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280 Cards in this Set
- Front
- Back
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Why are penicillins practically ideal antibiotics
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active against a variety of bacteria and toxicity is low
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Principal adverse effect of penicillin
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allergic reaction
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what family of antibiotics do penicillin and cephalosporins belong
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beta-lactams
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Which of the following bacteria is Penicillin G inactive against
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gram-negative bacilli
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What serious adverse effect may occur when large IV doses of potassium penicillin G are administered rapidly
|
hyperkalemia - possibly causing dysrhythmias and even cardiac arrest
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what percent of patients who recieve penicillins experience an allergic reaction
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0.4%-0.7%
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Describe anaphylaxis? What is the primary treatment?
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laryngeal edema, bronchoconstriction, severe hypotension
epinephrine |
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if a petient has experienced an intense allergic reaction to penicillin in the past does this mean that an intense reaction will occur again
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no
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if any patient is ordered penicillin, what question should be asked?
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if they have a penicillin allergy
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For patients who have a history of mild allergic reaction to penicillins what may be used as an appropriate alternative
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cephalosporins (if allergic reaction was mild)
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what unit of measurement is used to meausre a dose of penicillin G
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units
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What is most common side effect of ampicillin
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Rash and diarrhea
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what is more stable in stomach acid, amoxicillin or ampicillin
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amoxicillin
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How do penicillins kill bacteria
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by weakening the bacterial cell wall
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what is not same administration time as penicillin
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gentamicin
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What has 4 generations
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cephalosporins
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most common allergic reaction to cephalosporins
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maculopapoular rash
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when will the reaction to cephalsoporins occur
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several days after the onset
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How frequently is vancomycin used? why?
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only for severe infections
because it is a potentially toxic drug |
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Three principal indication for vancomycin?
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antibiotic-associated pseudomembranous colitis, infection with MRSA and treatment of serious infection with susceptible organisms in patients allergic to penicillins
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For most infections by what route is vancomycin given? why?
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parenterally (by slow IV infusion) because absorption from the GI tract is poor
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what is the only reason vancomycin would be given by the oral route?
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infection of the intestine
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What adverse effect at the IV site is common with vancomycin? How can it be minimized?
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Thrombophlebitis; by administering vancomycin in dilute solution and by changing the infusion site frequently
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can patients allergic to penicillins be given vancomycin?
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yes because they don't show cross-reactivity
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name 5 things that should not be tken at the same time as oral tetracycline because insoluble metal compunds (chelates) may form and decrease absorption
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calcium supplements
milk products iron supplements magnesium-containing laxative antacids |
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Why are tetracyclines contraindicated for use by pregnant women and children under 8 years?
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teeth discoloration
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What is the most common result of photosensitivity when taking tetracycline? how should patients be advised?
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exaaggerated sunburn
to avoid prolonged exposure to sunlight, wear protective clothing and apply a sunscreen to exposed skin |
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What action should be taken in regards to administering tetracyclines to avoid drug interaction with chelates?
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should be administered at least 2 hours before or 2 hours after ingestion of chelating agents
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how common is erythromycin used
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treatment of first choise for several infections
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name 4 gastrointestinal disturbances that are the most common adverse effect of erythromycin?
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epigastric pain, nausea, vomiting and diarrhea
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Describe the most severe adverse reactions with clindamycin?
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antibiotic-associated Pseudomembranous Colitis. Characterized by profuse, watery diarrhea (10-20 watery stools per day) abdominal pain, fever and leukocytosis
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Name 2 serious injuries that aminoglycosides can cause
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inner ear and kidney
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3 of the most commonly used aminoglycosides
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gentamicin, amikacin and tobramycin
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Why are the inner ear and kidney vulnerable to aminoglycoside toxicity?
