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Questions and Answers
Which factor does NOT directly determine blood pressure?
Which factor does NOT directly determine blood pressure?
What is the primary function of baroreceptors in the cardiovascular system?
What is the primary function of baroreceptors in the cardiovascular system?
What is the role of the renin-angiotensin-aldosterone system in blood pressure regulation?
What is the role of the renin-angiotensin-aldosterone system in blood pressure regulation?
In what circumstance might hypotension occur as an effect of blood pressure agents?
In what circumstance might hypotension occur as an effect of blood pressure agents?
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Which term describes hypertension that has no identifiable cause?
Which term describes hypertension that has no identifiable cause?
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Which of the following is NOT a risk factor for hypertension?
Which of the following is NOT a risk factor for hypertension?
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What is the first step in the stepped care management of hypertension?
What is the first step in the stepped care management of hypertension?
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Which class of drugs should be avoided during pregnancy due to absolute contraindication?
Which class of drugs should be avoided during pregnancy due to absolute contraindication?
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Older adults are more susceptible to which of the following when using antihypertensive medications?
Older adults are more susceptible to which of the following when using antihypertensive medications?
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Which of the following lifestyle modifications is NOT recommended for managing hypertension?
Which of the following lifestyle modifications is NOT recommended for managing hypertension?
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What is a significant concern when initiating drug therapy for children with hypertension?
What is a significant concern when initiating drug therapy for children with hypertension?
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Which medication class alters the Renin-Angiotensin-Aldosterone System (RAAS)?
Which medication class alters the Renin-Angiotensin-Aldosterone System (RAAS)?
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In which situation should caution be taken when using ACE Inhibitors?
In which situation should caution be taken when using ACE Inhibitors?
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When managing hypertension, which factor is critical for older adults during drug administration?
When managing hypertension, which factor is critical for older adults during drug administration?
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What is the connection between chronic kidney disease and hypertension?
What is the connection between chronic kidney disease and hypertension?
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Which class of drugs primarily blocks the conversion of angiotensin I to angiotensin II?
Which class of drugs primarily blocks the conversion of angiotensin I to angiotensin II?
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What is a common adverse effect associated with ACE inhibitors?
What is a common adverse effect associated with ACE inhibitors?
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Which of the following medications is an Angiotensin II Receptor Blocker?
Which of the following medications is an Angiotensin II Receptor Blocker?
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Which patient condition would be a contraindication for the use of renin inhibitors?
Which patient condition would be a contraindication for the use of renin inhibitors?
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What is the primary mechanism of action of calcium channel blockers?
What is the primary mechanism of action of calcium channel blockers?
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In which condition would thiazide diuretics be indicated?
In which condition would thiazide diuretics be indicated?
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What effect do vasodilators have on blood pressure?
What effect do vasodilators have on blood pressure?
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Which of the following indicates a potential risk when using calcium channel blockers?
Which of the following indicates a potential risk when using calcium channel blockers?
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What common adverse effect can be expected with the use of Angiotensin II Receptor Blockers?
What common adverse effect can be expected with the use of Angiotensin II Receptor Blockers?
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Which of these drugs is not a part of the RAAS-based medication classes?
Which of these drugs is not a part of the RAAS-based medication classes?
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What precaution should be taken when administering diuretics?
What precaution should be taken when administering diuretics?
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What is an important consideration when using NSAIDs with RAAS drugs?
What is an important consideration when using NSAIDs with RAAS drugs?
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Which adverse effect is specific to nitroprusside used as a vasodilator?
Which adverse effect is specific to nitroprusside used as a vasodilator?
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Which is a characteristic side effect linked to beta-blockers?
Which is a characteristic side effect linked to beta-blockers?
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What is the primary action of beta-blockers?
What is the primary action of beta-blockers?
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Which of the following is a common adverse effect of beta-blockers?
Which of the following is a common adverse effect of beta-blockers?
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Which medication class blocks both alpha and beta receptors?
Which medication class blocks both alpha and beta receptors?
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Which of the following is an absolute contraindication for the use of nonselective alpha-adrenergic blockers?
Which of the following is an absolute contraindication for the use of nonselective alpha-adrenergic blockers?
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What effect do alpha1-blockers primarily have on the cardiovascular system?
What effect do alpha1-blockers primarily have on the cardiovascular system?
