UNIT 4 EXAM PHARM

Classes of Antihypertensives

Beta-blockers (↓HR & contractility), ACE inhibitors (block angiotensin II → vasodilation), ARBs (block angiotensin II receptors), Calcium channel blockers (↓Ca → relax vessels), Diuretics (↓fluid volume), Vasodilators (direct vessel relaxation). They differ by mechanism and target.

Why beta blockers after heart attack

They decrease heart rate, blood pressure, and myocardial oxygen demand, reducing risk of reinfarction and improving survival.

Calcium channel blockers

Block calcium entry into cardiac and smooth muscle → vasodilation, ↓BP, ↓HR, and ↓contractility.

Adverse effects of antihypertensives Beta-blockers

bradycardia, fatigue, sexual dysfunction

Adverse effects of antihypertensives ACE inhibitors

cough, hyperkalemia, angioedema

Adverse effects of antihypertensives CCBs

edema, constipation

Adverse effects of antihypertensives Diuretics

electrolyte imbalance

Adverse effects of antihypertensives ARBs

dizziness, Erectile dysfunction can occur in some.

Multiple antihypertensives effects

Additive hypotension, dizziness, syncope, electrolyte imbalances, and risk of bradycardia or toxicity with cardiac drugs.

Why diuretics for hypertension

They reduce blood volume by increasing urine output → lowers blood pressure.

Antiarrhythmic classes

Class I (Na blockers), Class II (beta-blockers), Class III (K blockers), Class IV (Ca blockers). Each affects cardiac electrical activity differently.

Antiarrhythmic adverse effects

Class I: proarrhythmia; Class II: bradycardia; Class III: QT prolongation; Class IV: hypotension, bradycardia.

Meds for arrhythmias

SVT: adenosine; Atrial fibrillation: beta-blockers, calcium channel blockers, anticoagulants, amiodarone.

Nursing education antihypertensives

Monitor BP/HR, rise slowly (orthostatic hypotension), adherence, avoid abrupt stopping, lifestyle changes.

Cardiac glycosides

Increase cardiac contractility and slow HR; used in heart failure and atrial fibrillation.

Cardiac glycoside patient

Heart failure patients or those with atrial fibrillation needing rate control.

Class II antiarrhythmics and COPD/asthma

Beta-blockers can cause bronchoconstriction → worsen respiratory conditions.

Assessment before digoxin

Check apical pulse (hold if <60 bpm), potassium levels, ECG changes, renal function.

Foods to avoid with digoxin

High-fiber foods may reduce absorption; low potassium increases toxicity risk.

Digoxin toxicity symptoms

Nausea, vomiting, visual halos (yellow/green), bradycardia, confusion.

Digoxin toxicity reversal

Digoxin immune Fab (Digibind).

Nitrates purpose

Vasodilation → ↓preload and myocardial oxygen demand; used for angina.

Nitrate side effects

Headache, hypotension, dizziness, reflex tachycardia.

Nitrate education

Avoid sudden standing, take as prescribed, avoid PDE-5 inhibitors, store properly.

Important assessments antihypertensives

Check BP, HR, dizziness, orthostatic changes; teach fall prevention.

HDL vs LDL

HDL = “good” cholesterol (removes cholesterol); LDL = “bad” (deposits in arteries).

Lipid-lowering drug classes

Statins, bile acid sequestrants, niacin, cholesterol absorption inhibitors; all reduce cholesterol via different pathways.

HMG-CoA reductase inhibitors

Statins; block cholesterol synthesis in liver; teach to monitor liver enzymes, avoid grapefruit.

Bile acid sequestrants

Bind bile acids in intestine → liver uses cholesterol to replace them; may cause constipation.

Cholesterol absorption inhibitor side effects

Diarrhea, abdominal pain, fatigue.

Niacin side effects

Flushing, itching, hepatotoxicity; used to increase HDL and lower triglycerides.

Stepped care management

Gradual approach to hypertension: lifestyle changes → add medications stepwise.

Step 2 hypertension

Add one antihypertensive drug if lifestyle changes are insufficient.

3 elements of BP

Cardiac output, peripheral resistance, blood volume.

Angina definition

Chest pain from myocardial ischemia due to reduced blood flow.

Types of angina

Stable (predictable), unstable (emergency), variant (vasospasm).

Nitroglycerin purpose

Relieves angina by vasodilation and improved blood flow.

Nitroglycerin forms timing

SL: 1–3 min; Patch: slow, sustained release.

Nitroglycerin adverse effects

Headache, hypotension, dizziness.

Nitroglycerin chest pain routine

Take SL every 5 min up to 3 doses; call EMS if not relieved after 1st or 3rd dose.

Sublingual medications work

Absorbed under tongue → rapid entry into bloodstream, bypassing liver.

SL/oral/patch/paste education

SL: don’t swallow; Patch: rotate sites; Oral: take consistently; Paste: measure carefully.

Beta blockers and diabetes

Mask hypoglycemia symptoms (tachycardia), making detection harder.

Metformin + beta blocker effects

Increased risk of hypoglycemia unawareness and possible lactic acidosis risk.

Phosphodiesterase inhibitors

Increase cGMP → vasodilation; used for erectile dysfunction and pulmonary hypertension.

Hypertension Bp numbers