General
What are the seven main drug categories to treat hypertension? Which one is the first line choice to treat HTN?
Diuretics, Adrenergic drugs, Vasodilators, Angiotensin-converting enzyme inhibitors, Angiotensin II receptor blockers (ARBs), Calcium channel blockers, and direct renin inhibitors
Diuretics
Clonidine (Catapres)
ACE inhibitors work as a first line drug for HF by:
-preventing sodium and water resorption by inhibiting aldosterone secretion
- diuresis: decreases blood volume and return to the heart
- Decreases preload, or the left ventricular end-diastolic volume
- Decreases work required of the heart
This group of drugs is characterized by "-sartan". They are used to treat HTN and HF and do not cause a cough. Evidence shows that they are better tolerated and associated with lower mortality after MI than other groups. What are they?
Angiotensin II Receptor Blockers (ARBs)
If a patient misses a dose they should _____________
never double up on doses if one is missed
What is a prodrug?
medication that turns into an active form once entering the body
This drug has a dual antihypertensive effect of reduction in heart rate (beta receptor blockade) and vasodilation (alpha receptor blockade). Some of its primary contraindications are bronchospastic conditions such as asthma, and various cardiac problems involving the conduction system. What is it?
Carvedilol (dual action alpha 1 and beta receptor blocker)
What are some indications that ACE inhibitors should be used in treatment?
HTN, HF, slow progression of left ventricular hypertrophy after MI, Renal protective effects in patients with diabetes
This group of drugs is primarily used for HTN and angina and works by causing smooth muscle relaxation by blocking the binding of calcium to its receptors, preventing muscle contraction. What are they?
Calcium channel blockers
Result in decreased peripheral smooth muscle tone, decreased SVR, and decreased BP
These drugs should never be stopped abruptly because this may cause ___________ and potentially lead to _______
rebound hypertensive crisis; stroke
What are the three most common adverse effects of Angiotensin II Receptor Blockers (ARBs)?
- Chest pain, fatigue, and hypoglycemia
Can also cause diarrhea, UTI, anemia, and weakness
Hyperkalemia and cough are less likely to occur than with ACE inhibitors
These drugs have a high incidence of orthostatic hypotension. Their other adverse effects include bradycardia with reflex tachycardia, dry mouth, drowsiness, sexual dysfunction, and rebound hypertension. What are they?
Adrenergic drugs
Hyperkalemia, Dry nonproductive cough, angioedema (rare)
- fatigue, drowsiness, headache, mood changes, impaired taste (these are more nonspecific)
These drugs directly relax arteriolar or venous smooth muscle (or both) and result in decreased SVR, decreased afterload, and peripheral vasodilation. What are they?
Vasodilators
Oral forms of antihypertensives should be given ______ so that absorption is _________
with meals; more gradual and effective
What is one of the main contraindications to specific antihypertensive drugs?
Asthma because use of those drugs can cause vasoconstriction and bronchospasm
I am the only ACE inhibitor that is available in both oral and parenteral preparations. What am I?
Enalapril (Vasotec)
What two levels should be monitored while administering ACE inhibitors to a patient? What could they be indicative of?
- BUN: indicative of renal impairment
- Potassium: indicative of hyperkalemia which puts the patient at risk for dysrhythmias
This drug is part of a newer class called selective aldosterone blockers and reduces BP by blocking the actions of aldosterone at its corresponding receptors in the kidney, heart, blood vessels, and brain. It is contraindicated if potassium levels are above 5.6. What is it?
Eplerenone
Patients should change positions slowly while taking this medication to avoid ____________
syncope from postural hypotension
Before beginning therapy the nurse should always obtain baseline ______
HR/BP
These two drugs are commonly used for erectile dysfunction, but they can also be used for pulmonary hypertension. What are they?
Sildenafil (Revatio) and Tadalafil (Adcirca)
Angiotensin-Converting Enzyme (ACE) Inhibitors are known for their suffix _____ . They are often used as first-line treatment for ________ .
"-pril", HF and hypertension
This drug is specifically indicated for treatment of artery hypertension in patients with moderate to severe HF and blocks receptors of the hormone endothelin. Warnings for hepatotoxicity and teratogenicity. What drug is it?
Bosentan
What is it important to educate male patients on about taking antihypertensives?
These drugs may cause impotence