Blood Pressure Medications

What role does the sympathetic nervous system (SNS) play in hypertension?

The SNS regulates cardiovascular function. Overactivity causes vasoconstriction and increased heart rate, increasing systemic vascular resistance and blood pressure.

What complications can result from uncontrolled hypertension?

Vision problems or blindness, stroke, myocardial infarction, heart failure, ventricular hypertrophy, coronary artery disease, aneurysm, and kidney disease/failure.

How does sodium and water retention contribute to hypertension?

Retention of sodium and water increases blood volume, which increases pressure on blood vessel walls and raises blood pressure.

Why is sodium restriction important in hypertension?

Lower sodium intake reduces fluid retention and blood volume, helping lower blood pressure.

What is the normal temperature range?

97°F–99°F

What is the normal heart rate range?

60–100 beats/min

What is the normal respiratory rate range?

12–18 breaths/min

What is the normal oxygen saturation range?

95–100%

What is considered a normal blood pressure?

Less than 120/80 mmHg

What is considered elevated blood pressure?

Systolic 120–129 mmHg and diastolic less than 80 mmHg.

What is Stage 1 hypertension?

Systolic 130–139 mmHg or diastolic 80–89 mmHg.

What is Stage 2 hypertension?

Systolic ≥140 mmHg or diastolic ≥90 mmHg.

What is a hypertensive crisis?

Systolic ≥180 mmHg or diastolic ≥120 mmHg.

What are the first-line medications for hypertension?

ACE inhibitors

ARBs

Calcium Channel Blockers (CCBs)

Thiazide diuretics

What does ECG stand for?

Electrocardiogram; a test that records the electrical activity of the heart.

What is gastric lavage?

A procedure that washes out stomach contents to remove ingested poisons, drugs, or toxins ("stomach wash").

What is a cathartic?

A strong laxative used to rapidly evacuate the bowel.

Can ACE inhibitors and ARBs be used together?

No. Combining ACE inhibitors and ARBs increases the risk of hyperkalemia.

What is the normal potassium level?

3.5–5.0 mEq/L.

What is hypokalemia?

Potassium level less than 3.5 mEq/L.

What is hyperkalemia?

Potassium level greater than 5.0 mEq/L.

What are the four RAAS inhibitor classes to treat high blood pressure ?

ACE inhibitors

ARBs

Aldosterone antagonists

Direct renin inhibitors

What is the drug suffix for ACE inhibitors?

-pril

What is the drug suffix for ARBs?

-sartan

What is the drug suffix for Aldosterone antagonists?

-one

Name five ACE inhibitors.

Captopril, Enalapril, Lisinopril, Ramipril, Benazepril.

End with “prils”

How do ACE inhibitors lower blood pressure?

Reduce the production of angiotensin II by blocking the conversion of angiotensin I to II

How do ACE inhibitors affect bradykinin?

ACE inhibitors increase bradykinin levels, causing vasodilation.

Why are ACE inhibitors considered kidney protective?

They reduce glomerular pressure and help protect kidney function.

Why are ACE inhibitors considered cardioprotective?

They prevent structural changes to the heart and blood vessels.

What are the three main effects of ACE inhibitors?

Vasodilation

sodium and water excretion

prevention of cardiac remodeling

What are the complications 6 for ACE

First dose orthostatic hypotension

Cough

Hyperkalemia

Rash and altered taste

Angioedema

Neutropenia

What is first-dose hypotension complication for ACE

A sudden drop in blood pressure after the first dose of a medication due to vasodilation.

How can first-dose hypotension be prevented with ACE inhibitors?

Stop diuretics 2–3 days before starting ACE inhibitors

start with a low dose,

Monitor blood pressure

What should a nurse do if hypotension occurs after an ACE inhibitor dose?

Place the client in a supine position.

What patient teaching is important regarding ACE inhibitors and position changes?

Change positions slowly to prevent orthostatic hypotension.

Why do ACE inhibitors cause a dry cough?

Increased bradykinin accumulation causes a persistent dry cough.

What should a patient do if they develop a dry cough while taking an ACE inhibitor?

Notify the provider and discontinue the medication if instructed.

What electrolyte imbalance is associated with ACE inhibitors?

Hyperkalemia.

What are signs of hyperkalemia?

Numbness, tingling, muscle weakness, palpitations, and paresthesia.

What should patients avoid while taking ACE inhibitors to reduce hyperkalemia risk?

Potassium supplements and salt substitutes containing potassium.

What skin-related adverse effect can occur with ACE inhibitors?

Rash and altered taste.

What is angioedema a complication for ACE

Swelling of the tongue and pharynx that can obstruct the airway.

How is severe angioedema treated?

Subcutaneous epinephrine and immediate discontinuation of the medication.

Which ACE inhibitor is associated with neutropenia a complication for ACE

Captopril.

What are nursing actions if you get Neutropenia from ACE

Monitor WBC counts every 2 weeks for 3 months

Reversible

Notify provider if fever and sore throat

What symptoms should patients report immediately while taking captopril?

Fever or sore throat because they may indicate neutropenia.

Are ACE inhibitors safe during pregnancy?

No. ACE inhibitors are contraindicated in pregnancy and lactation.

Which patients should use ACE inhibitors cautiously?

Older adults

patients with kidney disease

hypotension

heart disease

stroke

heart failure

hyperkalemia

hyponatremia

In which population are ACE inhibitors less effective and associated with increased angioedema risk?

