NYU Pharmacology, Week 3, Cardiovascular and Antihypertensive Agents

Factors influencing BP
Heart Rate
Inotropic
Neural processes
Humoral processes
Renin-angiotensin
Aldosterone
Atrial natriuretic factor

what two organ systems influence blood pressure
cardiac
renal

normal BP
120/80

Pre-hypertensive BP
120-139/80-89

Stage 1 Hypertension
140-159/90-99

Stage 2 Hypertension
160+/100+

Indicators of orthostatic hypotension
a difference in BP of 20 systolic and 10 diastolic between BP in a supine position and BP when sitting up.

common adverse effects of antihypertensives in older populations
orthostatic hypotension

Lowering BP to a controlled level has what beneficial effects?

relationship between blood pressure and diabetes
hyperglycemia causes atheroscleoris and contributes to systemic inflammation

Purpose of diuretics
promote Na+ and water depletion (extra cellular fluid volume)

First line of treatment for mild HTN
diuretics

a common loop diuretic
Furosemide

Common Thiazides
Hydrochlorothiazide

common side effects of loop diuretics
Nausea, diarrhea, electrolyte imbalances

Antihypertensive Drug classes
diuretics
beta-blockers
Alpha2 agonists
Alpha adrenergic blockers
ACE inhibitors
Angiotensin II receptor antagonists
Direct renin inhibitor
Calcium channel blockers

Action of Thiazides
inhibits active exchange of Cl-Na in the cortical diluting segment of the ascending loop of henle

Action of loop diuretics
inhibit exchange of Cl-Na-K in the thick segment of the ascending loop of henle

indicator that a medication is a beta-blockers
ends with -lol (e.g. metoprolol)

action of selective beta-Adrenergic
blocks beta 1 receptors

action of non selective beta-adrenergic
blocks beta 1 and 2 receptors

Prototype Beta-adrenergic blockers
Metroprolol (lopressor)

effects of beta blockers
leads to lower blood pressure
decreased cardiac output
decreased systemic vascular resistance
decreased heart rate, contractility and renin release

see slide 57
see slide 57

side effects of Metoprolol (lopressor)
dizziness
fatigue, weakness
diarrhea
nasal stuffiness
impotence
decreased libido
depression
mental changes
bradycardia/ heart block
trombocytopenia
agranulocytosis

contraindications to beta-blockers
second or third degree AV block
sinus bradycardia
heart failure

example of non-cardioselective beta-blocker
Inderal

the four adrenoreceptors
Alpha 1
Alpha 2
Beta 1
Beta2

role of alpha 1 recepotrs
vasoconstriction
increased peripheral resistance
increased blood pressure
mydriasis
increased closure of internal sphincter of the bladder

role of alpha 2 receptors
inhibition of norepinephrine release
inhibition of acetylcholine release
inhibition of insulin release

function of beta 1 receptors
tachycardia
increased lipolysis
increased myocardial contractility
increased release of renin

function of beta 2 receptors
vasodilation
slightly decreased peripheral resistance
bronchodilation
increased muscle and liver glycogenolysis
increased release of glucagon
relaxed uterine smooth muscle

prototype of alpha 2 agonists
Clonidine (catapres)

effect of alpha 2 agonists
decreased sympathetic activity
increased vagus activity
decreased Cardiac output, serum epinephrine, norepinephrine and renin release
reduced peripheral vascular resistance and increased vasodilation
minimal effect on cardiac output and renal blood flow

what medication type should not be mixed with alpha 2 agonists
beta blockers

side effects of alpha 2 agonists
drowsiness
dry mouth
dizziness
bradycardia
rebound hypertensive
if medication is stopped abruptly
peripheral edema

prototype for calcium channel blockers
amlodipine (Norvasc)

suffix of calcium channel blockers
-dipine

grapefruit juice’s effect on medication
it increases the potency of the drug and can cause toxicity

side effects of amlodipine
peripheral edema
headache
flushing
dizziness
nausea
fatigue
flush, dizziness
ankle edema
bradycardia
hypotension
angina
angioedema
heart block

what is angioedema
swelling

Examples of direct-acting arteriolar vasodilators
hydralazine, minoxidil, diozoxide

when are direct-acting arteriolar vasodilators used
in severe HTN

Mechanisms of action for direct-acting arterial vasodilators
hydralazine binds to and activates voltage gated potassium channels on vascular smooth muscle. The result is an efflux of potassium and a subsequent hyperpolarization of the cell. This prevents calcium-mediated activation and constriction of the smooth muscle, resulting in vasodilation

average urine output per hour
30-60 ml/hour

Nursing Assessment points for a patient on hypertensives
Assess past and current medication
Assess openness to lifestyle changes
Baseline vital signs, renal & liver function
daily weight
Oral intake & urinary output
Eye exam

Finish slides 63+

Warfarin
anti-coagulant

normal SA node rhythm
60-80 beats/min

normal AV node rhythm
40-60 beats/min

normal Ventricle rhythm
30-40 beats/min

Cardiovascular Agents
Antianginals
antihypertensives
antiipidemics & peripheral vasodilators

Purpose of antianginal drugs
treats angina

angina
decreased myocardial O2 supply can lead to anginal pain

symptoms of agina
chest tightness or pressure with pain radiating down left arm
referred jaw or neck pain
May have SOB, diaphoresis, pallor, clammy skin, GI symptoms
Usually lasts a few minutes and can lead to MI

three types of angina pectoris
classic
unstable
variant

classic angina
occurs with stress or emotion due to coronary artery narrowing or partial occlusion

Unstable angina
occurs frequently over course of a day with increased severity due to coronary artery narrowing or partial occlusion

Variant Angina
occurs with rest, caused by vasospasm

Main effect of Angina drug therapy
increases O2 supply or decreases O2 blood flow

Types of antianginal drugs
nitrates
beta-blockers
calcium channel blockers

1st agent to relieve angina
nitrates

main effects of nitrates
causes generalized vascular and coronary vasodilation

main complication of nitrates
can cause decreased BP

Nitrate Prototype drug
nitroglycerin

mechanism of action in nitrates for variant agina
relaxes coronary arteries leading to decreased vasospasm causing increased O2 supply

mechanism of action in nitrates for classic agina
dilates veins which leads to decreased preload and thus reduced O2 demand

Pharmacodynamics of nitroglycerin
reduces myocardial oxygen deman
increases cyclic guanosine monophosphate
decreases preload
decreases afterload

effect of cyclic guanosine monphosphate
smooth muscle relaxation and vasodilation

Nitroglycerin administration route
PO, sublingual, IV, topical

most common administration route for nitroglycerin
sublingual

storage considerations for nitroglycerin
some tablets decompose under heat and light

when is IV nitroglycerin administered
to manage acute CHF exacerbation

IV solvent for NTG
D5W (dextrose, not normal saline)

Most common side effects of nitroglycerin
Head ache
low BP
dizziness
lightheadedness
reflex tachycardia if NTG given too rapidly
life threatening circulatory collapse

interaction between NTG and beta-blockers, calcium channel blockers, antihypertensives, alcohol
enhanced hypotensive effect

NTG contraindicated with what kinds of medication and wu
seldenafil (Viagra), tadalafil, vardenafil to potenital for risk of sever hypotension or cardiovascular collapse

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