Drug Therapy for Hypertension – NUR 203 Review

These flashcards review key concepts from the NUR 203 lecture on blood pressure regulation, antihypertensive drug classes, side effects, patient education, lifestyle modifications, and current guideline recommendations.

What two factors determine systolic blood pressure?

Cardiac output, which equals heart rate (HR) × stroke volume (SV).

What primarily determines diastolic blood pressure?

Peripheral vascular resistance (PVR).

According to the American Heart Association, what blood pressure range is considered NORMAL?

Systolic < 120 mm Hg and diastolic < 80 mm Hg.

What systolic and/or diastolic pressures define a HYPERTENSIVE CRISIS?

Systolic > 180 mm Hg and/or diastolic > 120 mm Hg.

Define a hypertension emergency in terms of diastolic pressure.

Diastolic pressure greater than 120 mm Hg with evidence of organ damage.

Name four clinical conditions that can precipitate a hypertensive emergency.

Renal disease, eclampsia, cerebral hemorrhage, dissecting aortic aneurysm, or pheochromocytoma.

List at least four lifestyle factors that contribute to primary hypertension.

Obesity, excessive alcohol intake, smoking, stress, sedentary lifestyle, and high-salt diet.

In response to hypotension, what happens to heart rate and blood vessel caliber?

Heart rate increases and vessels constrict to raise cardiac output and BP.

Which hormone system is activated by decreased renal perfusion pressure?

The renin–angiotensin–aldosterone system (RAAS).

What enzyme converts angiotensin I to angiotensin II?

Angiotensin-converting enzyme (ACE) from the lungs.

List three major physiologic actions of angiotensin II.

Potent vasoconstriction, stimulation of aldosterone release, and direct increase in blood pressure.

What is the overall effect of aldosterone on the kidney?

Increased reabsorption of sodium and water, leading to higher blood volume.

Name four broad drug classes used to treat hypertension.

ACE inhibitors, angiotensin II receptor blockers (ARBs), calcium channel blockers (CCBs), and diuretics (among others).

How can you easily recognize ACE inhibitor drug names?

They typically end in “-pril” (e.g., lisinopril).

State the primary mechanism of ACE inhibitors.

They prevent conversion of angiotensin I to angiotensin II, resulting in vasodilation and decreased aldosterone.

List three common adverse effects of ACE inhibitors.

Hypotension, persistent dry cough, and hyperkalemia (angioedema is rare but serious).

Why are ACE inhibitors contraindicated in pregnancy?

They are teratogenic and can harm fetal renal development.

Give two key patient-teaching points for someone starting an ACE inhibitor.

Monitor blood pressure daily and report persistent cough or signs of hyperkalemia; avoid taking the drug with meals (for captopril).

How can you identify angiotensin II receptor blockers (ARBs) by name?

They end in “-sartan” (e.g., losartan).

What is the mechanism of ARBs?

They block angiotensin II receptors, preventing vasoconstriction and reducing systemic vascular resistance.

Which two patient groups often receive ARBs for renal protection?

Patients with hypertension and diabetic nephropathy.

State two common side effects of ARBs.

Dizziness and muscle cramps/weakness (others include diarrhea and angioedema).

What dietary restriction should be reinforced with both ACE inhibitors and ARBs?

Avoid potassium-rich salt substitutes due to risk of hyperkalemia.

Give two teaching points for patients on ARBs.

Monitor BP daily; stop the medication and contact the provider if pregnancy occurs.

Name four commonly used calcium channel blockers.

Amlodipine, diltiazem, verapamil, and nicardipine.

What is the primary action of calcium channel blockers on blood vessels?

They inhibit calcium influx in smooth muscle, causing relaxation and vasodilation.

Which beverage should be avoided while on many calcium channel blockers and why?

Grapefruit juice; it inhibits CYP3A4 metabolism and can raise drug levels.

What is the only currently available direct renin inhibitor and its brand name?

Aliskiren (Tekturna).

Why should aliskiren not be taken with a high-fat meal?

High fat decreases its absorption and efficacy.

Name three main categories of diuretics used for hypertension.

Thiazide diuretics, loop diuretics, and potassium-sparing diuretics.

Which diuretic class is considered first-line treatment for uncomplicated hypertension?

Thiazide diuretics (e.g., hydrochlorothiazide).

Which patient populations often respond best to thiazide diuretics?

Older adults and African-American patients.

Name a potent loop diuretic frequently used in heart failure.

Furosemide (Lasix).

Give two examples of vasodilator drugs used in hypertensive emergencies.

Hydralazine and sodium nitroprusside.

What serious autoimmune-like adverse effect can hydralazine cause?

Drug-induced systemic lupus erythematosus (SLE).

Which alpha1-adrenergic blocker is commonly prescribed for both hypertension and BPH?

Tamsulosin (Flomax) or doxazosin (Cardura).

State a hallmark side effect of alpha1-blockers that requires patient safety teaching.

Orthostatic hypotension with dizziness or syncope.

What central alpha2-agonist is used for hypertension and ADHD?

Clonidine (Catapres).

Why must clonidine not be stopped abruptly?

Abrupt withdrawal can cause rebound hypertension.

How can you recognize beta-adrenergic blocker drug names?

They end in “-olol” (e.g., metoprolol).

What are two common cardiovascular effects of beta-blockers?

Decreased heart rate and decreased myocardial contractility, lowering cardiac output.

Why should non-cardioselective beta-blockers be used cautiously in asthmatic patients?

They can cause bronchoconstriction by blocking beta2 receptors in the lungs.

What combined alpha-beta blocker is often used in heart failure management?

Carvedilol (Coreg) or labetalol for hypertension.

List three common reasons for poor antihypertensive medication compliance.

Lack of symptoms, side effects that make patients feel worse, and medication cost or complexity.

What eating plan is recommended to lower blood pressure through diet?

The DASH diet (Dietary Approaches to Stop Hypertension).

Name three core components of the DASH diet.

High intake of fruits and vegetables; limited sodium; emphasis on whole grains, lean proteins, and low-fat dairy.

According to JNC 8, what is the BP goal for adults aged 60 years or older without diabetes or CKD?

< 150/90 mm Hg.

State the first-line drug options recommended by JNC 8 for non-black adults without CKD.

ACE inhibitor, ARB, thiazide diuretic, or calcium channel blocker.

What is the nurse’s primary role in managing a patient with hypertension?

Educate on lifestyle changes, monitor BP, promote medication adherence, and assess for complications.

List two potential target-organ damages caused by uncontrolled hypertension.

Stroke (cerebrovascular accident) and chronic kidney disease (others include heart failure and retinopathy).