
Reduce proteinuria
ACE inhibitors adverse effects
Fatigue yata yata
Mood changes
Hyperkalemia
Dry cough
Angioedema
Angiotensin 2 receptor blockers
Also called angiotensin 2 blockers
Difference between ACE inhibitors and angiotenisve 2 blockers
Blockers dont cause a dry cough
Appear to be equally effective for hypertension
ACE inhibitors may treat HF better
Angiotensin 2 blockers suffic
TAN / sartan
Losartan, valsartan,
Ag2 receptor blocker mechanism of action
Block binding off ag2 to receptors, preventing aldosterone release
This blocks vasoconstriction
Ag 2 blocker indications
Hypertension
Adjunctive treatment for HF
Ag 2 blocker adverse effects
URT infections
Dizziness etc
Back pain
Hyperkalemia (less likely than ACE inhibitors)
Ca channel blockers use
Treatment for hypertension and angina
Causes smooth muscle relaxation by block that binding of calcium to receptors (prevent contraction0
Ca channel blockers mechanism of action
Bind to Ca receptors to prevent contraction of muscle
Leads to decreased muscle tone, SVR and BP
Ca channel blockers indications
Angina
Hypertension
Dysrhythmias
Migraines
Diuretics facts
First line antihypertensives
- decrease plasma and ECF volumes
This decreases workload of the heart and BP
Most common diuretic used in hypertension
Thiazide diuretics
Vasodilators examples
Minoxidil
Diazoxide
Vasodilators mechanism of action
Directly relax smooth muscle
Used for their ability to cause peripheral vasodilation
Results in decreased SVR
Vasodilators indications
Hypertension
Vasodilators adverse effects (different for different meds)
I can’t imagine this is that important
Hydralazine
- dizziness etc, tachycardia, edema, dyspnea, lupus
Minoxidil
- T wave ECG changes
- breast tenderness, rash, pericardial effusion
Sodium nitroprusside
- bradycardia, decrease platelet aggregation, rash, hypotension
Nursing implications
- obtain history
- assess for contraindications
- educate on important of not missing dose
- monitor BP
- dont stop abruptly
- give with meals
- IV with extreme caution
- dont go in saunas n shit
- educate about not being fat as hell
- monitor for adverse effects
Ace inhibits and lab values
Ace inhibitors can cause renal impairment
- identified by serum creatinine
Can cause hyperkalemia
