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How do beta blockers work?
- They block the sympathetic nervous system
- decrease CO (by slowing HR and contractility)
- supress reflex tachycardia caused by vasodialators
- reduce renin
- reduces Peripheral Vascular Resistance
-
ISA
- intrinsic sympathomimetic activity
- That is, they can produce mild activation of beta receptors while blocking receptor activation by strong agonists (eg, norepinephrine);
- as a result HR is slowed less than with other beta blockers
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What are some side effects of Beta Blockers
- impotence
- depression
- decreased contractility
- bradycardia
- decreased AV conduction
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Beta blockers should not be prescribed to a person with:
- asthmatic pts (can cause bronchoconstriction)
- sick sinus syndrome
- heart failure
- *use caution when prescribed to a diabetic pt because it can mask hypoglycemia
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Inderal's generic name is
propanolol
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Propanolol is a non selective beta 1 adrenergic antagonist
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Lopressor and Toprol's generic name is
metoprolol
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Metoprolol is a selective beta 1 adrenergic antagonist
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How do alpha 1 blockers work?
- Alpha blocking causes peripheral vasodialtation which decreases BP
- prevents reflex tachycardia
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What is an alpha 1 blocking agent?
- labetalol (Normodyne)
- carvedilol
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Alpha-1 blockers should use caution when prescribing to a pt with
- asthma
- heartblock
- severe tachycardia
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The most severe side effect with an alpha blocker is
orthostatic hypertension
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blocking of alpha 1 receptors does what?
Blocking of cardiac beta 1 reseptros does what?
blocking of beta 1 receptors on juxtaglomerular cells does what?
- alpha1 blockade promotes dilation of arterioles and veins
- blockade of cardiac beta1 receptors reduces heart rate and contractility
- blockade of beta1 receptors on juxtaglomerular cells suppresses release of renin.
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Carvedilol and labetalol use is contraindicated in pts with...
- Like other nonselective beta blockers, labetalol and carvedilol can exacerbate
- bradycardia
- AV heart block
- asthma.
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How do centrally acting alpha 2 agonists work?
- (clonidine, methyldopa) act within the brainstem to suppress sympathetic outflow to the heart and blood vessels.
- the result is vasodilation
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All alpha 2 agonists have what adverse effects
-
Clonidine can cause what if treatment is abruptly stopped
severe rebound hypertension
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methyldopa can cause what adverse effects?
- hemolytic anemia
- liver disorders
- *centrally acting alpha 2 agonist
-
what is the drug of choice for pregnant women with HTN
- methyldopa
- *displaces norephinphrine from storage sites
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what is the brand name of clonidine?
methyldopa?
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Verapamil is
- a calcium channel blocker
- Calan
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Diltiazem is
- a calcium channel blocker
- Cardizem
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nifedipine is
and is contraindicated in what pts?
- a calcium channel blocker
- MI and unstable angina
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What are some drugs that control hypertension by affecting the RAAS
- ACE inhibitors
- Angiotenson II receptor blockers
- Aldosterone Antagonists
- Direct Renin Inhibitors
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Catopril is
an ACE inhibitor
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How do ACE inhibitors work?
preventing formation of angiotensin II, and thereby prevent angiotensin II–mediated vasoconstriction and aldosterone-mediated volume expansion.
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Because of the risk of hyperkalemia, combined use of ACE inhibitorsand what is generally avoided.
potassium supplements or potassium-sparing diuretics
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can ACE INHIBITORS BE USED IN PREGO WOMEN?
No. can cause serious fetal harm
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What are the only anti hypertensive drugs that are specifically contraindicated in prego women?
- ACE inhibitors
- angiotensin receptor blockers (ARBs)
- direct renin inhibitors (DRIs)
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What are some adverse effects of ACE inhibitors
- cough
- first dose hypotension
- angioedema
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Losarton (Cozaar) is a
Angiotensin II receptor antagonis
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How do ARBs and ACE inhibitors differ in the way they lower BP?
The only difference is that ARBs do so by blocking the actions of angiotensin II, whereas ACE inhibitors block the formation of angiotensin II.
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What indicates a hypertensive crisis?
SBP >210/DBP >120
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What medication is used to treat a hypertensive crisis and how does it work?
- Nipride: a direct acting vaso dilator
- Directly relaxes vascular smooth muscle; dilates veins more than arteries, thus decreasing preload and afterload; and lowers BP dramatically.
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With which med should we be concerned about cyanide poisoning?
Nipride
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If a pt is having shock, what medication can the nurse expect to administer
- dopamine
- *continuous monitoring of the pts CV status is imperative
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