Pharmacology Blood Pressure/ap/hf

Front 1

Ace Inhibitors -- Captopril (Capoten)

Back 1

-reduce BP-HTN!!!, heart failure!!!, diabetic neuropathy-SLOWED PROGRESSION!!!, MI; prevent adverse cardiovascular events in pts at risk
-cough, angiedema, first-dose hypotension and hyperkalemia
-reduce levels of angiotensin II through inhibiting ACE = dilate BVs (arterioles), reduce blood volume and prevent or reverse pathologic changes in heart and bvs mediated by angiotensin II and aldosterone; increase levels of bradykinin-vasodilation secondary to increased production of prostaglandins and nitrx oxide
-2-3 times per day
-BP and WBC count and differential baseline
-not use 2nd 3rd trimesters, bilateral renal artery stenosis or hx of hypersenstivity rxn like angioedema to these
-caution in salt or volume depletion, renal impairment, collagen vascular disease, potassium supplements, salt substitutes, potassium sparing diuretics, aliskiren, lithium
-at least 1 hour before meal

Front 2

Ace Inhibitors -- Captopril (Capoten)

Back 2

-monitor BP closely for 2 hours after first dose and periodically thereafter; WBC count and differential every 2 weeks for first 2 months of therapy and periodically thereafter
-target is 140/90; HF-lessening of s/s like dyspnea, cyanosis, JVD, edema); monitor for proteinuria in DN
-first-dose hypotension (stop diuretics one week before, initial low dose-monitor BP for 2 hours following first dose and lie down; NS to restore pressure if needed)
-cough
-fetal injury
-angioedema-giant wheals and edema of tongue, glottis and pharynx-teach to seek ASAP medical attention; sub Q epinephrine
-renal failure (stenosis)
-dysgeusia and rash-avoid high doses, if persists= notify; dysegeusia-anorexia and wt loss, discontinue
-neutropenia-high risk of infection-early signs of infection are fever, sore throat, mouth sores and notify prescriber-most likely with renal impairment and collagen vascular diseases
-diuretics-one week; antihypertensive agents-reduced doses; avoid drugs that elevate potassium levels (aliskiren); minimize NSAID use because can interfere with effects; can raise lithium levels

Front 3

Angiotensin II Receptor Blockers -- Irbesartan, (Avapro), Losartan (Cozaar)

Back 3

-block action of angiotensin II not production; not cough (bradykinin) or hyperkalemia
-dilation arterioles, veins; prevent pathologic changes in cardiac structure; decrease aldosterone release so increase renal excretion of sodium and water; sodium and water further increased through dilation renal vessels
-reduce BP-HTN!!!, (heart failure!!!, diabetic neuropathy-SLOWED PROGRESSION!!!, prevent stroke in pts with HTN and LV hypertrophy)
-BP baseline
-not use 2nd 3rd trimesters, bilateral renal artery stenosis or hx of hypersenstivity rxn like angioedema to these
-target is 140/90; HF-lessening of s/s like dyspnea, cyanosis, JVD, edema); monitor for proteinuria in DN
-fetal injury
-angioedema-giant wheals and edema of tongue, glottis and pharynx-teach to seek ASAP medical attention; sub Q epinephrine
-renal failure (stenosis)
-antihypertensive agents-reduced doses

Front 4

Aldosterone Receptor Blockers -- Eplerenone (Inspra)

Back 4

-HTN and HF-may prevent or reverse pathologic effects of aldosterone on cardiovascular structure and function
-hyperkalemia-not use with potassium supplements, salt substitutes, potassium-sparing diuretics; combined with ACE inhibitors or ARBs caution; not use with serum above 5.5 mEq/L and pt with impaired renal function or type 2 diabetes with microalbuminuria-which both can promote hyperkalemia; monitor levels of those at risk
-inhibitors of CYP34A can increase these drug levels-reduce weak inhibitor like erythromycin and not use with strong inhibitors like ketoconazole, itraconazole
-caution with lithium levels and monitor freqeuntly
-retain potassium and increase excretion of sodium and water, which then reduces blood volume and pressure
-combined; reserved for people not respond to traditional