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because aminoglycosides become concentrated w/in cells of these structures
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Thiazide Diuretic, Frequently used in combination preparations
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hydrochlorothiazide
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Loop Diuretic, great diuresis, uncommon use in chronic hypertension
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furosemide (Lasix)
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Betablocker, widely used antihypertensive drug
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metroprolol (Lopressor)
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Alpha blocker, increased orthostatic hypotension
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doxazosin
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Centrally Acting, work in brainstem
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clonidine
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Calcium Channel Blockers, use cautiously in bradycardia, heart failure
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amlodipine
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ACE Inhibitors, persistent cough, less effective in African Americans than White Americans
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lisinopril
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Direct Acting Vasodilator, used for hypertensive emergencies
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nitroprusside (Nipride)
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What pharmacologic class of drugs has been shown to have the best response for hypertension in African Americans and therefore are the drugs of first choice?
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Controlled trials have shown that diuretics can decrease morbidity and mortality in blacks. Accordingly, diuretics are drugs of first choice.
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What pharmacologic classes of antihypertensive drugs has been shown to be least effective in African Americans?
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Monotherapy with beta blockers or ACE inhibitors is less effective in blacks than in whites.
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The ultimate goal in treating hypertension is to
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to reduce cardiovascular and renal morbidity and mortality
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What happens when nitroglycerin is administered orally?
|
Most of each dose is destroyed on its first pass through the liver
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What other drugs can nitroglycerin intensify the effects of therefore care should be exercised
|
Other hypotensive agents
|
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Where is nitroglycerin ointment applied? Is there any advantage to applying nitroglycerin directly over the heart
|
The ointment is applied to the skin of the chest, back, abdomen, or anterior thigh. Since nitroglycerin works by dilating peripheral veins, there is no mechanistic advantage to applying topical nitroglycerin directly over the heart.
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digoxin is expected to have a positive inotropic effect? what does that mean?
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increased force of ventricular contraction
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what does high fiber foods do to digoxin
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it decreases the effectiveness significantly
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how frequently should serum digoxin levels be scheduled to be checks if they had been normal/ in range?
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annually
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3 most common GI affects of digoxin?
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anorexia, nausea and vomiting
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how does monitoring and reporting common GI and CNS side effects reduce the risk of developing more the serious side effects of dysrhythmias
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since adverse affects on these symptoms frequently precede development of dysrhthmias, they can provide advance warning of more serious toxicity
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2 frequent CNS effects from digoxin
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fatique
visual disturbance such as blurred vision, yellow tinge, arrpearance of halos around dark objects |
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most seriou adverse effect of digoxin
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dysrhythmias
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Because serious dysrhythmias are a potiential consequence of digoxin therapy, what should be frequently evaluated on all patients
|
change in heart rate and rhythm
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in digoxin levels when might additional measurements be useful
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digoxin dose is changed
symptoms of heart kidney function deteriorates signs of toxicity appears drugs that can effect digoxin levels are added to or deleted from the regimen |
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before giving digoxin what would you do?
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assess apical pulse for one full minute
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when would you withhold the dose of digoxin and notify the physician?
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if the heart rate is less than 60 bpm or if a change in rhythm is detected
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how is the effectiveness of hypertension treatment evaluated?
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monitor BP periodically. Goal is to reduce it to less than 140/90
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for first dianosis of hypertension what would you use?
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hydrochorothiazide only
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higher risk of anaphylactic reaction
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penicillins
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caution with penicillin allergy
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cephalsporins
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photosensitvity, staining of developing teeth
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tetracycline
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drug/drug interaction - cardiac side effects
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erythromycin
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high risk of c. diff with prolonged use
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clindamycin
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ototoxicity, permanent chochlear and vestibular damage
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gentamicin
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drug/drug interaction - potentiative
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timethroprim/sulfamethoxazole
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severe reaction with alcohol
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metronidazole
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necrosis possible at IV site
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vancomycin
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rebound congestion with prolonged use
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nasal sprays
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dose may be meausred in units
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penicillin
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improvements with new generations
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cephalsporins
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not with dairy/antacids/metal ions
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tetracycline
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safe alternative if pencillin allergy
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erythromycin
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caution patient about diarrhea
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clindamycin
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not same adminstration time as penicillin
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gentamicin
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oral dose not absorbed, treats intestines
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vancomycin
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given PRN in cough, medication
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codeine
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Describe red person syndrome, when does it occur, how is it prevented?
