UNIT 4 Hypertension Drug Therapy Diuretics pt.2

Sympatholytics 1

• Beta Adrenergic Blockers (lol)

• 🫀 Beta-1 Blockers (The "-LOL" Drugs)

What Do They Do? (MOA)

Examples end in "-lol"

• Metoprolol Atenolol
  "If it's a LOL, it slows the roll!"

Beta-1 receptors are mostly in the HEART ❤

When Beta-1 blockers block these receptors:

✅ Heart beats slower /decrease BP and decrease C.O.
✅ Heart pumps less forcefully
✅ Blood pressure decreases

They also block renin release from the kidneys

Less renin → Less activation of the RAAS (Renin-Angiotensin-Aldosterone System)

Result:
✅ Less fluid retention
✅ Lower blood pressure
"Block Beta-1 = Heart has less fun!"

• Slower heart rate

• Lower BP

• Less renin

• Beta Adrenergic Blockers (lol)

Easy Way to Remember the Effects

Beta-1 Blockers:

🫀 Slow the Heart
↓ Heart Rate

💪 Decrease Pumping Power
↓ Cardiac Output

💉 Lower Blood Pressure
↓ BP

🚽 Decrease Renin
↓ RAAS activity

🎵 Phrase:
"Slow, Low, and Go"

• Slow heart

• Low BP

• Go easy on the heart

---

Uses (Why We Give Them)

Think:❤ Heart Problems

• Hypertension (HTN)

• Congestive Heart Failure (CHF)

• Angina

• Tachyarrhythmias

🧠 Brain Problems

• Migraines

👁 Eye Problems

• Glaucoma

🎵 Memory Phrase:
"Heart, Head, and Eyes"

• Heart = HTN, CHF, Angina, Arrhythmias

• Head = Migraines

• Eyes = Glaucoma

Sympatholytics 1

• Beta Adrenergic Blockers (lol)

• whole effects

Side Effects Heart

❤ Bradycardia (slow heart rate)

Brain

🧠 Drowsiness
🧠 CNS depression
🧠 Mental depression

Stomach

🤢 GI upset
"Beta Blockers Bring You Down"

• Slow heart, Sleepy, Depressed, GI upset

Important Monitoring 🩸 Diabetics

Monitor blood glucose

Why?
Beta blockers can hide signs of low blood sugar , especially:

• Fast heart rate

• Palpitations
  "Beta blockers can MASK low sugar."

🧈 Lipids

Monitor serum lipid levels

Some beta blockers may affect cholesterol and triglycerides.
"Check the fat while slowing the heart."

CHF Warning

⚠ Use cautiously in CHF patients.

Why?
These drugs decrease how hard the heart pumps.

However, many beta blockers are used in CHF long-term, but they must be started carefully and monitored closely.
"Weak heart? Start low, go slow."

Super Quick NCLEX Study Sheet

🫀 Beta-1 Blockers = "-LOL" drugs

MOA

• Block Beta-1 receptors

• ↓ Heart Rate

• ↓ Cardiac Output

• ↓ Blood Pressure

• ↓ Renin release

Uses

• HTN

• CHF

• Angina

• Tachyarrhythmias

• Migraines

• Glaucoma

Side Effects

• Bradycardia

• Drowsiness

• GI upset

• CNS depression

• Depression

Monitor

• Blood glucose (especially diabetics)

• Lipid levels

• Heart rate & BP

🎵 Ultimate Memory Trick:

"LOL = Lower Output & Lower pressure"

LOL

• Lower heart rate

• Output decreases

• Lower BP

BETA BLOCKERS

drugs

propranolol (Inderal®)

         metoprolol (Lopressor®)

         nadolol

         atenolol (Tenormin®)

nebivolol (Bystolic®)

carvedilol (Coreg®)- (alpha-1 blocker too) 

Sympatholytics

🩸 Alpha-1 Blockers (The "-AZOSIN" Drugs)

Examples end in "-azosin”

• Prazosin,Terazosin, Doxazosin
  "A-ZO-SIN = Arteries Zoom Open Suddenly!"

What Do They Do? (MOA) Normally...

