60 terms

Antihypertensives

Terms from UCLA "Antihypertensives" packet
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Sympathetic nervous system uses _______ reflexes to maintain blood pressure
baroreceptor
Baroreceptor nerve endings are located in the walls of_______
1. carotid arteries
2. aortic arch
High blood pressure stretches the receptors causing an impulse down the ______ nerve and to the vasomoter center of brain located in the ________
1. vagus
2. medulla
vasomotor center responds by decreasing ____
1. HR
2. Inotropy
3. vasodilation- decreasing BP via PVR
When BP is low, a message is sent to the sympathetic nervous system to secrete
1. epinephrine
2. norepinephrine
which causes vasoconstriction and increased INOTROPY, CHROMOTROPY, AND DROMOTROPY all increasing BP
what happens when renal blood flow is decreased because of poor blood pressure
RENIN is secreted from the kidneys
Renin helps form____
angiotensin I, a weak vasoconstrictor
in the blood vessels of the lungs angiotensin I is converted to ___
angiotensin II by Angiotensin Converting Enzyme or ACE.
Angiotensin II is a potent vasoconstrictor which increases BP
Angiotensin II constricts vessels increasing BP, but also acts on the adrenal cortex to stimulate secretion of ____
aldosterone
Aldosterone causes sodium ______in the kidneys
reabsorption.
Increased sodium levels in the kidneys cause a release of what hormone
anti-diuretic hormone
Antihypertensive drugs include what 5 classes
1. diurectics - effect volume
2. ACE inhibitors- can't change angiotensin I to II
3. Vasodilators/ Nitrates
4. Calcium channel blockers- vasodilators
5. Beta blockers- inhibit inotropics
What do diurectic drugs do
promote formation and execretion of urine
most antihypertensives affect either ___or ___
1. blood volume
2. pre-load
largest % of water and sodium is reabsorbed here______
proximal tubule 65%
what % water and sodium reabsorbed in the Loop of Henle
20%
what % water and sodium reabsorbed in the distal tubule
5%
Loop Diuretics are used for what type of Pt.
Loop of Henle
Usually used for CHF. Too strong for HTN.
what problems do loop diuretic Pts. encounter
1.orthostatics are a problem. pts. are often prescribed beta blockers for reflux tachycardia.
2. syncopal episodes are common
Thiazides
Distal tubule
1. really good for HTN w/out causing low BP= Normal range
Potassium-sparing diuretics
Spironalactone= fluid retention is not too bad.
If pt. is on Lasix, their retention is bad.
Osmotic diuretics
Proximal tubule
1. A large sugar molecule.
2. used for cerebral edema, transfusion reactions.
3. too strong for CHF
Loop diuretic prototype drug
furosemide (Lasix)
Mechanism of action for furosemide (Lasix)
inhibits reabsorption of sodium and chloride in Loop of Henle therefore increasing urinary output
indications for furosemide (Lasix)
1. CHF
2. Pulmonary edema
thiazide diuretic prototype drug
hydrochlorothiazide (HCTZ, Microzide)
Mechanism of action for HCTZ
acts on distal tubule increasing excretion of sodium chloride, potassium and therefore after
Indication for HCTZ
1. CHF
2. HTN
3. edema (especially from corticosteroid or estrogen therapy)
Osmotic diuretic drug prototype
mannitol (Osmitrol)
Mechanism of action for mannitol (Osmitrol)
inhibits sodium and water absorption in the kidneys via a large sugar molecule filtered through the glomerulus
Indications for mannitol (Osmitrol)
1. cerebral edema
2. blood transfusion reactions
NOTE: too strong for pulmonary edema, congestion (use lasix)
side effects with all diuretics
1. headache
2. dizziness
3. altered mental status
4. nausea/vomiting
5. dehydration
6. hypotension
what do ACE inhibitors do
don't allow for angiotensin I to be converted to angiotensin II.
no angiotensin II equals no vasoconstriction, which equals decreased PVR>k=Low BP
Name the 4 ACE inhibitors
1. benazapril (Lotensin)
2. captopril (Capoten)
3. enalapril (Vasotec)
4. lisinopril (Zestril)
Name 4 vasodilators/nitrate drugs
1. nitroglycerine (Nitrolingual, Nitrostat, Nitrobid, Tridil
2. amyl nitrate (Vaporole)
3. nitroprusside (Nipride)
4. hydralazine (Apresoline)
What do Vasodilators do
decrease intracellular calcium levels= causing vasodilation
NITRATES are among the vasodilators
what is the vasodilator/nitrate prototype drug
nitroglycerin (Nitrolingual, NITROSTAT, Nitrobid, Tridil)
Besides vasodilator and nitrate what other class is nitroglycerine (Nitrolingual, NITROSTAT, Nitrobid, Tridil)
antianginal (coronary arteries)
Mechanism of action for nitroglycerin (Nitrolingual, NITROSTAT, Nitrobid, Tridil)
1. relaxes smooth muscle= venous dilation/pooling
2. decreases myocardial oxygen demand
3. decreases preload and afterload
4. increases coronary artery perfusion by dilation of coronary arteries & relaxation of coronary vasospasms
indications for nitroglycerin (Nitrolingual, NITROSTAT, Nitrobid, Tridil)
1. Chest pain
2. Acute pulmonary edema
3. CHF
contraindications for nitroglycerin (Nitrolingual, NITROSTAT, Nitrobid, Tridil)
pt. with suspected head trauma or cerebral hemorrhage (increased ICP)
trade name for amyl nitrate
Vaporole
Mechanism of action for amyl nitrate (Vaporole)
1. Angina
2. Hypertension
trade name for nitroprusside
Nipride
Mechanism of action for nitroprusside (Nipride)
relaxes arterial and venous smooth muscle
Indication for nitroprusside (Nipride)
1. Hypertensive crisis
2. CHF with HTN
Special handling procedures with nitrates
drugs are very sensitive to light and should be protected from it.
trade name for hydralazine
Apresoline
Indications for hydralazine (Apresoline)
1. Hypertensive crisis
2. PREGNANCY (PRE-ECLAMPSIA)
furosemide
Lasix
hydrochlorothiazide
1. HCTZ
2. Microzide
mannitol
Osmitrol
benazapril
Lotensin
captopril
Capoten
enalapril
Vasotec
lisinopril
Zestril
nitroglycerine
1. Nitrostat
2. Nitrolingual
3. Nitrobid
4. Tridil
amyl nitrate
Vaporole
nitroprusside
Nipride
hydralazine
Apresoline