Chapter 34: HYPERTENSION (9) Flashcards
HTN
consistent elevation of systemic arterial BP
HTN factors
- Genetic factors
- Environmental factors
- diet
-exercise
-age
Primary HTN
Also called essential, there is NO identifiable cause
Secondary HTN
Caused by another disease
Where does prolonged HTN damage?
- Heart
- Eyes
- Brain
- Kidneys
How does prolonged HTN damage the heart?
Hypertrophy, MI, HF
What to watch for with heart damage from HTN
Rapid weight gain (5lbs in 2-3/days), SOB, BLE edema
How does prolonged HTN damage the eyes?
Blindness - frequent eye checks
How does prolonged HTN affect the brain?
Stroke - assess speech changes, drooping face, one sided weakness
How does prolonged HTN affect the kidneys?
Kidney failure
What to watch for with the kidneys and prolonged HTN?
protein in the urine (micro-macro albuminuria)
Kidneys like fishing nets, let micro pass but not macro
if macro is in urine = kidney problem
What arterial changes occur with prolonged HTN
Endothelial inflammation
arteriosclerosis
Atherosclerosis
What do arterial changes with prolonged HTN end with?
increased afterload leading to hypertrophy
CAD leading to MI
Cerebrovascular disease leading to stroke
What can lifestyle changes do for HTN
May eliminate the need for pharmacotherapy
What are some lifestyle changes to non pharmacologically treat HTN?
- Limit alcohol
- Restrict sodium consumption
- Dash diet
- Aerobic exercise at least 30 mins 3-5x/week
- Tobacco cessation
- Stress management
- Maintain optimum weight
What is the DASH diet?
rich in fruits, veggies, whole grains, and low fat dairy foods (includes meat fish, poultry, nuts and beans)
limited in sugar sweetened foods and drinks, red meat and added fats
What are racial differences associated with HTN treatment
Same therapy for blacks and nonblacks with CKD
Different therapy for blacks and nonblacks without CKD
Lower systolic BP with diabetics (decreased resistance to kidneys)
What’s important to note when managing HTN?
Not all people with a BP higher than 140/90 need pharmacotherapy
What are the different types of antihypertensives? (9)
- Diuretics
- Angiotensin-converting enzyme inhibits (ACEI)
- Angiotensin 2 receptor blockers (ARBS)
- Calcium channel blockers (CCBs)
- Beta 1 blockers (BBs)
- Beta 2 blockers
- Alpha 1 blockers
- Alpha 2 agonists
- Vasodilators
Goal of pharmacotherapy?
To reduce morbidity and mortality
What is pharmacotherapy individualized to?
Patients risk factors
Comorbid medical conditions
degree of BP elevation
What are some patient adherence factors to consider?
- Difficult of changing established lifestyle habits
- Choose generic forms to decrease cost of drug for pt
- occurrence of ADEs
- Encourage patient to report ADEs to adjust dosage (BB, depression, fatigue)
Diuretics are
often the 1st choice in treating mild-moderate HTN
What diuretic is first line treatment?
Thiazide diuretics
What do diuretics do?
Decrease blood volume and decrease pressure
ADEs of diuretics
Dehydration
Hyponatremia
hypokalemia (less with K+ sparing)
Nocturne (if given too late in the day)
Orthostatic hypotension
What are the 3 kinds of diuretics + prototype drug
- Thiazide/thiazide like diuretics
- most common for HTN
- HYDROCHLOROTHIAZIDE - Potassium-sparing diuretics
- TRIAMTERENE, SPIRONOLACTONE - Loop (high-ceiling) diuretics
- usually not used for HTN
- FUROSEMIDE, BUMETANIDE = K+
What do ACEIs do?
