Antihypertensives

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246559
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Antihypertensives
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2013-11-12 15:10:41
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Antihypertensives
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  1. Explain how blood pressure works.
    • Blood pressure=COxSVR
    •  (Cardiac output X systemic vascular resistance)
  2. What is considered normal BP measurements?
    <120/80
  3. What is considered the "warning" range for BP measurements?
    12-139/80-89
  4. Studies have shown that what conditions are associated with HTN?
    HF, Stroke, Renal failure
  5. HTN is classified by two categories, what are they?
    • By Cause: Unknown (idiopathic, essential, primary) 90% of HTN cases
    • Known cause: Secondary HTN 10% of cases
  6. What are some cultural considerations with HTN?
    • African americans ^risk of HTN
    •    d/t meds <effective: beta-blockers, ACE-inhibitors
    • Effective meds: alpha1 blockers & Calcium channel blockers
    • Asian Americans are 2xs as sensitive to beta-blockers.
    • Different drugs used for different ethnicities
  7. What are the Anti-hypertensive Drug categories?
    • Diuretics
    • Sympatholytics
    • Direct acting arteriolar vasodilators
    • Angiotensin converting enxyme (ACE) inhibitors
    • Angiotensin II receptor blockers (ARBs)
    • Calcium channel blockers (CCBs)
  8. What is the general action of Diuretics?
    • <the plasma & extracellular fluid volumes
    • =<preload, cardiac output & total peripheral resistance.
    • Overall effect: <workload of the heart &<BP
  9. What are the most commonly used diuretics for HTN?
    Thiazides
  10. Name the Sympatholytic drugs (sympathetic depressants).
    • Beta-adrenergic blockers
    • Centrally acting alpha2 agonists
    • Alpha-adrenergic blockers
    • Adrenergic neuron blockers (peripherally acting sympatholytics)
    • Alpha1 - and beta1 adrenergic blockers
  11. Which Sympatholytic drugs for HTN can cause the 1st dose syncope?
    ALL
  12. The overall action of Sympatholytic drugs used for HTN is what?
    <BP & HR
  13. How do the Beta-adrenergic blockers (sympatholytic beta-blockers) act as Antihypertensives?
    <cardiac output by <HR, contractility & renin release = <BP
  14. What are the A/E of the Beta-adrenergic blockers (sympatholytics)?
    Insomnia, depression, & impotence
  15. How do the Centrally acting Alpha2 agonists (sympatholytics) act as Antihypertensives?
    Stimulate the alpha2 receptors= <the sympathetic response from brainstem to the peripheral vessels= <peripheral vascular resistance & ^vasodilation
  16. Which Centrally acting Alpha2 agonists are used to treat HTN & to manage withdrawal symptoms in opioid or nicotine dependent clients?
    Clonidine (Catapres): 7 day patch
  17. Which Centrally acting Alpha2 agonist (sympatholytic), is used for Gestational HTN d/t it's pregnancy safety?
    Methyldopa (Aldomet)
  18. What are the S/E of Centrally Acting Alpha2 Agonists? (sympatholytics)
    Na+ & water retention, dry mouth, bradycardia

    **becareful w/HF pts
  19. What is the general action of the Antihypertensive drugs in the Alpha-Adrenergic Blockers group? (sympatholytics)
    Blocks the alpha-adrenergic receptors= vasodilation & <BP
  20. What are the two categories of the Antihypertensive Alpha-Adrenergic Blocker drugs & what do they treat? (sympatholytic)
    • Selective Alpha1: HTN & BPH
    • Non-selective Alpha blockers: HTN CRISIS
  21. Name the Antihypertensive Alpha-Adrenergic blockers in the Selective Alpha1 class.
    • Cardura
    • Hytrin
    • Minipress
  22. What is the action of the little used Antihypertensive Adrenergic Neuron Blocker, Resperpine?
    (Peripherally acting sympatholytic)
    Block norepinephrine release that results in lowering BP