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flushing, rash, pruritus, urticaria, tachycardia, and hypotension
result from release of histamine by infusing vancomycin slowly (over 60 min. or more) |
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why can oral vancomycin be given to patients with renal impairment?
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because it is not absorbed from the GI tract
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what are cephalosporins
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beta-lactam antibiotics that weaken the bacterial cell wall, causing lysis and death
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what are the major cause of cephalosporin resistance
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production of beta-lactamases
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Why has the use of tetracycline, broad spectrum antibiotics, declined
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because of the resistance and because antibiotics have greater selectivity and less toxicity are now available
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by what 2 routes are tetracyclines used to treat acne
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topically and orally
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when combined with metronidazole and bismuth subsalicylate, what else is tetracycline used to treat
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H. pylori
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Brand name of clarithromycin
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Biaxin
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Brand name of azithromycin
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Zithromax
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How commonly is clindamycin currently used? Why?
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limited use because it can promote severe antibiotic-associated colitis, a condition that can be fatal
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Damage to what part of the ear causes impairment of hearing?
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sensory hair cells in the cochlea
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Darmage to what part of the ear causes disruption of balance?
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sensory hair of the vestibular apparatus
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What is the risk of ototoxicity in aminoglycosides primarily related to?
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excessive trough levels
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Define trough level
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lowest level between doses and occurs just prior to administering the next dose
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What is responsible for the nephrotoxicity associated with aminoglycosides? how significant is the interpatient variation with aminoglycoside therapy?
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levels in the kidney being 50 times higher than levels in serum; it must be individualized because of the variability among patients
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What other antibiotic is combined with aminoglycosides frequently to enhance bacterial kill?
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penicillin
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why is aminoglycosides and penicillin combination effective
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because penicillin disrupts the cell wall and thereby facilitate access of aminoglycosides to their site of action
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what drug interaction may occur when penicillin is combined with aminoglycosides?
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when penicillin is present in high concentrations it can inactive aminoglycosides by direct chemical interaction
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how can the chemcial interaction between penicillin and aminoglycosides when combined be avoided
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they should not be mixed together in the same IV solution
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what other 2 antibiotics besides penicillin be combined with aminoglycosides to enhance bacterial kill
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cephalosporins and vancomycin
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traditionally what has been the dosing schedule for aminoglycosides
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divided doses given at equally spaced intervals around the clock
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what doses schedule is common today in aminoglycosides
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total daily dose all at once
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what provides the best basis for adjusting aminoglycoside dosage
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monitoring serum drug levels
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What is the principal advantage of gentamicin over the other majuor aminoglycosides
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when resistance is not a problem in the hospital, gentamicin is prefrred because it is cheaper
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in hospitals when is amikacin the preferred agent
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when the resistance to gentamicin and tobramycin is common
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what important uses do the sulfonamides still have
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UTI
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how do sulfonamides suppress bacterial growth
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inhibiting synthesis of folic acid a compound required by all cells to synthesize DNA, RNA and proteins
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for what opportunistic infection, which thrives in immunocompromised hosts, is TMP/SMZ the treatment of choice
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UTI, otitis media, bronchitis, shigellosis and pneumonia
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when TMP/SMZ is given to aids patients what may occure
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produces high incidence of adverse effects
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what is the incidence of adverse effects (rash, recurrent fever, leukopenia) of TMP/SMZ in patients suffering from AIDS?
