Antihypertensive Medications - CH 42

Essential hypertension

95% of hypertension ; stress, alcohol, smoking, obesity

Secondary hypertension

5% renal and endocrine disorders

What race has a higher change of having hypertension?

African Americans

What race are beta blockers and ACE inhibitors less effective for unless given with a diuretic?

African Americans

What race is twice as sensitive to beta blockers and other antihypertensives?

Asain-americans

What race has a low response to beta blockers?

Native americans

Renin is released when ..?

BP drops

Nicotine is a ____

vasoconstrictor

What are nonpharmacologic methods to decrease BP

Stress reduction, exercise, salt restriction, decrease alcohol, smoking cessation

Hypertension goal <60 and >60

<60 140/90

>60 150/90

Is systolic or diastolic BP more important as a cardiovascular disease risk?

Systolic BP

Alcohol increases ….

Renin

Obesity increases …

cardiac output, stroke volume, and left ventricular filling

Diuretics promote sodium depletion which decreases ….

ECF volume

What is the first line treatment for mild hypertension?

Diuretics

What are the five types of sympatholytic drugs?

Beta blockers

Centrally acting alpha 2 agonists

Alpha blockers

Adrenergic neuron blockers

Alpha 1 and beta 1 blockers

What do beta blockers do?

Antihypertensive, Antianginal, Antidysrhythmic

Decrease HR, BP, Renin release, Cardiac output, contractility

Examples of nonselective beta blockers

Propranolol, Carvedilol

Examples of selective beta blockers

Atenolol

Metoprolol

What does Carvedilol do?

decreases remodeling of the heart

Why should you never abruptly stop taking beta blockers?

Rebound hypertension

What effects might make a patient want to stop taking beta blockers?

Might make them feel worse/more tired and that is normal!

Why should you be careful with nonselective beta blockers?

Blocking beta 2 affects the respiratory system

What are contraindications of beta blockers?

Bradycardia

Atrioventricular blocks

COPD

How do beta blockers affect blood glucose?

Inhibits glycogenolysis when hypoglycemic

What does alpha 1 and alpha 2 do?

alpha 1 - increase cardiac contractility, vasoconstriction, and dilates pupils

alpha 2 - inhibits norepinephrine release, promotes vasodilation, decreases GI motility and tone

what does beta 1 and beta 2 do?

beta 1 - increase cardiac contractility, increase BP and HR, increase renin secretions

beta 2 - increase BF, decrease GI tone and motility, increase glucose, decrease GI motility and tone

When using beta blockers, a decrease in HR mask the tachycardia of ___ and ___

hypotension and hyperglycemia

What do centrally acting alpha 2 agonists do?

They decrease the sympathetic response from brain stem to peripheral vessels and stimulate alpha 2 receptors

What is an example of a centrally acting alpha 2 agonist?

Clonidine

Why should you not stop centrally acting alpha 2 agonists abruptly?

rebound hypertension

What are side effects of centrally acting alpha 2 agonists?

Sodium and water retention (Diuretics are often prescribed to avoid fluid retention)

What do alpha blockers do?

vasodilation and decrease BP (assume alpha 1)

What are two alpha blockers? (OSIN)

doxazosin

prazosin

what are side effects of alpha blockers?

orthostatic hypotension, nausea, headache, drowsiness, edema, weight gain, and nasal congestion

alpha blockers do NOT effect …

glucose metabolism

what do adrenergic neuron blockers do?

block norepinephrine release which causes vasodilation

decreases peripheral vascular resistance, cardiac output, BP

Adrenergic neuron blockers are ____ acting

peripherally

what is an example of an adrenergic neuron blocker?

Reserpine

What are some negative effects of adrenergic neuron blockers?

orthostatic hypotension (rise slowly), vivid dreams/nightmares, suicidal ideations, and sodium/water retention (give with diuretics)

What do alpha 1 and beta 1 blockers do together?

decrease BP and HR moderately

What is an example of a alpha 1 and beta 1 blocker?

Labetalol

What happens if labetalol is taken in large doses?

airway resistance and AV heart block

Contraindications for labetalol

asthma

What are side effects of labetalol (alpha 1 and beta 1 blockers)

Orthostatic hypotension, GI disturbances, Dry mouth

What do direct-acting arteriolar vasodilators do?

