BLOOD PRESSURE MEDICATION Flashcards
What are the 3 conditions that can cause HTN?
- OSA
- Kidney Dx
- HYPERthyroidism
Why are some patients reluctant to take hypertensive medications?
Because it has no Sign and Symptons ‘SILENT KILLER” and they feel “okay”
What is the use of Diuretics?
Decrease the amount of fluid in the bloodstream —–> decrease in BP
This type of diuretics is the “FIRST LINE” therapy for HTN
THIAZIDE
What are the 5 Classes of Diuretics?
- CHLORTHAlidone
- Furosemide
- Hydrochlorothiazide
- Mannitol
- Spironolatone
Aside from HTN, what are the other uses of Diuretics?
- Peripheral Edema
- Pulmonary Edema
- Heart Failure
This type of diuretics is mainly use for cerebral edema
MANNITOL
which part of nephron does Furosemide work on?
ASCENDING loop of HENLE
—> that is why it is referred to as “LOOP DIURETICS”
What are the adverse effects of Diuretics?
-Dehydration
-Hypotension
-Electrolyte Imbalance (HYPOKALEMIA)
How do you prevent “Nocturia” when taking diuretics?
Take the medication before 2 pm
What are the 2 things that you should know about Furosemide?
- Powerful
- Produce Rapid Result
What are the CM of Hypokalemia?
FATIGUE
Weakness
Muscle Cramps
N/V
Dysrhythmias
How do you counteract Hypokalemia when taking Furosemide?
Eat Potassium Rich Foods
What are examples of Potassium rich foods? (remember yellow and orange)
-Winter squash
-Sweet potatoes
-Baked Potatoes
-White Beans
-Yogurt
-Orange Juice
-Broccoli
-Cantaloupe
What are the 2 rare adverse effects of FUROSEMIDE?
- Ototoxicity
- Tinnitus
—-> this is reversible once the medication is stop
What type of diuretics is HYDROCHLOROTHIAZIDE and CHLORTHALIDONE?
Thiazide diuretics
What type of furosemide are the first line treatment fro HTN?
Thiazide
-Hydrochlorothiazide
-Chlorthalidone
Why is thiazide diuretics considered as the first line treatment for HTN?
- Safe
- Effective
- Inexpensive
What are the key issues for Thiazide that can also be seen with Loop diuretics?
They both cause Hypokalemia
What should a nurse do if a patient is taking loop diuretics and thiazide?
- Monitor for S&S of Hypokalemia
What kind of diuretics is Spinorolactone?
POTASSIUM SPARRING
What does Potassium Sparring means?
It causes nephrons to hold on to potassium rather than excreting it
—> may lead to HYPERKALEMIA
If Spinorolactone is considered as “WEAK” diuretics, why is it still prescribed?
To counteract the potassium loss by diuretics like furosemide and HCTZ
What kind of food should a patient taking Potassium Sparring diuretics should avoid?
- Potassium rich foods
- Salt substitute (they are high in K+)
Muscle cramps is associated with?
HYPOKALEMIA
Muscle Weakness is associated with?
HYPERKALEMIA
Mannitol can only be administered _______
IV
What does mannitol do to the blood?
HYPERTONIC
Describe the mechanism of Mannitol
Once it reaches the Kidney, it is filtered by glomerulus which pulls water out into the urine (makes you pee)
How can a mannitol treat CEREBRAL EDEMA?
Mannitol cannot cross BBB
so it creates an OSMOTIC FORCE that pulls extra fluid out of the brain
this type of diuretics is important in treating Head Trauma?
Mannitol
What are the 2 key issues with Mannitol
- It leaks out of regular capillaries = EDEMA / [worsens HF and P.Edema]
- It crystallizes at room temperature
How do you avoid the crystallization of Mannitol?
Store it in room warmer temperature
Use IV FILTER when administering it
What medical device should you put to monitor U/O for patient taking Mannitol?
Urinary Catheter
What are the 2 other names of Beta Blockers?
-Sympatholytics
-beta adrenergic antagonist
Beta blockers are commonly prescribe for?
-HTN
-Angina Pectoris
-Atrial Fibrillation
-Cardioprotection [following a heart attack]
What are the 2 types of Beta Blocker?
- Cardioselective agents
- Non selective agents
What are the 2 cardioselective agents? (BETA BLOCKER)
- ATENOlol
- METOPROlol
What are the 3 Nonselective Agents? (BETA BLOCKERS)
- CARVEDIlol
- LABELAtol
- PROPANOlol
which beta blockers are alpha1, beta1, and beta2 receptors?
Carvedilol and Labelatol
Which receptors does Propanolol blocks?
beta1 and beta2
Which hormone is beta blocker related to?
Adrenaline
What happens when adrenaline is activated?
Increase BP, HR, and expanded AIRWAYS [lungs]
How does beta blockers work?
It stops the adrenaline system by blocking receptors
This receptor is located in the ARTERIES and VEINS
Alpha1
What happens when ALPHA1 is: ACTIVATED vs BLOCKED
Activated = VASOCONSTRICTION (increase BP)
Blocked = VASODILATION (decrease BP + decrease the workload of heart)
What happens when Beta1 is: ACTIVATED vs BLOCKED
Activated = cause heart to beat FASTER and STRONGER (increase BP)
Blocked = decreases HR and stregth of contraction (decrease BP) + improves heart rhythm problems
This receptor is located in the heart
Beta1
This receptor is located in the lungs
Beta2
What happens when Beta2 is: ACTIVATED vs BLOCKED
Activated = Bronchodilation
Blocked = Bronchoconstriction [not good]
What happens when beta blockers work too well?