Vasodilation by reducing angiotensin 2
- decreased aldosterone effects
increases effectiveness of diuretics
- protect kidney
Common ACEI agents
enalpril, lisinopril, captopril
ACEI ADEs
Persistent cough
postural hypotension
hyperkalemia
angioedema
ARBS
Inhibit effects of angiotensin 2
- similar effects to ACEIs
ARBS ADEs
hypotension
angioedema (less common compared to ACEIs)
more expensive
no cough
Calcium channel blockers selective drugs
DIHYDROPIRIDINE
- relax arterial smooth muscle
- nifiedipine, amlodipine
CCBs Nonselective drugs
NONDIHYPROPIRIDINE
- relax arterial smooth muscle
- affect myocardial contraction and HR
- verapamil, diltiazem
CCBs ADEs
reflex tachycardia
peripheral edema
exacerbation of some dysrhythmias
worsens HF
research shows greater efficacy in African Americans and elderly patients
Adrenergic Antagonists
- used for cardio disorders
- block adrenergic receptors in SNS
What receptors do adrenergic antagonists block?
- Beta 1 adrenergic receptors
- Alpa 1 adrenergic receptors
- Alpha 2 and beta adrenergic receptors
- peripheral adrenergic neurons
Nonselective ABs and BBs
Carvedilol, labetalol
- block both alpha 1 and beta adrenergic receptors
How do nonselective ABs and BBs act in the body
decrease CO
decrease renin secretion
block vasoconstriction of arterioles and veins
Nonselective ABs and BBs ADEs
orthostatic hypotension
bradycardia
bronchoconstriction
potential for arrhythmias
watch with asthmatics, COPD, and DMs
What do BBs do
decrease HR, contractility, and cardiac conduction velocity = decreased BP
BB agents
Propanolol
metoprolol
atenolol
timolol
BB ADEs:
High doses:
- fatigue, activity intolerance
-erectile dysfunction
- masks symptoms of hypoglycemia
- clinical depression
Direct acting vasodilators
relax arterial smooth muscle directly = decrease resistance and decreased afterload
Vasodilators can also affect
some drugs affect veins which decrease preload (eg isosorbide denigrate)
Vasodilators ADEs
- reflex tachycardia & hypotension (compensatory increase in HR due to sudden BP drop)
- fluid retention (can be minimized with BBs and diuretics)
Vasodilators agents
hydralazine, diazoxide, nitroprusside
Vasodilators prototype drug?
Hydralazine
Hydralazine therapeutic
Antihypertensive
Hydralazine pharmacologic
direct vasodilator
Hydralazine uses
moderate to severe HTN
hypertensive emergiences
acute HF
Hydralazine MOA
Causes peripheral vasodilation
decrease PVR, HR, and CO
decreases afterload
selective for arterioles
Hydralazine ADEs
HA
tachycardia
palpitations
flushing
N/V/D
Orthostatic Hypotension
Lupus like syndrome
Hydralazine serious ADEs
Blood dyscrasia
Hydralazine contraindications/precautions
Lupus
CV disease
rheumatic Heart disease
renal impairment
slow aetylators
CAD
Hydralazine drug interactions
- severe hypotension with antihypertensives of MAOIs
- NSAIDs may decrease antihypertensive action
Hydralazine pregnancy category
C
Hydralazine OD treatment
- gastric lavage, activated charcoal, administration of a plasma volume expander
- treat tachycardia with a beta blocker
Hydralazine Considerations
Hx and Px
monitor lab tests fro antinuclear antibody timer before and during lab therapy
monitor I&O
watch for ADEs
Assess for rapid drop in BP and subsequent tachycardia
What classifies a Hypertensive emergency
Diastolic over 120
evidence of organ damage
most common cause is untreated/poorly controlled essential HTN
Urgency classification of HTN
Diastolic over 120
no evidence of organ damage
more conservative treatment
What is the prototype drug used for hypertensive emergencies?
Nitroprusside sodium (nitropress)
Nitroprusside therapeutic
Antihypertensive
Nitroprusside pharmacologic
direct vasodilators
Nitroprusside uses
aggressive, life threatening HTN
Nitroprusside MOA
direct relaxation of arteries and veins
Nitroprusside ADEs
Hypotension
headahce
dizziness
skin flushing
Nitroprusside contraindications
high ICP
inadequate cerebral circulation
compensatory HTN
serious renal impairment
Nitroprusside Pregnancy category
C
Nitroprusside treatment of OD
Vasopressor for extreme hypotension
cyanide antidote kit for cyanide toxicity
