How do diuretics lower bp?
- decrease Na and water
- decrease blood volume
- decrease bp
What are the three groups of diuretics?
- 1. Thiazide
- 2. Loop
- 3. Potassium-Sparing
Which drug is often used in combination with other antihypertensives for water retention?
What is the most effective medication in the treatment of HTN and how do they work?
- Adrenergic Inhibiting Agents
- modify function of sympathetic nervous system
What are the different groups of Adrenergic Inhibiting Agents
- 1. Beta - (lol)
- 2. Central - Catapress
- 3. Peripheral - Resperine, Guan-
- 4. Alpha - (osin)
How do beta blocking adrenergic inhibitors lower BP?
- Inhibit renin secretion and typical beta response
- decreases CO and BP
How do centerally acting adrenergic inhibitors lower bp?
- Catapres -
- suppresses norephrine and renin
- decreases CO, BP, HR, SV and increases Na and water
leads to edema so a diuretic is combined with catapres
What is Catapres-TTS?
- clonidine transdermal patch
- peak 2-3 days
- change wkly
- rotate spots
What are some possible side effects of Catapres?
- Retinal degeneration
- Postural hypertension
- PO-needs to be reduced after 2-3 days
What kind of antihyperlipidemic is Methyldopa?
Centerally acting adrenergic inhibitor
What are some side effects of methyldopa?
- thrombocytopenia and leukopenia
- NEED TO MONITOR CBC
What type of antihypertensive is Reserpine and how does it work?
- Peripherally acting adrenergic inhibitor
- Blocks catecholamines, decreases norepinephrine, neuron impulses have no effect on vessels
- -vasodilation, decrease in BP
- -little to no effect on CO
Reserpine is contraindicated in who?
depression, gallstones, epilepsy, arrhythmias, parkinsons, PUD
What are some side effects of Reserpine?
black stools, hemaemesis, nightmares, parkinson like syndrome, depression leading to suicide (months after stopped)
*Orthostatic hypotension not usual
Which antihypertensive should you administer with meals or milk?
Which drug should you not take with nasal decongestants?
What are the different types of alpha adrenergic blocking agents?
- - osin
- Prazosin- MINIPRESS
How does minipress work to reduce bp?
- blocks alpha 1 receptors
- - decrease PVR, BP -especially diastolic
- -little to no effect on CO (unless pt has CHF may increase CO)
- -reduces preload and afterload
What is "first-dose hypotensive reaction"?
Which drug may cause this effect and how can you prevent it?
- May occur .5-1.5 hours after initial dose or rapid increase- may cause lightheadedness, dizziness, syncope.
- Minipress and Doxazosin (effect is less in dox)
- Administer first dose at bedtime to minimize and increase dosage slowly
Which drug is a dual action alpha and beta blocker?
- Carvedilol (Coreg)
- used in ED
- PO only
- Use: HTN and HF
What type of drug is Captopril?
1st - ACE inhibitor (pril)
What are the side effects of captopril?
- agranulocytosis, neutropenia, proteinuria, loss of taste - does return, increased BUN and K
- Patient should avoid emotional encounters and stress
What type of drug is Losartan (Cozaar) and how does it work?
- Angeotensin II Reductase Inhibitor
- blocks effects of angiotensin II causing vasodilation
- -decreases bp, na & water, and blood volume
Which drug has an adverse effect of upper respiratory infection and dyspepsia?
Aliskiren (Tekturna) is what type of drug?
Oral renin inhibitor
Which drug is less effective on African Americans?
Oral renin inhibitor-aliskiren (tekturna)
Amoldipine (Norvasc) and Cardene IV are which type of antihypertensive?
Calcium channel blockers
Diazoxide (Hyperstat) is which type of antihypertensive?
- Arteriolar Vasodilator
- relaxes smooth muscle - decrease PVR- does not effect venous vessels- reflexive increase in CO and HR(due to decreased BP) will maintain corornary and cerebral blood flow
When in Diazoxide (hyperstat) used?
- rapid reduction in hypertensive emergencies
- IV only
Clients with intolerance to thiazide diuretics may not tolerate which drug?
Which drug requires you to lie down during therapy and 30 minutes after administration?
Which drug should be administered in less than 30 seconds and why?
- Diazoxide- hyperstat
- because slower admin will result in decreased duration of effect
*Admin as fast as you can!
Which type of drug is hydralazine (apresoline) and how does it work?
- arteriolar vasodilator
- relaxes smooth muscle, decrease bp -diastolic more, reflex increase in co & hr.
- increase in renin= increases Na and water
SLE-like syndrome is a side effect of which drug?
arterial vasodilator-- hydralazine -Apresoline
Which drug treats male pattern baldness when used topically?
arteriolar vasodilator- Minoxidil (Loniten)
Which drug has an adverse reaction of thiocyanate and cyanide toxicity?
arterial and venous dilator drug- Nitroprusside (Nipride)