Ch. 13: Drugs for Hypertension Flashcards
a drug that opposes the excitatory effects of norepinephrine released from sympathetic nerve endings at alpha receptors and causes vasodilation and a decrease in blood pressure. also called alpha-adrenergic blocking agents
alpha blocker
drugs that combine with the effects of alpha blockers and beta blockers
alpha-beta blockers
diffuse swelling of the face, including the eyes, lips, and tongue. may progress to swelling of the trachea, which is life threatening
angioedema
group of drugs that modulate the renin-angiotensin-aldosterone system and lower blood pressure
angiotensin II receptor antagonist
substance or drug that lowers BP
antihypertensive
hardening of the arterial walls
arteriosclerosis
clogging, narrowing, and hardening of the large arteries and medium size blood vessels of the body, which can lead to stroke, heart attack, and eye and kidney problems
atherosclerosis
drug that limits the activity of epinephrine (a hormone that increases BP); reduce the heart rate and force of muscle contraction, thereby reducing the oxygen demand of the heart
beta blocker (beta adrenergic blocker)
force of blood pushing against the walls of the arteries as it flows through them
blood pressure
drug that slows the movement of calcium into the cells of the heart and blood vessels, relaxing blood vessels and reducing the workload of the heart
calcium channel blocker
drugs that lower BP by stimulating alpha receptors in the brain, which open peripheral arteries and ease blood fow
central-acting adrenergic agents
blood pressure when the heart is resting between beats
diastolic blood pressure
drugs that act directly on the smooth muscle of small arteries, causing these arteries to expand
direct vasodilators
drug that eliminates excess water and salt from the body
diuretic
arterial disease in which chronic high BP is the primary symptom. abnormally elevated BP
hypertension
dangerously high and life-threatening BP of acute onset
hypertensive crisis
low BP
hypotension
reduction of systolic BP of at least 20 mmHg or diastolic of at least 10 mmHg within 3 minutes of standing
orthostatic hypotension
hypertension for which there is no known cause but is associated with risk factors; 85-90% of hypertensive cases
primary (essential) hypertension
hypertension caused by specific disease states and drugs
secondary hypertension
blood pressure when the heart contracts
systolic BP
any drug that relaxes blood vessel walls
vasodilator
a drug that lowers blood pressure by working with the angiotensin-converting enzyme
ACE inhibitor
what are some lifestyle changes for treating hypertension?
decrease sodium intake, decreased fat intake, lose weight, exercise regularly, quit smoking, decrease alcohol intake, decrease and manage stress
what medications should a patient with high BP not take?
OTC allergy and cold drugs that contain phenylephrine
what are some disorders that could cause secondary hypertension?
partial blockages of the arteries to the kidneys, diseases that damage the kidneys such as infections and diabetes, tumors of the adrenal glands, sleep apnea
what are some drugs that could cause secondary hypertension?
NSAIDs and corticosteroids; OTC allergy and cold drugs that contain phenylephrine
what should you do before giving any antihypertensive drug?
obtain a complete list of drugs the patient is taking, obtain a baseline set of vitals (if low, hold drug and consult provider), ask patient about s/s such as dizziness, light-headedness, and headaches; ask women if they are pregnant, plan to become pregnant, or are breastfeeding
what should you do after giving any hypertensive drug?
monitor VS every 4-8 hours, ask pt about dizziness and light-headedness (signs of hypotension), notify provider of positive orthostatic vitals, tell pt to call for help when getting up and change positions slowly
what should you teach all patients taking antihypertensive drugs?
proper techniques for checking BP and HR and keep a daily record of these, remind about s/s of hypotension, remind to change positions slowly, instruct them not to drive or operate machinery until they know how the drug will affect them, keep all follow-up appts, never take a double dose, notify prescriber of s/s of hypotension or chest pain, these drugs help control not cure hypertension, obtain and wear a medical bracelet
what should you tell a patient to do if they miss a dose?
if they next dose is not due for over 4 hours, take the missed dose as soon as possible. if it is due sooner than 4 hours, skip the missed dose and return to the normal schedule
these are often the first-choice drugs for hypertension
diuretics
how do diuretics work?
they help eliminate excess salt and water from the body tissues and blood, which causes a decrease in body fluids and lowers blood pressure. some also relax arteries to further decrease BP
what diuretics are commonly prescribed for uncomplicated hypertension?