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55%
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What are the majority of uncomplicated community - acquired UTI's are caused by
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Escherichia coli
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how many hospital acquired UTIs are caused by E. coli
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less than 50%
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in what instances would it be more likely that a urinary infection was caused by multiple organisms
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patients with indwelling catheter, renal stones or chronic renal abscesses
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What are the traditional agents of choice for UTIs
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Trimethoprim/sulfamethoxazole
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where resistance to UTIs with Trimethoprim/sulfamethoxazole exists what drugs are a good alternative
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Fluroquinolones
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how wide a spectrum of activity do fluoroquinolones have
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broad spectrum
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what can be said about the safety and chance of microbial resistance with fluroquinolones
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side effects are generally mild, resistance develops slowly
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brand name of ciprofloxacin
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Cipro
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2 routes can ciprofloxacin be administered
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PO and IV
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because of concerns about tendon injury for what age group is systemic ciprofloxacin generally avoided
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children under 18 years old
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Brand name of Metronidazole
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Flagyl, Protostat
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For what suprainfection is metronidazole considered a drug of choice
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C. difficile
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for what prophylaxis is metronidazole used for
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in surgical procedures associated with a high risk of infection by anaerobes (eg. colorectal surgery, abdominal and vaginal surgery)
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for what disease is metronidazole used in combination with a tetracycline and bismuth subsalicylate
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PUD
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seasonal rhinitis occur
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occurs in spring and fall
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perennial rhinitis occur
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nonseasonal
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3 symptoms of allergic rhinitis can antihistamines relieve
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sneezing, rhinorrhea and nasal itching
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what symptoms will not be relieved by antihistamines
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nasal congestion
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what adverse effect is the most frequent complaint about antihistamines
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sedation
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What is rebound congestion
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develops when topical agents are used more than a few days. With prolonged use, as the effects of each application wear off, congestion becomes progessively worse
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what route leads to rebound congestion: oral or topical
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topical
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when should coughs be considered beneficial and not be suppressed
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cough is beneficial to remove foreign matter and excess secretions from the bronchial tree; producitve cough is characteristic of chronic lung disease and should be suppressed
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What is the name of the therapeutic class of drugs that suppress cough
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antihussives
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name 2 opioids used most often for cough suppression
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codeine and hydrocodone
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name the most effective cough suppressant available
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codeine
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what effect does codeine have on a cough
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can decrease the frequency and intensity of the cough
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how does the doses recommended in codeine for a cough compare with the dose needed to relieve pain
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doses are low, about 1/10 those needed to relieve pain
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Why is the routine use of antibiotics not justified in the treatment of colds
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because colds are caused by viruses, there is no justification for the routine use of antibiotics
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name 5 agents that are commonly used in combination over the counter cold remedies
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nasal decongestant
anti-tussive analgesic antihistamine caffeine |
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why is caffeine included in over the counter cold remedies
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to offset the sedative effects of the antihistamine
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define angina pectoris
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a sudden pain beneath the sternum, often radiating to the left shoulder and arm
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what precipitates anginal pain
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oxygen supply to the heart is insufficient to meet oxygen demand
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name 4 factors that determine cardiac oxygen demand
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heart rate
contractility preload afterload |
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what is the cardiac oxygen supply determined by
|
myocardial blood flow
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What is another name for stable angina
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exertional angina or angina of effort
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name four things that may trigger or precipate an anginal attack
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physical activity
emotional excitement large meals cold exposure |
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what is the underlying cause of exertional angina
|
coronary artery disease (CAD) a condition characterized by deposition of fatty plaque in the arterial wall
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non drug therapy for stable angina
|
avoid over exertion
avoid heavy meals avoid emotional stress avoid exposure to cold |
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what is the cause of variant angina
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coronary artery spasm, which restricts blood flow to the myocardium
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in contrast to stable angina, when does pain occur with variant angina
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at any time even during rest and sleep
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in contrast to stable angina, how is the variant angina treated
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increasing cardiac oxygen supply
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how do organic nitrates relieve angina
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relieve angina by causing vasodilation
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what is the drug of choice for treating acute anginal attacks
|
nitroglycerin
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in stable angina which vessels are primarily affected by nitroglycerin which resuls in pain relief
|
peripheral blood vessels
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how does nitroglycerin decreses the pain of exertional angina
|
by decreasing cardiac oxygen demand.