African American/Black patients.

How do diuretics interact with ACE inhibitors? Ace interactions

They increase the risk of first-dose hypotension.

How do NSAIDs interact with ACE inhibitors? Ace interactions

NSAIDs decrease the antihypertensive effect of ACE inhibitors.

How do potassium-sparing diuretics interact with ACE inhibitors? Ace interactions

They increase the risk of hyperkalemia.

How do ACE inhibitors affect lithium? Ace interaction

ACE inhibitors increase lithium levels and can cause toxicity.

What is first-dose hypotension?

A sudden drop in blood pressure after the first dose or first few doses of a medication due to vasodilation.

What is orthostatic hypotension?

A drop in blood pressure when moving from lying or sitting to standing.

What causes first-dose hypotension?

An initial response to a medication, often due to vasodilation.

What causes orthostatic hypotension?

Failure of the body to compensate for position changes.

When does first-dose hypotension occur?

Usually after the first dose or first few doses of a medication.

When can orthostatic hypotension occur?

Any time when standing up.

What is the mnemonic for potassium-sparing diuretics?

SEAT

What does SEAT stand for?

Spironolactone, Eplerenone, Amiloride, Triamterene.

What is lithium used for?

Lithium is a mood stabilizer used to treat bipolar disorder.

What is the therapeutic lithium level?

0.6–1.2 mEq/L.

What are nursing admnistration tips for ACE

• Blood pressure is monitored after the first dose for

at least 2 hr to detect hypotension

• Notify provider if cough, rash, altered taste, or signs of infection occur

• Rise slowly

• Can be given in combination with hydrochlorothiazide

Name six ARBs/ Angiotensin II Receptor Blockers

Losartan, Valsartan, Irbesartan, Candesartan, Olmesartan, Telmisartan.

What is the drug suffix for ARBs?

-sartan

How do ARBs work?

They block angiotensin II type 1 receptors on blood vessels, preventing vasoconstriction and aldosterone release.

What are the effects of ARBs?

Vasodilation and excretion of sodium and water by decreasing release of aldosterone

Why are ARBs considered kidney protective?

They reduce protein loss in urine, especially in clients with diabetes mellitus.

Why are ARBs considered cardioprotective?

They reduce heart muscle thickening and lower the risk of stroke.

What are the three main therapeutic effects of ARBs?

Lower blood pressure,

relax blood vessels,

protect the kidneys.

What are the 4 complictions that happen with ARBS

Angioedema

Fetal Injury

Hypotension

Dizziness, lightheadness

What serious adverse effect can occur with ARBs?

Angioedema.

What is angioedema?

Swelling of the tongue and pharynx that can obstruct the airway.

How is severe angioedema treated?

Administer subcutaneous epinephrine and discontinue the medication.

What pregnancy risk is associated with ARBs?

Fetal injury.

What should women of childbearing age taking ARBs be taught?

Use contraception while taking the medication.

What are common cardiovascular side effects of ARBs?

Hypotension, dizziness, and lightheadedness.

What nursing interventions are important for hypotension caused by ARBs?

Monitor blood pressure and advise clients to rise slowly.

What should patients avoid if ARBs make them dizzy?

Activities requiring alertness until effects are known.

What are the 3 contradications for ARBs

1. CANNOT USE IN PREGNANCY/LACTATION

2. Hepatic impairment (liver issues)

3. Childbearing age – use contraception (fetal injury)

Are ARBs safe during pregnancy?

No. ARBs are contraindicated in pregnancy and lactation.

Why should ARBs be used cautiously in renal disease?

They can worsen hyperkalemia and affect kidney function.

How do other antihypertensives interact with ARBs?

They produce additive hypotensive effects.

How do ARBs interact with lithium?

ARBs increase lithium levels and can cause toxicity.

Can ARBs be combined with hydrochlorothiazide?

Yes.

Nursing administations for ARBS

• Can be given in combination with hydrochlorothiazide

• If taken for heart failure, monitor weight and edema

What should be monitored when ARBs are used for heart failure?

Weight and edema.

Which medication class is considered first choice: ACE inhibitors or ARBs?

ACE inhibitors are first choice; ARBs are second choice.

Do ACE inhibitors and ARBs lower heart rate?

No. They lower blood pressure but do not lower heart rate.

Can ACE inhibitors or ARBs be given if the heart rate is below 60 bpm?

Yes, because they do not decrease heart rate.

Name the two aldosterone antagonists discussed in this chapter.

Eplerenone and Spironolactone.

Potassium Sparring

How do aldosterone antagonists work?

They block aldosterone receptors in the kidneys, causing sodium and water excretion while retaining potassium.

What effect do aldosterone antagonists have on blood pressure?

They reduce blood volume and lower blood pressure.

What special benefit does eplerenone provide after a myocardial infarction?

It reduces cardiac remodeling and scarring, improving heart function.

What conditions are treated with aldosterone antagonists?

Hypertension, heart failure, premenstrual syndrome, polycystic ovary syndrome, acne in young females, and primary hyperaldosteronism.

What are the three major effects of eplerenone?

Lower blood pressure

relax blood vessels

reduce fluid buildup

What are the complications for Aldosterone Antagoinists

Hyperkalemia, hyponatremia

Flu like manifestations

gynecomastia

dizzines and fatigue

What electrolyte imbalances can aldosterone antagonists cause?

Hyperkalemia and hyponatremia.