Thiazide diuretics
what are the intended responses of diuretics?
urine output increased, decreased volume in blood vessels, excess salt in the body is decreased, blood vessels are dilate, BP is lowered
what are side effects of diuretics
dizziness, light-headedness, postural hypertension, hypokalemia, hyponatremia
what are adverse effects of diuretic drugs?
‘passing out’ or falling when changing positions, muscle weakness, blurred vision
what should you do before giving diuretics?
check the most recent potassium level, inform the prescriber if it is lower than 3.5, ask about allergic reactions to thiazide drugs
what should you do after giving diuretics?
monitor urine output and BP to determine effectiveness, watch for signs of ototoxicity with IV admin of furoseminde, monitor blood electrolytes (especially potassium)
what should you teach patients about taking diuretics?
keep a record of daily weights (weigh at the same time every day wearing the same type of clothes, on the same scale), report side effects such as: muscle weakness or cramps, sudden decrease in urination, irregular heart beat; take any potassium pills or liquids that are ordered; drink the same amount of fluid they void; teach them about which foods are high in potassium
how do ACE inhibitors work?
they block the production of an enzyme that is necessary for angiotensin II to be made (angiotensin II constricts blood vessels) and help to decrease the buildup of water and salt in the blood and body tissues. so the result is that blood vessels relax and BP is decreased. this also decreases the work load of the heart and increases the blood flow and oxygen to the heart and other organs
ACE inhibitors are given to patients with what types of health problems?
heart failure, kidney disease, and diabetes
what are ACE inhibitors commonly prescribed along with?
diuretics
what is the suffix for most ACE inhibitors?
-pril
what are some common ACE inhibitors?
captopril (Capoten), enalapril (Vaotec), lisinopril (Prinivil, Zestril), perindopril (Aceon), quinapril (Accupril), ramipril (Altace), trandolapril (Mavik)
what are the intended responses of ACE inhibitors?
production of angiotensin II decreased, vasodilation of blood vessels is increased, excess tissue water and salt are decreased, BP is lowered, workload on the heart is decreased
what are common side effects of ACE inhibitors?
hypotension, protienuria, taste disturbances, hyperkalemia, headache, dry persistent cough, diarrhea, nausea, and unusual fatigue
if a patient has a dry cough with one type of ACE inhibitor, what will happen when they take others?
they will likely have the cough then as well and should be prescribed another type of antihypertensive
what are the modifiable risk factors for hypertension?
smoking, overweight, sedentary lifestyle, diabetes, hyperlipidemia, oral contraceptives
what are non-modifiable risk factors for hypertension?
age, gender, family history, race
what are adverse effects of ACE inhibitors?
fever and chills; hoarseness; swelling in the face, hands, and feet; trouble swallowing or breathing; stomach pain; chest pain; rashes and itching skin; yellow eyes or skin; allergic reactions and kidney failure are rare, but are seen; angioedema; neutropenia (look for signs of infection); photosensitivity
what should you do if you notice a patient taking an ACE inhibitor develops a dry, persistent cough?
notify the prescriber and discontinue the drug
what should you do before giving an ACE inhibitor?
ask if the client has had any allergic reactions to any other drugs because they are more likely to develop an allergic reaction to an ACE inhibitor than any other BP medication; ask if they are also taking diuretics because ACE inhibitors enhance the BP lowering effects of them.
what should you monitor after giving an ACE inhibitor?
the clients potassium levels to make sure they are not too high (especially if they are already taking a potassium sparing diuretic); keep track of urine output and weight to monitor their kidney function; monitor for allergic reactions
what should you teach a patient who is taking an ACE inhibitor?
