HTN: Part 1

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BCnurses2014
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198211
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HTN: Part 1
Updated:
2013-02-07 00:14:13
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HTN
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HTN
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  1. Afterload definition
    Resistance to blood outflow from heart
  2. Increase in afterload =
    • Increased resistance
    • Vasoconstriction
    • Increased BP
  3. Decrease in afterload =
    • Decrease in resistance
    • Vasodialation
    • Heart doesnt have to work as hard
    • AKA "unload"
  4. Hypertension definition
    Generally refers to a persistent elevation of BP greater than 140/90 mmHg
  5. Essential HTN (cause)
    Unknown direct cause
  6. Secondary HTN (cause)
    • Linked to another problem
    • Ex: Renal disease
  7. Risk factors for HTN
    • Smoking
    • Obesity
    • Diabetes mellitus
    • Dyslipidemia
    • Physical inactivity
    • Diet
    • Age (over 60)
    • Genetic predisposition, male gender
  8. Lifestyle modifications
    • Diet
    • Alcohol moderation
    • Exercise/weight reduction
    • Stop smoking
    • Stress management
    • Control of diabetes
  9. Pharmacological classes of HTN drugs
    • ACE-I
    • ARBs
    • Beta blockers
    • Calcium channel blockers
    • Diuretics
    • Extras
  10. ACE-I generic drugs end in what?
    -prils
  11. ACE-I mechanism of action
    Blocks the angiotensin converting enzyme (ACE)
  12. What does the angiotensin converting enzyme do?
    The ACE converts angiotensin I to angiotensin II (ATII), a potent vasoconstrictor
  13. Therapeutic effects of ACE-I
    • Decrease in BP, constriction, resistance, & afterload
    • Renal protective vascular effects
  14. Indications of ACE-I
    • HTN
    • CHF & MI
    • Renal protection in diabetic patients
  15. Precautions of ACE-I
    • Other antihypertensives and diuretics may increase hypotensive effects
    • Impaired renal function
  16. Contraindicaitons of ACE-I
    • Baseline hyperkalemia (drug will increase K)
    • Children, pregnant, lactating women
  17. Normal potassium range
    3.5-5
  18. Side/adverse effects of ACE-I
    • "ACE cough"
    • Fatigue
    • Dizziness
    • Hyperkalemia
    • Angioedema (swelling of face)
  19. Nursing actions of ACE-I
    • Assessment: BP, I/O, daily weight, side effects
    • Physical assessment focus: Cardiac, pulmonary
    • Lab work: Potassium levels, renal function
    • Patient education: Side effects, BP monitoring, drug interactions, hypotension symptoms, renal function
  20. Prototype drugs for ACE-I
    • Vasotec (enalapril)
    • Zestril (lisinopril)
  21. ARB generic drugs end in what?
    -sartans
  22. ARB mechanism of action
    Block binding of ATII to its receptors
  23. Therapeutic effects of ARBs
    • Decrease BP, constriction, resistance, & afterload
    • Renal protective vascular effects
  24. Indications of ARBs
    • HTN (often used for those who are intolerant of ACE-I)
    • CHF & MI
    • Renal protection in diabetic patients
  25. Precautions of ARBs
    • Other hypertensives and diuretics may increase hypotensive effects
    • Impaired renal funciton
  26. Contraindications of ARBs
    • Baseline hyperkalemia (drug will increase K)
    • Children, pregnant & lactating women
  27. Side/adverse effects
    • Headache
    • Upper respiratory infection
    • Sinusitis
    • Muscle weakness/cramps
    • Angioedema
    • Fatigue
    • Dizziness
    • Hyperkalemia
  28. Nursing actions of ARBs
    • Assessment: BP, I/O, daily weight, side effects
    • Physical assessment focus: Cardiac & pulmonary
    • Lab work: Potassium levels, renal function
    • Patient education: Side effects, BP monitoring, drug interactions, hypotension symptoms, renal function
  29. Prototype drugs for ARBs
    • Benicar (olmesartan)
    • Cozaar (losartan)
  30. Beta blocker generic drugs end in what?
    -olol
  31. Mechanism of action of beta blockers
    • Cardioselective: Bind to, and block B1 receptors (May still block some B2)
