Hypertension has 3 Classifications

                 1. Prehypertension             =   <120- ___ /80-89

                 2. Stage 1 hypertension      =     140-___/90-99

                 3. Stage 2 hypertension      =     > 160/___

1. <120-139/ 80-89

2.  140-159/ 90-99

3.   > 160/100

Incidence of Hypertension 

1. __%  of general population 

2. __%  of African American population

3. __%  of HTN is considered "essential or primary" 

(essential or primary HTN means that there is no clear cause of elevated bp...in secondary HTN the cause of the problem can be ccorrected with surgery such as tumors)

1. 30%  of general population

2. 51%  of African American population

3. 90%  of HTN is considered "essential or primary"

Cardiac Output= ______ ______x HR

Stroke Volume

Blood Pressure = CO x __________ ________ __________ (PVR)

Peripheral Vascular Resistance (PVR)

Antihypertensive Drug Classes 

(5)

1. Diuretics

2. Sympotholytic Drugs 

3. Angitensin Converting Enzyme (ACE) Inhibitors

4.________ Receptor Blockers (ARB)

5. _______ Channel Blockers (CCB)

4. Angitensin Receptor Blockers (ARB)

5. Calcium Channel Blockers (CCB)

There is a step approach to management of HTN this includes 2 things.

1.

2.

1. Lifestyle Modification

2. Classes of drugs added one at a time.

3 Types of Diuretics

1. Thiazide Diuretics

2. ____ Diuretics

3. Potassium ______ Diuretics

1. Thiazide Diuretics

2. Loop Diuretics

3. Potassium Sparing Diuretics

Thiazide Diuretic 

Action:                          __________

Therapeutic Effect:      Reduces Blood Pressure

Side Effect:                    ________

Action:

1. The drug inhibits Sodium reabsorption on the early portion of the distal tubule     of the nephron.

2. By inhibiting sodium reabsorption, more sodium is retained within the nephron.

3. More sodium in the nephron= osmotic water attraction to nephrons

4. Increase in sodium+ water through the nephron = increased renal excretion of     fluid.

Therapeutic Effect:      Reduces Blood Pressure

Side Effect: Fluid loss, hypotension, electolyte loss ESPECIALLY                                   POTASSIUM loss (hypokalemia = potassium depletion)

Loop Diuretic

Action:  

Therapeutic Effect:    Reduces Blood Pressure

Side Effect:

Action: 

1. Drug inhibits sodium and chloride reabsorption from the nephron.

2. This thereby prevents the reabsorption of the water that follows these             electrolytes

3. Increased renal excretion of fluids

Therapeutic Effect:    Reduces Blood Pressure

Side Effect:    fluid loss, hypotension, dizziness, fatigue, electrolyte loss which

                     can lead to POTASSIUM LOSS = (hypokalemia) 

Potassium Sparing Diuretics 

Action: __________

Therapeutic Effect:     Reduction in Blood Pressure

Side Effects: ____________

Action :

1. Sodium is reabsorbed in tubules while potassium is spared

2. Water reabsorption occurs

3. Increase in renal excretion of fluids

Therapeutic Effect:    Reduction in Blood Pressure

Side Effects:  fluid loss, hypotension, hyponatremia (sodium depletion), hyperkalemia with dysrhythmias.

3 Types of Sympatholytics

1. ____ Blockers

2. Mixed _____ & Beta Blockers

3. _________ Acting Agents

1. Beta  Blockers

2. Mixed Alpha & Beta Blockers

3. Centrally Acting Agents

Beta Blockers 

aka beta-adrenergic blockers

Action: ________

Therapeutic Effect:  Reduces Blood Pressure

Side Effects: ________

Action:

1. Decreases beta receptor stimulation

2. Decrease HR contractility and cardiac contractility..

3. Reduces cardiac output; decreases general sympathetic activity including to

    peripheral vessels. 

Therapeutic Effect:  Reduces Blood Pressure

Side Effects:  hypotension, BRADYCARDIA, impaired glucose levels.                              fatigue, insomnia, activity intolerance, bronchoconstriction,                              impotence.

Mixed Alpha and Beta Blocker

(Coreg) 

MOA: _____

Therapeutic Effect: _______

Side Effects: __________

Mechanism of Action:

Antihypertensive that possesses nonselective B-blocking and a-adrenergic blocking activity. It also causes vasodialation.

Therapeutic Effect: 

Reduce cardiac output, exercise induced tachycardia, reflex orthostatic tachycardia, reduction in PVR.

