N301- Drugs affecting BP

• Stroke Volume (blood volume
• Heart Rate
• Contractility
• venous return
• peripheral resistance

• 1. lifestyle changes- stop smoking, low fat diet, close to idea body weight, exercise
• 2. continue with lifestyle changes and add one or more drugs (start with milder agens first and then increase)
• Drug selection determined by co-morbid conditions and patient response (heart failure, diabetes, chronic pulmonary condiitons)

• Thiazides- decrease arterial resistance, don't work well with glomular filtration problems, hypokalemia
• Loop Diuretics- are stronger, glomelular filtration not a problem
• Potassium Sparing- risk for hyperkalemia, don't use with ACE and ARBs, weaker than others

• slow the HR and cardiac contractility
• decreased CO
• suppresses reflex tachycardia
• reduces renin
• reduces peripheral vascular resistance
• would not use in chronic pulmonary conditions or Sick Sinus Syndrome
• mask hypoglycemia
• -OLOL ending
• SE: depression, impotence, sleep disorders

• beta blocker
• non-selective beta 1 adrenergic antagonist
• good for antianxiety to slow down HR

• beta blocker
• selective beta 1 adrenergic antagonist
• affects HR more than lungs

• EMERGENCY USE- BP is sky high
• Alpha/Beta blocking agent
• blocks beta 1- supresses hear rate and contractility
• blocks beta 2- broncho constriction
• blocks alpha1- causes peripheral vasodialation, causes ortho hypotention
• beta 1 blockade suppresses release of renin
• alpha 1 only cause severe hypotension and not used for treating BP normally

• Centrally Acting Alpha Agonist
• orally or patch
• decreases HR, BP, vasoconstriction, and renal vascular resistance
• inhibits sympathetic nervous system response and reduces sympathetic outflow from the CNS
• SE: causes sedation because centrally acting
• Controls withdrawl symptoms from abuse substrances b/c of sympatholytic effect

• Centrally Acting Alpha Agonist
• displaces norepinephrine from storage sides decreasing BP
• Drug of choice for pregnant women
• doesn't decrease CO or renal blood flow
• can cause hemolytic anemia (decreased Hgb and Hmt)- would do direct coomb's test in pregnancy
• AST, ALT, billirubin to look at liver function

• Calcium Channel Blocker
• inhibits movement of calcium ions across the cardiac and arterial muscle cell membranes
• dilates coronary arteris and peripheral arterioles decreasing after load and peripheral resistance

• inhibits calcium ion influx, reduce afterload
• inhibit coronary artery spasm

• they both affect SA and AV node conduction, slowing the HR
• also used for angina because decrease oxygen demand
• concerned with bradycardia, and vagal stimulation with constipation

• Calcium Channel Blocker
• inhibits clacium ion influx
• vasodilation affects on coronary and peripheral arterioles- causes reflex tachycardia
• DOES NOT slow SA node or prolong AV node conduction

Dihydropyridine-> decrease cardiac work and energy consumption, increases O2 delivery to myocardium

• Angiotensin Converting Enzyme (ACE) Inhibitor
• blocks conversion of angiotensin I to angiotensin II
• prevents sodium and water retention
• decreases peripheral vascular resistance
• shouldn't be used with potassium sparing diuretics b/c can cause hyperkalemia
• SIDE EFFECTS: Chronic cough, first dose hypotension, Angiodema (swelling of lips and tongue that will cause need for trach)
• CONTRAINDICATED in 2nd and 3rd trimesters

• Angiotensin Receptor Blocker
• Prevents angiotensin II from binding to receptors in many tissues, thus blocking the vasoconstriction and aldosterone secreting effects of angiotensin II
• peripheral resistance reduced->lower BP and afterload
• Upper Respiratory Infections are common
• No chronic cough
• contraindicated in pregnancy
• risk for hyperkalemia

• promote dilation or arterioles- postural hypotension risk is low
• Problems: reflex tachycardia, renin release, fluid retention

• direct acting vasodilator
• decreases peripheral resistance and arterial BP
• given with beta blockers or clonidine to prevent reflex tachycardia
• given with diuretics to offset fluid retention from increased production of angiotensin II
• SE: Systemic Lupus Erythema (SLE) lupus like syndrome
• Given IV

• used to treat HYPOTENSIVE CRISIS (>210/120)
• directly relaxes vascular smooth muscle; dilates veins more than arteries, thus decreasing preload and aftterload; lowers BP dramatically
• ***Hardcore ICU drug***
• given IV
• cyanide poisoningis possible because of metabolite

• HYPOTENTION treatment (Vasopressor)
• stimulation of alpha 1 and beta 1 and dopamine receptors
• catecholamine and a precursor to NE
• vasopressor used in treating shock
• will NOT WORK if hypovolemic- administer isotonic fluids to replace volume first
• IV administration in acute settings
• Vesicant- need central access