    • Nonselective: Bind to, and block any B receptor
  32. B1 receptors are located in what part of the body?
    Heart
  33. B2 receptors are located in what part of the body?
    Lungs
  34. Therapeutic effects of beta blockers
    • Decrease BP, constriction, resistance & afterload
    • Negative chronotrope
    • Negative inotrope
  35. Chronotrope =
    Heartrate
  36. Inotrope =
    Contractility (force of contractions)
  37. Indications of beta blockers
    • HTN
    • Angina (chest pain)
    • Cardiac dysrhythmias
  38. Precautions of beta blockers
    • Other antihypertensives and diuretics may increase hypotensive effects
    • Pulmonary disease or illness
    • Heart failure; bradycardia
    • Can mask evidence of hypoglycemia
  39. Contraindications of beta blockers
    • Some pulmonary diseases
    • Some cardiac dysrhythmias
    • (patient specific)
  40. Side/adverse effects of beta blockers
    • CHF
    • Some dysrhythmias
    • Bronchospasm/bronchoconstriction (dyspnea, wheezing)
    • Fatigue
    • Depression
    • Impotence
  41. Nursing actions for beta blockers
    • Assessment: BP, HR, pulmonary status, I/O, daily weight, side effects
    • Physical assessment: Cardiac & pulmonary
    • Patient education: Side effects, HR/BP monitoring, drug interactions, hypotension symptoms, renal function, effects with stress testing
  42. Prototype drugs for beta blockers
    • Inderal (propranolol)
    • Lopressor (metoprolol)
    • Tenormin (atenolol)
  43. Mechanism of action of calcium channel blockers (CCBs)
    • Inhibits the transport of calcium into myocardial and smooth muscle cells
    • Decrease cardiac output
    • Decrease HR and force of myocardial contraction
    • (Not as strong as beta blockers)
  44. Therapeutic effects of calcium channel blockers
    • Decrease BP, constriction, resistance, & afterload
    • Negative chronotrope
    • Negative inotrope
    • Decrease coronary artery spasms
  45. Indications of calcium channel blockers
    • HTN
    • Cardiac dysrhythmias
    • Angina
    • Migraine headaches
  46. Precautions of calcium channel blockers
    • Other hypertensives and diuretics may increase hypotensive effects
    • Bradycardia
    • Heart failure
    • Fluid overload
  47. Contraindications of calcium channel blockers
    • Acute MI
    • Some cardiac dysrhythmias
  48. Side/adverse effects of calcium channel blockers
    • Bradycardia/tachycardia
    • Fluid overload, peripheral edema
    • Constipation
  49. Nursing actions of calcium channel blockers
    • Assessment: BP, HR, I/O, peripheral edema, daily weight, side effects
    • Physical assessment: Cardiac & pulmonary
    • Patient education: Side effects, HR/BP monitoring, drug interactions, hypotension symptoms, renal function
  50. Prototype drugs for calcium channel blockers
    • Calan (verapamil)
    • Cardizem (diltiazem)
    • Norvasc (amlodipine)
  51. Classes of diuretics
    • Loop
    • Potassium-sparing
    • Thiazide and thiazide-like
    • Osmotic
    • Carbonic anhydrase inhibitors (CAI)
  52. Mechanism of action of loop diuretics
    • Inhibits Na+ and Cl- reabsorption in the loop of henle, and, therefore, H2O
    • Dilates blood vessels
  53. Therapeutic effects of loop diuretics
    Potent diuresis resulting in substantial fluid loss
  54. Indications of loop diuretics
    • HTN
    • Fluid overload/edema associated with CHF, hepatic or renal disease
  55. Precautions of loop diuretics
    • Impaired renal function
    • Pre-existing intravascular dehydration
    • Pre-existing electrolyte disturbances (hypokalemia)
  56. Contraindications of loop diuretics
    • Chronic renal failure
    • Untreated dehydration/electrolyte disturbances
    • Sulfa allergy
  57. Side/adverse effects of loop diuretics
    • Electrolyte disturbances = hypokalemia
    • Dehydration
    • Hypotension
    • Dizziness
  58. Nursing actions for loop diuretics
    Assessment: BP, I/O, K+, Mg++
  59. Prototype drugs for loop diuretics
    Lasix (furosemide)
  60. Mechanism of action of potassium-sparing diuretics
    • Acts of distal tubule
    • Block sodium/potassium exchange
    • Block aldosterone receptors
    • Increase Na+ and H2O excretion while retaining K+ and H+
  61. Therapeutic effect of potassium-sparing diuretics
    • Diuresis
    • Less K+ excretion
  62. Indications of potassium-sparing diuretics
    • HTN
    • Fluid overload/edema
    • Hyperaldosteronism
  63. Precautions of potassium-sparing diuretics
    • Impaired renal function
    • Pre-existing dehydration
