Pharm Exam 2

Normal BP

<120/<80 mmHg

Elevated BP

120-129 and <80 mmHg

HTN stage 1

130-139 or 80-89 mmHg

HTN stage 2

≥140 or ≥90 mmHg

Hypertensive crisis

>180 and/or >120 mmHg

ACE inhibitors examples

Captopril, enalapril, lisinopril, ramipril, benazepril

ACE inhibitor MOA

Block conversion of angiotensin I to angiotensin II

ACE inhibitor effect on bradykinin

Increase bradykinin, causing vasodilation

ACE inhibitor major effects

Decrease vasoconstriction, decrease aldosterone, excrete sodium and water, lower BP

ACE inhibitors are what protective?

Kidney protective and cardioprotective

ACE inhibitor uses

Hypertension, heart failure, myocardial infarction, kidney disease, diabetes mellitus

ACE inhibitor classic adverse effect

Cough

ACE inhibitor dangerous adverse effect

Angioedema

ACE inhibitor electrolyte risk

Hyperkalemia

ACE inhibitor pregnancy

Contraindicated in pregnancy

ACE inhibitor HR question

They lower blood pressure, not heart rate

ACE inhibitor angioedema treatment

Stop med, notify provider, severe cases may need epinephrine

ACE inhibitor nursing teaching

Rise slowly due to hypotension risk

ACE inhibitor nursing teaching 2

Report cough, rash, altered taste, infection signs

ACE inhibitor potassium teaching

Avoid potassium supplements unless prescribed

ACE inhibitor breastfeeding/pregnancy teaching

Do not take during pregnancy or breastfeeding

ARB examples

Losartan, valsartan, irbesartan, candesartan, olmesartan, telmisartan

ARB MOA

Block angiotensin II type 1 receptors

ARB effect

Vasodilation and decreased aldosterone release

ARB benefit

Kidney protective in diabetes and cardioprotective

ARB uses

Hypertension, heart failure, diabetic kidney problems

ARB common difference vs ACE

Less cough than ACE inhibitors

ARB major adverse effect

Angioedema

ARB fetal risk

Fetal injury; avoid in pregnancy

ARB nursing teaching

Use contraception if of childbearing age

ARB hemodynamic effect

Lowers BP, not heart rate

ACE vs ARB

ACE = first choice, cough more common; ARB = second choice, less cough

ACE key memory

Avoid in pregnancy, angioedema, cough, elevated potassium

Aldosterone antagonist examples

Spironolactone, eplerenone

Aldosterone antagonist MOA

Block aldosterone receptors, excrete sodium and water, retain potassium

Aldosterone antagonist uses

Hypertension, heart failure, primary hyperaldosteronism

Spironolactone extra uses

PMS, PCOS, acne in young females

Eplerenone extra cardiac point

Helps prevent cardiac scarring after MI

Aldosterone antagonist biggest electrolyte risk

Hyperkalemia

Aldosterone antagonist other electrolyte issue

Hyponatremia

Spironolactone endocrine effects

Gynecomastia, impotence, menstrual irregularities, hirsutism, deepening voice

Aldosterone antagonist contraindications

High potassium, severe kidney problems, potassium supplements, other potassium-sparing meds

Aldosterone antagonist interaction

ACE inhibitors and ARBs increase hyperkalemia risk

Eplerenone interaction

Avoid grapefruit juice

Aldosterone antagonist teaching

Avoid salt substitutes containing potassium

Hyperkalemia symptoms to report

Palpitations, muscle twitching, weakness, paresthesias

Direct renin inhibitor example

Aliskiren

Aliskiren MOA

Binds renin and prevents angiotensinogen from becoming angiotensin I

Aliskiren effect

Decreases angiotensin II and aldosterone, lowers BP

Aliskiren uses

Hypertension alone or with another antihypertensive

Aliskiren adverse effects

Angioedema, rash, cough, hyperkalemia, diarrhea, hypotension

Aliskiren contraindications

Pregnancy, severe kidney disease, concurrent ACEI/ARB in diabetes

Aliskiren food interaction

High-fat meals reduce absorption

Aliskiren teaching

Take at same time daily and avoid high-fat meal

Calcium channel blocker classes

Dihydropyridines and non-dihydropyridines

Dihydropyridine examples

Nifedipine, amlodipine, nicardipine, felodipine

Non-dihydropyridine examples

Verapamil, diltiazem

CCB basic effect

Relax blood vessels and reduce cardiac strain

Dihydropyridine main effect

Vasodilation and BP lowering

Non-dihydropyridine main effect

Vasodilation plus slowed cardiac electrical conduction

Nifedipine uses

Angina and hypertension

Verapamil/diltiazem uses

Cardiac dysrhythmias, atrial fibrillation, atrial flutter, SVT

Nifedipine common adverse effect

Reflex tachycardia

Nifedipine other adverse effects

Orthostatic hypotension and peripheral edema

Verapamil common GI effect

Constipation

Verapamil/diltiazem cardiac adverse effects

Bradycardia, heart failure, dysrhythmias

CCB toxicity findings

Hypotension, bradycardia, AV block, ventricular tachydysrhythmias

CCB contraindications

Severe heart valve problems, unstable angina, very low BP

CCB caution

Use cautiously with liver problems

Verapamil interaction

Increases digoxin levels

Verapamil/diltiazem interaction with beta blockers

Can cause bradycardia and heart failure

CCB grapefruit interaction

Grapefruit juice can cause toxicity

Nifedipine toxicity support

Monitor ECG/vitals; may need norepinephrine, calcium, lidocaine, IV fluids

Direct-acting vasodilator example

Hydralazine

Hydralazine use

Hypertension, hypertensive emergencies, eclampsia, heart failure

Hydralazine contraindications

CAD and aortic dissection

Hydralazine side effects

Reflex tachycardia, dizziness, weakness, fatigue, headache, fluid retention

Hydralazine abrupt stop risk

Hypertensive emergency or heart failure

Hydralazine teaching

Move slowly and avoid hazardous activity after first dose

Organic nitrite vasodilator

Nitroglycerin

Nitroglycerin use

Acute angina attack and prophylaxis of chronic stable or variant angina

Nitroglycerin route for acute chest pain

Sublingual under the tongue

Nitroglycerin max acute dosing

3 doses, 5 minutes apart

Nitroglycerin BP rule

Hold if systolic BP <100 or drops by 30 mmHg

Nitroglycerin lethal interaction

Sildenafil/Viagra

Nitroglycerin normal first-dose effects

Headache, hypotension, flushing

Nitroglycerin patch teaching

Remove old patch first, rotate sites, wear gloves

Nitroglycerin storage

Keep in original dark glass bottle in cool dry place

Nitroglycerin emergency teaching

Call 911 if pain persists 5 minutes after first dose at home

Alpha-1 blocker examples

Prazosin, doxazosin, terazosin

Alpha-1 blocker first-dose teaching

Take first dose at bedtime to reduce first-dose hypotension

Clonidine class

Centrally acting alpha-2 agonist

Other central alpha-2 agonists

Guanfacine, methyldopa

Clonidine MOA

Activates alpha-2 receptors in brain, decreasing norepinephrine release

Clonidine effect

Relaxes blood vessels, slows HR, lowers BP

Clonidine uses

Hypertension; also ADHD

Clonidine adverse effects

Drowsiness, sedation, dry mouth

Clonidine dangerous stop risk

Rebound hypertension

Clonidine discontinuation

Stop gradually over 2-4 days

Methyldopa special pregnancy point

Safe in pregnancy and lactation