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82 Cards in this Set
- Front
- Back
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What agents are these classified as
-sympatholytics -ace Inhibitors -CCB -Vaso dilators -diuretics |
Antihypertensive Agents
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What do sympatholytics inhibit?
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SNS (ie BB, alpha blockers)
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What drugs do you tell pts to hold for surgery
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Diuretics
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Why do you tell pts to continue antihypertensive meds prior to sg(except diuretics)
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-fewer fluctuations in BP & HR
-less likely to suffer cardiac dysrhythmias |
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What are some concerns to think about if your pt is on antihypertensives and they are having surgery?
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-oversedation
-Blunted response if u give sympathomimetics -attenuation of SNS: ortho BP & dec. BP from acute blood loss, body position changes, dec. venous return due to + press. vent. |
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What type of drug is clonidine
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Sympatholytic
centrally acting selective partial ALPHA2 AGONIST |
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Is clonidine a central acting drug
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Yes
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Clonidine is used to tx
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HTN, (refractory), not a first line drug, used as an add on for difficult to control pts.
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What pts. is clonidine effective in
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Severe HTN and Renin dep. dz.
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Clonidine causes vessels to
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vasodilate
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What kind of pain is clonadine used for
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Refractory pain (pts. w/ pumps)
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What does clonidine do to mac req.
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decreases by 50% (use less agent)
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Side effects of clonidine ,seen when used as neuraxial (epidural,spinal)
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hypotension,sedation, dry mouth
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What are the benefits of giving clonidine as preanesthetic?
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-enhances post op analgesia
-blunts reflex tachycardia -dec. fluct. of BP & HR -dec. plasma catechholamines -dec. Mac req. |
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Does clonidine cause resp depression and oversedation with intrathecal morphine use?
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NO
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Why is clonindine a good drug to use for CAD and hx of MI pts.
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they cant tolerate reflex tachycardia and clonidine does not do this.
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Does clonidine augment or attenuate the pressor responsed to IV ephedrine and explain why
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AUGMENTS;
ephedrine releaes norepi and clonidine does not completely block ALL norepi; Norepie stronger. |
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what are the effects when clonidine is given w/ tetracaine or bupivicaine in subarachnoid space
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Block last longer- sensory and motor blockade
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Can you use clonidine with OB patients and why or why not?
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NO!!!
Fetal bradycardia |
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What does clonidine do to BP and HR during sg.
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Increased incidence of hypotension and bradycardia;
MONITOR PT CAREFULLY!!! |
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What are some other uses of clonindine other than for HTN
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-opiod and nicotine withdrawl
-shivering -hemodynamic effects of ketamine (ketamine inc. BP & HR) |
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What is the MOA of clonidine
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stimulates alpha2 inhibitory neurons (inhibits relese of norepi)
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What does clonidine do to BP, HR, C.o.
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decreases all (due to decreased symp. outflow of CNS to periphery
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How can clonidine be given
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-PO, rapidly absorbed, duration 8 hrs.
-transdermal, weekly, 48 hrs to kick in |
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Which is better to use for HTN urgency? clonidine PO or transdermal
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PO
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What are the most common side effects of clonidine
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Sedation and xerostomia (dry mouth)
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What are ALL the side effects of clonidine
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-sedation
-dry mouth -50% dec. in anesth requ. -Bradycardia (tx w/ anticholiner) -Fluid ret. (tx w/ diuretics) -skin rashes -impotence -orth. hypot -high k |
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What happens to BP if you stop clonidine abruptly
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REBOUND HTN (instruct pt to take up unitl sg)
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What are some pre-rebound htn effects that might clue you that pt is about to experience rebound HTN with the use of clonidine
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-nervousness
-HA -Diaphoresis -abd. pain -Tachycardia |
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Can you give a BB to tx clonidine rebound htn
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NO!!!!!! You will Block beta 2 vasodilating effects and leav alpha 1 receptor unopposed.
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What is the tx of rebound htn caused by stopping clonidine
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1. restart clonidine
2. start periph. vasodilators (hydralazine or nitroprusside) |
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What is considered to be the first line agents for the tx of systemic htn, CHF, mitral regurg
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ACE Inhib.
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Should ACE Inhib. be used for diabetics and why or why not
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YES, delays nephropathy
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Why is ACE Inhib. good for heart failure
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Regresses Left Vent. hypertrophy
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Which type of antihypertensive agents would be good for a pt wiht htn & heart dz?
