Chapter 44 Antihypertensives

Question 1

REGULATORS OF BLOOD PRESSURE

Answer 1

Baroreceptors in the aorta and carotid sinus
Vasomotor center in the medulla
Hormones: antidiuretic hormone (ADH), atrial natriuretic peptide (ANP), brain natriuretic peptide (BNP)

Question 2

PHYSIOLOGIC RISK FACTORS

Answer 2

Physiologic risk factors
➢Excessive intake of saturated fat and simple carbohydrates
➢Alcohol: increases renin secretions
Cultural responses to antihypertensive agents
➢African Americans
➢Asian Americans
Hypertension in older adults

Question 3

GUIDELINES FOR DETERMINING HYPERTENSION

Answer 3

Category
Systolic Pressure
Diastolic Pressure
Normal
Less than 120 mm Hg
Less than 80 mm Hg
Prehypertension
120 to 139 mm Hg
80 to 89 mm Hg
Stage 1 hypertension
140 to 159 mm Hg
90 to 99 mm Hg
Stage 2 hypertension
Greater than 160 mm Hg
Greater than 100 mm Hg

Question 4

ANTIHYPERTENSIVE DRUGS

Answer 4

Diuretics
➢Thiazides: hydrochlorothiazide
➢Loop (high-ceiling) diuretics: furosemide (Lasix)
➢Combinations of hydrochlorothiazide with potassium-sparing diuretics and other antihypertensive drugs (e.g., ACE inhibitors)
Side effects
➢Potassium loss or hypokalemia and others

Question 5

SYMPATHOLYTICS

SYMPATHETIC DEPRESSANTS) (CONT.

Answer 5

•Centrally acting alpha2 agonists: methyldopa, clonidine, guanabenz, and guanfacine
➢Contraindications
•Impaired liver function
➢Side effects
•Sodium and water retention, dry mouth, bradycardia
➢Diuretics are frequently prescribed to avoid fluid retention.
➢Avoid abruptly stopping drug.
•Rebound hypertension may result.

Question 6

NURSING PROCESS: BETA-ADRENERGIC BLOCKERS

Answer 6

•Assessment
•Nursing diagnoses
•Planning
•Nursing interventions
➢Patient teaching
➢Cultural considerations
Evaluation

Question 7

SYMPATHOLYTICS
(SYMPATHETIC DEPRESSANTS) (CONT.)
Alpha adrenergic blockers

Answer 7

Alpha-adrenergic blockers
➢Action
●Block the alpha-adrenergic receptors, resulting in vasodilation and decreased blood pressure
➢Drugs
●Doxazosin (Cardura)
●Prazosin HCl (Minipress)
●Terazosin HCL (Hytrin)
➢Side effects: orthostatic hypotension, nausea, headache, drowsiness, nasal congestion caused by vasodilation, edema, and weight gain

Question 8

SYMPATHOLYTICS
(SYMPATHETIC DEPRESSANTS) (CONT
Adrenergic neuron blockers

Answer 8

Adrenergic neuron blockers (peripherally acting sympatholytics)
➢Block norepinephrine release from the sympathetic nerve endings, decrease in norepinephrine release, result lower BP
➢Reserpine
➢Side effects: Orthostatic hypotension

Question 9

SYMPATHOLYTICS
(SYMPATHETIC DEPRESSANTS) (CONT.)
Alpha 1 and beta 1 adrenergic blockers

Answer 9

Alpha1- and beta1-adrenergic blockers
➢Labetalol (Normodyne)
➢Carteolol (Cartrol)

Question 10

NURSING PROCESS: ALPHA- ADRENERGIC BLOCKERS

Answer 10

Assessment
Nursing diagnoses
Planning
Nursing interventions
➢Patient teaching
➢Cultural considerations
Evaluation

Question 11

DIRECT-ACTING ARTERIOLAR VASODILATORS

Answer 11

Relaxing the smooth muscles of the blood vessels, mainly the arteries, causing vasodilation
Hydralazine
Minoxidil

Question 12

CALCIUM CHANNEL BLOCKERS

Answer 12

Action
➢Decrease calcium levels and promote vasodilation
Examples
➢Diphenylalkylamine (verapamil), benzothiazepines (diltiazem), and dihydropyridine (amlodipine and others)
Side effects/adverse reactions
●Flush, headache, dizziness, ankle edema, bradycardia, and AV block

Question 13

HYPERTENSION

Answer 13

Selected regulators of blood pressure

➢Kidneys via renin-angiotensin system