CO =
SV x HR
BP =
CO x SVR
normal bp
less than 120
---------------
less than 80
elevated bp
120-129
---------
less than 80
stage 1 bp
130-139
---------
80-89
stage 2 bp
140 or higher
---------------
90 or higher
hypertensive crisis
higher than 180
—————————
higher than 120
what affects bp?
smoking
obesity
lack of exercise
salt
alcohol
older age
genetics
CKD
adrenal/thyroid disorders
sleep apnea
bp classification meds
angiotension-converting enzyme inhibitors (ACE)
angiotensin II receptor blockers (ARBs)
direct renin inhibitors
calcium channel blockers
centrally acting alpha2 agonists
beta adrenergic blockers
hydralazine (vasodilator)
meds for hypertensive crisis
ACE inhibitors patho
stops angiotensin I from converting to angiotensin 2
vasodilates
excretion of sodium and water
reduces damage in the blood vessels and heart from angiotensin 2 and aldosterone
ACE inhibitors uses
HTN
HF
MI
diabetic and nondiabetic nephropathy
pt at high risk of cardiovascular event
ACE inhibitors meds
-prils
enalapril (vasotec)
lisinopril (prinival)
captopril
administration: PO
ACE inhibitors complications
orthostatic hypotension
stop diuretic temp. 2-3 days before starting ACE inhibitors
assess orthostatic hypotension after meds
dry, persistent cough
if develop, switch ACE to ARBs
hyperkalemia
priority for heart dysrhythmias
risk for renal pt.
monitor urine output
less potassium in diet
monitor for muscle wkns
angioedema
ACE contrindications
cautious with pts with renal impairment
DO NOT TAKE BOTH ACE AND ARBs TOGETHER
potassium supplements and potassium sparing diuretics inc hyperkalemia risk
NSAIDs dec effect of ACE
angiotensin II receptor blockers (ARBs) patho
blocks the action of angiotensin II in the body
vasodilates arterioles and veins
excretes sodium and water (by decreasing release of aldosterone)
an alternative to ACE inhibitors if these are not tolerated by the patient
DO NOT TAKE BOTH ACE AND ARBs TOGETHER
ARBs uses
HTN
HF
stroke prevention
MI prevention
reduces mortality following MI
ARBs meds
-sartans
losartan (cozaar)
valsartan (diovan)
irbesartan (avapro)
ARBs complications
no dry cough or hyperkalemia
angioedema
treat with subQ epinephrine
discontinue med
fetal injury
use contraceptives while on med
hypotension
dizziness, lightheadedness
what do ARBs do to bp?
decreases bp by decreasing vasocontriction, vascular resistance, afterload
direct renin inhibitors patho
stops initiation of RAAS system
binds with renin to inhibit production of angiotensin I
direct renin inhibitors med
aliskiren (tekturna)
direct renin inhibitors complications
hyperkalemia
hypotension
angioedema
rash
cough
diarrhea
direct renin inhibitors contraindications
pts with hyperkalemia
inc hyperkalemia w/ ACE, potassium sparing supplements, potassium sparing
cautious with older adults
cautious with pts w/ asthma, other resp. disorders, hx of angioedema, diabetes mellitus, kidney/hepatic disease, hypotension
high fat foods dec absorption
calcium channel blockers (CCBs) patho
blocks calcium, dec. contractility and blood vessels dilate
cause contraction of heart and vessels
blocks calcium channels in blood vessels
vasodilation of vascular smooth muscle in the peripheries & arteries/arterioles of the heart
DON’T GIVE TO HF PTS
CCBs meds
IV or PO
verapamil (verelan)
diltiazem (cardizem)
amlodipine (norvasc)
CCBs uses
angia
hypertension
a-fib
SVT (supraventricular tachycardia)
diltiazem is used for
a-fib
CCBs complications
orthostatic hypotension
peripheral edema
diuretics will not help
suppression of cardiac function
if their heart is weak, what type of med make it worse?
CCBs
for HF pts with inc bp, do not give
CCBs
CCBs interactions
verapamil can increase digoxin levels
concurrent use of beta blockers
NO GRAPEFRUIT!!!