BRADYCARDIA + HYPOTENSION
—> beta blockers lower HR and BP, so if they work too well, they will cause Bradycardia and Hypotension
TRUE OR FALSE: ALPHA1 Receptors DOES NOT change the HR?
TRUE
A patient taking beta blocker should ___________ and ______________ before starting strenuous activity
- stand up SLOWLY
- Check how body is reacting to beta blockers
When should you HOLD the beta blocker?
HR is <50
SBP is <100
Before administering beta blockers, what should the nurse ALWAYS DO/check?
Check Hr and BP
What are the issues of Beta Blockers for patient with DIABETES?
HYPOGLYCEMIA
- when beta 2 is blocked [receptor responsible in triggering muscles and live to release stored glucose when patient has low BS], stored glucose will no be produced
- When HR is increased, you may feel SHAKY and SWEATY, which is a signal for pt with diabetes to check and blood sugar and correct it
—>Beta blockers mask this symptom making it harder for them to recognize if they are being HYPOGLYCEMIC
What is a good education for a patient with diabetes taking beta blockers?
ALWAYS CHECK BS
Why should patient with ASTHMA or COPD avoid taking nonselective beta blockers?
patient with asthma or COPD uses albuterol [beta2 antagonist], which means it activates the beta2 receptor. On the other hand, non selective betablockers BLOCKS the beta2 receptors
Why do beta blockers cause Depression?
because they cross BBB
What should a client considered when giving beta blockers for patient with history of depression?
Beta blockers can cause depression because they cross BBB
what is an example of beta blocker that crosses BBB and cause depression?
Pronapolol
What is the disadvantage of beta blockers for patients that are men?
It may cause erectile dysfunction
—> hypertension may also cause E.D
What are the 3 ACE inhibitors?
- Benazepril
- Lisonopril
- Ramipiril
Ace inhibitors are prescribed for?
-HTN
-Heart Failure
-cardioprotection
Angiotensin II is responsible for ______ and ________
- Vasoconstriction (increase bp)
- Aldosterone Secretion (increase blood volume = increase bp)
What are the 3 Major effects of Angiotensin II?
- Vascular Smooth Muscle contraction (increase bp)
- triggers receptors in the adrenal gland causing released of ALDOSTERONE (water retention = increase blood volume = increase bp)
- High levels of aldosterone = harmful changes in heart muscle
How does Ace inhibitor works?
It blocks the enzyme “ACE” that converts angiotensin I into its active form [angiotensin II]
—–> This causes VASODILATION and PREVENTS release of aldosterone
—————> clients will urinate more and will have a lower bp + heart is protected against pathological changes that occur after MI
What are the side effects of Ace INHIBITORS?
- HYPOTENSION
- HYPERKALEMIA
- PERSISTENT DRY COUGH
- ANGIODEMA
What is the meaning of ARBS?
Angiotensin II Receptor Blockers
What are the 3 ARBS?
- Losartan
- Olmesartan
- Valsartan
Aside from treating HTN, HF, and cardioprotection, what other treatments are ARBS used for?
slows the progression of CKD by reducing the pressure inside the kidney
What is the mechanism of action of ARBS?
it blocks angiotensin II receptor in blood vessels (VASODILATION) and adrenal glands (SECRETION OF SODIUM AND WATER)
What are the side effects of ARBS?
HYPOTENSION
ANGIODEMA
What are the side effects of ACE INHIBITOR that ARBS does not have?
Hyperkalemia and Cough
If ARBS only has 2 less side effects compared to Ace inhibitor, why is it not prescribed more?
the evidence for CARDIOPROTECTION is much stronger for ACE INHIBITOR
What are the 2 types of Calcium Channel Blocker?
- Dihydropyridines
- NonDihydropyridines
What are the 2 Dihydropyridines?
- Amlopidine
- Nifedipine
What are the 2 NonDihydropyridines?
- Diltiazem
- Verapamil
What should the client avoid when taking NonDihydropyridines?
Grapefruit Juice
How are Calcium channel blockers prescribed?
-HTN
-Chest Pain
-Atrial Fibrillation
What kind of Calcium Channel Blockers are prescribed for atrial fibrillation?
NonDihydropyridines
How does CCBs works?
CCBs block calcium channels in arteries = VASODILATION and Decereased BP
What are the second effect of NonDihydropyridines aside from blocking calcium channel in arteries?
they block calcium channels in SA and AV nodes causing decrease in HR
What are the adverse Effect of CCBs?
VASODILATION
-HYPOTENSION
-O.H
-Edema on ankles and feet
-Facial Flushing
-H.A
When client experiences Edema on ankles and feet, what does the prescriber do to avoid this?
-Decrease the dose of CCBs
-Add Ace Inhibitor
-Compression Stockings
What are the side effects of NonDihydropyridines?
BRADYCARDIA
—> this will be worse if patient is also taking a beta blocker
What is the other side effects of Verapamil?
CONSTIPATION
Why does Verapamil cause constipation?
Verapamil blocks the calcium channel blocker in smooth muscle of intestines
This medication is prescribed for HTN and combined with other antihypertensive medication?`
Hydralazine
How does hydralazine works?
causes arterioles to dilate
It has short life and requires frequent dosing
What are the side effects of hydralizine?
Hypoytension
HA
–>watch out for diziness and lightheadedness