Side Effects:

Bradycardia, hypotension, bronchospasm, cardiac insufficiency, cardiogenic shock, cardiac arrest in a situation of overdose. 

Centrally Acting Agents 

Action: _______

Therapeutic Effect:  Reduces Blood Pressure

Side Effects: ________

Action:

1. Inihibits sympathetic discharge from the brainstem. 

2. Decreased sympathetic receptor stimulus to the heart and peripheral vessels.

Therapeutic Effect: Reduces Blood Pressure

Side Effects: hypotension, Peripheral Edema, decreased libido

Angiotension Converting Enzyme Inhibitors

(ACE Inhibitors) 

& 

Angiotension Receptor Blockers 

(ARB) 

Action: _________

Therapeutic Effect: Decreased Blood Pressure

Side Effects: ____________

Action: 

1. Blocks angio 1 to angio II,

2. Prevents vasoconstriction & blocks renin & aldosterone

3. decreases fluid retention 

Therapeutic Effect: Decreased Blood Pressure

Side Effects:

ACE = headache, dizziness, hypotension, PERSISTENT DRY COUGH, \              renal impairment, hyperkalemia.

ARB = same side effects..... except less cough

Calcium Channel Blockers (CCB) 

Action: ________

Therapeutic Effect:  Reduces Blood Pressure

Side Effects: ___________

Action:

1. Blocks the entry of calcium into vascular smooth muscle.

2. Vasodialation and reduced pvr.

Therapeutic Effect:  Reduces Blood Pressure

Side Effects:  hypotension, EDEMA IN ANKLES AND FEET, dizziness, weakness, Dysrhythmias, myalgias, arthalgias.

Angina

Chest pain associated with cardiac ischemia. 

  (presents differently in men and women)

        The oxygen supply to tissues does not meet oxygen demand.

         Metabolites build up and cause pain.

       Precipitators= physical and/or emotional exertion 

3 Drugs Used to Treat Angina

1. Nitrates (fast acting and long acting)

2. ____ Blockers

3. Calcium Channel Blockers

1. Nitrates (fast acting and long acting)

2. Beta Blockers

3. Calcium Channel Blockers

Nitrates 

Action: _______

Therapeutic Effect: Coronary vasodialation and reduction in chest pain.

Side Effect: __________

Action:

1. Potent vasodialator in vascular smooth muscle. 

Therapeutic Effect: Coronary vasodialation and reduction in chest pain.

Side Effects: headache, POSTURAL HYPOTENSION, facial flushing, dizziness.

Beta Blockers to treat Angina

Action: __________

Therapeutic Effect: Treatment of stable angina.

Action: 

1. Blocks sympathetic output

2. Decreases heart rate & decreases contractility

3. reduction in cardiac workload (less oxygen demand)

Therapeutic Effect: Treatment of stable angina.

Calcium Channel Blockers

Action: ________________

Therapeutic Effect: Treatment of Angina

Action:

1. Relaxes vascular & coronary smooth muscles

2. Results in less vascular resistance

3. less cardiac workload

4. less oxygen demand

Therapeutic Effect: Treatment of angina

Arrhythmias 

(5 types)

1. Sinus

2. Supraventricular

3. Atrioventricular Junctional

4. Conduction Disturbances

5. Ventricular

Classification of Antiarrhythmic Drugs 

1- Class 1: Sodium Channel Blockers 

        A. Subclass A

        B. Subclass B (emergency)

        C. Subclass C 

2- Class 2: Beta Blockers

3- Class 3: Drugs that prolong repolarization

4- Class 4: Calcium Channel Blockers

Class 1 Antiarrhytmics 

(Sodium Channel Blockers)

Subclass A

Subclass B

Subclass C

Action: _________

Therapeutic Effect: primary treatment of VENTRICULAR                                             ARRHYTMIAS

Side Effects: _______

Action:

1. Alter depolarization and repolarization of cardiac cells.

Therapeutic Effect: primary treatment of VENTRICULAR                                             ARRHYTMIAS

Side Effects: increased Arrhythmias, dizziness, visual disturbances.

