Antihypertensives Flashcards
Normal BP
less than 120/80
Elevated BP
SBP between 120-129 and DBP less than 80
HTN Stage 1
SBP between 130-139 or DBP between 80-89
HTN Stage 2
SBP greater than or equal to 140 or diastolic greater than or equal to 90
HTN Urgency
180/120 without s/s of end-organ damage
HTN Emergency
HTN with s/s of end-organ damage (malignant, accelerated)
Result of HTN (diseases)
- HF
- CAD/ACS
- AMS
- CVA
- RF
- PVD
- papilledema
- preeclampsia
- eclampsia
- aortic aneurism/dissection
ways the body increases BP in chronological order (5)
- Norep, Epi (CNS/PNS/adrenal) => tachycardia, vasoconstriction
- Angiotensinogen (liver) + renin (kidney)=> angiotensin I
- Angiotensin I + ACE (epithelium) = angiotensin II (vasoconstriction)
- Angiotensin II => aldosterone (adrenal) => fluid retention
- ADH (hypothalamus) => fluid retention
diuretics side effects
- prevent renal reabsorption of fluid => diuresis and natriuresis => decreased IV volume
- “diuretic contraction” = increased concentration of blood content that are not excreted in urine (blood cells, glucose, uric acid, lipids = electrolyte imbalances)
- decreased BP = orthostatic hypotension, dizziness, syncope, FALL
= poor renal perfusion => AKI
= tachycardia (reflex tachy too)
= hypovolemia SO assess for edema and assess pt’s wt daily
diuretics electrolyte imbalance side effects
- hypokalemia
- hypomagnesemia
- hyponatremia
- metabolic acidosis
- hyperglycemia
- hyperuricemia
- hyperlipidemia
LOW: K, Mg, Na, bicarb
HIGH: Ca, BG, uric acid, LDL
diuretics hypokalemia s/s and nursing (3)
- K+ replacement always should be considered along with diet high in K+ (exception?)
- Monitor for S/S (AMS, ileus, N/V, weakness, respiratory arrest, ventricular dysrhythmia)
- Dysrhythmia (check Hx., place on cardiac monitor and treat as indicated)
diuretics hypomagnesemia nursing (3)
- Monitor for S/S (dysrhythmia, weakness, tremor, muscle twitching)
- Dysrhythmia (check Hx., place on cardiac monitor and treat as indicated)
- Report low Mg level to provider and replace (PO/IV)
diuretics hyponatremia s/s and nursing (1)
- Monitor for S/S (muscle cramps, weakness, brain herniation, AMS, seizure, coma)
diuretics metabolic acidosis nursing (2)
- Monitor for low Bicarb on the ABG
2. Caution: patient with respiratory disorders are at higher risk of acidosis
diuretics hyperglycemia nursing (1)
- Monitor BG more closely in patients with diabetes (higher risk of hyperglycemia)
diuretics hyperuricemia nursing (2)
- Monitor uric acid levels
2. Caution in gout patients (assess history)
diuretics hyperlipidemia nursing (3)
- Caution in patient with hyperlipidemia (review Hx)
- Higher risk of atherosclerosis complications (angina, CVA, etc.)