drinking alcohol increases BP lowering effects; take at same time every day; captopril should be taken 1 hour before eating or on an empty stomach; avoid salt substitutes; go to ER immediately if they notice facial swelling; wear protective clothing and limit direct sunlight when taking enalapril, quinapril, or ramipril
what should you consider before giving an ace inhibitor to a child?
they have a higher risk for severe side effects so the benefits should greatly outweigh the risks
what considerations should you make before giving an ACE inhibitor to a pregnant or breastfeeding woman?
they are pregnancy category D and can cause birth defects; should not be given to women who are pregnant or are thinking about becoming pregnant; these drugs pass into breast milk and should not be given to breast feeding women because they can lower BP and lead to kidney damage in the infant
what category is lisinopril?
pregnancy category C during the first trimester and D in the second and third
what are older adults at higher risk for when taking ACE inhibitors?
postural hypotension and should take extra precautions when changing positions or standing up
what should you watch for after giving the first dose of ACE inhibitors?
first dose hypotension
why do we want to be careful when giving lithium with an ACE inhibitor?
because it could make them hold on to more potassium and reach a toxic level
what is the suffix for most angiotensin II receptor antagonists?
-sartan
what are angiotensin II receptor antagonists (ARBs) usually given with?
diuretics
why are ARBs a better choice than ACE inhibitors?
they have fewer side effects and are better tolerated
when are lower doses of ARBs given?
when a patient is taking diuretics or has kidney or liver impairment
how are ARBs metabolized and excreted by the body?
they are broken down by the liver and excreted through the kidney - this is why you don’t want to give higher doses to someone with kidney or liver impairment
what are some common ARBs?
losartan (Cozaar); valsartan (Diovan); irbesartan (Avapro); candesartan (Atecand); telmisartan (Micardis); eprosartan (Teveten)
what are the intended responses of ARBs?
vasodilation of blood vessels is increased; excess body water and salt are decreased; BP is lowered; workload on the heart is decreased
what are the side effects of ARBs?
few documented - dizziness, fatigue, headache, hypotension, diarrhea, hyperkalemia
what are the adverse effects of ARBs?
rare - kidney failure; angioedema; liver toxicity or drug-induced hepatitis
what should you do before giving ARBs?
check blood urea nitrogen (BUN) and creatinine levels (checking for kidney function); ask whether they have had kidney or liver disease because these can worsen liver problems
what should you do after giving ARBs?
watch for s/s of angioedema; check urine output and weight and report decreased urine output or increased weight to prescriber; check potassium lab values; assess heart rate and rhythm (especially monitoring for a slow rate); assess for an increase height of T waves (sign of hyperkalemia); assess bowel sounds (increased bowel sounds and diarrhea are signs of hyperkalemia)
what should you teach a patient about taking ARBs?
precautions related to antihypertensives; alcohol use, exercise, standing for long periods, and hot weather may contribute to hypotension; talk to doctor if they are pregnant or planning to become pregnant; go to ED immediately if they notice s/s of angioedema; remind them that angioedema can show up months to years after starting drug
what considerations should you make when giving ARBs to a child?
safe use under 18 has not been established
what considerations should you make about giving ARBs to pregnant or breastfeeding women?
pregnancy category C during first trimester and D during the second and third; it is not known if they pass into breast milk, but breast feeding women should not take these drugs
what category is valsartan during pregnancy?
it is a category D through all trimesters
how do calcium channel blockers work?
they block calcium from entering the muscle cells of the heart and arteries which causes a decrease in the contraction of the heart and dilates the arteries. widening the arteries causes a decrease in BP and reduces the workload of the heart
which patients are initially lower doses of calcium channel blockers used for?
older patients with hepatic or renal impairment
what are the intended responses of calcium channel blockers?
heart contraction decreased, artery dilation increased, heart workload decreased, BP lowered, blood flow and oxygen to heart are increased
what are the side effects of calcium channel blockers?
