HES-005-Session-17-SAS.docx

**Session 17** 1. 2. Describe the pharmacologic action of the different antihypertensive drugs. 3. WORD SCRAMBLE ============= -- ----------------- [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] -- ----------------- ANTIHYPERTENSIVE DRUGS =...

**Session 17** 1. 2. Describe the pharmacologic action of the different antihypertensive drugs. 3. WORD SCRAMBLE ============= -- ----------------- [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] -- ----------------- ANTIHYPERTENSIVE DRUGS ====================== - affect different areas of blood pressure control so in most cases, these agents are combined for synergistic effect. - Ninety percent of cases of hypertension have no known cause. Therefore, the main action of antihypertensive agents is to alter the body's regulating mechanisms (e.g. baroreceptors, renin-angiotensin-aldosterone system, etc.) responsible for maintaining normal blood pressure. - Different people have different responses towards hypertensive agents because hypertension is multifactorial. For an instance, the presence of comorbidities (e.g. diabetes, myocardial infarction, etc.) may make some antihypertensives not suitable for treatment. 1. essential hypertension: there is elevated total peripheral resistance. Also, the organs are perfused effectively and people with essential hypertension usually exhibit no symptoms. It is also the reason why hypertension is tagged as the "silent killer." 2. secondary hypertension is characterized by elevated blood pressure due to a known cause. For example, a [tumor] in the adrenal medulla called phaeochromocytoma can cause the organ to release a high amount of catecholamines, which greatly increase blood pressure. - Normal -- systolic: \ - Allergy to ACE inhibitors. Prevent severe hypersensitivity reactions. - Renal impairment. Decreased renal blood flow effect of these drugs can exacerbate renal impairment. - Heart failure. Changes in hemodynamics caused by these drugs can exacerbate heart failure. - Hyponatremia and hypovolemia. Can be exacerbated by the therapeutic effects of the drug. - Pregnancy and lactation. Can cause potential adverse effects to the fetus and can decrease milk production. Pregnant women are advised to use barrier type of contraceptives while taking this drug. - GI: irritations, ulcer, constipation, liver injury - GU: renal insufficiency, renal failure, proteinuria - CV: reflex tachycardia, chest pain, heart failure, cardiac arrhythmias - EENT: rash, alopecia, dermatitis, photosensitivity - - Allopurinol: increased risk for hypersensitivity - - Educate patient on importance of healthy lifestyle choices which include regular exercise, weight loss, smoking cessation, and low-sodium diet to maximize the effect of antihypertensive therapy. - Administer drug on empty stomach one hour before or two hours after meal to ensure optimum drug absorption. - Monitor renal and hepatic function tests to alert doctor for possible development of renal and/or hepatic failure as well as to signal need for reduced drug dose. - Monitor for presence of manifestations that signal decreased in fluid volume (e.g. diarrhea, vomiting, dehydration) to prevent exacerbation of hypotensive effect of drug. - Educate patient and family members about drug's effect to the body and manifestations that would need reporting to enhance patient knowledge on drug therapy and promote adherence. II. - Like ACE inhibitors, they can also be used alone for treatment of hypertension or in combination with other antihypertensive agents. - Utilized in treatment of heart failure for patients who do not respond to ACE inhibitors. - By blocking the effects of angiotensin receptors in vascular endothelium, these drugs are able to slow down the progress of renal disease in patients with type 2 diabetes and hypertension. - Children: safety and efficacy of ARBs has not been established in this age group. - Adults: ARBs are not allowed during pregnancy. - Older adults: are more susceptible to drug toxicity because of underlying conditions that would interfere with metabolism and excretion of drug. Renal and hepatic function should always be monitored. - Allergy to ARBs. Prevent severe hypersensitivity reactions. - Renal and hepatic impairment. Can alter metabolism and excretion of drugs which can increase the risk for toxicity. - Hypovolemia. Can be exacerbated by the drug's action on blocking important life-saving compensatory mechanisms. - Pregnancy and lactation. Can cause potential adverse effects to the fetus and potential termination of pregnancy between second and third trimester. It is still not known whether ARBs can enter breast milk but it is generally not allowed in lactating women because of potential adverse effects to the neonate. - CNS: headache, dizziness, syncope, weakness - Respiratory: symptoms of upper respiratory tract infections (URTI), cough - GI: diarrhea, abdominal pain, nausea, dry mouth, tooth pain - - Phenobarbital, indomethacin, rifamycin: loss of effectiveness of ARBs - - Educate patient on importance of healthy lifestyle choices which include regular exercise, weight loss, smoking cessation, and low-sodium diet to maximize the effect of antihypertensive therapy. - Administer drug with food to prevent GI distress associated with drug intake. - Monitor renal and hepatic function tests to alert doctor for possible development of renal and/or hepatic failure as well as to signal need for reduced drug dose. - Provide comfort measures (e.g. quiet environment, relaxation techniques, etc.) to help patient tolerate drug effects. - Educate patient and family members about drug's effect to the body and manifestations that would need reporting to enhance patient knowledge on drug therapy and promote adherence. III. - - These drugs inhibit the movement of calcium ions across myocardial and arterial muscle cell membranes. As a result, action potential of these cells are altered and cell contractions are blocked. - Resultant effects include: depressed myocardial contractility, slow cardiac impulse in conductive tissues, and arterial dilation and relaxation. - Like ACE inhibitors and ARBs, they can also be used alone for treatment of hypertension or in combination with other antihypertensive agents. - Extended-release preparations are usually indicated for hypertensions in adults. - Children: calcium-channel blockers is the drug group that is first considered in cases of hypertension in this age group that needs drug therapy. - Adults: these drugs are not allowed during