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Which condition is a caution for using clonidine?
Which condition is a caution for using clonidine?
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What must be monitored closely in patients taking beta-blockers who have diabetes?
What must be monitored closely in patients taking beta-blockers who have diabetes?
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What adverse effect can occur due to alpha-adrenergic blockers?
What adverse effect can occur due to alpha-adrenergic blockers?
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Which of the following is NOT an indication for the use of beta-blockers?
Which of the following is NOT an indication for the use of beta-blockers?
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In which drug-drug interaction should caution be exercised when administering vasopressors?
In which drug-drug interaction should caution be exercised when administering vasopressors?
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Which nursing consideration is crucial before administering beta-blockers?
Which nursing consideration is crucial before administering beta-blockers?
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What is a potential serious consequence of abruptly stopping beta-blocker therapy?
What is a potential serious consequence of abruptly stopping beta-blocker therapy?
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Which of the following drugs is an example of a beta-blocker?
Which of the following drugs is an example of a beta-blocker?
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What effect do vasopressors have on the body?
What effect do vasopressors have on the body?
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Study Notes
Blood Pressure Agents
- Blood pressure (BP) is determined by heart rate, stroke volume, and total peripheral resistance
- Baroreceptors and the renin-angiotensin-aldosterone system (RAAS) work together to regulate BP
- Uncontrolled hypertension increases the risk for coronary artery disease, stroke, renal failure, and vision loss
- Hypertension is categorized as elevated, stage 1, stage 2, and hypertensive crisis based on BP readings
- Risk factors for hypertension include stress, chronic kidney disease, obesity, decreased physical activity, insulin resistance, diabetes, increased age, cigarette smoking, alcohol use, and genetic predisposition
Medications for Hypertension
- Antihypertensive agents are grouped into five categories: drugs affecting the RAAS, sympathetic nervous system blockers, calcium channel blockers, vasodilators, and diuretics
Drugs Affecting the RAAS
-
Angiotensin-converting enzyme inhibitors (ACEIs)
- Action: Blocks angiotensin I from converting to angiotensin II, lowering BP, increasing sodium and water excretion, and slightly increasing potassium levels
- Indications: Hypertension, congestive heart failure, left ventricular dysfunction, and prevention of diabetic nephropathy
- Adverse Effects: Hypotension, renal insufficiency, fatigue, dizziness, pancytopenia, GI irritation, rash, hyperkalemia, and cough
- Nursing Considerations: Monitor for cough, check CBC labs
-
Angiotensin II Receptor Blockers (ARBs)
- Action: Blocks angiotensin II from binding to receptors, resulting in vasodilation and reduction of aldosterone release
- Indications: Hypertension, congestive heart failure, and prevention of diabetic nephropathy
- Adverse Effects: Headache, dizziness, syncope, weakness, hypotension, GI complaints, rash, hyperkalemia, renal damage
- Nursing Considerations: Assess for liver impairment and monitor liver function
-
Renin Inhibitors
- Action: Inhibits renin, leading to a decrease in BP, aldosterone, and sodium reabsorption
- Indication: Hypertension
- Adverse Effects: Hyperkalemia and diarrhea
- Nursing Considerations: Monitor for hyperkalemia
Calcium Channel Blockers
- Action: Inhibits calcium movement across cell membranes in cardiac and arterial muscle, leading to decreased heart rate and relaxation/dilation of arteries
- Indications: Hypertension, angina, and arrhythmias
- Adverse Effects: CNS effects, cardiovascular effects (hypotension), GI effects, skin reactions
- Nursing Considerations: Monitor blood pressure, cardiac rhythm, and cardiac output; Provide patient education about drug interactions with grapefruit juice
Vasodilators
- Action: Directly acts on vascular smooth muscle, causing relaxation and vasodilation, reducing BP
