Hypertension/Cholesterol Meds

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Hypertension/Cholesterol Meds
2010-12-06 22:51:56
nursing htn med

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  1. Fxn of Alpha 1:
    • B: Bladder: contraction
    • E: Eye: contriction of radial muscle = mydriasis
    • V: Veins: constriction
    • A: Arterioles: (skin, mucous memranes, viscera) constriction
    • S: Sex Organs: (male) ejaculation, constricts prostate capsule
  2. Fxn of Alpha 2:
    • inhibition of trasmitter release
    • reduces T release when too much accumulates in synaptic gap
  3. Fxn of Beta 1:
    • Heart:
    • ↑ HR
    • ↑ Contractility
    • ↑ AV Conduction

    • Kidneys:
    • ↑ Renin
  4. Fxn of Beta 2:
    • L: Liver: gylcogenolysis
    • A: Arterioles: (heart, lung, skel. musc) dilation
    • B: Bronchi: dilation
    • S: Skeletal Muscle: ↑ contraction, glycogenolysis
    • (plus uterus relaxation)
  5. Fxn of Dopamine:
    • Kidney:
    • dilation of kidney vasculature
    • enhances renal perfusion
  6. Prazosin [Minipress]
    • Alpha Adrenergic Blocker
    • Selective Alpha-1
    • Use: Hypertension
    • A/E: Orthostatic Hypotension/First Dose Effect (also ↓ejaculation, nasal congestion)
    • Take first dose @ bedtime to avoid first dose effect
  7. Propanolol
    • Nonselective Beta Blocker
    • Beta-1 and Beta-2
    • Use: Hypertension (angina, HF, dysrhythmia) Reduces CO
    • A/E: Bradycardia, Heart Block, Rebound Excitation, Blocks Genolysis (↑BG)
    • Diabetics! Masks Hypoglycemic Tachycardia
  8. Metropolol
    • Selective Beta Blocker
    • Beta-1 only
    • Use: Hypertension (angina, HF, MI) reduces CO
    • A/E: Bradycardia, ↓CO, Rebound Excitation, Can Cause HF
    • Diabetic! masks hypogylcemic tachycardia
  9. Captopril [Capoten]
    • ACE Inhibitor
    • Blocks Production of AngioII in lungs
    • Uses: Hypertension (Diabetic Nephropathy, HF, MI)
    • AE: Cough (↑bradykinin), First Dose, Hyperkalemia, AngioEdema, Renal Failure)
    • No K+ Supplements
  10. Losartan [Cozaar]
    • ARB
    • Blocks Action of AngioII
    • Use: Hypertension (Diabetic Nephropathy, Stroke Prevention, HF, MI, Migraine)
    • AE: AngioEdema, Renal Failure
    • Doesn't work in the lungs, so no bradykinin effect, so no Cough and no HyperKalemia like the ACE inhibitors
  11. Verapamil & Diltiazem
    • CCB: Calcium Channel Blockers (like BB's)
    • works on VSM of both Heart and Arterioles
    • Use: Hypertension, Angina, Cardiac Dysrhythmia
    • AE: Constipation (dizzy, flush, HA, edema, bradycarda [SA], Heart Block [AV], ↓contr.)
    • (think "calcium = contraction")
  12. Nifedipine
    • CCB: Calcium Channel Blockers (like BB's)
    • works on VSM of only Arterioles
    • Use:Hypertension, Angina Pectoris
    • AE: Reflex Tachycardia
    • Little Constipation, unlike Verapamil
  13. Lovastatin
    • HMG-CoA Reductase Inhibitor
    • Lowers Cholesterol (statins are most effective) by inhibiting cholesterol production, which stims ↑LDL receptors in liver (more LDL drawn from blood into liver)
    • Use: Lower Colesterol, Prevent CV Events
    • AE: Myopathy, Hepatotoxicity
    • Take in the evening because endogenous absorption increases at nighttime.
  14. Nicotinic Acid [Niacin]
    • Lowers Cholesterol by targeting VLDLs, therefore ↓LDL
    • Use: lowers cholesterol, DOC for Pancreatitis, best at ↓HDL
    • AE: Flushing, GI, Hepatotoxicity, Hyperglycemia
    • Don't take long-acting preparations because ↑risk hepatotoxicity. Take with food.
  15. Cholestyramine
    • Bile-Acid Sequestrant
    • Lowers Cholesterol by preventing reabsorption of Bile Acids into Liver, leading to ↑LDL receptors in Liver
    • Use: Reduce LDL (can pair w/statins)
    • AE: Constipation (↓uptake of Vit ADEK, can form complexes w/other drugs)
    • take other drugs 1 hr before or 4 hrs after
  16. Ezetimibe
    • Lowers Cholesterol, works on cells on small intestine to decrease absorption of cholesteral
    • Use: Lower Cholesterol
    • AE: generally well tolerated
    • No constipation/GI effects like other cholesterol drugs.
    • Newest for HyperCholestemia.
  17. Where do Diuretics work?
    the nephron of the kidney
  18. Furosemide [Lasix]
    • High Cieling (Loop) Diuretic
    • works in Asceding Loop of Henle, where 20% water reabsorption takes place; blocks reabsorption so water is excreted
    • use: Edema, Hypertension
    • ae: Hypokalemia, Hypernatremia, Ototoxicity, Hyperglycemia, dehydration, ortho hypotn, hyperuricemia
    • intrxn: Digoxin (↑dyrhythmia), Ototoxic Drugs (↑risk hearing loss), Potassium-Sparing Diuretics (help prevent hypokalemia)
    • Greatest amount of Diuresis, very strong effect.
  19. Hydrochlorothiazide [HydroDIRUIL, HCTZ]
    • Thiazide Diuretic
    • blocks reabsabsorption in early segment of DCT, where 10% water is reabsorbed
    • use: Hypertension, Edema, CHF
    • ae: all the same as Furosemide, but to a lesser degree
    • intrxn: Digoxin (toxicity), NSAIDs (blunt fx), Antihypertensives (change fx), Lithium (↑ to toxic levels), Potassium-Sparing Diuretics (compensate K+ loss)
    • Most Widely Used, more mild effects.
    • Dependent on Renal Fxn, cannot use if Renal Impairment.
  20. Spironolactone [Aldactone]
    • Potassium-Sparing Diuretic
    • blocks receptors for Aldosterone in DCT, so K+ is retained and Na, Cl, H2O are excreted (takes ~48hrs)
    • use: (usually combined) Hypertension, Edema, CHF (also Hyperadolsteronism, PMS, PCOS, Acne)
    • ae: Hyperkalemia (lethal dysrhythmia possibility)
    • intrxn: Agents that ↑K+ (K+ suppl, salt subs, other K+ sparing diuretics), ACE/ARB/DRI, Thiazide/Loop Diuretics (counteracts K+ wasting)
  21. Mannitol [Osmitrol]
    • Osmotic Diuretic
    • works in Lumen of Nephron to create Omotic Force to inhibit passive reabsorption of water, so urine flow increases
    • use: prophy Renal Failure, ↓ICP, ↓IOP
    • ae: Edema, CHF, F/E Imbalance, N/V, HA
    • freely filtered in glomerulus
    • minimal reabsorption, not majorly metabolized
    • pharmacologically inert (no direct effects)