- Monitor lipid panel
Nursing with diuretics (5)
- Assess ability to use the urinal/BSC in 30 minutes after taking
- Adherence
- build rapport to understand the root cause of non-adherence
- avoid taking potassium supplement while skipping the diuretic dose = hyperkalemia & fluid overload!! you can skip the dose but then ALSO skip your potassium
- Take diuretics earlier in the day rather than close to bedtime
- Keep a log of BP & daily weight
- Contraindications:
- Hypovolemia, pregnancy, lactation, anuria (oliguria - low level of urine)
thiazides and thiazide-like diuretics drugs (3) and routes
PO (IV only chlorothiazide) Thiazides: 1. chlorothiazide - PO/IV 2. hydrochlorothiazide (aka HCTZ) - PO Thiazide-like: 1. *metolazone*, chlortalidone, indapamide - Give it an hour before Loop
loop diuretics - furosemide, bumetanide, torsemide general
Strongest and safest diuretics
renal vasodilator
- All diuretics cause AKI due to loss of blood volume/lower BP (lower renal perfusion)
- only diuretic that may be used in CKD and AKI
aldosterone receptor blocker; K-sparing diuretics drugs - spironolactone, eplerenone, triamterene, amiloride MOA and route
PO, Weakest diuretics
MOA: blocks the action of aldosterone => K retention, water, Na, bicarb excretion
drugs that block the heart and BV (sympatholytic drugs) (3)
- beta-blockers
- alpha2 agonist
- diuretics
drugs that affect only the BVs (5)
- direct acting vasodilators
- alpha-1 blockers
- ACEi
- ARB
- CCB
beta-blockers (-lol) drugs and route
IV/PO
- propranolol**
- nadolol
- timolol
- metoprolol**
- atenolol**
- esmolol
- carvedilol**
- labetalol**
alpha-2 agonist - methyldopa, clonidine, guafacine - MOA
MOA: decreased sympathetic stimulation
—->decreased HR, decreased CO, vasodilation (decreased peripheral resistance)
antihypertensives drugs (2) and route
IV/PO
- hydralazine
- minoxidil
alpha-1 blocker drugs (5)
For HTN & BPH:
- prazosin
- terazosin
- doxazosin
ONLY for BPH:
- tamsulosin
- silodosin
ACE inhibitors (-pril) drugs (5)
- benzepril
- captopril
- lisinopril
- enalapril
- enalaprilat
angiotensin receptor blockers (ARBs) MOA
block the receptor site of angiotensin II
- —> very similar to ACEi but not as effective
- —> prevents vasoconstriction = low BP
- —> tachycardia (reflex)
what are the 2 types of calcium channel blockers (ccb’s)
- -dipine: specific to vasculature, used for HTN
2. verapamil & diltiazem: used for tachy-dysrhythmia
vasculature CCBs drugs (2) and route
IV/PO (specific to vasculature)
- amlodipine
- nifedipine
managing symptomatic w/ drugs for hypotension & orthostatic hypotension (4)
- IV fluid - crystalloid (NS) or colloid volume expander (albumin) if edematous
- midodrine PO/IV - if the pt is at risk of hypervolemia or after hemodialysis
- MOA: alpha1 agonist = vasoconstriction
- SE: urinary retention (BPH), supine HTN (HTN associated with lying supine, check BP & administer while pt is in supine position)
- Contraindications: AKI
FOR HYPOVOLEMIC SHOCK (EMERGENCY)
- emergency drugs, used for shock and cardiopulmonary resuscitation
3. vasopressin = ADH
4. dobutamine (beta1 agonist)
drug groups for HTN
- diuretics
- beta blockers
- alpha2 agonists
- direct acting vasodilators
- alpha1 blockers
- ACEi
- ARB
- CCB
drug groups for hypotension
- crystalloid IV
- colloid IV
- alpha1 agonist
- emergency medicines
loop diuretics - furosemide, bumetanide, torsemide routes
IV/PO/IM
loop diuretics - furosemide, bumetanide, torsemide nursing
- DILUTE & very slow IVP to avoid tinnitus
- –> ototoxicity
aldosterone receptor blocker; K-sparing diuretics drugs - spironolactone, eplerenone, triamterene, amiloride secondary indication (2)
- With other diuretics to balance potassium
2. Treatment of adult acne (MOA: anti-androgenic effect)
aldosterone receptor blocker; K-sparing diuretics drugs - spironolactone, eplerenone, triamterene, amiloride nursing (4)
Diet:
- avoid high potassium foods (oranges, grapefruit, potatoes, bananas, dried fruits)
Monitor HYPERkalemia:
- Place on heart monitor (dysrhythmia)
- —>Bradycardia/cardiac arrest, peaked T (cardiac monitor)
- Monitor for paresthesia, abd/muscle cramps, weakness, fatigue
- avoid with ACEi, ARB
aldosterone receptor blocker; K-sparing diuretics drugs - spironolactone, eplerenone, triamterene, amiloride adverse affects (1)
- Anti-androgenic effect
- —>male (impotence, gynecomastia)
- —>female (deepened voice, irregular menstrual cycles)
beta-blockers (-lol) MOA (3)
- decrease HR (negative chronotrope)
- decrease excitability (negative dromotrope)
- decrease BP
beta-blockers (-lol) indication and secondary uses
Indication: angina/MI, dysrhythmia, HTN, HF
—->secondary uses: glaucoma, migraine
beta-blockers (-lol) side effects
- even selective beta-blockers become nonselective at high dose (blocking beta2 and bronchospasms)
- —> monitor breath sounds (for worsening or new wheezing)
- bradycardia, hypotension, dysrhythmia (FALL)
- —>monitor trend of HR, BP, cardiac rhythm
- —>postural hypotension and FALL (Nursing: lie down if feeling dizzy, avoid sudden changes of position)
- —>impotence, decreased libido (build rapport and discuss factors that may affect adherence)
beta-blockers (-lol) contraindications (4)
- bradycardia, hypotension (call provider and hold for HR less than 60 or SBP less than 90)
- asthma, COPD (bc bronchospasm is a possible side effect!)
