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49 Cards in this Set
- Front
- Back
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What is blood pressure?
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BP = CO (cardiac output) x SVR (systemic vascular resistance)
the force of blood pushing against the walls of the arteries. highest at systolic (the heart beats, pumping blood), lowest at diastolic (rest between beats) |
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What targeted organ damage come from Hypertension? |
Brain (stroke), Heart, Eye (fundus reliable indicator of long term effectiveness of treatment), PVD, Renal failure |
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What is normal blood pressure range? |
Stystolic less than 120/ Diastolic less than80 |
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What is prehypertensive blood pressure range? |
S: 120-139/ D: 80-89 |
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What is stage 1 hypertension blood pressure range? |
S: 140-159/ D: 90- 99 |
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What is stage 2 hypertension blood pressure range? |
S: 160 or higher/ D: 100 or higer |
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What percentage of primary hypertension cases are from unknown cases? |
90%, usually needs lifelong drug therapy |
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What percentage of secondary hypertension cases are from known cause? |
10% |
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What medication is used to treat hypertension?
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Antihypertensive Drugs
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What are the categories of antihypertensive drugs?
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-Adrenergic Drugs
-Angiotensin-converting enzyme (ACE) inhibitors -Angiotensin II receptor blockers (ARBs) -Calcium channel blockers (CCBs) -Diuretics -Vasodilators -Direct renin inhibitors |
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What are the five subcategories of Adrenergic drugs? |
-Centrally and Peripherally acting adrenergic neuron blockers -Centrally acting alpha 2 receptor agonist -Peripherally acting alpha 1 receptor blocker -Peripherally acting beta blockers *Cardioselective beta 1 *Nonselective beta 1 & 2 -Peripherally acting dual alpha 1 and beta blocker |
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What do Centrally acting alpha 2 receptor agonists do? |
-Stimulate presynaptic alpha 2- adrenergic receptors in the brain (Decrease norepinephrine release) -Decrease sympathetic outflow from CNS -Stimulate alpha 2 adrenergic receptors, reduces renin activity -Results in decrease blood pressure |
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What are drugs from Centrally acting alpha 2 receptor agonists? |
-Clonidine -Methyldopa (used for hypertension in pregnancy) |
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What are the actions for Peripheral alpha 1 blockers? |
-Block alpha 1- adrenergic receptors (decrease arterial and venous vasoconstriction) |
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What are the drugs for Peripheral alpha 1 antagonists? |
-Doxazosin -Terazosin -Prazosin
* Drugs often cause first dose syncope, usually prescribed at bedtime |
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What are the actions of Beta Blocker? |
-Reduce BP by reducing HR with Beta 1 -Reduced secretion of renin -Long-term use caused reduced peripheral vascular resistance |
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Examples of Beta Blockers |
-Nebivolol -Propranolol -Atenolol
*Remember beta blockers end in "lol" |
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What are the actions of Dual action alpha 1 and beta blockers?
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-Reduce HR
-Cause vasodilation -Decreased BP |
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Dual- action alpha 1 and beta blocker drugs? |
-Carvedilol -Labetalol |
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When do you use adrenergic drugs? |
-All treats hypertension -CAA2RA: last to use, -PAA1RA: relieve symptoms of BPH, management of severe HF |
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What Centrally acting alpha 2 receptor agonist is useful in withdrawal symptoms in opioid dependent? |
Clonidine |
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What peripherally acting alpha 1 receptor agonist relieves symptoms of BPH? |
Tamsulosin (Flomax) |
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What are the adverse effects of Adrenergic Drugs? |
-High incidence of orthostatic hypotension -Bradycardia with reflex tachycardia (Compensation) -Dry Mouth -Drowsiness, sedation -Constipation -Depression -Edema -Sexual dysfunction (impotence in males) -Rash |
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What does ACE stand for? |
Angiotensin Converting Enzymes |
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What does ACE do? |
Indirectly ^ BP by causing blood vessels to constrict. Does this by converting angiotensin I to angiotensin II, which constricts the vessels. |
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What do ACE inhibitors do? |
They are used to lower BP |
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What are Angiotensin-Converting Enzyme Inhibitors? |