-sympatholytics -ace Inhibitor -ARB's -Vasodialtors |
ACE Inhib.
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How do you tx hypotension and bradycardia induced by use of clonidine in sg.
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Give fluids and sympathomimetics
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What drugs end in "-PRIL"
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ACE Inhib.
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Captopril is from what type of antihypertensive agent
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ACE Inhib
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Is Captopril long or short acting
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Short, given first to see if pt tolerates then usually switched to longer acting ACE Inhib.
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What is the MOA of ACE Inhib.
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Blocks the conversion of angiotensin I to angiotensin II
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What are some effects of ACE Inhib.
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-Dec BP
-dec. afterload -Inc. C.O. (good for heart failure pts.) -inhibits release of aldosterone |
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What does ACE inhib do to K levels? increase or decrease
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Increase; due to the blocking of aldosterone (ald. normally excretes k so blocking it may increase levels)
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What are the most common adv. effects of ACE Inhib
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1.cough
2.inc. resp congestion 3.rhinorhea (runny nose) |
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Does ace have any CNS effects
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NO
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Does rebound htn occur with ACE Inhib like they do with clonidine
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NO
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True of false; you will see metabolic changes with ACE Inhib
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FALSE
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What are some effects you dont see with ace inhib that you do see with BB
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No CHF
NO bronchospasm NO bradycardia NO exacerbation of PVD |
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What is a LIFE THREATENING adv effect associated with ACE Inh.
and what other drug do you also see this in |
ANGIOEDEMA, ARB's
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Why do you get a cough with ACE Inhib
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Due to bradykinins (which are found in the lung)
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Why should ACE Inhib be used cautiously with renal pts.
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decreases GFR and incr. K
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What is the tx for angioedema
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EPI 0.3-0.5 ml of 1:1000
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What electrolyte does ACE Inhib incrrease
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K+ , due to dec. production of alsoterone
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Should you stop ACE inhibitors for surgery
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No, continue them until surgery and reinitiate them post-op ASAP
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What does ARB stand for
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Angiotensin Receptor Blockers
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MOA of ARB's
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Directly block the angiotensin II receptor
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Which blocks all (2) angiotensin pathways? AECI or ARB's
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ARB's
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Is cough a side effect of ARB's like it is for ACE Inhib?
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NO , ARB do no prevent the breakdown of bradykinins.
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Renal insufficiency and hyperkalemia are possible cause of which agents?
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ACEI, ARB's
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What are the adv effects of ARB's
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-Angioedema
-hypotension severe -Neutropenia |
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Which drugs end in "-sartan"
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ARB's
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What is Aliskiren
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A renin inhibitor
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what is aliskiren used for
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Tx of HTN
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Why would you give Aliskiren to a pt instead of ACEI
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Pt intolerant to ACEI cough
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Aliskiren inhibits angiot I or II
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Both and all pathways
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Contraindiations of aliskiren
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-hypersensitive to alikiren or any components.
-Hx of angioedema -Bilat renal art stenosis -Pregnancy (just like for ACEI) |
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What are adverse rx with aliskiren
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-dizziness
-rash -high K -diarrhea -creatine kinase elevated -BUN and Ser. creat elevated -cough |
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Name some vasodilators
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-hydralazine
-apresonle -minoxidil |
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What is hydralazine
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A direct vasodlator of arterioles (little effect on veins)
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What does hydralzine do to SVR
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Decreses
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What is commonly used to tx pregnancy related HTN crisis
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Hydralzine & Apresoline
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Does Hydralzine & Apresoline cause reflex tachy
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yes, which leads to myocardial oxygen demand
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What does hydralazine do to HR, SV, CO
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Increased
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What is a MAJOR side effect of Hydralzine & Apresoline
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SLE (lupus) or + ana in 10% of pts. -thats alot.
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Does the SLE symptoms stop if you stop Hydralzine
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Yes
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What 2 drugs cause SLE
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Hydralazine and procainamide (antiarrhythmic)
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Why would you have to give a diuretic with hydralazine
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Fluid retention
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What is minoxidil
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orally active antihtn.
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MOA of minoxidil
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Direct relaxation of arterial smooth muscle
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What type of htn is minoxidil used for
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Refractory HTN, ESRD pts
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What is a major side effect of minoxidil that may cause pericardial effusions and cardiac tamponade
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Fluid Retention (Give diuretics with )
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What is an unexpected side effect of minoxidil
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Hair growth (Rogaine)
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What other drug should you give to pts on vasodilators because of fluid retention
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Diuretics
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