Norepinephrine (NE) binds to Alpha-1 receptors and causes:

🩸 Blood vessels to squeeze/tighten (vasoconstriction)

⬆ Blood pressure goes up

Alpha-1 Blockers stop this

They block NE from attaching to Alpha-1 receivers.

Result:

🩸 Blood vessels relax

🩸 Blood vessels widen (vasodilation)

⬇ Blood pressure drops
"Block Alpha-1 = Vessels Unwind!"

Easy Way to Think About It

Imagine your blood vessels are a garden hose.

Without Alpha-1 Blockers:

🤏 Hose is squeezed

⬆ Pressure rises

With Alpha-1 Blockers:

🫱 Hose relaxes

⬇ Pressure drops
"Relax the vessel, lower the pressure."

Sympatholytics

🩸 Alpha-1 Blockers (The "-AZOSIN" Drugs)

Uses (Why We Give Them)

🩸 Hypertension (HTN)

Blood vessels open up → BP decreases

❤ Angina

Heart doesn't work as hard because BP is lower

🚽 BPH (Benign Prostatic Hyperplasia)

Relaxes muscles around the bladder and prostate

➡ Easier urination

"A-ZOSIN helps Pressure and Peeing."

• Pressure = HTN, Angina

• Peeing = BPH

Side Effects

🚨 Orthostatic Hypotension

When standing up:

⬇ BP drops suddenly

😵 Dizziness,😵 Lightheadedness,😵 Fainting

🎵 Phrase:
"A-ZOSIN? Rise Slow-sin!" (Stand up slowly!)

BP drops →

Body tries to compensate →

❤ Heart beats faster

🎵 Phrase:
"Pressure falls, heart calls!"

🤢 GI Upset

• Nausea

• Stomach discomfort

🚽 Increased Urination

Because urinary flow improves

Sympatholytics

• Alpha-1 blockers/antagonists (azosin)

super easy summary

Alpha-1 Blockers = "-AZOSIN"

MOA

• Block Alpha-1 receptors

• Block NE binding

• Vasodilation

• ↓ Blood Pressure

Uses

• HTN

• Angina

• BPH

Side Effects

• Orthostatic hypotension ⭐

• Reflex tachycardia

• GI upset

• Increased urination

Patient Teaching

• Change positions slowly

• Watch for dizziness

• Fall precautions

Ultimate Memory Trick "A-ZOSIN OPENS THE HOSE"

Open vessels → ↓ BP

Open prostate/bladder → Easier pee

Open too fast → Dizziness when standing

🩸🚽 A-ZOSIN = Open Vessels, Open Pee Pathway 🚽🩸

3. Alpha-1 blockers (alpha-1 antagonists)

DRUG

prazosin (Minipress®)

         terazosin

   doxazosin (Cardura®) 

Alpha-2 Central Agonists

Sympatholytics 3

( Think: "Turn Down the Brain's Blood Pressure Signal" )

Super Easy MOA

Normally, your brain sends signals:

📢 "Raise the blood pressure!"
📢 "Tighten the blood vessels!"

Alpha-2 Agonists do the opposite

They act on Alpha-2 receptors in the brain and tell the body:

🤫 "Calm down."
🤫 "Stop sending so many signals."

Result:

✅ Blood vessels relax (vasodilation)

✅ Blood pressure decreases

✅ CNS activity slows down
"Alpha-2 = Tell the body 'Shhh...'"

Alpha-1 = GO! 🚗 Alpha-2 = SLOW! 🛑

Alpha-2 agonists make the nervous system quieter.

🎵 Phrase:
"Alpha-2 tells the body what NOT to do."

Uses

Hypertension (HTN)

Lowers blood pressure

❤ Angina

Less work for the heart

🎵 Memory Trick:
"Calm the pressure, calm the chest."

Sympatholytics

• Alpha-2 Central Agonists

Side Effects

Side Effects ⬇ Hypotension

Blood pressure gets too low

😴 Drowsiness

Feeling sleepy

👄 Dry Mouth

Very common side effect

🎵 Memory Trick:
"Low, Slow, Dry"

• Low BP

• Slow/sleepy

• Dry mouth

---

Patient Teaching

✅ Change positions slowly

✅ Avoid driving until you know how sleepy it makes you

✅ Sip water or chew sugar-free gum for dry mouth
"Stand Slow, Expect Low, Mouth Gets Dry Though."

