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How do diuretics lower bp?
- decrease Na and water
- decrease blood volume
- vasodilation
- decrease bp
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What are the three groups of diuretics?
- 1. Thiazide
- 2. Loop
- 3. Potassium-Sparing
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Which drug is often used in combination with other antihypertensives for water retention?
Diuretics
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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
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What are the different groups of Adrenergic Inhibiting Agents
- 1. Beta - (lol)
- 2. Central - Catapress
- 3. Peripheral - Resperine, Guan-
- 4. Alpha - (osin)
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How do beta blocking adrenergic inhibitors lower BP?
- (-lol)
- Inhibit renin secretion and typical beta response
- decreases CO and BP
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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
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What is Catapres-TTS?
peak?
- clonidine transdermal patch
- peak 2-3 days
- change wkly
- rotate spots
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What are some possible side effects of Catapres?
- Retinal degeneration
- Postural hypertension
- PO-needs to be reduced after 2-3 days
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What kind of antihyperlipidemic is Methyldopa?
Centerally acting adrenergic inhibitor
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What are some side effects of methyldopa?
- thrombocytopenia and leukopenia
- NEED TO MONITOR CBC
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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
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Reserpine is contraindicated in who?
depression, gallstones, epilepsy, arrhythmias, parkinsons, PUD
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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
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Which antihypertensive should you administer with meals or milk?
Reserpine
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Which drug should you not take with nasal decongestants?
Reserpine
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What are the different types of alpha adrenergic blocking agents?
- - osin
- Prazosin- MINIPRESS
- Tetrazosin
- Doxazosin
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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
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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
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Which drug is a dual action alpha and beta blocker?
- Carvedilol (Coreg)
- used in ED
- PO only
- Use: HTN and HF
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What type of drug is Captopril?
1st - ACE inhibitor (pril)
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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
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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
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Which drug has an adverse effect of upper respiratory infection and dyspepsia?
Losartan- Cozaar
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Aliskiren (Tekturna) is what type of drug?
Oral renin inhibitor
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Which drug is less effective on African Americans?
Oral renin inhibitor-aliskiren (tekturna)
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Amoldipine (Norvasc) and Cardene IV are which type of antihypertensive?
Calcium channel blockers
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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
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When in Diazoxide (hyperstat) used?
- rapid reduction in hypertensive emergencies
- IV only
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Clients with intolerance to thiazide diuretics may not tolerate which drug?
Diazoxide (Hyperstat)
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Which drug requires you to lie down during therapy and 30 minutes after administration?
Diazoxide- hyperstat
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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!
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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
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SLE-like syndrome is a side effect of which drug?
arterial vasodilator-- hydralazine -Apresoline
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Which drug treats male pattern baldness when used topically?
arteriolar vasodilator- Minoxidil (Loniten)
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Which drug has an adverse reaction of thiocyanate and cyanide toxicity?
arterial and venous dilator drug- Nitroprusside (Nipride)
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