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Explain how blood pressure works.
- Blood pressure=COxSVR
- (Cardiac output X systemic vascular resistance)
What is considered normal BP measurements?
What is considered the "warning" range for BP measurements?
Studies have shown that what conditions are associated with HTN?
HF, Stroke, Renal failure
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
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
What are the Anti-hypertensive Drug categories?
- Direct acting arteriolar vasodilators
- Angiotensin converting enxyme (ACE) inhibitors
- Angiotensin II receptor blockers (ARBs)
- Calcium channel blockers (CCBs)
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
What are the most commonly used diuretics for HTN?
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
Which Sympatholytic drugs for HTN can cause the 1st dose syncope?
The overall action of Sympatholytic drugs used for HTN is what?
<BP & HR
How do the Beta-adrenergic blockers (sympatholytic beta-blockers) act as Antihypertensives?
<cardiac output by <HR, contractility & renin release = <BP
What are the A/E of the Beta-adrenergic blockers (sympatholytics)?
Insomnia, depression, & impotence
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
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
Which Centrally acting Alpha2 agonist (sympatholytic), is used for Gestational HTN d/t it's pregnancy safety?
What are the S/E of Centrally Acting Alpha2 Agonists? (sympatholytics)
Na+ & water retention, dry mouth, bradycardia
**becareful w/HF pts
What is the general action of the Antihypertensive drugs in the Alpha-Adrenergic Blockers group? (sympatholytics)
Blocks the alpha-adrenergic receptors= vasodilation & <BP
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
Name the Antihypertensive Alpha-Adrenergic blockers in the Selective Alpha1 class.
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**
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)
What patients are the Sympatholytic Antihypertensive Alpha1 & beta1 receptor blockers contraindicated in?
COPD clients d/t bronchial constriction
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
Name the Direct-acting Vasodilators used as Antihypertensives.
- Nipride, Nitropress
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
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
What are the A/E of the Direct-Acting Arteriolar Vasodilator Hydralazine?
Dizziness, HA, anxiety, tachycardia, N/V/D, anemia, dyspnea, edema, nasal congestion
What are the A/E of the Direct-acting Arteriolar Vasodilators Sodium Nitroprusside (Nitropress)?
Bradycardia, hypotension, possible cyanide toxicity (rare)
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
Name the Angiotensin Converting Enzyme Inhibitors (ACE inhibitors) that are safe and used a lot.
- Captrpril: very short half-life
- Lisinipril, prinivil, accupril: long half-lives
- **HTN & types of HF
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
What are the A/E of ACE Inhibitors?
Fatigue, HA, dizziness, mood changes, impaired taste, hyperkalemia, dry nonproductive cough
*1st dose hypotension may occur
What are the Angiotensin II Receptor Blockers (ARBs) drug names?
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
What are the A/E of Angiotensin II Receptor Blockers (ARBs)?
- ^resp infections
- dizziness, inability to sleep, diarrhea, dyspnea, heartburn, nasal congestion, back pain, fatigue
- Hyperkalemia MUCH less likely to occur
What can Calcium Channel Blockers be used to treat?
Name the Calcium Channel Blockers used as Anti-hypertensives.
- Bezothiazepines: Diltiazem
- Phenylalkamines: Verapamil
- Dihyropyridines: Amlodipine
How do the Calcium Channel Blockers cause an Anti-hypertensive effect?
<peripheral smooth muscle tone & <systemic vascular resistance = <BP
What are the critical assessments before administering Anti-hypertensives?
BP & PULSE
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
What client teaching should be done with Anti-hypertensive meds?
- Impotence is expected
- Life-style changes: <Na+, <fat, <Wt, <alcohol
- avoid smoking