chp 43. Blood Pressure

Angiotensin converting enzyme inhibitors

BLOCKS CONVERSION OF angiotensin I TO angiotensin II

→ Relaxes & widens blood vessels

What does Angiotensin Converting Enzyme Inhibitors do to the body?

LOWERS BP and IMPROVES blood flow

→liver and kidney fx

Captopril (Capoten), Enalapril (Vasotec), Lisinopril (Prinivil, Zestril)

ACE inhibitors → RAAS

→used for HYPERTENSION

A: angioadema

C: cough

E: elevated K

NOT FOR PREGNANCY

hold for SBP<100

check electrolytes → K

Angiotensin Receptor Blockers ARBs

Relaxes/widens blood vessels

LOWERS BP

Losartan, Olmesartan, Valsartan, Candesartan

ARBs→RAAS, vascular smooth muscle

→HYPERTENSION

renal dysf(x), liver (metabolized in)

NOT FOR PREGNANCY

hold for SBP<100

Calcium Channel Blockers

REDUCES amount of Ca ENTERING cells of heart/blood vessels

→relaxes blood vessel, decreases HR

Dihydropyridines: amlodipine (Norvasc), nifedipine (Procardia), Nicardipine

Vascular smooth muscle

→HYPERTENSION

dizziness, edema, flushing, reflex tachycardia

hold SBP<100

Non-Dihydropyridines: Diltiazem (Cardizem), Verepamil (Calan)

Heart, Vascular Smooth Muscle

→HYPERTENSION

constipation, dizziness, edema, flushing, bradycardia, electrical arrhythmias

hold SBP<100 HR<60

Vasodilators

WIDENS blood vessels for more BLOOD FLOW

→reduces BP

→HYPERTENSIVE

CRISIS/HYPERTENSIVE EMERGENCY

short use

Sodium Nitroprusside

Continuous IV infusion

→HYPERTENSIVE CRISIS

hypotension, Cyanide poisoning, Thiocyanate toxicity

Hydralazine

IV push, small doses (oral not for emergencies)

→HYPERTENSIVE CRISIS

reflex tachycardia

headache, dizziness, weakness, fatigue

Vasopressors

Dobutamine

Dopamine

Noepinephrine

Vasopressin

CRITICAL CARE ONLY → continuous monitoring

Antihypotensive Agents

Midodrine

hypotension → VASOCONSTRICTION

targets vascular smooth muscle

Alpha adrenergic agonist

What do antihypotensive agents do to the body?

increases SNS fx

increases BP

Education/assess for antihypotensive agents

not good for patients affected by vasoconstriction

→BAD FOR HTN AND CAD

check BP and HR