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what happens when nitroglycerin is adminstered orally
|
most of each dose is destroyed on its first pass through the liver
|
|
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why can nitroglycerin be given by so many uncommon routes
|
it is highly lipid soluble and crosses membranes with ease
|
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3 principle adverse effects of nitroglycerin
|
headache
hypotension tachycardia |
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when is severe headache most likely during nitroglycerin therapy? how long does this condition last
|
initial therapy
diminshes over the first few weeks of treatment |
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what other drugs can nitroglycerin intensify the effects of therefore care should be exercised
|
hypotensive drugs
|
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What should be done to prevent tolerance to nitrates
|
use in lowest effective dosages; long-acting forumlations should be used on an intermittant schedule that allows at least 8 drug free hours every day, usually at night
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how can tolerance of nitrates be reversed
|
by withholding for a short time
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Name the three forms of nitroglycerin used to abort an ongoing anginal attack and to provide prophylaxis in anticipation of exertion
|
sublingual tablets, transmucosal tablets, translingual spray
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Name the four forms of nitroglycerin used for sustained prophylaxis against angina
|
transdermal patches, topical ointment, transmucosal tablets and sustained release oral capsules
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What other drugs can nitroglycerin intensify the effects of therefore care should be exercised
|
Other hypotensive agents
|
|
|
Where is nitroglycerin ointment applied? Is there any advantage to applying nitroglycerin directly over the heart?
|
The ointment is applied to the skin of the chest, back, abdomen, or anterior thigh. Since nitroglycerin works by dilating peripheral veins, there is no mechanistic advantage to applying topical nitroglycerin directly over the heart.
|
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Since nitroglycerin tablets are chemically unstable and can lose effectiveness over time, how are they stored?
|
Shelf life can be prolonged by storing tablets in a tightly closed, dark container
|
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What will be the result if a patient swallowed the nitroglycerin tablet that was supposed to be placed under the tongue?
|
Nitroglycerin tablets formulated for sublingual we are ineffective if swallowed.
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list 4 characteristics of heart failure
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ventricular dysfunction
reduced cardiac output insufficient tissue perfusion signs of fluid retention |
|
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list three things that digoxin can do when used for heart failure?
|
can reduce symptoms, increase exercise tolerance and decrease hospitalizations
|
|
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what mechanical effect does digoxin exert on the heart
|
positive inotropic action on the heart
|
|
|
define positive inotropic action. Also think: what would be definition of negative inotropic action?
|
the drug increases the force of ventricular contraction and can thereby increases cardiac output
|
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in patients with heart failure what does increased myocardial contractility increases
|
cardiac output
|
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how does a reduced heart rate effect ventricular filling
|
it allows a more complete ventricular filling
|
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how does increased cardiac output affect urine production
|
the increase in cardiac output increases renal blood flow, and thereby increases production of urine
|
|
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what is the most serious adverse effect of digoxin
|
dyshythmias
|
|
|
because serious dysrhythmias are a potential consequence of digoxin therapy what should be frequently evaluated on all patients
|
all patients should be evaluated frequently for changes in heart rate and rhythm
|
|
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what should outpatients be taught to monitor and report
|
monitor their pulses and instructed to report any significant changes in rate or regularity
|
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what is the most common cause of dysrhythmas in patients receiving digoxin
|
hypokalemia secondary to the use of diuretics
|
|
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because low potassium can precipitate dysrhythmias, what is imperative
|
it is imperative that serum potassium levels be kept w/in a normal range
|
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what is one symptom of hypokalemia that a patient should be taught to look for and notify their physician
|
muscle weakness
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|
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what is an important implication of digoxin having a nrrow therapeutic range
|
drug levels only slightly higher than therapeutic greatly increase the risk of toxicity
|
|
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3 most common GI affects of digoxin
|
anorexia
nausea vomiting |
|
|
