N301- Drugs affecting BP

  1. Cardiac Output is determined by....
    • Stroke Volume (blood volume
    • Heart Rate
    • Contractility
    • venous return
    • peripheral resistance
  2. Steps for treating Hypertension...
    • 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)
  3. Diuretics
    • 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
  4. Beta Blockers
    • 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
  5. propanolol
    • beta blocker
    • non-selective beta 1 adrenergic antagonist
    • good for antianxiety to slow down HR
  6. metoprolol
    • beta blocker
    • selective beta 1 adrenergic antagonist
    • affects HR more than lungs
  7. labetalol
    • 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
  8. clonidine
    • 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
  9. methyldopa
    • 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
  10. verapamil
    • 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
  11. diltiazem
    • inhibits calcium ion influx, reduce afterload
    • inhibit coronary artery spasm
  12. what does verapamil and diltiazem have incommon?
    • 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
  13. nifedipine
    • 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
  14. what does nifedipine have that verampamil and diltiazem don't?
    Dihydropyridine-> decrease cardiac work and energy consumption, increases O2 delivery to myocardium
  15. captopril
    • 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
  16. losartan
    • 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
  17. Direct Acting Vasodilators
    • promote dilation or arterioles- postural hypotension risk is low
    • Problems: reflex tachycardia, renin release, fluid retention
  18. hydralazine
    • 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
  19. nitroprusside
    • 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
  20. dopamine
    • 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
Card Set
N301- Drugs affecting BP
drugs affecting BP