Drugs affecting blood pressure chapt 43

Question 1

What do cardiac meds do

Answer 1

Increase/decrease cardiac output
Increase/decrease blood pressure
Regulate cardiac rhythm
Decrease cardiac chest pain
Goal is to restore physiologic balance

Question 2

What is blood pressure

Answer 2

The force of blood against artery walls
Systolic pressure
Heart contracts

Diastolic pressure
Heart relaxes

Question 3

What causes hypertension?

Answer 3

Increased SNS stimulation
Increased activity of renin-angiotensin-aldosterone system
Diet, lack of exercise, stress , sodium intake, weight, ETOH, smoking
White Coat Hypertension(HTN @ doctors office)

Genetic variances

Question 4

What are age related causes of hypertension?

Answer 4

Decreased vasodilation
Plaque formation

Question 5

What are the stages of hbp?

Answer 5

Prehypertension: 120-129/ elevated
Stage 1 hypertension: 130-139
Stage 2 hypertension: 140-159
Stage 2 hypertension/crisis higher than 160

Question 6

Stepped Care Approach to Treating Hypertension
What is step 1?

Answer 6

Step 1: Lifestyle Modifications
Weight reduction
Smoking cessation
Moderation of alcohol intake
Reduction of salt in diet
Increase in aerobic physical activity

Question 7

Stepped Care Approach to Treating Hypertension
What is step 2?

Answer 7

If inadequate response –> continue lifestyle modifications & add drug therapy

Diuretic (decreases serum sodium levels and blood volume)
ACE inhibitor (blocks the conversion of angiotensin I to angiotensin II)
Calcium-channel blocker (relaxes muscle contraction) or other autonomic blockers
Angiotensin II receptor blocker (blocks the effects of angiotensin on the blood vessel)

Question 8

Stepped Care Approach to Treating Hypertension
What is step 3?

Answer 8

If inadequate response –> change dosage/ class or add additional medication

Question 9

Stepped Care Approach to Treating Hypertension
What is step 4?

Answer 9

If inadequate response—> 2nd or 3rd agent or diuretic agent added
All of the previous measures are continued.

Question 10

What are drug categories

Answer 10

**Angiotensin-converting enzyme inhibitors
**Angiotensin II receptor antagonists
**Vasodilators
Anti-arrhythmic
Anti-angina –> not primary use, but lowers BP
Diuretics
Sympathetic Nervous System Blockers

Question 11

How does the renin-angiotensin- aldosterone system work

Answer 11

-Decrease in blood flow to kidneys  kidneys secrete renin into circulation  travels to liver

-Renin converts angiotensinogen to angiotensin I

-Angiotensin I converts to angiotensin II in lungs

Angiotensin II constricts blood vessels  BP

-Angiotensin II also stimulates adrenals to secrete Aldosterone
Causes sodium & water retention
Increases blood volume

Question 12

What are 2 drug categories that affect RAS

Answer 12

-Angiotensin-Converting Enzyme (ACE) Inhibitors
-Angiotension II Receptor Blockers (ARBs)

Question 13

What are
-captopril (Capoten)
and
-enalapril (Vasotec)

Answer 13

Angiotensin-Converting Enzyme (ACE) Inhibitors

Question 14

What are indications of
-captopril (Capoten)
and
-enalapril (Vasotec)

Answer 14

Angiotensin-Converting Enzyme (ACE) Inhibitors
HTN

Question 15

What are therapeutic actions of
-captopril (Capoten)
and
-enalapril (Vasotec)

Answer 15

Angiotensin-Converting Enzyme (ACE) Inhibitors

Act in the lungs  prevent ACE from converting Angiotensin I to Angiotensin II

a powerful vasoconstrictor and stimulator of aldosterone release (see Fig.43.3). This action leads to a decrease in BP and in aldosterone secretion with a resultant increase in serum potassium and a loss of serum sodium and fluid.

Question 16

What are adverse effects of
-captopril (Capoten)
and
-enalapril (Vasotec)

Answer 16

Angiotensin-Converting Enzyme (ACE) Inhibitors

Hypotension, dizziness
Reflex tachycardia
GI issues
Irritating cough
pancytopenia (captopril)

Question 17

What are contras of
-captopril (Capoten)
and
-enalapril (Vasotec)

Answer 17

Angiotensin-Converting Enzyme (ACE) Inhibitors
-Allergy
-contraindicated during pregnancy because of the potential for serious adverse effects on the fetus and during lactation because of potential decrease in milk production and effects on the neonate.