    • Pre-existing electrolyte disturbance (hyperkalemia)
  64. Contraindications of potassium-sparing diuretics
    • Untreated dehydration/electrolyte disturbances
    • Renal failure
  65. Side/adverse effects of potassium-sparing diuretics
    • Electrolyte disturbances = hyperkalemia
    • Weakness
    • Dizziness
  66. Nursing actions for potassium-sparing diuretics
    Assessment: I/O, BP, K+
  67. Prototype drugs for potassium-sparing diureticsĀ 
    Aldactone (spironolactone)
  68. Mechanism of action for thiazide and thiazide-like diuretics
    • Inhibit Na+, K+, and Cl- reabsorption in the distal tube --> water loss
    • Relaxes/dilates peripheral arterioles
  69. Therapeutic effects of thiazide and thiazide-like diuretics
    • Excretion of H2O, Na+, K+, Cl-, without altering the pH
    • Peripheral arteriole relaxation = decreased resistance and afterload
  70. Indications of thiazide and thiazide-like diuretics
    • HTN
    • Fluid overload/edema
  71. Precautions of thiazide and thiazide-like diuretics
    • Impaired renal function
    • Pre-existing dehydration
    • Pre-existing electrolyte disturbance (hypokalemia)
  72. Contraindications of thiazide and thiazide-like diuretics
    • Severe renal failure
    • Hepatic coma
  73. Side/adverse effects of thiazide and thiazide-like diuretics
    • Electrolyte disturbances (hypokalemia)
    • Headache
    • Dizziness
  74. Nursing actions of thiazide and thiazide-like diuretics
    Assessment: I/O, BP, K+
  75. Prototype drugs for thiazide and thiazide-like diuretics
    • HydroDiuril or Microzide (hydrochlorothiazide, HCTZ)
    • Zaroxolyn (metolazone)
  76. Mechanism of action of osmotic diuretics
    • Increase osmotic pressure in glomerular filtrate
    • Fluid pulled into renal tubules, especially proximal and descending loop of henle
  77. Therapeutic effects of osmotic diuretics
    • Osmotic diuresis, with minimal effects on electrolytes
    • Shifts fluid: decrease cerebral edema = decrease intracranial pressure (ICP)
    • Early acute renal failure: rapid excretion of fluid from kidneys
  78. Indications of osmotic diuretics
    • Considered the osmotic diuretic of choice
    • Increased intracranial pressure
    • Early acute renal failure
  79. Precautions for osmotic diuretics
    • IV solution must be filtered because it crystalizes
    • Should be stopped if cardiac, pulmonary, or renal impairment occurs
  80. Contraindications of osmotic diuretics
    • Severe renal disease
    • Pulmonary edema
  81. Side/adverse effects of osmotic diuretics
    • Convulsions
    • Pulmonary congestion
  82. Nursing actions of osmotic diuretics
    • Assessment: I/O, BP, renal function, electrolytes
    • Physical assessment: Neuro, pulmonary, renal
  83. Prototype drugs for osmotic diuretics
    Osmitrol (mannitol)
  84. Mechanism of action of carbonic anhydrase inhibitors (CAI)
    • Inhibits carbonic anhydrase activity to decrease sodium bicarbonate production
    • Sodium/water excretion
  85. Therapeutic effects of carbonic anhydrase inhibitors (CAI)
    • Decrease circulating sodium bicarbonate
    • Decrease aqueous humor production which decreases intraocular pressure (IOP)
  86. Indications of carbonic anhydrase inhibitors (CAI)
    • Altitude sickness
    • Edema resistant to other treatment
    • Glaucoma; increased intraocular pressure
  87. Precautions for carbonic anhydrase inhibitors (CAI)
    Electrolyte disturbances
  88. Contraindications for carbonic anhydrase inhibitors (CAI)
    • Severe renal or hepatic dysfunction
    • Adrenal gland dysfunction
    • Pre-existing electrolyte imbalance (hyponatremia, hypokalemia)
  89. Side/adverse effects of carbonic anhydrase inhibitors (CAI)
    • Acidosis
    • Drowsiness, paresthesias
    • Hypokalemia
  90. Nursing actions for carbonic anhydrase inhibitors (CAI)
    Assessment: I/O, acid base balance, serum glucose/fingerstick blood sugars
  91. Prototype drugs for carbonic anhydrase inhibitors
    Diamox (acetazolamide)
  92. Mechanism of action for alpha1 antagonists
    • Blocks alpha1 - adrenergic receptors
    • Prevents norepinepherine from attaching which leads to smooth muscle relaxation
  93. Therapeutic effects of alpha1 antagonists
    • Decrease BP = (relaxes/dilates peripheral arterioles and veins)
    • Relaxes smooth muscle of bladder neck and urethra
  94. Indications of alpha1 antagonists
    • HTN
    • Benign prostatic hypertrophy (BPH) (overgrowth of prostatic gland)
  95. Precautions for alpha1 antagonists
