RET1350: Drugs Affecting Circulation

\_____ is characterized by a blood pressure greater than 140/90.

hypertension

\___ is only used if a patient has a BP that is CHRONICALLY high.

hypertension

What type of hypertension is due to a disease process?

secondary

What type of hypertension has an unknown etiology?

primary

What BP denotes stage 1 hypertension?

130-139 (systolic) or 80-89 (diastolic)

What BP denotes stage 2 hypertension?

\>140 or \>90

What BP denotes hypertensive crisis?

\>180 and/or \>120

A \___ \___ occurs when a patient has a BP \>180/120.

hypertensive crisis

\___ \___ usually has no signs or symptoms of organ complication, but the pt may complain of severe headaches, SOB, nose bleeds, and severe anxiety.

hypertensive urgency

Over what time period are hypertensive urgencies controlled?

24-48 hours

\___ \___ can lead to acute, chronic, or progressive organ injury and requires admission to the ICU for BP monitoring.

hypertensive emergency

What type of modality is used for ABG and BP monitoring in hypertensive emergencies?

arterial lines

What are 6 other medical emergencies that can occur due to a hypertensive crisis?

1. retinopathy 2. renal failure 3. angina 4. LV failure 5. eclampsia 6. stroke

Too \___ BP results in under perfusion of tissue.

low

What types of medications are given to pts with too low BP?

pressors or volume adding medications

Too \___ of BP results in stress on the systems.

high

What types of medications are given to patients with too high of BP?

diuretics or antihypertensives

What is the risk of dropping BP too rapidly?

under perfused organs

How much should BP be dropped within the first hour?

When should BP be dropped to 160/100?

within 2-6 hrs

Over what time period should BP be further dropped if tolerated?

24-48 hours

What is the 1st line management of HTN in non black pts without comorbidities?

Chlorothiazide (Diuril)

\_____ or Diruril works by increasing Na+ and Cl- excretion.

Chlorothiazide

What 4 conditions are indicated for chlorothiazide?

HTN, chronic edema, chronic heart failure, ascities

Hypokalemia, hypocalcemia, hyperuricemia, hyperglycemia, hyperlipidemia, and sexual dysfunction are all side effects associated with \____.

Chlorothiazide

What type of effect is produced by chlorothiazide?

dose ceiling

How long does a patient need to use chlorothiazide to get the full effect?

2-4 wks

What types of medications have an additive effect with thiazides?

K+ sparing diuretics

What are 2 K+ diuretics used for managing HTN?

Amiloride (Midamor); triamterene (Dyrenium)

What types of diuretics are weak if used alone?

K+ sparing

What side effects are associated with K+ sparing diuretics?

1. dyspepsia 2. cramps 3. nausea 4. diarrhea 5. mental confusion 6. lethargy 7. headache 8. dizziness 9. leg cramps

\____ \___ suppress the renin angiotensin-aldersterone system by blocking conversion of angiotensin I to angiotensin II.

ace inhibitors

Affinity for \____ for ACE is 30000x greater than for angiotensin I.

ACEI

\____ inhibit kinase which is responsible for the degradation of the vasodilators bradykinin, prostoglandin E2 and prostacyclin which enhances the antihypertensive effects of theses drugs.

ACEIs

What is the hemodynamic effect of angiotensin converting enzyme inhibitors?

1. reduce peripheral arterial resistance 2. increase CO 3. increase renal blood flow

\____ relieve arterial constriction and decrease resistance to flow of blood being pumped from the heart.

ACEIs

What type of drug is Enalopril (Vasotec)?

ACEI

What are ACEIs indicated for?

preferred HTN

\____ are effective alone or with thiazide type diuretics.

ACEIs

What is the most common side effect for ACEIs?

dry cough

What is a rare side effect of ACEI?

angioedema

What types of drugs do ACEIs have significant interactions with?

NSAIDs

\___ \___ \___ \___ are indicated for HTN and treatment of heart failure.

angiotensin II receptor blockers

What are 5 side effects associated with angiotensin II receptor blockers?

1. orthostatic hypotension 2. hyperkalemia 3. neutropenia 4. nephrotoxicity 5. fetotoxicity

\___ \__ \__ inhibit renin to prevent conversion of angiotensin to angiotensin I.

direct renin inhibitors

\___ is released from the kidney's juxtaglomerular cells in response to reduced renal perfusion, hypotension, or hypertension.

renin

What side effects are associated with direct renin inhibitors?

1. diarrhea 2. headache 3. dizziness 4. fatigue 5. headache 6. upper respiratory tract infection 7. nasopharyngitis 8. back pain

What are 2 calcium channel blockers?