- Indications: Severe hypertension, hypertensive emergencies, and malignant hypertension
- Adverse Effects: CNS effects, cardiovascular effects, skin reactions, GI upset, potential for cyanide toxicity, headache, dizziness, dyspnea, and vomiting
- Nursing Considerations: Monitor BP closely, provide patient education about adverse effects, and maintain comfort
Diuretics
- Action: Increase sodium and water excretion from the kidneys, leading to reduced BP
- Indications: Hypertension
- Nursing Considerations: Refer to Chapter 51 for detailed information about various diuretics
Sympathetic Nervous System Blockers
- Beta-Blockers:
- Action: Blocks beta-adrenergic receptors, decreasing heart rate and contractility
- Alpha-Adrenergic Blockers:
- Action: Blocks alpha-adrenergic receptors, causing vasodilation and reducing peripheral resistance
- Alpha- and Beta-Blockers:
- Action: Blocks both alpha and beta receptors, resulting in combined effects on heart rate, contractility, and vasodilation
General Nursing Considerations for Antihypertensive Agents
- Assess for allergies, pregnancy, impaired renal function, previous heart failure, and history of salt or volume depletion
- Monitor vital signs, weight, urine output, and electrolytes
- Educate patients regarding drug actions, adverse effects, and lifestyle modifications
- Encourage adherence to prescribed drug therapy, lifestyle changes, and use of appropriate contraceptive methods
- Monitor for drug interactions, particularly with NSAIDs and other RAAS drugs, grapefruit juice, cyclosporine, and other medications
- Provide comfort measures and safety precautions to minimize risk of injury
- Carefully monitor patients in situations that may lead to fluid volume depletion (e.g., dehydration, vomiting, diarrhea)
- Teach patients to report adverse effects immediately
Nonselective Adrenergic Blocking Agents
-
Alpha2-Agonist: Clonidine
- Stimulates alpha2 receptors in the CNS, inhibiting cardiovascular centers
- Decreases sympathetic outflow from the CNS, leading to lower blood pressure
- Used for treating hypertension
- Available in oral and transdermal formulations
- Absolute Contraindications: Allergy
- Relative Contraindications: Narrow Angle Glaucoma, Severe Hypertension, Hypotension, Bradycardia
- Cautions: Cardiovascular Disease, Diabetes, Hyperthyroidism, Renal/Hepatic Impairment
- Adverse Effects: CNS, Cardiovascular, Genitourinary
- Drug Interactions: Beta-blockers, Adrenergic-antagonists, CNS depressants/alcohol
Beta-Blockers
- Actions
- Blocks beta receptors in the heart
- Decreases heart rate and cardiac muscle contraction
- Vasodilates, increasing blood flow to the kidneys, decreasing renin release
- Indications: Hypertension, angina, tachyarrhythmias, migraine headache, Myocardial Infarction (MI), glaucoma
- Absolute Contraindications: Allergy
- Relative Contraindications: Acute/unstable heart failure, bradycardia and heart block, bronchospasm, Chronic Obstructive Pulmonary Disease (COPD), acute asthma
- Cautions: Renal and hepatic dysfunction, diabetes
- Adverse Effects:
- CNS: Headache, fatigue, dizziness, depression, sleep issues, disorientation, memory loss
- Cardiovascular: Bradycardia, hypotension
- Respiratory: Bronchospasm, dyspnea, pulmonary edema
- Gastrointestinal: Nausea/vomiting/diarrhea, pain
- Genitourinary: Decreased libido and impotence
- Alterations in glucose levels
- Drug Interactions: Clonidine, NSAIDs, insulin/hypoglycemic agents
- Nursing Considerations:
- Assessment: History of lung conditions or diabetes
- Implementation: Take apical pulse prior to administering and hold if below 60bpm, do not abruptly stop medication, patients with diabetes should monitor blood glucose closely
Alpha-adrenergic Blocker (Non-selective)
- Actions:
- Blocks Alpha1 receptors: vasodilation resulting in decreased blood pressure
- Blocks Alpha2 receptors: prevents norepinephrine feedback loop, resulting in increased reflex tachycardia
- Indications: Diagnose and manage episodes of hypertension
- Administration: Intramuscular (IM) or intravenous (IV) only
- Absolute Contraindications: Allergy
- Relative Contraindications: Coronary artery disease (CAD), Myocardial Infarction (MI)
- Drug Interactions: Alcohol
- Adverse Effects:
- Cardiovascular: Hypotension, angina, MI, arrhythmia, increased reflex tachycardia, flushing
- Central Nervous System: Cerebral vascular accident (CVA), headache, weakness, dizziness
- Note: This is a short acting agent and should not be used for long-term therapy.
