Unit 7.1 Antihypertensives PDF

Antihypertensives NUR 210/BSL 101 Unit 7  Two reasons – Too much fluid Vasoconstriction Physiologic risk factors Physiologic Risk Excessive intake of saturated fat and simple...

Antihypertensives NUR 210/BSL 101 Unit 7  Two reasons – Too much fluid Vasoconstriction Physiologic risk factors Physiologic Risk Excessive intake of saturated fat and simple Factors carbohydrates Alcohol: increases renin secretions Obesity Cultural responses to antihypertensive agents African Americans Asian Americans  Nonpharmacologic control Nonpharmacological Stress-reduction techniques Control of Hypertension Exercise Salt restriction Decrease alcohol ingestion Smoking cessation  Diuretics Antihypertensive Beta adrenergic blockers Drugs Alpha adrenergic blockers Calcium channel blockers Angiotensin converting enzyme inhibitors Angiotensin 2 receptor blockers  Metoprolol – more selective beta 1 Propanolol – non-selective – blocks beta 1 and beta 2 (lungs) Beta adrenergic Action blockers Blocks the adrenergic affect, which lowers end in ‘-olol’ blood pressure and heart rate 1 Uses Hypertension Also used as an anti-dysrhythmic and anti- angina Can be used as dual therapy along with a diuretic for African Americans Beta-Adrenergic Blockers for Hypertension Side effects/adverse reactions 1 Same as when studied in unit 4 Beta-Adrenergic Contraindications Same as we studied in unit 4 Blockers Propanolol is non-selective so no asthma for Hypertension or COPD 1 Interactions Same as unit 4  Action ◦ Block the alpha-adrenergic receptors, Alpha-adrenergic resulting in vasodilation and decreased blood pressure blockers Prazosin Uses ◦ Hypertension ◦ Heart failure ◦ Benign prostatic hypertrophy ◦ Can be used as monotherapy in African Americans  Side effects/adverse reactions Dizzy, drowsy, headache Alpha-adrenergic Peripheral edema, weight gain blockers Urinary incontinence Prazosin Erectile dysfunction Orthostatic hypotension, hypotension Palpitations Elevated liver enzymes Safer for asthma and diabetics  Contraindications Caution Alpha-adrenergic ◦ Decreased blood pressure blockers Prazosin Interactions Other drugs that lower blood pressure High protein binding drugs Alcohol OTC cold medications  Amlodipine – Also verapamil and diltiazem Action Blocks calcium’s movement in and out of cells which promotes Calcium Channel vasodilation and decreased Blockers heart rate end in ‘-pine’ Uses Hypertension Anti-angina Anti-dysrhythmic Peripheral vascular disease Can be used as monotherapy in African Americans  Side effects/adverse reactions Calcium Channel Flushing Blockers Headache end in ‘-pine’ Dizziness Peripheral edema Erectile dysfunction Hypotension, orthostatic hypotension Bradycardia  Contraindications Calcium Channel Caution Blockers ◦ Hepatic impairment end in ‘-pine’ Interactions Other drugs that lower blood pressure Cold medications  Lisinopril Action Angiotensin- Inhibits formation of angiotensin II (a Converting Enzyme strong vasoconstrictor) and blocks release of aldosterone (holds on to (ACE) Inhibitors – water & NA, releases K) end in ‘-pril’ So by inhibiting angiotensin II the patient has inhibited vasoconstriction (results in vasodilation) and releases water and NA and holds K Uses Hypertension Heart failure Can be used as dual therapy along with a diuretic for African Americans  Side effects/Adverse reactions Angiotensin- Constant irritating non-productive cough Converting Enzyme Headache (ACE) Inhibitors – GI upset end in ‘-pril’ Insomnia Erectile dysfunction Orthostatic hypotension, hypotension Hyperkalemia Tachycardia Angioedema Nephrotoxic  Contraindications Angiotensin- Pregnancy Converting Enzyme Potassium-sparing diuretics such as (ACE) Inhibitors – spironolactone Salt substitutes that contain potassium end in ‘-pril’ Interactions Potassium containing medication Other anti-hypertensives OTC cold medication  Angiotensin II Losartan Action Receptor Blockers Inhibits binding of angiotensin II to its (ARBs) – end in receptor ‘-sartan’ or ‘-tan’ Inhibits angiotensin II (no 1 vasoconstriction) and inhibits the release of aldosterone (release sodium and water – hold on to potassium Uses Hypertension Heart failure  Contraindications Angiotensin II Pregnancy Receptor Blockers Lactating (ARBs) – end in ‘-sartan’ or ‘-tan’ Interactions 1 Other anti-hypertensives Alcohol NSAIDS can increase renal dysfunction/hyperkalemia OTC cold medicine  Angiotensin II Side Effects/adverse reactions DOES NOT cause the cough of Receptor Blockers ACEI (ARBs) – end in Dizzy, drowsy, fatigue ‘-sartan’ or ‘-tan’ Insomnia, headache 1 Erectile dysfunction Orthostatic hypotension Hyperkalemia Hypotension Renal dysfunction  Assessment Vital signs Nursing process – Know the drugs that lower heart rate Electrolytes – know the drugs that anti- affect