CCBs nursing interventions
verapamil: administer inj. slowly over 2-3 mins
monitor BP & HR
pulse <60 bpm
systolic BP <90 bpm
centrally acting alpha2 agonists patho
dec sympathetic outflow, thus dec stimulation of adrenergic receptors of both the heart and peripheries
dec HR and CO
vasodilates
centrally acting alpha2 agonists uses
migraine headache
anxiety management
management of ADHD
centrally acting alpha2 agonists complications
dry mouth
drowsiness
centrally acting alpha2 agonists contraindications
avoid using during lactation
pts w/ bleeding disorder or are on anticoags
cautious in pts w/ stroke, asthma, COPD, MI, diabetes, depressive disorder, CKD
centrally acting alpha2 agonists meds
clonidine (catapres)
patch or PO
methyldopa (aldomet)
centrally acting alpha2 agonists nursing interventions
2x/day
larger dose at bedtime to dec daytime sleepiness
beta adrenergic blockers patho
aka beta blockers
sympatholytic
dec. sympathetic stimulation
dec HR
dec myocardial contractility
dec cardiac output
dec rate of conduction thru AV node
cardioselective
affects beta1
only the heart
does not affect lungs
choose beta1 to block
non-cardioselective
blocks beta1 & beta2
affects heart and lungs
don’t give to COPD, asthma pt b/c bronchospasms
BB uses
hypertension
angina
tachy-dysrhythmias
HF
MI
treatment of hyperthyroidism, migraines
cardio-protective
BB complications
bradycardia
dec CO
orthostatic hypotension
can cause an AV block
what to check when taking BB?
apical pulse for 1 min
do not give if less than 60 bpm
BB meds
-lol
metoprolol (lopressor)
cardioselective
atenolol (tenormin)
cardioselective
propanolol (inderal)
non-cardioselective
contraindicated for patients w/ asthma
carvedilol (coreg)
labetalol
BB contraindications
diabetes
produces glycogenolysis: breakdown glycogen
lung diseases
pts with hypotension, renal, angina, older adults
BB cannot increase
blood sugar
→
can mask tachycardia and signs of hypoglycemia
BB nursing interventions
PO
1 or 2x/day
take with food to inc absorption
How and when is hydralazine given?
given for hypertensive crisis thru IV
hydralazine
vasodilator → dec PVR
direct acting smooth muscle relaxant
dec peripheral resistance
PO or IV
can elicit a reflex sympathetic stimulation of the heart, so it is not a primary drug for hypertension
has a rebound effect
not for 1st line of HTN
hypertensive crisis meds
nitroprusside (centrally acting vasodilator)
nitroglycerin (vasodilator)
nicardipine (CC blocker)
esmolol (BB)
nitroprusside effect on bp
dec bp to prevent sudden spike in bp
commonly IV
action of emergency drugs for a hypertensive crisis
direct and immediate vasodilation
rapid reduction in BP
monitor for hypotension
lightheadedness
dizzy
n&v
dec LOC
chest pain ***
monitor ECG and BP cont.
keep pt supine
must have its own dedicated IV line if it is an IV drip
nitroprusside: protect IV container from light
sensitive to light b/c deactivates drug
hypertensive crisis med complications
excessive hypotension
rapid administration can dec BP rapidly
monitor BP and ECG
supine during administration
bradycardia, tachycardia, ECG changes
hypertensive crisis med contraindications
pts w/ HF, dec PVR, AV shunt
cautious w/ pt w/ liver & kidney disease, hypothyroidism, hypovolemia, fluid and electrolyte imbalances, older adults
do not administer nitroprusside in the same infusion as any other medications
hypertensive crisis med nursing interactions
dilute for IV infusion
protect IV container from light
discard after 24 hrs
monitor vitals and ECG cont.
meds affecting urinary output
loop diuretics
thiazide diuretics
potassium sparing diuretics
osmotic diuretics
meds affecting urinary output uses
manage blood pressure
excrete fluid causing edema for HF, kidney and liver disease
prevention of kidney failure
dec SV, CO, preload
loop diuretics
PO, IV, IM
used for hypertensive crisis too
work in the ascending limb of loop of henle
blocks reabsorption of sodium, chloride and water
K, Ca wasting
causes extensive diuresis
used in emergent situations and daily maintenance
furosemide is not used for daily maintenance if pt only has HTN
daily use for renal & HF pts
loop diuretic meds
PO, IV, IM
furosemide (lasix)
bumetanide (bumex)
torsemide (demedex)
loop diuretic complications
dehydration
hypotension
ototoxicity
hypokalemia
monitor K
T wave depression
muscle wkns
hypomagnesemia
hypoglycemia
hyperuricemia
hypocalcemia
dec HDL, inc LDL
furosemide
monitor for ototoxicity
esp. if giving thru rapid IV push
give over 2 mins
if given fast will experience tinnitus and damage ears
loop diuretic contraindications
avoid during pregnancy
pt w/ anuria
cautious in pts w/ diabetes, dehyration, CV disease, gout electrolyte depletion
cautious w/ pts taking digoxin, lithium, ototoxic meds, NSAIDs, antihypertensives
loop diuretic interactions
digoxin toxicity can occur in presence of hypokalemia