Alpha1-blockers
- Actions:
- Blocks alpha1-receptor sites
- Decreases vascular tone resulting in vasodilation, decreasing blood pressure
- Indications: Hypertension
- Absolute Contraindications: Allergy
- Cautions: Heart failure, renal failure or hepatic impairment
- Adverse Effects: CNS, cardiovascular, genitourinary, skin
- Drug Interactions: Drugs used for erectile dysfunction (ED)
Alpha- and Beta-blockers (Nonselective Adrenergic Blocking Agents)
- Actions:
- Blocks norepinephrine at all alpha and beta receptors in the Sympathetic Nervous System (SNS)
- Lower blood pressure and heart rate
- Increased renal perfusion
- Decreased renin
- Indications: Hypertension
- Drugs: Carvedilol, Labetalol
- Absolute Contraindications: Allergy
- Relative Contraindications: Heart block, bradycardia, liver disease
- Cautions: Lung disease/bronchospasm, diabetes
- Adverse Effects: CNS, cardiovascular, respiratory, hypoglycemia, skin rash, GI/GU issues, liver failure
- Drug Interactions: Antidiabetic agents
Hypotension
- Blood pressure becomes too low
- When the heart muscle is damaged and unable to pump effectively
- With severe blood or fluid loss, when volume drops dramatically
- When there is extreme stress and the body's levels of norepinephrine are depleted, leaving the body unable to respond to stimuli to raise blood pressure
Antihypotensive Agents: Vasopressors
- Actions:
- Stimulate all adrenergic receptors/SNS
- Increase heart rate and myocardial contractility
- Constricts blood vessels, increasing blood pressure
- Dilates bronchi, increasing rate/depth of breathing
- Indications: Hypotensive states, shock, heart failure, anaphylaxis, bronchospasm/acute asthma
- Drugs: Dobutamine, Dopamine, Epinephrine, Norepinephrine
- Absolute Contraindications: Allergy, Pheochromocytoma
- Relative Contraindications: Hypovolemia
- Cautions: Tachycardia, hypertension, disease that limits blood flow
- Adverse Effects: Cardiovascular, Central Nervous System
- Drug Interactions: Any drug or substance that increases heart rate or blood pressure
Sympathetic Nervous System Blockers
-
Nursing Process
- Assessment:
- History: Contraindications and cautions
- Physical: CNS, cardiac/perfusion, respiratory, abdominal, urinary, vitals, ECG
- Labs: Electrolytes, renal and hepatic function, glucose
- Nursing Diagnoses/Conclusions:
- Impaired comfort
- Altered tissue perfusion
- Altered cardiac output
- Altered breathing pattern
- Injury risk
- Activity intolerance
- Altered sensory perception
- Knowledge deficit
- Implementation:
- Take apical pulse prior to administering and hold if below 60bpm
- Prepare medication carefully
- Monitor blood pressure
- Do not abruptly stop medication
- Encourage patient to make lifestyle modifications
- Change position slowly
- Safety and comfort measures
- Patients with diabetes should monitor blood glucose closely
- Do not crush extended release (ER) formulations
- Patient teaching:
- Consult a healthcare professional before taking any over-the-counter (OTC) medication or herbal/alternative therapies
- Emphasize the importance of follow-up exams
- Evaluation:
- Evaluate response to drug
- Evaluate effectiveness of the teaching plan
- Evaluate effectiveness of comfort and safety measures
- Evaluate compliance with the regimen
- Assessment:
Antihypotensive Drugs: The Nursing Process
- Assessment:
- History: Contraindications and cautions
- Physical: Respiratory, cardiac/perfusion, abdominal, skin, weight, vitals
- Labs: Kidney and liver function
- Nursing Diagnoses/Conclusions:
- Altered tissue perfusion
- Altered sensory perception
- Impaired comfort
- Knowledge deficit
- Implementation:
- Monitor blood pressure and heart rate
- Provide safety and comfort measures
- Provide thorough patient teaching
- Evaluation:
- Evaluate response to drug
- Evaluate effectiveness of teaching plan
- Evaluate effectiveness of comfort and safety measures
- Evaluate compliance with regimen
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Description
Explore the key concepts of blood pressure regulation and the various antihypertensive medications. This quiz covers the mechanisms of blood pressure control, risk factors for hypertension, and the different classes of medications used to manage high blood pressure. Test your understanding of these crucial health topics.