Sympatholytics

• Alpha-2 Central Agonists

10-Second NCLEX Summary

Alpha-….

🧠 Work in the brain

MOA

• Stimulate Alpha-2 receptors

• Decrease CNS activity

• Vasodilation

• Lower BP

Uses

• HTN

• Angina

Side Effects

• Hypotension

• Drowsiness

• Dry mouth

Ultimate Memory Trick

🎵 "Alpha-2 Says SHH!"

🧠 Brain quiets down
⬇ BP goes down
😴 You get sleepy
👄 Mouth gets dry

SHH = Sleepy, Hypotension, Hydrate (dry mouth)

Alpha 2 central agonists

DRUG

clonidine

methyldopa

🩸 Vasodilators = "Vessels Relax"

MOA (What they do)

They relax the smooth muscles in blood vessels .

➡ Blood vessels get wider (dilate)
➡ Blood pressure goes down
➡ Blood flows more easily
"Vaso-DILATOR = DILATES vessels."

Uses

❤ CHF (Heart Failure)

🩸 HTN (High Blood Pressure)

❤ CAD (Coronary Artery Disease)
"Help the Heart, Lower the Pressure."

Side Effects

🔥 Flushing (red/warm face), 🤕 Headache

⬇ Hypotension, ❤ Rapid heartbeat (reflex tachycardia)

🤢 Nausea/Vomiting
"Hot Head, Low Pressure, Fast Heart."

• Hot = Flushing

• Head = Headache

• Low Pressure = Hypotension

• Fast Heart = Tachycardia

Patient Teaching

⚠ Change positions slowly, ⚠ Watch for dizziness

⚠ NEVER take with ED medications (such as Sildenafil )

❌ Vasodilator + ED med = BP can drop dangerously low
"No ED + VD = BP too LOW!"

Super Quick NCLEX Summary

Vasodilators

🩸 Vasodilators = Relax blood vessels

Uses

• CHF

• HTN

• CAD

Side Effects

• Flushing

• Headache

• Hypotension

• Rapid heartbeat

• N/V

Teaching

• Stand up slowly

• BP Monitor

• ❌ No ED meds

Ultimate Memory Trick

🎵 "Open the Pipes, Drop the Pressure." 🚰⬇🩸

Vasodilators

DRUGS

hydralazine

minoxidil (Rogaine®)

nitroprusside (Nipride®, Nitropress®)

🩸 RAAS (Renin-Angiotensin-Aldosterone System) Easy Way to Think About It

When the kidneys notice:

⬇ Low blood pressure

⬇ Low blood flow

They panic and say:

📢 "We need more blood pressure!"

Step-by-Step

1⃣ Kidneys release RENIN

🫘 Kidney senses low BP

➡ Releases renin

2⃣ Renin makes Angiotensin I

Think of Angiotensin I as an inactive helper .

3⃣ ACE converts Angiotension I → Angiotension II

ACE = Activates
"ACE makes Angiotensin II AWESOME (strong)."

4⃣ Angiotensin II

This is the BIG player ⭐

🩸 Squeezes blood vessels (vasoconstriction)

⬆ Raises BP

📢 Tells adrenal glands to release aldosterone

5⃣ Aldosterone

Aldosterone says:

🧂 "Keep the salt!"

💧 "Keep the water!"

➡ More sodium retained

➡ More water retained

➡ More blood volume

⬆ Blood pressure rises

Renin-Angiotensin-Aldosterone (RAA) System

Ultimate Memory Trick

🎵 "Low Pressure? RAAS Saves the Day!"

R = Renin

A = Angiotension II squeezes vessels

A = Aldosterone keeps salt & water

S = Salt retained

➡ BP goes UP! ⬆🩸

RAAS = Kidneys raise blood pressure by squeezing blood vessels and retaining salt and water. 🩸🧂💧⬆

• GOAL:  Increase in blood pressure

ACE Inhibitors

( Think: "Stop Angiotensin II = Lower BP" )

Common endings:

• Lisinopril, Enalapril, Ramipril
  "ACE Inhibitors END in -PRIL and LOWER the PRESSURE."