pregnancy. - Older adults: are more susceptible to drug toxicity because of underlying conditions that would interfere with metabolism and excretion of drug. Renal and hepatic function should always be monitored. - Allergy to calcium-channel blockers. Prevent severe hypersensitivity reactions. - Heart block (sick sinus syndrome). Can be exacerbated by conduction-slowing effect of the drug. - Renal and hepatic impairment. Can alter metabolism and excretion of drugs which can increase the risk for toxicity. - Pregnancy and lactation. Can cause potential adverse effects to the fetus and should not be used unless the benefit to the mother clearly outweighs the risk to the fetus. It is not clear whether this drug can enter breast milk so another method of feeding is implemented for lactating mothers who are taking this drug. - CNS: headache, dizziness, light-headedness, fatigue - CV: hypotension, bradycardia, peripheral edema, heart block - GI: nausea, hepatic injury - - Increased serum level and toxicity of cyclosporine if taken with diltiazem. - - Educate patient on importance of healthy lifestyle choices which include regular exercise, weight loss, smoking cessation, and low-sodium diet to maximize the effect of antihypertensive therapy. - Monitor blood pressure and heart rate and rhythm to detect possible development of adverse effects. - Provide comfort measures for the patient to tolerate side effects (e.g. small frequent meals for nausea, limiting noise and controlling room light and temperature to prevent aggravation of stress which can increase demand to the heart, etc.) - Educate patient and family members about drug's effect to the body and manifestations that would need reporting to enhance patient knowledge on drug therapy and promote adherence. - Emphasize to the client the importance of strict adherence to drug therapy to ensure maximum therapeutic effects. IV. - - These antihypertensive agents exert their effect by acting directly on smooth muscles. Consequently, there will be muscle relaxation and vasodilation. Both of these will cause drop in blood pressure. - As mentioned, these drugs are only used for hypertension cases that do not respond to other drug therapies. - Nitroprusside is used in maintaining controlled hypotension during surgery. - Nitroprusside is administered intravenously; hydralazine is available for oral, intravenous, and intramuscular use; and minoxidil is available for oral use only. - Allergy to direct vasodilators. Prevent severe hypersensitivity reactions. - Cerebral insufficiency. Can be exacerbated by drug's action to cause sudden drop in blood pressure. - Peripheral vascular disease, CAD, heart failure, tachycardia. These conditions can be exacerbated by sudden drop in blood pressure. - Pregnancy and lactation. Can cause potential adverse effects to the fetus and should not be used unless the benefit to the mother clearly outweighs the risk to the fetus. The drug can enter the breast milk and can cause potential adverse effects to the neonate. If needed by lactating mothers, another method of feeding is instituted. - CNS: headache, dizziness, anxiety - CV: reflex tachycardia, heart failure, edema, chest pain - GI: nausea, vomiting, GI upset - EENT: rash, lesions (e.g. minoxidil is associated with abnormal hair growth.) - Nitroprusside is metabolized into cyanide so it can cause cyanide toxicity characterized by dyspnea, ataxia, loss of consciousness, distant heart sounds, and dilated pupil. - - Each drug in this group act differently on the body so each drug should be checked for potential drug-to-drug and drug-to-food interactions. - Educate patient on importance of healthy lifestyle choices which include regular exercise, weight loss, smoking cessation, and low-sodium diet to maximize the effect of antihypertensive therapy. - Monitor blood pressure and heart rate and rhythm closely to evaluate for effectiveness and ensure quick response if blood pressure falls rapidly or too much. - Provide comfort measures for the patient to tolerate side effects (e.g. small frequent meals for nausea, li miting noise and controlling room light and temperature to prevent aggravation of stress which can increase demand to the heart, etc.) - Monitor patient for any manifestations that could decrease fluid volume inside the body (e.g. vomiting, diarrhea, excessive sweating, etc.) to detect and treat excessive hypotension. - Educate patient and family members about drug's effect to the body and manifestations that would need reporting to enhance patient knowledge on drug therapy and promote adherence. - Emphasize to the client the importance of strict adherence to drug therapy to ensure maximum therapeutic effects. **CASE SCENARIO** You will read and analyze the case scenario. Answer all the questions based on the data presented in the scenario. 1. How will you respond? \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ 2. Formulate a health teaching plan to ensure Mr. M.G's compliance to his medication regimen. Multiple Choice =============== 1. A. B. C. D. 2. E. F. G. H. 3. A student nurse was asked to take the blood pressure of a patient in the emergency room. The BP reads 140/90 mmHg. She would be correct to say that this BP belongs to [ ] classification. I. J. K. L. 4. M. N. O. P. 5. A patient receiving nitroprusside begun manifesting headache, distant heart sounds, imperceptible pulses, and shallow breathing. The nurse knows that these are signs of? Q. R. S. T.. 6. the nurse is administering antihypertensive drugs to older adults patients. the nurse knows that which adverse effect is of most concern for these patients? U. V. W. X. 7. Y. Z. A. B. 8. A client receiving HCTZ 25 mg q.d. and digoxin 0.125 mg q.d. complains of nausea and vomiting, and of seeing halos around lights. The client\'s serum digoxin level is 2.5 ng. The appropriate nursing intervention is to: C. D. E. F. 9. Nitroprusside (Nitropress) is prescribed for a client admitted with a blood pressure of 220/110. What action by a new nurse would require intervention by the charge nurse? G. H. I. J. 10. The nurse reviews the teaching plan with a client receiving nifedipine (Procardia). Which of the following client behaviors indicates understanding? K. L. M. N. 11. A diuretic is added to the treatment regimen for a client with hypertension. The nurse explains that diuretics help reduce blood pressure by: O. P. Q. R. 12. S. T. U. V. 13. W. X. Y. Z. 14. A. B. C. D. 15. E. F. G. H. 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. I CARE WHY ? ============