concurrent use of antihypertensives
NSAIDs reduce diuretic effect
loop diuretic nursing considerations
BP
K (3.5-5.1)
hypokalemia
monitor I/O’s
30mL/hr OR 0.5mL/kg/day
furosemide: expect urine output in 15 mins
give in the morning
avoid late in the day to prevent nocturia
advise pt about orthostatic hypotension
no sudden changes in movement
sit, dangle before getting up
foods high in potassium
avocado
banana
potatoes
spinach
beans
citrus juices
fish
thiazide diuretics patho
K wasting
con be given with ARBs or others
works in the early distal convoluted tubule
blocks reabsorption of sodium, chloride and water at this site
promotes diuresis
less compared to loop diuretics
less reabsorption on kidneys
may be used with other antihypertensive agents for BP control
thiazide diuretics meds
hydrochlorathiazide (HCTZ)
metolazone
thiazide diuretic uses
FIRST LINE FOR ANTIHYPERTENSIVE MANAGEMENT
edema
may be used with other antihypertensive agents for BP control
reduce urine production in diabetics
Ca wasting
thiazide diuretic complications
dehydration
hyponatermia
hypokalemia
hyperglycemia
hyperuricemia
hypomagnesemia
inc lipids
thiazide diuretic contraindications
void during preg
if taken during lactation, do not breastfeed
renal impairment
cautious in pts w/ diabetes, dehyration, CV disease, gout electrolyte depletion
cautious w/ pts taking digoxin, lithium, ototoxic meds, NSAIDs, antihypertensives
thiazide diuretic interactions
digoxin toxicity can occur in presence of hypokalemia
concurrent use of antihypertensives
NSAIDs reduce diuretic effect
thiazide diuretic nursing considerations
BP
K (3.5-5.1)
hypokalemia
monitor I/O’s
30mL/hr OR 0.5mL/kg/day
give in the morning
avoid late in the day to prevent nocturia
advise pt about orthostatic hypotension
no sudden changes in movement
sit, dangle before getting up
don’t give to pt with high calcium
monitor Ca levels (hyperparathyroidism, cancer)
thiazide diuretic effectiveness
dec BP
dec edema
inc urine output
potassium sparing diuretics patho
blocks aldosterone action resulting in K retention and excretion of Na and H2O
often combined w/ other diuretics
useful in HF
therapeutic effect can take up to 12-48 hrs
potassium sparing diuretics meds
PO
spironolactone (aldactone)
triamterene
HCTZ/triam
combo drug
potassium sparing diuretics uses
hypertension
edema
HF
potassium sparing diuretics complications
caution with ACE, ARBs, and renin inhibitors
all causes changes in K+ levels
hyperkalemia
elevated T waves
wkns
fatigue
dyspnea
dysrhythmias
endocrine effects
deep voice
hirsutism
drowsiness, metabolic acidosis
potassium sparing diuretics contraindications
don’t give to pts w/ hyperkalemia, potassium supplements, or other potassium sparing diuretic
don’t give pts w/ severe kidney failure and anuria
cautious w/ pts that have kidney or liver disease, electrolyte imbalances, metabolic acidosis
potassium sparing diuretics interactions
concurrent use of ACE inhibitor, ARBs, direct renin inhibitors inc risk for hyperkalemia
concurrent use of potassium supplements, salt substitutes, another potassium sparing diuretic inc risk for hyperkalemia
potassium sparing diuretics nursing administration
daily weight
monitor BP & I/O’s
ECG periodically
monitor K levels
avoid salt substitutes that contain potassium
dec potassium foods
triamterene turns urine bluish color
osmotic diuretic
reduces ICP and intraocular pressure (IOP)
draws fluid back into the vascular and extravascular space
initially will inc blood volume
not used for HTN crisis
affects heart diseases and kidney
IV infusion only
filter needle used
monitor dehydration and edema
monitor serum osmolarity q6h = >300 then stop mannitol b/c dehydrated
monitor for inc ICP
seen mostly in ICU and neuro ICU
osmotic diuretic med
mannitol (osmitrol)
mannitol is a
potent diuretic
mannitol uses
prevents kidney failure in hypovolemic shock and severe hypotension
decreases ICP caused by cerebral edema
draws fluid from brain into the blood stream
dec IOP by drawing ocular fluid into the bloodstream
for hyponatremia and fluid volume excess
promotes sodium retention and water excretion
administered for the oliguria phase of acute kidney injury
ensuring pt has adeq. renal perfusion
mannitol complications
HF
pulmonary edema
rebound inc intracranial pressure
fluid and electrolyte imbalances, metabolic acidosis
mannitol interactions
lithium excretion thru kidneys inc
inc risk for hypokalemia w/ cardiac glycosides
mannitol nursing administration
cont. IV infusion
use a filter needle
daily weight
I/O’s
blood electrolytes
monitor K levels
mannitol effectiveness
normotensive BP
absence of cardiac dysrhythmias
absence of chest pain
control of heart failure manifestations
normal kidney function AEB normal lab values
dec in IOC or IOP
dec in pulmonary or peripheral edema
weight loss
inc in urine output