constipatoin, nausea, headache, flushing, rash, edema (usually legs), hypotension, drowsiness, dizziness, gingival hyperplasia in children, gynecomastia when taking verapamil
what are the adverse effects of calcium channel blockers?
dysrhythmias; irregular, rapid, pounding, or excessively slow heart rhythms; Steven-Johnson syndrome; difficulty breathing; irregular, rapid, or pounding heart rhythm; slow heart rate; bleeding; chest pain; vision problems
what are symptoms of Stevens-Johnson Syndrome?
different types of skin lesions, itching, fever, aching joints, generally feeling ill
what are some adverse effects of verapamil and diltiazem?
they have increased abilities to reduce the strength and rate of heart contraction so patients with heart failure symptoms may worsen. they can cause atrial flutter, atrial fibrillation, paroxysmal supraventricular tachycardia, exacerbate bradycardia, sick sinus syndrome, heart failure, second or third degree heart block
what do verapamil and diltiazem do?
they are agents that act on vascular smooth muscle and the heart so that overall cardiac effects are vasodilation accompanied by reduced arterial pressure and increased coronary perfusion
what are therapeutic uses for verapamil and diltiazem?
angina pectoris, hypertension, cardiac dysrhythmias, verapamil can be used for migraines
what are dihydropyridines?
calcium channel blockers that act mainly on vascular smooth muscle. they don’t act on the heart’s calcium channels as much and are not used to treat dysrhthmias because they have no direct effect on cardiac conduction or contractile force. -pine
when would you use nicardipine HCL (Cardene) IV?
for short-term treatment of hypertension when oral therapy is not feasible or desired?
what are precautions used with nicardipine HCL (Cardene) IV?
liver and renal impairment, CHF, closely monitor HR and BP
what is an adverse reaction with nifedipine?
reflex tachycardia
what should you do before giving calcium channel blockers?
find out if the patient has any health problems that could be affected by these drugs like heart failure, blood vessel disease, and liver or kidney disease
what should you do after giving calcium channel blockers?
report any irregular heart rhythms to prescriber, watch for side effects and adverse effects; if pt develops skin lesions, itching, fever, and achy joints, report this to the prescriber immediately
what should you teach a patient about taking calcium channel blockers?
general issues/precautions associated with taking antihypertensive; exercising in hot weather can cause dizziness and low BP; get up slowly; don’t stop suddenly taking these drugs or hypertension may return
has safe use for pediatric patients been indicated with calcium channel blockers?
no
what pregnancy category are calcium channel blockers?
category C, pregnant women should not take them unless the benefits outweigh the risks and should not take them while breast feeding
what are some examples of calcium channel blockers?
amlodipine (Norvasc); diltiazem (Cardizem); felodipine (Plendil); nicardipine (Cardene); nifedipine (Adalat, Procardia, Procardia XL); verapamil (Calan, Isoptin)
what is the suffix for beta blockers?
-olol
how do beta blockers work?
they block the effects of epinephrine on the heart, decreasing the heart rate and force of heart contractions, which leads to decreased BP. as a result, the heart does not work as hard and requires less O2.
what is the difference between cardioselective and noncardioselective beta blockers?
cardioselective drugs only work on the cardiovascular system while noncardioselective drugs work on all of the organs and systems of the body
how are beta blockers prescribed to someone with kidney damage?
in lower doses or with increased time between the doses
what are the intended responses of beta blockers?
heart rate decreased, decreased force of heart contraction, decreased work of heart, lowered BP
what are the side effects of beta blockers?
decreased sexual ability, dizziness or light-headedness, drowsiness, insomnia, fatigue or weakness, dyspnea, wheezing, cold hands or feet, mental depression, SOA, bradycardia, edema in ankles feet or lower legs, depression (first time or recurrent)
what are adverse effects of beta blockers?
bradycardia (very slow); chest pain; severe dizziness or fainting; fast or irregular heart rate; dyspnea; bluish colored fingernails and palms; siezures; ‘passing out’ or falling when changing positions; back or joint pain; dark urine; orthostatic hypotension; fever or sore throat; hallucinations; irregular heart rate; skin rash; unusual bleeding or bruising; yellow eyes or skin; hypo or hyperglycemia in a pt with diabetes
what should you do before giving beta blockers?