what are the 2 frequent CNS effects from digoxin
|
visual disturbances
fatique |
|
|
how does monitoring and reporting common GI and CNS side effects reduce the risks of developing the serious side effect of dysrhythmias
|
since adverse effects on these symptoms frequently precede development of dysrhythmias, symptoms involving the GI tract and CNS can provide advance warning of more serious toxicity, accordingly patients should be taught to recognize these effects and instructed to notify the prescriber if they occur
|
|
|
name 2 drugs that can significantly raise serum digoxin levels
|
thiazide diuretics and loop diuretics
|
|
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how do meals high in fiber affect the bioavailability of digoxin
|
decreases absorption significantly
|
|
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name 4 things knowledge of serum digoxin levels is used for
|
establishing dosage
monitoring compliance diagnosing toxicity determining the cause of therapeutic failure |
|
|
how offen are routine serum digoxin levels recommended once a stable blood level has been achieved
|
annual measuremement
|
|
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when might additional measurement be useful in digoxin
|
dosage change
symptoms of Heart failure intensify kidney function deteriorates signs of toxicity appear drugs that can affect digoxin levels are added to or deleted from the regimen |
|
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what form of digoxin is inside capsules of Lanoxicaps (perhaps accounting for the greater absorption)
|
solution
|
|
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what route of administration of digoxin shuld be avoided
|
intramuscular adminstration
|
|
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when should administration of digoxin be withheld
|
if HR is less than 60 bpm, or if a change in rhythm is detected
|
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define digitalization
|
refers to the use of a loading dose to achieve high plasma levels of digoxin quickly
|
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if left untreated, what can hypertension lead to?
|
heart disease
kidney disease stroke |
|
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can hypertension be cured? how does this factor affect treatment?
|
cannot be cured only symptoms can be reduced
treatment must continue lifelong, making nonadherence a significant problem |
|
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normal BP
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< 120 / 80
|
|
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prehypertension BP
|
systolic 120-139
diastolic 80-89 |
|
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hypertension BP
|
systolic above 140
diastolic above 90 |
|
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stage 1 hypertension BP
|
systolic 140-159
diastolic 90-99 |
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stage 2 hypertension BP
|
systolic > or equal 160
diastolic > or equal to 100 |
|
|
2 broad categories of hypertension
|
primary (essential) hypertension - no identifable cause; chronic progessive disorder
secondary hypertension - brought on by a primary cause/ may be possible to treat |
|
|
what will happen if patients with high BP do not get treatment
|
can lead to heart disease, heart failure, angina, kidney disease and stroke
|
|
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who is at a greater risk of hypertension
|
older people
african american & Mexican Americans obese people postmenopausal women |
|
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how long does treatment for high BP last
|
treatment must continue lifelong
|
|
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when is drug therapy used to treat secondary hypertension
|
if it is not possible to treat the cause, or a cure isn't possible, it can be managed with the same drugs used for primary hypertension
|
|
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what is the treatment goal for most patients with stage 1 / stage 2 hypertension
|
to maintain BP below 140/90
|
|
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what intervention is needed for people with prehypertension
|
lifestyle changes
|
|
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what intervention is needed for people with hypertension - either stage 1 or 2
|
a combination of lifestyle changes and drugs
|
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identify 3 benefits of lifestyle modications in the management of chronic hypertension
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lower BP
thereby decreasing the need for drugs decreases other cardiovascular risk factors |
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7 components for lifestyle changes for hypertension
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weight loss
sodium restriction The DASH diet (dietary approcahes to stop hypertension) eating plans alcohol restrictions aerobic exercies smoking cessation maintenance of potassium and calcium intake |
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what should be included in the DASH eating plan? what should be avoided
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diets in rich in fruits, low fat dairy products and low in total fat, saturated fats and cholestrol
the plan encourages intake of whole grain products, fish, poultry, and nuts, and recommends minimal intake of red meat and sweets |
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what 2 factors produce arterial pressure? what happens if either one of these factors increases?