Class 2 Antiarrhythmic 

(Beta Blockers)

Action: ________

Therapeutic Effect: Primarily used to treat ATRIAL TACHYCARDIAS

Side Effects: __________

Action:

1. Decrease stimulation of sympathetic nervous system beta receptors. 

2. SLowing of conduction in the hear and decreased heart rate. 

Therapeutic Effect: Primarily used to treat ATRIAL TACHYCARDIAS

Side Effects: bradycardia, increase in other arrhythmias, bronchoconstriction

Class 3 Arrhythmic Drugs 

(Drugs that prolong repolarization)

Action: _______

Therapeutic Effect: primarily used to treat VENTRICULAR ARRYTHMIAS

Side Effects: increase in arrhythmias, liver toxicity

Action: 

1. Delay repolarization of cardiac cells

2. Slowing and stabalization of heart rate. 

Therapeutic Effect: primarily used to treat VENTRICULAR ARRYTHMIAS

Side Effects: increase in arrhythmias, liver toxicity

Class 4 Antiarrhythmics 

(Calcium Channel Blockers)

Action : _______

Therapeutic Effect: primarily used to treat ATRIAL ARRHYTHMIAS

Side Effects: bradycardia, dizzinessm headaches

Action:

1. Blocks calcium entry into cardiac cells.

2. decreased conduction and excitability of cardiac cells.

Therapeutic Effect: primarily used to treat ATRIAL ARRHYTHMIAS

Side Effects: bradycardia, dizzinessm headaches

Heart Failure

-Chronic Condition effects _ million + individuals

- One of the most common causes for hospitalization

- High incidence of rapid readmission following discharge.

The heart is unable to pump a sufficient blood supply to meet the demands of the body. 

-Chronic Condition effects 5 million + individuals

- One of the most common causes for hospitalization

- High incidence of rapid readmission following discharge.

Signs of Right Sided Heart Failure

- Weight Gain

- Peripheral Edema

- Enlarged Liver

- Abdominal Pain

- Neck vein distention

- Weakness

- Fatigue

- Nausea

Signs of Left Sided Heart Failure

- Cough and frothy sputum

- Weight gain

- Difficulty breathing 

      -Dyspnea

      - Orthopnea (cant lye down and breathe)

- Abnormal Lung Sounds

- Pleural Effusion

- Weakness

- Fatigue

- Confusion, Restlessness (hypoxia)

Heart Failure Treatment Goals 

3

1. Improve activity tolerance

2. Improve oxygenation

3. Maintain/ or improve quality of life 

Pharmacologies can improve the hearts pumping ability by:

1. Increasing the force of myocardial contractions

2. Decreasing the workload of the myocardium

4 Agents that Decrease Cardiac Workload

1. ACE Inhibitors

2. Beta Blockers

3. Diuretics

4. Nitrates

Agent that decrease cardiac workload

(ACE Inhibitors) 

Action: ______

Therapeutic Effects: Less Fluids =  Decreased BP 

Side Effects: ________

Action:

1. Blocks I to II.

2. Decreases workload

3. Impairs Fluid Retention

Therapeutic Effects: Less Fluids =  Decreased BP 

Side Effects: Headache, dizziness, dry cough, hypotension, renal impairment, hypokalemia.

Agents that decrease cardiac workload

(Beta Blockers)

Action : _____

Therapeutic Effect:  Atrial tachycardia

Side Effects: ________

Action:

1. Decrease stimulation in heart, lung, periphery.

2. Decrease HR and workload.

Therapeutic Effect: Atrial tachycardia.

Side Effects: Bradycardia, increase in other arrhythmias, bronchoconstriction, lower BP, INCREASED QUALITY OF LIFE.

Agents that Decrease Cardiac Workload

(Diuretics)

Action: _______

Therapeutic Effect: Decreases BP 

Side Effects: Electrolyte loss, hypotension, hypokalemia.

Action:

1. Inhibits sodium reabsorption.

2. Increases renal excretion.

Therapeutic Effect: Decreases BP 

Side Effects: Electrolyte loss, hypotension, hypokalemia.

Agents that decrease cardiac workload

(Nitrates)

Action: ______

Therapeutic Effect: Increase in coronay flow, decrease in agina.

Side Effects: __________

Action: 

1. Vasodialator in vascular smooth muscle.

Therapeutic Effect: Increase in coronay flow, decrease in agina.

Side Effects: Headache, postural hypotension, facial flushing, dizziness.

Agents that increase the force of the myocardial contractions 

(Cardioglycans)

Action : _______

Therapeutic Effect: _______

Side Effects: bradycardia, GI disturbances,                              fatigue, malaise, and weakness.

Action:

1. Increase intracellular calcium.

2. Enhanced cardiac contractility; inhibits sympathetic activity.

3. Normalized conduction.

4. Decreased Heart Rate. 

Therapeutic Effect: positive inotrope and negative chronotrope contributes to                                    therapeutic usefulness in heart failure. 

Side Effects: bradycardia, gi disturbances, fatigue, malaise, and weakness.