if the pt has diabetes, check their blood sugar because beta blockers can mask the symptoms of hypglycemia; ask about a history of depression; check HR, BP; ask about weight change and a history of asthma
what should you do after giving a beta blocker?
monitor HR and BP; monitor for hypoglycemia and SOA; check for edema
what should you teach patients about taking beta blockers?
general precautions related to antihypertensives; not to sit or stand up quickly; don’t suddenly stop taking beta blockers because this puts them at risk for an MI; notify prescriber of weight gain or SOA (worsening signs of heart failure); make sure they inform the physician that they are taking a beta blocker before any procedure or emergency treatment or medical tests or allergy shots; report chest pain experienced during activity to prescriber; stay out of direct sunlight, use sunblock and wear protective clothing; can cause new onset depression or worsen depression
what are pediatric considerations for beta blockers?
no evidence that they are at greater risk, but parents need to talk to prescriber about risks and benefits
what are considerations for pregnant women regarding beta blockers?
most are category C and shouldn’t be taken unless absolutely necessary. are excreted in breast milk so women who are breast feeding should consult with prescriber about continued use of the drug
what pregnancy category is atenolol? acebutolol?
atenolol is category D, acebutolol is category B
why are older adults prescribed a lower dose of beta blockers?
they have a higher rate and intensity of side effects such as dizziness. a common side effect for them is mental confusion
what are some common side effects with older people taking beta blockers?
they may have increased mental confusion and decreased tolerability to cold temperatures
how do alpha blockers work?
they block receptors in arteries and smooth muscles, relaxing blood vessels and leading to an increase in blood flow and a decrease in BP
what does the risk of hypotension with alpha blockers increase with?
the dose
what are the intended responses of alpha blockers?
artery relaxation and dilation; blood flow increased, BP lowered
what are the side effects of alpha blockers?
dizziness, drowsiness, fatigue, headache, nervousness, irritability, stuffy or runny nose, nausea, pain in arms and legs, hypotension, weakness, may have first dose hypotension (they may initially be more sensitive to it, but as they take it more they will become less sensitive)
what is the suffix for alpha blockers?
-zosin
what are adverse effects of alpha blockers?
lower BP more than desired; fainting; SOA; dyspnea; fast, pounding, or irregular heart rhythm; chest pain; swollen feet, ankles, or wrists.
adverse effects are rare
what drugs should you not give with alpha and beta blockers?
drugs for erectile dysfunction
what should you teach patients who are taking alpha blockers?
don’t drive or operate machinery for at least 24 hours after the first dose, weight themselves twice a week and check ankles for swelling. any signs of fluid overload should be reported to prescriber
when should you give the alpha blockers prazosin and terazosin?
give the fist dose at bedtime and caution the patient not to get up without assistance. orthostatic hypotension is common for the first dose
has safe use of alpha blockers been established in children?
no, parents should discuss risks and benefits with prescribers
what pregnancy category are alpha blockers? does it pass into breast milk?
pregnancy category C. it passes into breast milk so mothers who plan to breast feed need to talk to their pediatrician
what considerations should you make with the older adult taking alpha blockers?
higher frequency and stronger side effects with these drugs especially hypotension, confusion, and increased risk for falling, so they often need lower doses.
how do alpha-beta blockers work?
they combine the effects of alpha and beta blockers. they relax blood vessels like alpha blockers and slow the heart rate and decrease force of heart contractions like beta blockers
what are some common alpha-beta blockers?
carvedilol (Coreg) and labetalol HCL (Normodyne, Trandate)
what are the intended responses of alpha beta blockers?
artery relaxation and dilation are increased, decreased heart rate, decreased force of heart contraction, decreased workload on the heart, blood flow and oxygen to the heart are increased, BP decreased
what are the side effects of alpha-beta blockers?