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cardiac output and peripheral resistance
an increase in either will increase BP |
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list four factors that influence cardiac output
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heart rate
myocardial contractility (force of contraction) blood volume venous return |
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which of the four cardiac fractors do drugs such as beta blockers, verapamil and diltiazem affect
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decreases heart rate and contractile force
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which of the four cardiac factors do diurectics affect
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decrease in blood volume
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which of the four cardiac do drugs classified as venodilators affect
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venous return
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what type of drugs can reduce blood BP by decreasing peripheral vascular resistance
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drugs that promote arteriole dilation
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list the five ways drugs can lower BP
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reducing heart rate
myocardial contractility blood volume venous return tone of arteriolar smooth muscle |
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what class of diuretics are among tghe most commonly used antihypertensive drugs
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thiazide diruetics
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identify the 2 mechanism by which thiazides reduce blood pressure
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reduction of blood volume and reduction of arterial resistance
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what is the principal adverse effect of thiazides
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hypokalemia
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why are high-ceiling (loop) diuretics not used routinely for most individuals with chronic hypertension
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for chronic hypertension, the amount of fluid loss that loop diuretics can produce is greater than needed or desirable
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what is the brand name of furosemide
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Lasix
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How much of a hypotensive effect do potassium-sparing diuretics have?
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modest hypotensive effects, degree of diuresis is small
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how widely are the beta blockers used to treat hypertension
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among the most widely used anithypertensive drugs
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for what population of patientsw are beta blockers are less effective
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african americans
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list the adverse effects beta blockers have on the following factors and the treatment recommendation for related groups of patients
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heart - bradycardia
lungs - promote bronchoconstriction blood glucose - mask the signs of hypoglycemia mental status and sexual function - depression, insomnia, bizare dreams and sexual dysfunction |
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what is the mechanism of action of alpha 1 blockers
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prevent stimulation of alpha 1 recepters on arterioles and veins, thereby preventing sympathetically mediated vasoconstriction. The resultant reduces both peripheral resistance and venous return to the heart
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what is the band name of doxazosin
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Cardura
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What is the most disturbing side effect of alpha blockers?
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orthostatic hypotension
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what is the mechanism of action that are both alpha and beta blockers
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blocks stimulation of beta 1 (myocardial) and beta 2 (pulmonary, vascular, and uterine) - adrenergic receptor sites. Also has alpha 1 - adrenergic blocking activity, which may result in more orthostatic hypotension
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Brand name of labetalol
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Trandate
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what is the mechanism of action of Centrally activing Alpha 2 agonists
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act w/in the brainstem to suppress sympathetic outflow to the heart and blood vessels. The result is vasodilation and reduced cardiac output, both of which helps lower BP
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Brand name of clonidine
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Catapres, Catapres - TTS, Duracion
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Brand name of methyldopa
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Aldomet
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What is the mechanism of action of direct acting vasodilators
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promoting dilation of arterioles
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brand name of hydralazine
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Apresoline
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what side effects is minimal because direct-acting vasodilators do not cause significant dilation of veins
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orthostatic hypotension
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what is the mechanism of action of calcium channel blockers
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promote dilation of arterioles
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What does the abbreviation ACE mean
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angiotensin-converting enzyme
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what is the mechanism of action of ACE inhibitors
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preventing the formation of angiotensin II and thereby prevent angiotensin II - mediated vasoconstriction and aldosterone - mediated volume expansion
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for what population of patients are ACE inhibitors less effective
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african americans
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name four principal adverse effects of ACE inhibitors
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peristent cough
1st dose hypotension angioedema hyperkalemia |
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what is the mechanism of action of angiotensin II receptor blockers
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works like ACE inhibitors, prevent angiotensin II - mediated vasoconstriction and release of adlosterone, block the actions of angiotensin II
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what is the small difference between the action of angiotensin II receptor blockers and ACE inhibitors
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ARBs block the actions of angiotensin II, whereas ACE inhibitors block the formation of angiotensin II