Front 5

Calcium Channel Blockers --
Verapamil (Calan), amlodipine (Norvasc)

Back 5

Verapamil: HTN, angina pectoris, cardiac dysrhythmias (atrial fibrillation, atrial flutter, paroxysmal supraventricular tachycardia)
-BP, pulse rate, labs of liver and kidney function; angina pectooris-frequency and severity of anginal attacks
-not severe hypotension, sick sinus syndrome (in absence of electronic pacing), 2nd or 3rd degree AV block, caution in HF, liver impairment or those taking digoxin or beta blockers
-sustained relsease for HTN, whole-measure BP and pulse-hypotension or bradycardia-notify prescriber and withhold med
-IV-cardiac dysrhythmias-injections over 2-3 min and monitor ECG for AV block, sudden reduction in heart rate, prolongation of PR or QT interval-have facilities for cadioversion and cardiac pacing immediately available
-AP-chart time, intensity and circumstances of attacks and likely precipitating event and notify prescriber if increases; HTN-monitor BP peridically-goal 140/90-teach to self-monitor BP and maintain BP record
-peripheral edema
-constipation-increase fluid and fiber
-cardiosuppression-bradycardia, AV block, HF-teach about slow heartbeat, shortness of breath, weight gain and notify prescriber if occur
-digoxin-increases risk or partial or complete AV block-monitor for missed beats, slowed ventricular rate; can increase digoxin plasma levels-reduce digoxin dose

Front 6

Calcium Channel Blockers --
Verapamil (Calan), amlodipine (Norvasc)

Back 6

-beta blockers-can cause bradycardia, AV block, HF-monitor closely for cardiac suppression; give IV this and beta blockers several hours apart
-toxicity-remove unabsorbed drug with gastric lavage then cathartic; IV calcium to counteract excessive vasodilation and reduced myocardial contractility; raise BP with IV NE, IV fluids and palce pt in modified trendeelenburg's position can help; bradycardia and AV block reversed with isoproterenol and atropine-or if severe, electronic pacing; ventricular tachydysrhythmias can be treated with DC cardioversion-antidysrhythmic drugs like lidocaine or procainamide can also be used
-block calcium channels in heart and blood vessels-dilation of peripheral arterioles, arteries and arterioles of heart increase coronary perfusion; blockade at SA node reduces heart rate; blockade at AV node decreases AV nodal conduction; blockade in myocardium decreases force of contraction

amlodipine:
-AP, HTN
-swallow whole
-caution with hypotension, sick sinus syndrome (in absence of electronic pacing), angina pectoris (because of reflex tachycardia), HF, and 2nd/3rd degree AV block
-peripheral edema-swelling in ankles or feed and instruct to notify prescriber; reflex tachycardia-can be suppressed with a beta blocker
-block calcium channels in BVs and not really in heart

Front 7

Vasodilators -- Hydralazine (Alazine, Apresoline)

Back 7

-arteriolar dilation-decreases peripheral resistance and arterial BP fall-then heart rate and myocardial contractility increases
-HTN (with beta blocker), diuretic?
-parenteral used to lower BP rapidly in severe hypertensive episodes
HF-usually with isosorbide dinitrate (dilates veins)-short term to reduce afterload
-give with beta blocker to reduce reflex tachycardia
-increased blood volume-this drug induced hypotension can cause sodium and water retention-diuretic to prevent
-systemic lupus erythematosus-like syndrome-muscle pain, joint pain, fever, nephritis, pericarditis and presence of antiniclear antibodies-rare when less than 200 mg/day
-other antihypertensive drugs-avoid excessive hypotension

Front 8

Sympatholytics (Adrenergic Antagonists)
Beta-Adrenergic Blockers Propanolol (Inderal)

