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Questions and Answers
What is a common suffix associated with Dihydropyridine calcium-channel blockers?
What is a common suffix associated with Dihydropyridine calcium-channel blockers?
Which of the following is NOT a nursing consideration for administering calcium-channel blockers?
Which of the following is NOT a nursing consideration for administering calcium-channel blockers?
In the management of severe hypertension, which vasodilator is used intravenously?
In the management of severe hypertension, which vasodilator is used intravenously?
What is a common adverse effect of nitroprusside that requires monitoring during treatment?
What is a common adverse effect of nitroprusside that requires monitoring during treatment?
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What is a potential side effect of minoxidil related to hair?
What is a potential side effect of minoxidil related to hair?
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Why are lifestyle choices emphasized in the management of patients on calcium-channel blockers?
Why are lifestyle choices emphasized in the management of patients on calcium-channel blockers?
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Which statement correctly describes the use of hydralazine?
Which statement correctly describes the use of hydralazine?
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Which of the following would be an appropriate patient education regarding vasodilators?
Which of the following would be an appropriate patient education regarding vasodilators?
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Which of the following factors is likely to increase cardiac output?
Which of the following factors is likely to increase cardiac output?
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What is the primary role of compliance in relation to blood pressure?
What is the primary role of compliance in relation to blood pressure?
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If blood volume decreases, which of the following is expected to occur?
If blood volume decreases, which of the following is expected to occur?
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How does blood vessel length affect resistance?
How does blood vessel length affect resistance?
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Which of the following increase vascular resistance in the blood vessels?
Which of the following increase vascular resistance in the blood vessels?
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Which of the following is a potential adverse effect of calcium-channel blockers?
Which of the following is a potential adverse effect of calcium-channel blockers?
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In patient education for antihypertensive medications, what should be emphasized?
In patient education for antihypertensive medications, what should be emphasized?
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What should be considered when educating a patient about lifestyle changes for managing hypertension?
What should be considered when educating a patient about lifestyle changes for managing hypertension?
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What is a primary effect of selective beta-blockers on the heart?
What is a primary effect of selective beta-blockers on the heart?
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Which of the following is a notable caution for patients taking beta-blockers regarding blood pressure?
Which of the following is a notable caution for patients taking beta-blockers regarding blood pressure?
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What nursing consideration is important for patients on beta-blockers due to fatigue?
What nursing consideration is important for patients on beta-blockers due to fatigue?
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Which beta-blocker is considered non-selective and also blocks alpha-1 receptors?
Which beta-blocker is considered non-selective and also blocks alpha-1 receptors?
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What is a common adverse effect seen with non-selective beta-blockers that practitioners must monitor?
What is a common adverse effect seen with non-selective beta-blockers that practitioners must monitor?
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Which of the following medications is specifically noted for management of chronic angina and hypertension?
Which of the following medications is specifically noted for management of chronic angina and hypertension?
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What is a key aspect of patient education for those prescribed beta-blockers regarding blood sugar?
What is a key aspect of patient education for those prescribed beta-blockers regarding blood sugar?
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In terms of lifestyle changes, which of the following is important for patients on antihypertensive drug therapy?
In terms of lifestyle changes, which of the following is important for patients on antihypertensive drug therapy?
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Study Notes
Antihypertensive Drugs
- Roger Carlo P. Pineda, RN, MD lectured
- Regie De JESUS, RN, PhDN provided slides
- This is a nursing lecture
Review of Blood Pressure
- Four variables influence blood flow and blood pressure:
- Cardiac output
- Compliance
- Volume of blood
- Resistance
Cardiac Output
- Cardiac output is the measurement of blood flow from the heart through the ventricles
- Measured in liters per minute
- Factors that increase cardiac output (elevate heart rate/stroke volume/both) elevate blood pressure and promote blood flow
- Increased by:
- Sympathetic stimulation
- Thyroid hormones
- Increased calcium ion levels
- Decreased by:
- Parasympathetic stimulation
- Elevated or decreased potassium ion levels
- Decreased calcium levels
- Anoxia
- Acidosis
Compliance
- Compliance is the ability of a compartment to expand to accommodate increased content
- Metal pipe is not compliant, balloon is
- Greater the compliance of artery, more effectively it expands to accommodate surges in blood flow without increased resistance or blood pressure
Blood Volume
- Relationship between blood volume, blood pressure, and blood flow is intuitive
- Decrease in blood volume decreases pressure and flow
- Increase in blood volume increases pressure and flow
Resistance
- Blood viscosity is the thickness of fluids affecting their ability to flow
- Blood viscosity is directly proportional to resistance and inversely proportional to flow.
- Conditions that cause viscosity to increase also increase resistance and decrease flow
- Blood vessel length is proportional to its resistance: longer the vessel, greater the resistance, lower the flow
- Blood vessel diameter inversely proportional to resistance
- Vessel diameter change through the body in different types of vessels with vascular tone reflecting contractile state of smooth muscle
- Greater the blood vessel diameter, the less blood contacts vessel wall (lower friction), lower resistance, thus increasing flow
A. Baroceptors (Pressure Receptors)
- Specialized cells in the arch of the aorta and other tissues
- Sensory input from baroreceptors received in the medulla (vasomotor center)
- High pressure stimulates medulla to cause vasodilation, decrease in cardiac rate and output
B. Renin-Angiotensin-Aldosterone System (RAAS)
- Drop in blood pressure/fluid volume releases renin from the kidney
- Renin acts on angiotensinogen in the liver to form angiotensin I
- ACE (enzyme) from the lungs converts angiotensin I to angiotensin II
- Angiotensin II acts on the adrenal gland to release aldosterone
- Aldosterone acts on kidneys to stimulate reabsorption of salt (NaCl) and water (H₂O)
Types of Hypertension
-
- Essential Hypertension (Primary):
- Ninety percent of cases have no known cause
- Elevated total peripheral resistance
- Organs perfused effectively and no symptoms ("Silent Killer")
-
- Secondary Hypertension:
- Elevated blood pressure due to a known cause
- E.g., tumor in the adrenal medulla (pheochromocytoma) causes high amount of catecholamine release, greatly increasing blood pressure
Blood Pressure Categories
- This section presents categories of blood pressure measurements (systolic and diastolic in mm Hg) for normal, elevated, high blood pressure (stage 1 & 2), and hypertensive crisis.
