Perfusion3700partI-student

Perfusion: Nursing Pharmacology Overview

  • Instructor: Iomi Tweneboa-Kodumsn, RN

Learning Objectives

  • Identify various categories of antihypertensive medications.

  • Discuss the mechanism of action and common side effects of each medication prototype.

  • Differentiate between hypertensive urgency vs hypertensive emergency.

  • Understand the role of nurses in caring for clients receiving antihypertensive medications (both adult and pediatric).

  • Discuss pertinent client education regarding antihypertensive therapy for adults and pediatrics.

Hypertension Overview

Risk Factors

  • Demographics: Race, gender, socioeconomic status.

  • Physiological Factors: Increased sodium intake, renin-angiotensin-aldosterone system (RAAS), aldosterone effects, sympathetic nervous system activity.

Clinical Manifestations

  • Common Symptoms:

    • Headaches

    • Dizziness

    • Chest pain

    • Vision changes

    • Shortness of breath

    • Renal dysfunction

    • Fatigue

    • Nosebleeds

Hypertension Management

Medications

  • Diuretics

  • Antihypertensive Therapy Categories:

    • Beta-blockers

    • Calcium channel blockers

    • Angiotensin-converting enzyme (ACE) inhibitors

    • Angiotensin II receptor blockers (ARBs)

    • Alpha 1 blockers, Alpha/beta blockers

    • Aldosterone antagonists

    • Centrally-acting alpha2 antagonists

    • Direct acting vasodilators

Lifestyle Management

  • Weight management

  • Dietary changes

  • Reducing alcohol consumption

  • Increasing exercise

  • Stress reduction techniques

Pediatric Hypertension

Clinical Manifestations

  • Headache

  • Migraines

  • Vomiting

  • Visual changes

  • Seizures

Medications for Pediatrics

  • Amlodipine Tablets: 5 mg (Rx)

  • Valsartan: 40 mg, 160 mg, 320 mg (various doses available)

  • Propranolol: Available as oral solution and tablets.

Lisinopril: ACE-Inhibitor

Therapeutic Uses

  • Treats hypertension

  • Reduces/prevents heart failure

Contraindications

  • History of angioedema

  • Hypersensitivity

Adverse Drug Reactions

  • Hypotension

  • Tachycardia

  • Edema

  • Dizziness

  • Hyperkalemia

  • Renal failure

Nursing Role and Client Education for Lisinopril

  • Nursing Roles: Administer medications timely, monitor blood pressure, assist with position changes to minimize falls.

  • Client Education:

    • Take medication as prescribed daily and consistently.

    • Monitor blood pressure.

    • Avoid salt substitutes high in potassium.

    • Change positions slowly to avoid dizziness.

    • Notify provider of allergic responses.

Propranolol: Beta-Blocker

Therapeutic Uses

  • Treats hypertension

Contraindications

  • Hypersensitivity

  • History of bronchospasms

Adverse Drug Reactions

  • Bradycardia

  • Hypotension

  • Decreased appetite

  • Cold extremities

Nursing Role and Client Education for Propranolol

  • Nursing Roles: Administer same time each day, monitor blood pressure.

  • Client Education: Monitor blood pressure and change positions slowly.

Valsartan: Angiotensin II Receptor Blocker

Therapeutic Uses

  • Treats hypertension

Contraindications

  • History of angioedema

  • Hypersensitivity

  • Pregnancy

Adverse Drug Reactions

  • Dizziness

  • Hypotension

  • Headache

Nursing Role and Client Education for Valsartan

  • Similar nursing roles and education as Lisinopril.

Amlodipine: Calcium Channel Blocker

Therapeutic Uses

  • Treats hypertension

Contraindications

  • Hypersensitivity

Adverse Drug Reactions

  • Edema

  • Hypotension

  • Flushing

  • Rash

Nursing Role and Client Education for Amlodipine

  • As per previous medications.

Hydrochlorothiazide: Thiazide Diuretic

Therapeutic Uses

  • Treats hypertension

Contraindications

  • Hypersensitivity

  • Clients with sulfa drug allergies

Adverse Drug Reactions

  • Hypotension

  • Orthostatic hypotension

  • Rash

  • Vomiting

Nursing Role and Client Education for Hydrochlorothiazide

  • As per previous medications.

Hypertension in Adult Clients

Clinical Manifestations

  • Symptoms include headache, dizziness, renal dysfunction, visual changes, chest pain, shortness of breath, and nosebleeds.

Angiotensin Converting Enzyme Inhibitors Overview

  • Mechanism of Action: Inhibits ACE to prevent the conversion of angiotensin I to II; reduces vasoconstriction, and sodium retention.

  • Common drugs include Benazepril, Enalaprilat, Fosinopril, etc.

Adverse Drug Reactions and Client Education for ACE Inhibitors

  • Report dry cough, hypotension signs, and monitor vital parameters.

Angiotensin II Receptor Blockers (ARBs)

  • Similar effects and precautions as ACE inhibitors but less likely to cause cough.

Calcium Channel Blockers Overview

  • Treat hypertension, angina, and cardiac dysrhythmias.

  • Drugs like Amlodipine, Diltiazem, Verapamil. Watch for bradycardia and hypotension.

Aldosterone Antagonists

  • Therapeutic Use: Treat hypertension and heart failure; educate about managing potassium levels.

Sympatholytics/Antiadrenergics: Beta Blockers Overview

  • Monitor heart rate and blood pressure closely; educate about potential adverse reactions such as dizziness and fatigue.

Centrally Acting Alpha2 Agonists

  • Drugs like Clonidine; monitor closely for sedation and rebound hypertension.

Direct-Acting Vasodilators

  • Administer for hypertensive emergencies; monitor for hypotension and assess for reflex tachycardia.

Knowledge Checks

  • Review understanding through multiple scenarios and questions relating to specific medications and nursing actions.

References

  • ATI Supreme Package, Drugs.com, Advanced Nursing texts.