Easy MOA Normal RAAS

Renin → Angiotension I → ACE → Angiotension II

Angiotensin II:
🩸 Squeezes blood vessels

🧂 Holds salt & water

⬆ Raises BP

ACE Inhibitors

❌ Block ACE

➡ Less Angiotensin II

➡ Blood vessels relax (vasodilation)

➡ Less aldosterone

➡Less salt & water retained

➡ Less blood volume→➡ Lower BP
"No ACE = No Squeeze."

Use

🩸 HTN (High Blood Pressure)

🎵 "ACE takes the pressure off."

ACE Inhibitors

Important Side Effects

⬆ Potassium (Hyperkalemia) ⭐

Normally aldosterone helps get rid of potassium.

Less aldosterone = potassium stays in the blood.

➡ Hyperkalemia ➡ Can cause arrhythmias
"ACE KEEPS K+"

🩸 Hypotension

BP can get too low

😷 Dry Cough ⭐

Very common test question

😮 Angioedema ⭐

Swelling of lips, tongue, face
Medical emergency

Other = Headache, Dizziness, GI upset, Rash

ACE Inhibitors

Super Quick NCLEX Summary

💊 ACE Inhibitors (-PRIL)

MOA

• Block ACE

• ↓ Angiotensin II

• Vasodilation

• ↓ Aldosterone

• ↓ Salt & water retention

• ↓ Blood Pressure

Use

• HTN

Major Side Effects

• Hyperkalemia ⭐

• Dry cough ⭐

• Angioedema ⭐

• Hypotension

• Headache

• Dizziness

Ultimate Memory Trick

🎵 "PRIL = Pressure Reduced, Potassium Increased, Lips may swell."

PRIL

• Pressure ↓

• R relaxed vessels

• Increased K+

• L ips swell (angioedema) & cough

ACE inhibitors

DRUG

captopril

         enalapril (Vasotec®)

         lisinopril (Zestril®)

         benazepril (Lotensin®)

         quinapril

         ramipril 

💊 ARBs (Angiotensin II Receptor Blockers)

( Think: "Block Angiotensin II from doing its job" )

Common endings:

• Losartan, Valsartan, Irbesartan
  "ARBs end in -SARTAN and STOP Angiotensin."

Easy MOA Normally

Angiotensin II says:

🩸 "Squeeze the blood vessels!"

🧂 "Keep salt and water!"

⬆ BP goes up

ARBs

❌ Block Angiotensin II receptors

So Angiotensin II cannot work.

Result:

🩸 Blood vessels relax (vasodilation)

🧂 Less aldosterone released

💧 Less salt & water retained

⬇ Blood pressure drops
"No receiver = No squeeze."

Uses

🩸 HTN (High Blood Pressure)

🎵 "SARTAN lowers the pressure."

💊 ARBs (Angiotensin II Receptor Blockers)

( Think: "Block Angiotensin II from doing its job" )

side effects

Side Effects

⬇ Hypotension

BP may get too low

🤕 Headache 😵 Dizziness 😴 Drowsiness 🤢 Nausea 😷 Cough (less common than ACE inhibitors)

Potassium

⚠ Monitor potassium levels

Some ARBs can increase potassium, so labs are still checked.
"SARTAN? Still scan K+."

💊 ARBs (Angiotensin II Receptor Blockers)

( Think: "Block Angiotensin II from doing its job" )

ARBs (-sartan) vs ACE Inhibitors (-pril)

ACE Inhibitors (-pril)	ARBs (-sartan)
Block ACE	Block Angiotensin II receptors
😷 Common cough	😷 Less cough
😮 Angioedema possible	😮 Usually no angioedema
⬆ K+	Monitor K+

"Can't take a PRIL? Try a SARTAN."

💊 ARBs (Angiotensin II Receptor Blockers)

( Think: "Block Angiotensin II from doing its job" )

Super Quick NCLEX Summary

💊 ARBs = -SARTAN

MOA

• Block Angiotensin II receptors

• Vasodilation

• ↓ Aldosterone

• ↓ BP

Use

• HTN

Side Effects

• Hypotension

• Headache

• Dizziness

• Drowsiness

• Nausea

• Monitor potassium

Ultimate Memory Trick

🎵 "SARTAN Stops the Squeeze."