    Hepatic or renal disease
  96. Contraindications of alpha1 antagonists
    Acute heart failure
  97. Side/adverse effects of alpha1 antagonists
    • Orthostatic hypotension
    • Dizziness
    • Headache
  98. Nursing actions for alpha1 antagonists
    • Assessment: HR, BP, I/O, urinary symptoms
    • Patient education: drug/side effects, BP monitoring, drug interactions, hypotension symptoms, urinary function
  99. Prototype drugs for alpha1 antagonists
    Cardura (doxazosin)
  100. Mechanism of action for alpha1 (a1) and beta (B) receptor blocker
    • Nonselective receptor blocker which leads to smooth muscle relaxation
    • Negative inotrope
  101. Therapeutic effects of a1 and B receptor blockers
    • Decrease progression of heart failure
    • Decrease myocardial oxygen demand
  102. Indications of a1 and B receptor blockers
    • Heart failure
    • HTN
    • Angina
  103. Precautions for a1 and B receptor blockers
    Some pulmonary and cardiac diseases
  104. Contraindications for a1 and B receptor blockers
    • Decompensated class 4 heart failure
    • Asthma
    • Cardiac dysrhythmias
  105. Side/adverse effects of a1 and B receptor blockers
    • Bradycardia
    • Pulmonary symptoms
    • Dizziness
    • Fatigue
  106. Nursing actions for a1 and B receptor blockers
    • Assessment: HR, BP
    • Physical assessment: Evidence of worsening heart failure
    • Patient education: Drug/side effects, HR and BP monitoring, hypotension symptoms, drug interactions
  107. Prototype drugs for a1 and B receptor blockers
    Coreg (carvedilol)
  108. Mechanism of action of alpha2 (a2) adrenergic agonists
    • Stimulate a2 receptors which decreases sympathetic outflow
    • Decreases production of norepinepherine and renin activity
  109. Therapeutic effects of a2 adrenergic agonists
    • Peripheral arteriole relaxation
    • Decreased resistance and afterload
    • Pain control
    • Alcohol, opioid, and tobacco withdrawal management
  110. Indications of a2 adrenergic agonists
    • HTN
    • Migraine headaches/pain
    • Withdrawal symptoms
  111. Precautions for a2 adrenergic agonists
    • Recent MI
    • Chronic renal failure
    • Liver dysfunction
  112. Contraindications of a2 adrenergic agonists
    • Acute heart failure
    • Concurrent use of monoamine oxidase inhibitorsĀ 
  113. Side/adverse effects of a2 adrenergic agonists
    • Headache
    • Dizziness
    • Lightheadness
    • Syncope
  114. Nursing actions for a2 adrenergic agonists
    • Monitor BP and HR
    • Available as oral, topical, and epidural routes
    • Patient education: Drug/side effects, BP monitoring, hypotension symptoms, drug interactions
  115. Prototype drugs for a2 adrenergic agonists
    Catapres (clonidine)
  116. Mechanism of action for direct vasodilators
    Direct arterial smooth muscle vasodilation
  117. Therapeutic effects of direct vasodilators
    Decrease BP, constriction, resistance, afterload
  118. Indications for direct vasodilators
    • HTN
    • Malignant HTN
  119. Precautions for direct vasodilators
    • Renal disease
    • Stroke
  120. Contraindications of direct vasodilators
    • Cerebral edema
    • Acute MI
  121. Side/adverse effects of direct vasodilators
    • Headache
    • Dizziness
    • Reflex tachycardia
  122. Nursing actions for direct vasodilators
    • Assessment: HR/tachycardia, BP
    • Patient education: Drug/side effects, BP monitoring, hypotension symptoms, drug interactions
  123. Prototype drugs for direct vasodilators
    Apresoline (hydralazine)
  124. Mechanism of action for renin inhibitors
    • Direct renin inhibitor
    • Inhibits conversion of angiotensinogen to angiotensin 1
  125. Therapeutic effects of renin inhibitors
    Decrease BP, constriction, resistance, afterload
  126. Indications of renin inhibitors
    HTN
  127. Precautions for renin inhibitors
    • Increased aliskiren level: Lipitor, Nizoral
    • Decreased aliskiren level: Avapro (irbesartan)
    • Decreased Lasix (furosemide) level with aliskiren
  128. Contraindication of renin inhibitors
    Children, pregnant and lactating women
  129. Side/adverse effects of renin inhibitors
    • Headache
    • Dizziness
    • Angioedema
    • Cough
  130. Nursing actions for renin inhibitors
    • Assessment: HR, BP, renal function, K+
    • Patient education: Drug/side effects, BP monitoring, hypotension symptoms, drug interactions
  131. Prototype drugs for renin inhibitors
    Tekturna (aliskiren)

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