NA & K hypertensives Medication and medical history Renal and liver function Weight, edema I & O (to help assess for renal function – alpha blockers contraindicated in renal dysfunction, ACEI and A2RB can increase renal failure)  Teaching Take blood pressure and pulse daily and what to report Weigh daily report weight gain over 2 Nursing process – pounds in one day, 5 pounds in one anti- week Get up slowly hypertensives Do not stop antihypertensives abruptly Check with HCP before taking OTC meds (especially cold medicine) Beta blockers – teach diabetic patient interactions ACEI and A2RB – teach no salt substitute with K, low K diet, no K supplements  A patient’s blood pressure (BP) is 134/82 mm Hg. The health care provider prescribed a diuretic to lower this BP. The nurse knows that this BP is Practice Question #1 A. within the prehypertensive range. B. indicating stage 1 hypertension. C. indicating stage 1 hypertension according to the diastolic pressure. D. indicating stage 2 hypertension according to the new guidelines for hypertension. Practice Question Answer: B #1 Rationale: A BP of 134/82 indicates stage 1 hypertension. The systolic range for stage 1 is 130 to 139, and the diastolic range for stage 1 is 80 to 89.  A patient is receiving an angiotensin II receptor blocker (ARB). Which does the Practice Question nurse recognize as an ARB? #2 A. Losartan (Cozaar) B. Amlodipine (Norvasc) C. Captopril (Capoten) D. Metoprolol (Lopressor)  Answer: A Practice Question Rationale: ARBs have a suffix of -sartan. #2 Losartan (Cozaar) is an ARB. Amlodipine is a calcium channel blocker; captopril is an ACE inhibitor with a common suffix of - pril. Metoprolol is a beta blocker with a common suffix of -lol.  A patient is receiving an angiotensin II receptor blocker. It is most important for Practice Question the nurse to assess the patient for #3 A. constipation. B. tremors. C. asthmatic attacks. D. dizziness. Practice Question Answer: D #3 Rationale: Side effects/adverse effects of ARBs include dizziness, diarrhea, insomnia, occasional cough, and upper respiratory infection.  An African-American patient is to be treated with initial monotherapy to control hypertension. The nurse expects the patient Practice Question to receive #4 A. diuretics. B. angiotensin-converting enzyme inhibitors. C. alpha-adrenergic blockers. D. beta blockers.  Answer: C Rationale: African Americans do not respond Practice Question well to diuretics as the initial monotherapy for controlling hypertension. This group is #4 susceptible to low-renin hypertension; therefore, they do not respond well to beta blockers and ACE inhibitors. The antihypertensive drugs that are effective for African Americans are alpha1 blockers and calcium channel blockers.  The nurse should instruct a patient to not suddenly stop taking antihypertensives in Practice Question order to avoid #5 A. rebound bradycardia. B. rebound tachycardia. C. rebound hypertension. D. rebound hypotension. Practice Question Answer: C #5 Rationale: Abrupt discontinuation of antihypertensive drugs may cause rebound hypertension  A patient with hypertension is ordered to receive an ACE inhibitor. The nurse identifies a common benign side effect of Practice Question this class of medications as #6 A. hiccups. B. flatulence. C. abdominal distention. D. a dry cough.  Answer: D Practice Question Rationale: The primary side effect of ACE #6 inhibitors is a constant, irritated cough. Other side effects include nausea, vomiting, diarrhea, headache, dizziness, fatigue, insomnia, serum potassium excess, and tachycardia.  Before administering the alpha-adrenergic blocker prazosin (Minipress), it is most important for the nurse to assess the Practice Question patient for a history of #7 A. renal disease. B. refractory heart failure. C. hypertension. D. benign prostatic hypertrophy.  Answer: A Practice Question Rationale: Prazosin (Minipress) is used to #7 treat refractory heart failure, hypertension, and benign prostatic hypertrophy. Contraindication to use of the drug is renal disease.  When administering antihypertensive medications to Asian Americans, it is most important for the nurse to Practice Question A. increase the dose of beta blockers. #8 B. monitor blood pressure carefully. C. expect to administer the usual dose antihypertensive medications. D. understand that this cultural group does not believe in treating hypertension.  Answer: B Rationale: Asian Americans are twice as sensitive as whites to beta blockers and other Practice Question antihypertensives. A reduction in #8 antihypertensive dosing is frequently needed. Native Americans have a reduced or lower response to beta blockers compared with whites. Monitoring blood pressure and drug dosing should be an ongoing assessment for these cultural groups.