beta-blockers (-lol) nursing (3)
- masks hypoglycemia s/s (palpitation) so monitor DM pt’s BG for asymptomatic hypoglycemia)
- avoid stopping abruptly, wean off over 1-2 weeks
- at home keep a log HR/BP and associated s/s
alpha-2 agonist - methyldopa, clonidine, guafacine side effects
- sodium/water retention (use with diuretics & monitor daily wt and edema)
- bradycardia
- orthostatic hypotension, dizziness, FALL
- impotence, decreased libido
alpha-2 agonist drugs (3)
- methyldopa
- clonidine
- guafacine
alpha-2 agonist - methyldopa, clonidine, guafacine contraindications (2)
- pregnancy, lactation
alpha-2 agonist - secondary uses of clonidine
- Cancer pain
- ADHD
- opioid withdrawal
- migraine
- menopause flushing
alpha-2 agonist secondary uses of brimonidine & apraclonidine (1)
for eye drops for glaucoma
antihypertensives - hydralazine** and minoxidil - MOA
MOA: direct-acting vasodilator
antihypertensives - hydralazine** and minoxidil - side effects
- Less blood pressure in kidney => fluid/Na retention (combine with diuretics)
- increased permeability with arteriodilation (edema, nasal congestion, HA) combine with diuretic
- Orthostatic hypotension (FALL)
- tachycardia (reflex) (patient reports palpitation)
antihypertensives - hydralazine** and minoxidil - indications
quick management of acute HTN, preeclampsia
antihypertensives - hydralazine** and minoxidil - contraindications
RF, concurrently with sildenafil
alpha1 blocker - prazosin, terazosin, doxazosin, tamsulosin, silodosin - MOA
vasodilator (decreased peripheral resistance), relaxing prostate
alpha1 blocker - prazosin, terazosin, doxazosin, tamsulosin, silodosin - side effects
- orthostatic hypotension (FALL)
- sodium/water retention (use with diuretics & monitor daily wt & edema)
- tachycardia (reflex)
- erectile dysfunction
ACE inhibitors (-pril) MOA
MOA: angiotensin-converting enzyme inhibitor - prevent angiotensin II formation -> decreased peripheral resistance and afterload
ACE inhibitors (-pril) indication
Indication: HTN & HF
ACE inhibitors (-pril) contraindication
PAAK: pregnancy, allergy, AKI pts (but helpful to CKD pts), K increases
ACE inhibitors (-pril) side effects and adverse effects
- increases bradykinin (inflammatory mediator) = dry hacking cough, angioedema
- AKI, HYPERkalemia (monitor K, dysrhythmia, paresthesia, weakness, cramps)
- orthostatic hypotension, tachycardia (reflex), dizziness, fall (change position slowly, lie down if dizzy)
angiotensin receptor blockers (ARBs) indications
HTN & HF
angiotensin receptor blockers (ARBs) contraindications
PAAK: pregnancy, allergy, AKI pts (but helpful to CKD pts), K increases
angiotensin receptor blockers (ARBs) side effects
- AKI, hyperkalemia (monitor K, dysrhythmia, paresthesia, weakness, cramps)
- orthostatic hypotension, tachycardia (reflex), dizziness, FALL (change position slowly, lie down if dizzy)
calcium channel blockers (ccb’s) indication
- angina
- HTN
calcium channel blockers (ccb’s) side effects
- peripheral edema –> nursing: daily wt and I/Os
- decreased BP
= tachycardia reflex
= FALL
= monitor renal panel for AKI
calcium channel blockers (ccb’s) MOA
systemic vasodilation = decreased BP
—-> if SBP less than 90 = call the provider and hold drug