Antihypertensive Drugs (List)
- Angiotensin-converting enzymes inhibitors (ACE Inhibitors)
- Angiotensin II-Receptor Blockers (ARBs)
- Renin Inhibitors
- Calcium-Channel Blockers
- Vasodilators
- Diuretic Agents
- Sympathetic Nervous System Blockers
A. Angiotensin-converting enzymes inhibitors (ACE Inhibitors)
- Antihypertensive agents that act in the lungs
- Prevent conversion of angiotensin I into angiotensin II (potent vasoconstrictor)
- Decrease blood pressure with associated loss of serum sodium and fluid but with a slight increase in serum potassium
- Generic examples: benazepril, captopril, enalapril, lisinopril, quinapril, fosinopril, ramipril, etc.
- Indications: hypertension, diabetic nephropathy
- Not allowed during pregnancy
- Older adults: Renal and hepatic function monitored
- Adverse effects: GI irritations, ulcer, constipation, liver injury; GU: renal insufficiency, renal failure, proteinuria; CV: reflex tachycardia, chest pain, heart failure, cardiac arrhythmias (from HYPERKALEMIA); EENT: rash, alopecia, dermatitis, photosensitivity; Captopril associated with sometimes-fatal pancytopenia, cough, and GI distress
- Nursing considerations: Educate patient on healthy lifestyle, administer drug on empty stomach (1 hr before/2 hrs after meal), monitor for manifestations of decreased fluid volume (hypotensive effects)
B. Angiotensin II-Receptor Blockers (ARBs)
- Antihypertensive agents that block vasoconstriction and aldosterone release
- Block angiotensin II receptors in vascular smooth muscles and adrenal cortex
- Generic examples: azilsartan, candesartan, eprosartan, irbesartan, losartan, olmesartan, telmisartan, valsartan
- Indications: hypertension, heart failure in patients who do not respond to ACE inhibitors, slow progress of renal disease in patients with type 2 diabetes and hypertension
- Not allowed during pregnancy
- Older adults: Renal and hepatic function monitored
- Adverse effects: CNS: headache, dizziness, syncope, weakness; Respiratory: URTI symptoms, cough; GI: diarrhea, abdominal pain, nausea, dry mouth, tooth pain; EENT: rash, alopecia, dry skin
- Nursing considerations: Healthy lifestyle choices, administer with food, monitor for manifestations of decreased fluid volume (hypotensive effects), comfort measures
C. Renin Inhibitors
- A new drug (Aliskiren, Tekturna) released in 2007 inhibits renin and the conversion of angiotensinogen to angiotensin I
- This stops the renin-angiotensin-aldosterone system causing decreased blood pressure, decreased aldosterone release, decreased sodium reabsorption
D. Calcium-Channel Blockers
- Inhibit calcium ion movement across myocardial and arterial muscle cell membranes
- Resulting in altered action potentials and blocked cell contractions
- Resultant effects: depressed myocardial contractility, slow cardiac impulse, arterial dilation, relaxation
- Effective in angina treatment as decrease cardiac workload
- Indications: Hypertension, used alone or in combination, extended-release preparations for adults, children (first considered drug group in hypertension cases)
- Not allowed during pregnancy for adults
- Older adults: Renal and hepatic function monitored
- Adverse reactions: CNS: headache, dizziness, light-headedness, fatigue; CV: hypotension, bradycardia, peripheral edema, heart block; GI: nausea, hepatic injury; EENT: rash, skin flushing
- Generic names: amlodipine, felodipine, nifedipine, nicardipine, diltiazem, verapamil
- Nursing considerations: Healthy lifestyle, monitor blood pressure & heart rate/rhythm, comfort measures
E. Vasodilators
- Act directly on smooth muscles causing muscle relaxation and vasodilation (drops blood pressure)
- Used in severe hypertension and hypertensive emergencies
- Generic examples: hydralazine, minoxidil, nitropruisside
- Indications: hypertension that do not respond to other drug therapies, maintain controlled hypotension during surgery
- Adverse effects: CNS: headache, dizziness, anxiety; GI: nausea, vomiting, GI upset; EENT: rash, lesions (e.g., minoxidil causing abnormal hair growth); Cyanide toxicity from nitroprusside characterized by dyspnea, and other symptoms
- Nursing considerations: Healthy lifestyle choices, monitor blood pressure/heart rate/rhythm, comfort measures
F. Diuretic Agents
- Drugs that increase sodium and water excretion from the kidneys
- Often the first line of treatment for mild hypertension (e.g., Thiazide and Loop)
- Other uses include managing edema and glaucoma
- Five classes: Thiazide, Loop, Carbonic Anhydrase Inhibitors, Potassium Sparing, Osmotic
- Detailed information on each class
G. Sympathetic Nervous System Blockers
- Block many compensatory effects of the sympathetic nervous system
- Classes:
- Beta-blockers (selective & non-selective)
- Alpha-1 Blockers (Alpha-1 Adrenergic Blockers)/Alpha- Blockers (Alpha-2 Adrenergic Blockers)/Centrally Acting Adrenergic Drugs (i.e., Alpha2-agonists)
- Detailed information on each block class
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