dizziness, fatigue, weakness, orthostatic hypotension, diarrhea, impotence, hyperglycemia, anxiety, depression, drowsiness, insomnia, memory loss, mental status changes, nausea, constipation, decreased sex drive, itching and rash, back pain, muscle cramps, and paresthesia
what are the adverse effects of alpha-beta blockers?
suddenly stopping them can cause heart dysrhythmias, hypertension, or chest pain. can also have bradycardia, heart failure, and pulmonary edema, yellow skin or eyes, swelling of the feet or ankles, weight gain, wheezing or trouble breathing, cold hands or feet, and difficulty sleeping
what should you do before giving alpha-beta blockers?
obtain a baseline weight, check blood glucose levels in the patient with diabetes
what should you do after giving alpha-beta blockers?
check for signs of fluid overload, check diabetic patient’s glucose, intake and output, weigh them daily
what should you teach a patient taking alpha-beta blockers?
don’t stop taking them suddenly because this can lead to life-threatening problems. contact prescriber for irrecultar heart rate, bradycardia, and BP changes, can cause drowsiness so don’t drive or operate machinery, change positions slowly, carefully watch for signs of changes in blood sugar
what should you tell patients taking labetalol
they may become more sensitive to cold and need to dress warmly
what considerations should you make for pregnant and breastfeeding women taking alpha-beta blockers
they are category C. they cross the placenta and cross into breast milk and may cause slowed heart rate, hypotension, hypoglycemia, and depressed respirations in the newborn and should be avoided
how do central-acting adrenergic agents work?
they stimulate CNS receptors to decrease the constriction of blood vessels, leading to the dilation of the arteries and lower BP
what are some common central-acting adrenergic agents?
clonidine, methyldopa
what are the intended responses of central-acting adrengeric agents
vasodilation increased, BP lowered, heart workload decreased
what are side effects of central-acting adrenergic agents?
drowsiness, lethargy, dry mouth, nasal congestion, decreased mental status, bradycardia, edema, hypotension, depression, palpitations, constipation, nausea, vomting, rash, sweating, salt retention, weight gain
what are adverse effects of central-acting adrenergic agents?
myocarditis is a common allergic reaction to methyldopa
what should you do before giving central acting adrenergic agents?
obtain a baseline weight, if the drug is packaged with two patches, the smaller one contains the medication and the larger one is used to cover the smaller one
what should you do after giving central acting adrenergic agents?
monitor I&O, check feet and ankles for swelling, listen for crackling in lungs, watch for mental status changes, watch for depression
what should you teach the patient taking central-acting adrenergic agents?
drugs should be discontinued gradually, patch can stay on while swimming and bathing, if the patch falls off apply a new patch, how to relieve dry mouth symptoms
what category drug is clonidine?
pregnancy category c
what category is methyldopa?
pregnancy category B when prescribed by mouth and C when prescribed IV
what considerations should you make with the older adult on central acting adrenergic drugs?
they need lower doses because they are more sensitive to the side effects and are at increased risk for orthostatic hypotension
how does a vasodilator work?
it relaxes blood vessel walls, causing them to widen and decreasing BP
what are some common vasodilators?
hydralazine, minoxidil
what are the intended responses of vasodilators?
vasodilation increased, BP decreased, heart workload decreased
what aer some side effects of vasodilators?
tachycardia, hypernatremia, dizziness, drowsiness, fatigue, headache, chest pain, edema, dysrhythmias, low BP, diarrhea, nausea, vomiting, rashes, peripheral neuropathies
what adverse effect may occur with the vasodilator minoxidil?
Stevens-Johnson syndrome
what should you teach patients about vasodilators?
contact prescriber if you miss more than 2 doses, discontinue gradually, tell patients to report persistent hr increase of more than 20 beats per min, report weight gain of more than 3lbs per week
what pregnancy category is hydralazine?
c, but has been safely used in women who are pregnant and breastfeeding. small amounts pass into breast milk. talk to prescriber before taking