Back 8

-blocks beta1 and beta2 adrenergic receptors (heart, lungs)
-decreased automacticity of SA node, velocity of conduction through AV node-prolonged PR interval, myocardial contractility
-treating dysrhythmias caused by excessive sympathetic stimulation of heart=sinus tachycardia, severe recurrent ventricular tachycardia, exercise-induced tachydysrhythmias and paroxysmal atrial tachycardia caused by emotion/exercise, supraventricular tachydysrhythmias--suppresses excessive discharge of SA node, slows ventriculra rate by decreasing transmission or atrial impulses through AV node
-cardiac beta 1 receptors coupled with calcium channels, so they close too-so result is from decrease calcium influx
-can cause HF, AV block, sinus arrest, hypotension secondary to reduced cardiac output
-those with asthma-can cause bronchospasm
-do not give to those with asthma, sinus bradycardia, hig-degree heart block, HF
-reduce heart rate, decrease force of ventricular contraction, suppress impulse conduction through AV node-reduce CO
-HTN, AP, MI too
-inhibits glycogenolysis and mask tachycardia
-severe allergy

Front 9

Direct acting Vasodilators -- Sodium Nitroprusside (Niipride, Nitropress)

Back 9

fastest acting antihypertensive available-use for hypertensive emergencies
-venous and arteriolar dilation
-IV
-lower BP rapidly in hypertensive emergencies-give with oral antihypertensive medicatio-furosemide may be needed to prevent excessive retention of fluid; controlled hypotension during surgery
-BP monitored continuously for excessive hypotension (headache, palpitations, n/v, sweating)
-cyanide poisoning-infuse slowly and give with thiosulfate
-thiocyanate toxicity-disorientation, psychotic behavio, delirium, keep below 0.1 mg/mL if give over 3 days-less hazardous than cyanide poisoning

Front 10

Centrally Acting Alpha2 Agonists -- Clonidine (Catapres)

Back 10

-act within brainstem to suppress sympathetic outflow to heart and blood vessels-vasodilation and reduced cardiac output-which reduce BP
-dry mouth, sedation
-severe rebound hypertension if stop treatment abruptly

Front 11

nitroglycerin

Back 11

-reduce frequency and intensity of anginal attacks
-baseline frequency and inensity of anginal attacks, location of pain and precipitating factors-id risks like HTN, hyperlipidemia
-caution in hypotensive pts and pts taking meds to lower BP, including alcohol; not use with sildenafil (viagra) and other PDE5 inhibitors-life-threatening hypotension
-sublingual tabs-prophylaxis and termination of an acute attack-leave until fully dissolve and not swallow-call 911 or go to ED if not better in 5 min-while waiting for care, take one more tab and 3rd 5 min later; tabs stored in dark tightly closed bottle with no other meds-write date of opening and discard in 24 months, or sooner
-sustained-release oral-sustained protection ag anginal attacks-once or twice daily only, swallow whole

Front 12

nitroglycerin

Back 12

-transdermal-sustained protection ag anginal attacks-apply to hairless area of skin, use new patch and site everyday, only wear 12-14 hours to prevent tolerance
-translingual spray-prophylaxis or termination of an acute attack-direct spray against oral mucosa-not inhale it at all
-transmucosal (buccal) tablets-prophylaxis or termination of an acute attack or sustained prophylaxis-place btw upper lip and gum or in buccal area btw cheek and gum-will adhere to mucosa and dissolve over 3-5 hours; sustained prophylaxis is adminiser every 3 to 8 hours
-topical ointment-sustained protection ag attacks-before new dose, wipe off old-rotate sites, put in bands
-IV-angina pectoris not work with other therapy, perioperative control of BP, production of controlled hypotension during surgery, HF associated with acute MI; not use standard tubing and use a glass IV bottle; slowly at first and monitor cardiovascular status constantly
-not withdraw long-acting abruptly like transdermal, topical ointment, sustained-release tabs
-reduce risk factors to enhance effects-avoid activities that elicit like overexertion, heavy meals, emotional stress, cold exposeure-weight reduction, exercise, stop smoking, contributing disease states like HTN or hypercholesterolemia treated
-headache less over time
-orthostatic hypotension, reflex tachycardia-can be suppressed by a beta blocker, verapamil, diltiazem
-record frequency and intensity of anginal attacks, location of pain, factors that precipitate attacks
-avoid alcohol, caution when used with beta blockers, calcium channel blockers, diuretics and all other drugs that can lower BP