Pharmacology - Hypertension PDF

Bullet Point Nursing Pharmacology – Hypertension Disclaimer: These notes are designed to provide the key points of each topic and may not contain all necessary information. Every effort is made to ensure this content is up to date and accurate at the time of writing. No liability is assumed for the...

Bullet Point Nursing Pharmacology – Hypertension Disclaimer: These notes are designed to provide the key points of each topic and may not contain all necessary information. Every effort is made to ensure this content is up to date and accurate at the time of writing. No liability is assumed for the content or its relation to current standards and practices. This should not replace comprehensive nursing educational resources. Principles of hypertensive pharmacotherapeutics  Diagnosis of hypertension is when a blood pressure has a systolic over 130 or a diastolic over 80 o Per the 2017 AHA/ACC guidelines  Multiple low-dose agents are preferred versus high dose of a single agent  Monotherapy is limited to how much it can decrease the blood pressure o Roughly 10-20mm/hg systolic decrease per medication at standard dose  Pharmacotherapy should always be used in conjunction with lifestyle modifications o Reduce salt intake o Increase exercise. At least 150 minutes per week of aerobic activity o Decrease weight (If needed) o Quit smoking (If applicable) o Reduce alcohol consumption (If applicable) o Reduce caffeine intake (If applicable)  Always educate your patient on the basic pathophysiology of hypertension o Most patients are asymptomatic and require adequate education to promote medication compliance  Many hypertension medications are available in combination of two medications  Most HTN medications are not safe in pregnancy o Provider must ensure they are not pregnant when starting regimen and are on adequate means of pregnancy prevention  Higher doses increase side effects without proportional therapeutic benefit  Resistant hypertension is when target goal is not achieved with three appropriately dosed medications o Ensure compliance o Consider white coat syndrome o This patient should be referred to a hypertension specialist  Caution in rapidly lowering the blood pressure in hypertensive urgency / emergency  You must assess the patient’s blood pressure before and after administering any HTN drug  Always titrate and taper antihypertensive medications First line agents:  ACEI/ARB  Thiazide diuretics  Calcium channel blockers (Dihydropyridines) Alternative agents:  Beta blockers Bullet Point Nursing © 2023  Bullet Point Nursing  Alpha one blockers  Alpha two agonists  Direct vasodilators  Renin blockers  Sodium nitroprusside Drug class: Angiotensin Converting Enzyme Inhibitors (ACEI)  Drugs: o Lisinopril (Zestril) o Captopril (Capoten)  MOA: Inhibit the conversion of angiotensin one to angiotensin two  Indications: HTN, ACS, chronic kidney disease, stroke prevention, and heart failure  SE/AE: Kidney injury, angioedema, cough, and hyperkalemia o Captopril can cause neutropenia  Black Box warning: Teratogenic Drug class: Angiotensin Receptor Blockers (ARB)  Drugs: o Losartan (Cozaar) o Valsartan (Diovan)  MOA: Inhibits angiotensin two receptors  Indications: HTN and kidney disease  SE/AE: Kidney injury and hyperkalemia  Less likely to have a cough and angioedema versus ACEI  Black Box warning: Teratogenic Drug class: Thiazide Diuretics  Drugs: o Hydrochlorothiazide (HCTZ) o Chlorthalidone  MOA: Blocks reabsorption of sodium and chloride in the early distal convoluted tubule  Indications: HTN and edema  Most prescribed class of diuretics  Chlorthalidone is more potent than HCTZ  HCTZ is available in combination with many medications such as lisinopril and losartan Drug class: Calcium Channel Blockers (CCB) - dihydropyridines  Drugs: o Amlodipine (Norvasc) o Nicardipine (Cardene)  MOA: Inhibits calcium resulting in relaxation of vascular smooth muscle and vasodilation  Indications: HTN  SE/AE: Edema, orthostatic hypotension, Bullet Point Nursing © 2023  Bullet Point Nursing  Often used as first line treatment for hypertension in African Americans  This class of drugs can be subdivided into dihydropyridines and non-dihydropyridines  These drugs do not impact the heart rate Drug class: Calcium Channel Blockers (CCB) - non-dihydropyridines  Drugs: o Verapamil o Diltiazem (Cardizem)  MOA: Relaxation of vascular smooth muscle and vasodilation also decreases cardiac cellular excitability and contractility  Indications: Angina, atrial fibrillation, HTN, and SVT  SE/AE: Dysrhythmias  Assess HR and BP prior to admin  Not a first line agent for HTN Drug class: Direct vasodilators  Drug: o Hydralazine  MOA: Directly dilates arteries  Indications: Heart failure, hypertensive urgency, and HTN  SE/AE: Lupus like syndrome, reflex tachycardia and hypotension  Very common to get a headache when taking this medication  Isosorbide dinitrate is another vasodilator that is often given together due to dilating veins o Bidil is a combination medication of hydralazine with isosorbide dinitrate Drug name: Sodium Nitroprusside (Nipride)  MOA: Directly dilates arteries and veins  Indications: Acute heart failure and acute hypertension  SE/AE: Cyanide toxicity and hypotension  Black Box warning: For the two SE/AE noted above  IV route only Drug class: Alpha two agonist  Drug: o Clonidine o Methyldopa  MOA: Stimulates alpha two adrenergic receptor reducing sympathetic stimulation  Indications: Hypertension  SE/AE: Drowsiness  Methyldopa is considered relatively safe in pregnancy Drug class: Renin blocker  Drugs: Bullet Point Nursing © 2023  Bullet Point Nursing o Aliskiren  MOA: Inhibits renin  Indications: HTN  Alternative agent, never first line  Black Box warning: Teratogenic Drug class: Alpha one adrenergic antagonists  Drugs: o Doxazosin (Cardura) o Prazosin (Minipress)  MOA: Inhibits alpha one receptors  Indications: BPH and HTN  SE/AE: Orthostatic hypotension and reflex tachycardia, ED, fatigue  Other A1 antagonists are used only for BPH such as tamsulosin Drug class: Beta adrenergic antagonists (Beta blockers)  Drugs: o Propranolol o Metoprolol o Labetalol  MOA: Blocks beta one receptors  Indications: Angina, HTN, heart failure, AMI, dysrhythmias, migraines prevention, anxiety  SE/AE: Fatigue, ED  Black Box warning: Abrupt discontinuation can cause adverse cardiac effects  Can be divided into nonselective, cardioselective, and including vasodilating effects o Caution in those with underlying pulmonary conditions, can cause bronchoconstriction o Especially with nonselective  One of the safest options for HTN in pregnancy  Assess HR and BP prior to admin Additional options not discussed here are potassium sparing diuretics and loop diuretics Ask about CAMS as many can affect blood pressure Bullet Point Nursing © 2023  Bullet Point Nursing References 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. (2018) Journal of the American College of Cardiology; 71: e127-e248 Adams, M., Holland, N., & Urban, C. (2020). Pharmacology for nurses; A pathophysiologic approach. Pearson Burchum, J., & Rosenthal, L. (2022). Lehne's pharmacology for nursing care. Elsevier Mann, J. (2022) Choice of drug therapy in primary (essential) hypertension. www.uptodate.com Mccuistion, L., Vuljoin-DiMaggio, K., Winton, M., & Yeager, J. (2023) Pharmacology: A patient centered nursing process approach. Elsevier Bullet Point Nursing © 2023