Question 18

What to be cautious of when taking
-captopril (Capoten)
and
-enalapril (Vasotec)

Answer 18

Angiotensin-Converting Enzyme (ACE) Inhibitors

Impaired renal function; could be exacerbated by the effects of this drug in decreasing renal blood flow;

Salt/fluid depletion (*monitor weights

Question 19

What are drug to drug interactions of when taking
-captopril (Capoten)
and
-enalapril (Vasotec)

Answer 19

Angiotensin-Converting Enzyme (ACE) Inhibitors

NSAIDs – decreases antiHTN effect
ACE INHIBITORS CAN NOT BE TAKEN WITH FOOD

Question 20

What is losartan (Cozaar)?

Answer 20

Angiotension II Receptor Blockers (ARBs)

Question 21

What are the therapeutic actions of losartan (Cozaar)?

Answer 21

Angiotension II Receptor Blockers (ARBs)Allows

Angiotensin II to be made but prevents body from responding to Angiotensin II –>
prevents vasoconstriction
aldosterone secretion

Question 22

What are the indications of losartan (Cozaar)?

Answer 22

Angiotension II Receptor Blockers (ARBs)Allows

-hypertension,
-Slow renal dz in patients with HTN and type II diabetes

Question 23

What are adverse effects of losartan (Cozaar)?

Answer 23

Angiotension II Receptor Blockers (ARBs)Allows
Hypotension, dizziness
GI issues

Question 24

What are contras/cautions when taking losartan (Cozaar)

Answer 24

Angiotension II Receptor Blockers (ARBs)

-Impaired renal function
-Pregnancy

CAN be taken with food

Question 25

What is
hydralazine (PO, IV, IM)
nitroprusside (Nitropress) (IV)

Answer 25

Vasodilators

Question 25

What are therapeutic actions of
hydralazine (PO, IV, IM)
nitroprusside (Nitropress) (IV)

Answer 25

Vasodilators
-Acts directly on smooth muscle in blood vessels
Resulting in dilation, relaxation, and decreased PVR (Peripheral Vascular Resistance
-Reduces afterload

Question 26

What are indications of
hydralazine (PO, IV, IM)
nitroprusside (Nitropress) (IV)

Answer 26

Vasodilators
Often used in severe HTN crisis/ emergencies
lowers bp so sever and quick

Question 27

What are adverse effects of
hydralazine (PO, IV, IM)
nitroprusside (Nitropress) (IV)

Answer 27

Vasodilators
r/t changes in BP —> reflex tachycardia, dizziness, anxiety
Severe hypotension (freq VS when admin)
GI upset, N/V

Question 28

What are contras of
hydralazine (PO, IV, IM)
nitroprusside (Nitropress) (IV)

Answer 28

Vasodilators
Not in pregnancy/nursing
Cerebral insufficiency (cerebral insuffiecny will decreased blood flow even more to head)

Question 29

What are cautions of
hydralazine (PO, IV, IM)
nitroprusside (Nitropress) (IV)

Answer 29

Tachycardia, PVD, CAD, could be exacerbated bc lower bp

Question 30

What are cultural considerations with anti-hypertensives?

Answer 30

-More responsive to diuretics, calcium-channel blockers, and alpha-adrenergic blockers.

-Less responsive to ACE inhibitors, ARBs, renin inhibitors, and beta-blockers.

-Screening for hypertension among African Americans is important for detecting hypertension early and preventing the organ damage that occurs with prolonged hypertension. Because African Americans are more responsive to diuretics and calcium-channel blockers, the treatment approach should include the first-line use of either one of these medications or a combination of both along with diet and other lifestyle changes.

Question 31

What are life-span considerations of antihypertensives

Answer 31

Children–> long term effects not known
Diuretics, CCBs, BBs may be used

Older Adults —>renal/hepatic dz can lead to accumulation of drug

Question 32

Nursing Considerations: Anti-hypertensives
What to assess?

Answer 32

Allergies
VS, Neuro status
Physical assessment
Past medical history
Kidney dz, heart failure
Labs
Lifestyle influences

Question 33

Nursing Considerations: Anti-hypertensives
What are nursing diagnosis

Answer 33

Risk of falls/ injury r/t alterations in BP

Acute pain r/t GI distress (all) or cough (ACEI)

Ineffective tissue perfusion (total body) r/t changes in cardiac output

Question 34

Nursing Considerations: Anti-hypertensives
What are implementations?

Answer 34

Monitor BP closely
Safety measures
Educate signs of postural hypotension, safety measures
Educate (and encourage) lifestyle modifications
Proper administration:
Administer medications on empty stomach (ACEI)
Can administer with food to prevent GI distress (ARBs)

Question 35

Nursing Considerations: Anti-hypertensives
what to evaluate?

Answer 35

Monitor patient response to medication (maintenance of BP WNL)