SARTAN

• Stops Angiotensin II

• A arteries relax

• You reduce BP

• T rack potassium

• A voids most angioedema

• No squeeze

👉 One-line summary:
ARBs (-sartan) block Angiotensin II receptors, relax blood vessels, lower blood pressure, and usually cause less cough and angioedema than ACE inhibitors. 🩸⬇💊

7. Angiotensin II receptor antagonists/blockers (ARBs)

DRUG

         olmesartan (Benicar®)

💊 Renin Inhibitors

( Think: "Stop RAAS at the VERY beginning" )
"No Renin = No RAAS = Lower BP"

Easy MOA

Remember the RAAS pathway:

⬇ BP, ➡ Renin, ➡ Angiotensin I, ➡ ACE, ➡ Angiotensin II, ➡ Aldosterone, ➡ BP goes up

Renin Inhibitors

❌ Block Renin (the FIRST step)

So the whole chain slows down.

Result:

🩸 Less Angiotensin II

🩸 Less vasoconstriction

🧂 Less salt & water retention

⬇ Lower blood pressure
"Stop Renin, Stop the Rise."

(BP won't rise as much.)

Uses

🩸 HTN (High Blood Pressure)

🎵 "Renin Inhibitors reduce the pressure."

💊 Renin Inhibitors

( Think: "Stop RAAS at the VERY beginning" )
"No Renin = No RAAS = Lower BP"

side effect

Side Effects

🤕 Headache. 😷 Cough, 😵 Dizziness, 🤢 Upset stomach

🚶 Lightheadedness

⬇ Hypotension
"Low and Slow"

• Low BP

• Slow down when standing

• Dizziness/lightheadedness

Patient Teaching

✅ Change positions slowly

✅ BP Monitor

✅ Report severe dizziness or fainting
"Rise Slowly or Feel Lowly."

💊 Renin Inhibitors

( Think: "Stop RAAS at the VERY beginning" )
"No Renin = No RAAS = Lower BP"

Super Quick NCLEX Summary

💊 Renin Inhibitors

MOA

• Block renin

• Stop RAAS at the beginning

• Less Angiotensin II

• Less aldosterone

• Lower BP

Use

• HTN

Side Effects

• Headache

• Cough

• Dizziness

• Upset stomach

• Lightheadedness

• Hypotension

Ultimate Memory Trick

🎵 "RENIN = Beginning of the BP chain. Block it, and the whole chain slows down."

One-Line Summary

Renin inhibitors block the first step of RAAS, causing less vessel squeezing, less salt and water retention, and lower blood pressure. 🩸⬇💊

Renin Inhibitors

DRUG

         aliskiren  (Tekturna®)

💊 Calcium Channel Blockers (CCBs)

( Think: "Block Calcium = Relax and Slow Down" )

Easy MOA Normally

Calcium helps muscles contract.

More calcium = 💪 tighter blood vessels and stronger heart contractions.

Calcium Channel Blockers

❌ Block calcium from entering cells

Result:

🩸 Blood vessels relax (vasodilation)

⬇ Blood pressure decreases

❤ Heart works less hard

❤ Slows electrical conduction through the heart

❤ More blood flows to the heart (coronary arteries)
"Block Calcium = Relax and Slow."

Uses

🩸 HTN (High Blood Pressure) , ❤ Angina (Chest Pain)

❤ Tachyarrhythmias (Fast Heart Rhythms)
"Pressure, Pain, Pace"

• Pressure = HTN, Pain = Angina, Pace = Fast heart rhythms

Side Effects

🤕 Headache , 🔥 Facial flushing, 😵 Dizziness

⬇ Hypotension , ❤ Reflex tachycardia, 💩 Constipation

👄 Xerostomia (Dry Mouth)
"Hot Head, Dry Mouth, Can't Poop."

• Hot = Flushing

• Head = Headache

• Dry mouth

• Constipation

Patient Teaching

✅ Change positions slowly

✅ BP Monitor

✅ Watch for dizziness, ✅ Increase fluids/fiber if constipated
"Relaxed vessels can make you dizzy."