Relaxes the smooth muscles of the blood vessels, mainly the arteries

Vasodilation → decrease BP

Sodium and water retention → give with diuretic

Give direct acting arteriolar vasodilators with ___ to reduce reflex tachycaridia

beta blockers

What is an example of a direct-acting arteriolar vasodilator

Hydralazine

What are side effects of direct-acting arteriolar vasodilators?

Palpitations, edema, headache, dizziness (drop in BP causes increase in HR)

What do ACE inhibitors treat?

hypertension and heartfailure, lowers peripheral resistance

What are examples of ACE inhibitors? (PRIL)

enalapril

lisinopril

ramipril

What are side effects of ACE inhibitors?

Dry cough, hyperkalemia, angioedema, and tachycardia

What are contraindications of ACE inhibitors?

Potassium-sparing diuretics, such as spironolactone

Salt substitutes that contain potassium

ACE inhibitors cause a risk for _____

hyperkalemia

What drug do pts often switch to if they have a dry cough from ACE inhibitors

Angiotensin II Receptor Blockers (ARBs)

What do angiotensin II Receptor Blockers (ARBs) do?

Block vasoconstrictor effects of angiotensin II at the receptor site

Prevents the release of aldosterone

Why are ARBs given with thiazide diuretics given with and why?

Thiazide diuretics — balances potassium excess and loss

Examples of ARBs (sartan)

losartan and valsartan

What do direct renin inhibitors do?

bind with renin → decreases angiotensin I, angiotensin II, and aldosterone

What are direct renin inhibitors used with?

a thiazide diuretic or ARB

What is an example of a direct renin inhibitor?

Aliskiren

What do calcium channel blockers do?

Block the calcium channel in the vascular smooth muscle and promote vasodilation

Calcium channel blockers vasodilate the ___ because large central arteries are not as sensitive

arterioles

What are examples of calcium channel blockers?

verapamil, diltizem, amlodipine

What are the side effects of calcium channel blockers?

Flushing, headache, dizziness, ankle edema, bradycardia, and AV block

What are calcium channel blockers good for?

Chest pain

A patient’s blood pressure is 130/84. The health care provider plans to suggest nonpharmacologic methods to lower blood pressure. Which should the nurse include in teaching? (Select all that apply.)

a. Stress-reduction techniques

b. An exercise program

c. Salt restriction

d. Smoking cessation

e. A diet with increased protein

A, B, C, D

A patient has developed mild hypertension. The nurse acknowledges that the first-line drug for treating this patient’s blood pressure might be which drug?

a. Diuretic

b. Alpha blocker

c. Angiotensin-converting enzyme inhibitor

d. Alpha/beta blocker

A

An African American patient has developed hypertension. The nurse is aware that which group(s) of antihypertensive drugs are less effective in African American patients?

a. Diuretics

b. Calcium channel blockers and vasodilators

c. Beta blockers and angiotensin-converting enzyme inhibitors

d. Alpha blockers

C

The nurse knows that which diuretic is most frequently combined with an antihypertensive drug?

a. Chlorthalidone

b. Hydrochlorothiazide

c. Bendroflumethiazide

d. A potassium-sparing diuretic

B

The nurse is administering a beta blocker to a patient. Which is the most important assessment to perform before administration?

a. Urine output

b. Apical pulse

c. Potassium level

d. Serum level of medication

B

Captopril has been prescribed for a patient. The nurse should teach the patient that the most commonly occurring side effect of an angiotensin-converting enzyme drug is which of the following?

a. Nausea and vomiting

b. Dizziness and headaches

c. Upset stomach

d. Constant, irritating cough

D

A patient is prescribed losartan. The nurse teaches the patient that an angiotensin II-receptor blocker acts by doing what?

a. Inhibiting angiotensin-converting enzyme

b. Blocking angiotensin II from angiotensin I receptors

c. Preventing the release of angiotensin I

d. Promoting the release of aldosterone

B

During an admission assessment, a patient states that she takes amlodipine. The nurse should inquire about which signs and symptoms to determine whether the patient has any common side effects of amlodipine? (Select all that apply.)

a. Insomnia

b. Dizziness

c. Headache

d. Angioedema

e. Ankle edema

f. Hacking cough

A, B, D, E