Verapamil (Isoptin)

Diltiazem (Cardizem)

\___ \___ \___ block calcium channels in vascular smooth muscle and cardiac cells and cause coronary and peripheral vasodilation.

calcium channel blockers

What does vascular smooth muscle and cardiac cell contraction depend on?

calcium ion concentration

How does Ca+ enter vascular smooth muscle cells, myocardial cells, and pacemaker cells?

through voltage gated L type and T type calcium channels

Blockage of \___ channels mediates coronary and peripheral vasodilation and may cause reflex sympathomimetic activation or a negative inotropic effect.

L

\____ causes a negative inotropic and chronotropic effect resulting in vasodilation.

Verapamil

\___ is used to treat angina and arrhythmias.

Verapamil

Long acting formulations of \___ are specifically designed to target circadian rhythm of BP throughout the day.

Verapamil

Side effects of \__ \__ \__ include peripheral edema, gingival hyperplasia, and GERD (except with Diltiazim).

calcium channel blockers

\____ has potent negative inotropic effects and may exacerbate HF which is why it is not used in pts with severe left ventricular dysfunction.

Diltiazem

Metoprolol (Lopressor)

beta blocker

Propanolol (Inderal)

beta blocker

\__ \__ block beta receptors of the central nervous system.

beta blockers

Use of \__ \__ results in slower HR and lower BP.

beta blockers

What is one side effect of beta blockers?

bronchospasm

What type of drug will beta blockers not work with?

beta agonists

What type of receptors constrict the lungs?

beta receptors

What type of bronchodilator should be used in a patient on beta blockers?

anticholinergic (atrovent)

\__ \__ are used to manage hypertension, cardiac dysrhythmias, secondary prevention of MI, chronic HF, and pheochromocytoma.

beta blockers

\___ \___ act directly on the CNS to lower BP by depressing sympathetic outflow from CNS.

adrenergic agents

\____ agents are a2 agonists and affect CO and peripheral resistance.

adrenergic

\____ agents are very effective but not first line for HTN due to high incidence of anticholinergic effects.

adrenergic

\___ agents are peripheral acting antihypertensives that lower BP by reducing sympathetic activity to heart and blood vessels.

adrenergic

What type of antagonists are adrenergic agents?

alpha 1

What are 2 types of oral vasodilators?

1. Hydralazine 2. Sodium Nitroprusside

What is the brand name for hydralazine?

Apresoline

What is the brand name for sodium nitroprusside?

Nipride

What are 2 conditions hydralazine (Apresoline) is used to treat?

1. HF 2. angina

\____ lower BP by lowering resistance by acting on vascular smooth muscle by reducing PVR.

vasodilators

What type of drugs are second line Tx for HTN due to side effects?

vasodilators

\___ is defined as lack of o2 and decreased or no blood flow to the myocardium.

angina

What condition is characterized by heavy weight or pressure on the chest, burning sensation, or SOB?

angina

\____ are used for pharmacotherapy for angina.

nitrates

What pharmacotherapy reduces myocardial O2 demand by dilating coronary arteries and venous colalterals?

nitrates

\____ relax systemic vascular smooth muscle resulting in venous dilation.

nitrates

What flow/device should you give to a pt with angina?

2 L NC

What are the 5 formulations for nitroglycerin?

1. oral 2. IV 2. ointment 3. transdermal 4. translingual 5. sublingual

Sublingual Nitroglycerin: Frequency

Q 5 min x 3

What are 6 adverse reactions associated with nitroglycerin?

1. tachycardia 2. palpitations 3. hypotension 4. dizziness 5. flushing 6. headache

A \____ is a blood cloth that occludes a blood vessel.

thrombus

An \___ is a traveling blood clot that lodges in the lungs, brain, or extremity.

embolus

What are 3 categories of antithrombotics?

1. anticoagulants 2. antiplatelets 3. thrombolytics

\_____ prevent formation of the fibrin clot and prevent further clot formation in already existing thrombi.

anticoagulants

\____ inhibit the action of platelets in the initial stage of the clotting process.

antiplatelets

\___ break up thrombi by degrading fibrin.

thrombolytics

What type of medication binds to antithrombin III in order to inactivate thrombin to prevent clotting?

anticoagulants

What type of medication inactivates factor X to prevent formation of thrombin?

anticoagulants

What is the most common anticoagulant?

heparin

What are 2 types of heparin?

1. Unfractionated heparin

2. Low molecular weight heparin

Enoxaparin (Lovenox)

Anticoagulant (heparin)

What does dosage of heparin depend on?

blood level of PTT and ACT