    **LAST CHOICE D/T ORTHO HYPOTENSION**
  23. The well tolerated Sympatholytic Antihypertensive class of Alpha1 & Beta1 receptor blockers are dual action drugs.  Coreg, acts on the body in what way?
    • Block the a1-adrenergic receptor
    • <HR (b1-receptor blocker)
    • Vasodilation (a1-receptor blocker)
  24. What patients are the Sympatholytic Antihypertensive Alpha1 & beta1 receptor blockers contraindicated in?
    COPD clients d/t bronchial constriction
  25. What are the A/E of the Sympatholytic Antihypertensive drugs?
    • ** dry mouth, drowsiness, sedation, constipation**
    • HA, Nausea, sleep disturbances, rash, cardiac disturbances (palpitations)
    • ^incidence of orthostatic hypotension
  26. Name the Direct-acting Vasodilators used as Antihypertensives.
    • Hyperstat
    • Apresoline
    • Loniten
    • Nipride, Nitropress
  27. With the Direct-Acting Arteriolar Vasodilator Nipride/Nitropress, what are the NEED to know items?
    • Constantly monitor BP
    • Light sensitive drug
    • Can cause cyanide toxicity
  28. What is the action of the Direct-Acting Arteriolar Vasodilators like Nipride?
    • Directly relax arteriolar &/or venous smooth muscle
    • = <systemic vascular response, <afterload, & peripheral vasodilation
  29. What are the A/E of the Direct-Acting Arteriolar Vasodilator Hydralazine?
    Dizziness, HA, anxiety, tachycardia, N/V/D, anemia, dyspnea, edema, nasal congestion
  30. What are the A/E of the Direct-acting Arteriolar Vasodilators Sodium Nitroprusside (Nitropress)?
    Bradycardia, hypotension, possible cyanide toxicity (rare)
  31. What are the A/E of the Direct-acting Arteriolar Vasodilator Diazoxide?
    dizziness, HA, anxiety, orthostatic hypotension, dysrhythmias, Na+ & water retention, N/V, hyperglycemia in DM pts
  32. Name the Angiotensin Converting Enzyme Inhibitors (ACE inhibitors) that are safe and used a lot.
    • Captrpril: very short half-life
    • Enalapril
    • Lisinipril, prinivil, accupril: long half-lives
    • **HTN & types of HF
  33. What is the mechanism of action for the ACE Inhibitors?
    • Block the angiotensin converting enzyme, thus preventing the conversion of angiotensin II from angiotensin I.
    • Blocks release of Aldosterone
    • **result: <systemic vascular resistance (afterload), vasodilation= <BP
  34. What are the A/E of ACE Inhibitors?
    Fatigue, HA, dizziness, mood changes, impaired taste, hyperkalemia, dry nonproductive cough

    *1st dose hypotension may occur
  35. What are the Angiotensin II Receptor Blockers (ARBs) drug names?
    • Losartan
    • Diovan
    • Eprosartan
    • Irbesartan
  36. How do the Angiotensin II Receptor Blockers (ARBs) work?
    Allow angiotensin I to be converted to angiotensin II, but block receptors that recieve the angiotensin II
  37. What are the A/E of Angiotensin II Receptor Blockers (ARBs)?
    • ^resp infections
    • HA
    • dizziness, inability to sleep, diarrhea, dyspnea, heartburn, nasal congestion, back pain, fatigue
    • Hyperkalemia MUCH less likely to occur
  38. What can Calcium Channel Blockers be used to treat?
    • Anti-anginals
    • Anti-dysrhythmics
    • Anti-hypertensives
  39. Name the Calcium Channel Blockers used as Anti-hypertensives.
    • Bezothiazepines: Diltiazem
    • Phenylalkamines: Verapamil
    • Dihyropyridines: Amlodipine
  40. How do the Calcium Channel Blockers cause an Anti-hypertensive effect?
    <peripheral smooth muscle tone & <systemic vascular resistance = <BP
  41. What are the critical assessments before administering Anti-hypertensives?
    BP & PULSE
  42. What are the nursing implications with Anti-hypertensives?
    • do NOT miss a dose, NEVER double dose
    • TELL MD IF DOSE IS MISSED
    • do NOT abruptly stop taking
    • change positions slowly
  43. What client teaching should be done with Anti-hypertensive meds?
    • Impotence is expected
    • Life-style changes: <Na+, <fat, <Wt, <alcohol
    • avoid smoking
    • exercise

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