-Large group safe and effective -Often first line drugs for HF and hypertension -May be combined w/ a thiazide diuretic or calcium channel blocker -Caution use w/ NSAIDs bc they reduce the effect |
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What is the ending of ACE Inhibitors? |
"pril" all ACE inhibitors end in "pril" |
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ACE Inhibitor drugs |
-Captopril (Not prodrug) -Benazepril -Enalapril (Prodrug) -Fosinorpril -Lisinopril (Not prodrug) -Moexipril -Quinapril |
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MOA for Angiotensin-Conerting Enzyme Inhibitors |
-Inhibits ACE thus preventing formation of Angiotensin II -Angiotensin II is a potent vasoconstrictor & causes aldosterone secretion from adrenal glands -Prevent the breakdown of vasodilating substance bradukinin -Decreases BP |
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When are ACE inhibitors used? |
-Hypertension -HF (alone or with diuretics) -Cardioprotective -Drug of choice for diabetic patients (Renal protective) -Hypertensive with HF |
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What are prodrugs? |
Prodrug are some chemical substances which do not produce pharmacological effects until they are chemically altered within the body. So, they are basically inactive drugs which are converted to active drugs inside the body by chemical alterations. |
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Prodrugs |
-Enalapril (activated by esterase to the active enalaprilat) -Levadopa (activated by decaboxylase to active the active dopamine)
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What are the advantages of using prodrugs? |
-Improve bioavailability when drug itself is poorly absorbed from GI tract -Improve how selectively the drug interacts w/ cells or processes that are not its intended target -Reduces adverse or unintended effects of a drug |
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Adverse effects of Angiotensin-Converting Enzyme Inhibitor
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-Fatigue
-Dizziness -Headache -Mood changes -Impaired taste -Possible hyperkalemia -Dry, nonproductive cough * -Angioedema (rare but fatal) ***First-dose hypotensive effect may occur |
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What are Angiotensin II Receptor Blockers? |
-Lower BP -Well tolerated, don't cause dry cough |
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Angiotensin II Receptor Blockers are also known as, and the drugs end in what? |
ARBs and the ending is "tan" |
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ARBs drugs |
-Losartan* -Eprosartan -Valsartan* -Irbesartan -Candesartan -Olmesartan* -Telmisartan -Azilsartan
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MOA for Angiotensin II Receptor Blockers |
-Block the receptors that receive angiotensin II -Block vasoconstriction and release of aldosterone |
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What are ARBs used for |
-Hypertension -Adjunctive drugs for treatment of HF -Alone or with other drugs such as diuretics |
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What are adverse effects of Angiotensin II Receptor Blockers? |
-Upper Respiratory Infections*** - Headache (due to dilation) -Dizziness -Inability to sleep -Dyspnea -Heartburn -Back pain -Hyperkalemia much less likely to occur |
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MOA for calcium channel blockers
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-Causes smooth muscle relaxation by blocking the binding CA+ to its receptor, preventing muscle contraction
-Decreased peripheral smooth muscle tone - " systemic vascular resistance - " BP |
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When do you use calcium channel blockers? |
-Angina -Hypertension (Good for AAmericans) -Dysrhythmias -Migraine headaches -Raynaud's disease (lose of color in fingers)
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What do diuretics do? |
-Decrease plasma and extracellular fluid volumes -Results in decrease preload, cardiac output, total peripheral resistance -Overall effect decrease workload on heart and decreased BP |
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What is the most common diuretic used for hypertension? |
Thiazide diuretics
*First line antihypertensives
*Calcium channel blockers w/ thiazide diuretics are more effective w/ AAmericans than whites |
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Vasodilator drugs?
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-Diazoxide
-Hydralazine HCL -Minoxidil -Sodium nitroprusside |
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MOA for Vasodilators |
-Directly relax arteriolar and/ smooth muscle -Results in decreased systemic vascular response, afterload, and peripheral vasodilation |
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When do you use Vasodilators? |
-Hypertension -Sodium nitroprusside and IV diazoxide are reserved for the management of hypertensive emergencies ***Max dose only for 10min (cause server hypotension)
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What should the nurse do when giving antihypertensive drugs? |
-Journal BP therapy -DO NOT stop abruptly causes rebound hypertensive crisis and perhaps lead to stroke -**Oral forms w/ meals for gradual and effective absorption -Extreme caution w/ IV and use pump -Avoid hot tubs, prolong sitting or standing may aggravate low BP |