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brand name of hydralazine
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Apresoline
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brand name of losartan
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Cozaar
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what side effects is minimal because direct-acting vasodilators do not cause significant dilation of veins
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orthostatic hypotension
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what is the mechanism of action of calcium channel blockers
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promote dilation of arterioles
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What does the abbreviation ACE mean
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angiotensin-converting enzyme
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what is the mechanism of action of ACE inhibitors
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preventing the formation of angiotensin II and thereby prevent angiotensin II - mediated vasoconstriction and aldosterone - mediated volume expansion
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for what population of patients are ACE inhibitors less effective
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african americans
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name four principal adverse effects of ACE inhibitors
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peristent cough
1st dose hypotension angioedema hyperkalemia |
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what is the mechanism of action of angiotensin II receptor blockers
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works like ACE inhibitors, prevent angiotensin II - mediated vasoconstriction and release of adlosterone, block the actions of angiotensin II
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what is the small difference between the action of angiotensin II receptor blockers and ACE inhibitors
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ARBs block the actions of angiotensin II, whereas ACE inhibitors block the formation of angiotensin II
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brand name of losartan
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Cozaar
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What is the mechanism of action of aldosterone antagonists
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lower BP by promoting renal excretion of sodium and water
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what is the first approach to treating hypertension
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lifestyle changes
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what is the next step if lifestyle fail to lower BP enough
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drug therapy with lifestyle changes
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what does drug treament often begin with for lowering BP
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a single drug
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what are 2 reasons a second drug may be added to or substituted for the initial drug to help in treating hypertension
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if the intial drug was tolerated but inadequate, or the inital drug was poorly tolerated
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what are 4 reasons the intial drug may have been inadequate that should be explored before anohte drug is considered to help with treating hypertension
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insufficient dosage
poor adherence excessive salt intake presence of secondary hypertension |
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how many different drugs may be used if treatment for hypertension with 2 drugs is unsuccessful
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up to 4
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name 2 conditions that are especially problematic with hypertension
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renal disease and diabetes
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for what population of people is hypertension a major halth problem
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African American
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What pharmacologic clss of drugs has been shown to have the best responses for hypertension in AFrican Americans and therefore are the drugs of first choice?
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diuretics
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what pharmacologic classes of antihypertensive drugs has been shown to be least effective in African Americans
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monotherapy with beta blockers orACE inhibitors
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what antihypertensive drugs are generally preferred in older adults
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beta blockers and diuretcis
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Name 3 side effects that antihypertensive drugs can produce
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hypotension
sedation sexual dysfunction |
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the best way to identify unacceptable responses to antihypertensive drugs
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encourage the pateint to report them
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list 5 ways to promote adherence to hypertension treatment
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patient education
teach self monitoring minimize side effects establish a collaborative relationship simplify the regimen |
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define hypertensive emergency
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when diastolic BP exceeds 120 mm Hg. The everity of the emergency is dedtermined by the likelihood of organ damage
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What is usually the drug of first choice for acute severe hypertension
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nitroprusside (Nitropress)
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What route is nitroprusside
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IV
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What is nitroprusside mechanism
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a direct acting vasodilator that relaxes smooth muscle of arterioles and veins
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how fast is the onset and how long is the duration of nitroprusside
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begins in seconds and then fades rapidly when administration ceases
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define hypertension
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greater than 140/90
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what is the blood pressure goal of antihypertensive therapy
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to decrease morbidity and mortality w/out decreasing the quality of life
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What pharmacologic class of drugs are preferrred drugs for inital therapy of uncomplicated hypertension
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thiazide diuretics
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what is the major cause of treatment failure for antihypertensive therapy
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lack of pt adherence
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