💊 Calcium Channel Blockers (CCBs)

( Think: "Block Calcium = Relax and Slow Down" )

Super Quick NCLEX Summary

💊 Calcium Channel Blockers

MOA

• Block calcium entry into cells

• Vasodilation

• ↓ BP

• ↑ Coronary blood flow

• Slow heart conduction

Uses

• HTN

• Angina

• Tachyarrhythmias

Side Effects

• Headache

• Flushing

• Dizziness

• Hypotension

• Reflex tachycardia

• Constipation

• Dry mouth

Ultimate Memory Trick

🎵 "No Calcium, No Squeeze, Heart Takes It Easy."

👉 One-line summary:
CCBs block calcium, relax blood vessels, lower BP, improve blood flow to the heart, and slow the heart's electrical activity. 🩸❤⬇📚

CALCIUM CHANNEL BLOCKERS

Drug

Dihydropyridines

nifedipine (Procardia®)

amlodipine (Norvasc®)         

  nisoldipine

Nondihydropyridines

verapamil

diltiazem (Cardizem®)

🩸 HTN (Hypertension) Treatment Made SUPER EASY

Think of this chart as answering one question:

🎵 "How high is the BP, and what do we do next?"

Step 1: Know the BP Levels 🟢 Normal BP

Less than 120/80

Example:

• 118/76

• 110/70

✅ Keep healthy habits

📅 Recheck in 1 year

🎵 Memory Trick:
"Under 120/80? You're doing great-y!"

🟡 Elevated BP

120-129 AND bottom number less than 80

Example:

• 125/78

• 128/76

❌ No medication yet

✅ Lifestyle changes

📅 Recheck in 3-6 months
"Elevated? Educated!"
(Use lifestyle changes)

HTN Treatment and Follow-up

🟠 Stage 1 HTN vs 🔴 Stage 2 HTN

🟠 Stage 1 HTN

130-139 OR 80-89

Example:

• 134/84

• 138/88

Now ask:

Is cardiovascular risk high? (≥10%) NO

✅ Lifestyle changes only

📅 Recheck 3-6 months

YES

✅ Lifestyle changes

PLUS

💊 BP medication

📅 Recheck 1 month

🎵 Memory Trick:
"Stage 1? Check risk before the script."

(script = prescription)

🔴 Stage 2 HTN

140/90 or higher

Example:

• 145/92

• 160/100

✅ Lifestyle changes

PLUS

💊 BP medication

📅 Recheck in 1 month
"Stage 2? Meds for you."

HTN Treatment and Follow-up

Lifestyle Changes (Know These!)

Lifestyle Changes (Know These!)

These show up ALL the time on exams.

🥗 DASH Diet

heart-healthy eating

⚖ Lose weight

If overweight

🧂 Eat less sodium

Less salt

🍌 Increase potassium

(Unless contraindicated)

🚶 Exercise more 🚭 Stop smoking 🍺 Limit alcohol

"Less Salt, Less Scale, More Steps."

• Less salt

• Lose weight

• Exercise

Follow-Up Visits BP Goal Met? ✅

Keep treatment going

📅 Recheck in 3-6 months

BP Goal NOT Met? ❌

Check:

💊 Taking meds correctly?

💊 Missing doses?

💊 Need stronger treatment?

Then adjust medications.
"Not at goal? Check before adding more."

Reassessment Checklist (What Nurses Look For)

✅ Measure BP

✅ Check medication adherence

✅ Make sure patient is following treatment

✅ Check for orthostatic hypotension

(Feeling dizzy when standing)

✅ Review alcohol, smoking, and other substances

🎵 Memory Trick:
"BP, Pills, Position, Problems."

HTN Treatment and Follow-up

side by side

BP	What To Do
<120/80	Healthy habits, recheck 1 year
120-129/<80	Lifestyle changes, recheck 3-6 months
130-139/80-89	Lifestyle ± meds depending on risk
≥140/90	Lifestyle + meds

🟢 Normal = Nice

🟡 Elevated = Educate

🟠 Stage 1 = Check Risk

🔴 Stage 2 = Start Meds

"Nice → Educate → Check Risk → Start Meds"