CH 34: HTN - Drug classification + HTN crisis Flashcards
heart
- hypertrophy, MI, HF (watch for rapid weight gain, 5lbs/2-3 days), SOB, BLE edema
eyes:
- blindness –> have frequent eye checks
brain:
- stroke - assess for speech changes, drooping face, one-sided weakness
kidneys:
- kidney failure - watch for protein in urine (micro/macro-albuminuria)
What is the first line treatment option for HTN? and which drug is 1st choice?
diurectics = often first choice of drug for treating mild to moderate HTN
- thiazide diuretic = first line treatment option for HTN
- multi-drug therapy often required
What do diuretics do? are there any AEs?
decr blood volume and decr BP
AEs:
- dehydration
- hyponatremia
- hypokalemia (less w/ K+ sparing diuretics)
- nocturia (if taken too late in day)
- orthostatic hypotension
What diuretics are used for HTN?
- thiazide + thiazide-like diuretics (most common for HTN): hydrochlorothiazide
- potassium-sparing diuretics: triamterene, spironolactone
- loop (high-ceiling) diuretics: not usually used for HTN; furosemide, bumetanide (can cause K+ depletion)
ACEI - what are the adverse effects?
blocking renin-angiotensin-aldosterone system leads to decr in BP
- persistent cough
- postural hypotension
- hyperkalemia
- angioedema
Adrenergic antagonists - beta blockers AEs?
nonspecific causes bronchoconstriction - use w/ caution for pts w/ asthma / HF
- low doses: AEs uncommon
higher doses:
- fatigue, activity intolerance
- erectile dysfunction
- masks symptoms of hypoglycemia
- clinical depression
ARBS - what does it do and AEs?
- inhibits effects of angiotensin II
- similar effects to ACEI
- drug = losartan
fewer AEs than ACEI
- hypotension
- angioedema (more rare)
- more expensive
- no cough
Vasodilators - how do they lower BP?
- relax arterial smooth muscle directly = decr resistance (pressure coming back up) and decr afterload
- affects veins and arteries
- some drugs also affect veins, such as isosorbide dinitrate (long-acting nitrate) = decr preload
relax arteriolar smooth muscle –> decr resistance, and therefore decr afterload
Vasodilators - AEs?
- reflex tachycardia and hypotension
- compensatory incr in HR due to suden drop in BP
- fluid retention
- can be minimized with beta blockers and diuretics
Vasodilators - what agents are used?
- hydralazine
- diazoxide
- nitroprusside
Prototype drug for direct-acting vasodilators?
Therapeutic + pharmacologic classification
therapeutic: antiHTN
pharmacologic: direct vasodilator
prototype drug = hydralazine (Apresoline)
hydralazine (Apresoline) - what is the therapeutic effects and uses?
vasodilator
- moderate to severe HTN
- hypertensive emergencies
- acute HF
hydralazine (Apresoline) - what is the mechanism of action?
- causes peripheral vasodilation
- decr peripheral vascular resistance, HR & CO
- decr afterload
- selective for arterioles (selective for afterload)
hydralazine (Apresoline) - what are the nursing considerations?
- Hx & Px (esp BP)
- monitor lab tests for antinuclear antibody titer before and during therapy
- monitor I&O - potential with fluid retention/edema
- watch for adverse effects (i.e., palpitations/CP) - heart!!!
- assess for rapid drop in BP and subsequent tachycardia (can put into shock)
