given transdermal (patch good for 12 hrs), sublingual, buccal, and spray (x3 max)
What is the mechanism of action of Nitroglycerin(Nitro)?
Dilation of the veins and vascular smooth muscle to decrease O2 demand, and pressure on veins (decreases chest pain)
What type of medication is Nitroglycerin?
Organic Nitrate
What medications interact with Hydralazine?
Beta Blokcers help protect against the reflex tachycardia
Diuretics prevent Na and water retension and expansion of BV
BP meds will intensify
Antihypertensive meds need monitoring
What are some adverse effects of Hydralazine?
Reflex Tachycardia
Increase of Blood volume
Headache
Dizziness
Lupus-like syndrome
Fatigue
What is Hydralazine use for:
HTN
Hypertensive crisis *first drug of choice for emergency
HF
Explain the pharmacokinetics of Hydralazine.
Absorbed PO and parenteral which is faster.
Inactivated by metabolic process: Acetylation. The pace is genetically determined; those that acetylate slow have higher blood levels of the drug which can result in undesirable effects.
Hydralazine works to decrease BP by:
Dilation of the arteries that results from direct action of the vascular smooth muscle
What type of medication is Hydralazine?
This is a vasodilator
Beta Blockers common end with:
LOL
Beta Blockers are contraindicated in pts with:
Asthma
Diabetes (caution- can mask the signs of hypoglycemia)
Sick sinus syndrome
HF
COPD
or 2nd-3rd degree Heart Block
What are some adverse effects of Beta Blockers?
Sometimes blockade of the B1 cells can cause: brady cardia, and decreased AV conduction
Blockade of B2 cells promotes Vasoconstriction.
Common side effects:
insomnia
depression
bizarre dreams
sexual disfunction
dizziness
What is the therapeutic use of Beta Blockers?
Anginal Pectoris (stable)
NOT Vasopactic angina
Beta blockers work by:
Blocking primarity B1 cardiac cells, and also some B2 pulmonary cells
(Causing decreased contractility, and decreased respiratory rate)
What are some examples of Beta Blocker medications?
Propranolol
Metoprolol
Antenolol
Can a pregnant woman take any ARB medications?
No, can cause fetal harm
Calcium Channel Blockers are contraindicated in pts wtih:
Heart Block
What are some things that should be monitored as a nurse with a pt taking a Calcium Channel Blocker medication?
Monitor the BP
and Administer this med on an empty stomach.
What are the therapeutic uses of Calcium Channel Blockers?
Cardiac Dysrhthmias
Angina Pectoris
Essential Hypertension
Sometimes Migranes
What are the adverse effects of Diltiazem?
Dizziness
flushing
exacerbation of cardiac dysfunction
sick sinus syndrome
HF
Less constipation than verapamil
What are the adverse effects of Verapamil?
Facial Flushing
headache
dizziness
Edema of the feet and ankles
Constipation
What medications interact with Verapamil and Diltiazem?
Digoxin (risk of AV block is increased) and Beta Blockers (risk of excessive cardio suppression)
What are the two main Calcium Channle Blockers?
Verapamil, and Diltiazem
How do Calcium Channel Blockers work?
Block calcium channels in the heart and the blood vessels; reduces HR, increases coronary perfusion, dilation of arteries, decreased AV nodal conduction, decreases the force of contraction
What does a Calcium channel blocker typically end in?
DIPINE
Can you take antihypersensitive drugs with ARBs?
No, they interact
What are some adverse effects of ARBs?
Angioedema
Fetal Harm
Renal Failure
What are the therapeutic uses of ARBs?
HTN
HF
Nephropathy
MI
Stroke prevention
What are some examples of ARB medications?
Valsartan
Candesartan
Irbesartan
Olmeasartan
Iosartan
What are the pharmacokinetics of ARBs?
PO with or without food; metabolized in the liver, excreted in the kidneys
What are the therapeutic uses of ACE Inhibitors?
HTN
HF
L Ventricular dysfunction
Nephropathy
MI
Prevention of death in pts with high risk for cardiovascular evetns.
What is the Mechanism of action of an ARB?
Blocking the actions of Angiotensin II; causing a dilaton of the arterioles & veins (decreasing BP) which decrease the release of aldosterone.
What do ARBs commonly end in?
SARTAN
What do ACE Inhibitors commonly end in?
PRIL
What are some things that you want to monitor as a nurse with a pt taking ACE Inhibitors?
Monitor the WBC, K level, and BP
*educate on eating low K foods and avoiding OTC drugs
Can Lotensin or Enalapril be given to a pregnant woman?
No, ACE Inhibitors pose fetal injury.
What are some adverse effects of ACE Inhibitors?
Dry cough
Hyperkalemia
Renal Failure
Angioedema
First dose Hypertension
Nearly all ACE Inhibitors are PO with food, but what are the two that need to be given 1hr before meals?
Meoxipril, and Captopril
What are some examples of ACE Inhibitor Drugs?
Lotensin
Enalapril
Enalaprilat
Catopril
Lisinopril
Moexiprol
What is the Mechanism of Action of an ACE Inhibitor?
Blocking of Angiotensin I to Angiotensin II; this decreases aldosterone and kinase and increases bradykinin. Overall, vessels dilate (decreasing BP), and blood volume degreases.
Excretion in kidneys after liver metabolism which is minimal
Explain the mechanism of action of Digoxin.
Inhibits sodium, potassium, and ATPase- promoting Ca accumulation within the myocytes and facilitates the interaction of myocardial contractile proteins: actin and myosin.
They exert positive inotropic action on the heart ; increasing force of ventricular contraction- increasing cardiac output.
What type of medication is Digoxin?
Cardiac Glycoside
Drugs that interact with Spironolactone:
ACE Inhibitors
ARBs
Aldosterone antagonists- because of hyperkalemia promotion
***NOT to be taken with K supplement.
What is the mechanism of action of spironolactone?
Blocks aldosterone action in the kidneys.
*Small degree of diuresis so the hypotensive effects are modest.
What is the main K Sparing Diuretic?
Sprionolactone
Give some examples of K rich foods?
Bananas, citris fruits
Thiazides interact with what meds?
NSAIDs, K sparing diuretics, Digoxin.
Caution in pts with diabetes!
Adverse effects of thiazides include:
Hypokalemia
Dehydration
Hyperglycemia
Hyperuricemia
Uses of thiazides include:
HTN and Edema
What is the action of a thiazide diuretic?
Blocks tha Na reabsorption in the DCT in the kidney by two mechanisms: reducing blood volume and by reducing the arterial resistance
What is an example of a Thiazide diuretic?
Hydrocholorthiazide, chlorthalidone
What are special considerations of Loop diuretics?
Best time to take this med is in the morning
Usually takes a K supplement with this because of the loss of K with the Na.
Medications that interfere with loop diuretics include: