Hypertension Flashcards
Exam 1
What types of medications are used to treat hypertension?
Diuretics, Sympathetic nervous system blockers, beta blockers, calcium channel blockers, and vasodilators
What are the three types of Diuretics?
Potassium-sparing
Thiazide (thiazide-like)
Loop
What is the mechanism of action in general diuretics?
Increase urinary output, decrease circulating volume, and decrease arterial resistance
What medication is the 1st line management of mild hypertension?
Thiazide diuretics- Hydrochlorothiazide
What is the mechanism of action of Hydrochlorothiazide?
Works on the distal convoluted tubule to inhibit resorption of sodium/potassium/chloride and decrease cardiac output. Results in water loss. Also relaxes arterioles and decreases peripheral vascular resistance.
What are the side effects of Hydrochlorothiazide?
Electrolyte and metabolic disturbances- HYPOKALEMIA
Orthostatic hypotension
May worsen renal insufficiency
Hyperuricemia (elevated uric acid)
Can elevate levels of glucose, cholesterol, and triglycerides
What nursing actions should we perform when a patient receives Hydrochlorothiazide?
Monitor potassium levels
Can give potassium supplements
Encourage food rich in potassium (avocado, spinach, bananas, sweet potatoes)
What medication is a loop diuretic?
Furosemide (lasix)
What is the mechanism of action for loop diuretics?
Inhibits the kidneys ability to reabsorb sodium in the LOOP OF HENLE. Makes kidneys put more sodium in the urine. Water follows the sodium = increased urine output.
What are the side effects of Furosemide?
HYPOKALEMIA and other electrolyte abnormalities
Dehydration
Hypotension
Ototoxicity- difficulty hearing, usually transient with furosemide
What are some nursing considerations for a patient receiving Furosemide?
Monitor potassium levels
Patients typically receive KCL supplements with their Lasix dose
What is the normal range for potassium?
3.5 - 5.0
Why is hypokalemia so important to monitor for?
Potassium works on the heart and can cause rhythm problems
What medication is a potassium-sparing diuretic (aldosterone agonist)?
Spironolactone
What is the mechanism of action for spironolactone?
Blocks the action of aldosterone (sodium and water retention) = potassium retention and excretion of sodium and water
Why is Spironolactone given?
Usually given in combination with other hypertensives/diuretics to get more effect with a lower chance of hypokalemia. Only provides small amount of diuresis and hypotensive effect
What are side effects associated with Spironolactone?
Can see HYPERkalemia
Endocrine effects: deepened voice, impotence, irregular menstrual cycles, gynecomastia, hirustism
What are the three types of Sympatholytics?
- Alpha-adrenergic blockers
- Centrally acting alpha 2 agonists
- Beta adrenergic blockers
What is the mechanism of action of Sympatholytics?
Decrease blood pressure by decreasing PERIPHERAL VASCULAR RESISTANCE. Sympathetic nervous system BLOCKERS- decreased vasoconstriction
What are the two types of beta adrenergic blockers (beta-blockers)?
Beta 1 receptors and Beta 2 receptors
Where are Beta 1 receptors located?
In the hear (called cardioselective beta receptors)
Where are Beta 2 receptors located?
In the lungs
What 3 medications are beta blockers?
Metoprolol, propanolol, and carvedilol
What is the suffix for beta blockers?
-OLOL
What kind of beta blocker is propanalol?
non-selective beta blocker
What kind of beta blocker is carvedilol?
Alpha and beta blockers
What is the mechanism of action for beta blockers?
Increases nitric oxide to cause a vasodilation response. Blocks stimulation of beta-1 receptors to decrease heart rate and contractility.
What are the side effects of beta blockers?
Fatigue/lethargy
Bradycardia
Hypotension
Can mask hypoglycemia
What are nursing considerations with a patient receiving beta-blockers?
Wean when discontinuing
Possibility of rebound hypertension if discontinued abruptly
If it is a non-selective beta blocker, do not use in patients with asthma or other breathing conditions
Recognize the risk for hypotension and/or bradycardia.
Hold and contact provider if HR is less than 60 or a systolic BP less than 100
Why are alpha-2 adrenergic agonist (centrally acting sympatholytic) typically not the first-line treatment?
High side-effect profile
What medication is an alpha-2 adrenergic agonist?
Clonidine
What is the mechanism action of Clonidine?
Decrease sympathetic outflow resulting in decreased stimulation of adrenergic receptors (both alpha AND beta receptors). Main outcome: decreased blood pressure.
What is a nursing consideration for a patient receiving Clonidine?
Do NOT abruptly discontinue- risk for rebound hypertension
What are potential side effects of Clonidine?
Drowsiness (most common)
Rebound hypertension
May worsen pre-existing liver disease
What medication is a selective alpha-1 blocker?
Doxazosin
What is the mechanism action of Doxazosin?
Selective alpha-1 blockade
Venous AND arterial dilation
What are side effects of Doxazosin?
Hypotension
Dizziness
What are the 3 types of RAAS blockers?
1 ACE inhibitors
2 ARBs
3 Renin inhibitor
What medication is safe and efficacious first-line therapy for hypertension and heart failure?
ACE inhibitors
What is the suffix for ACE inhibitors?
-PRIL
What medications are ACE inhibitors?
Captopril and Lisinopril
What is the mechanism of action of Captopril and Lisinopril?
Blocks angiotensin-converting enzyme (ACE). Inhibits production of Angiotensin-2 (powerful vasoconstrictor). Inhibits aldosterone secretion and leads to less water retention
Why is Captopril and Lisinopril the drug of choice for Diabetes Mellitus?
Has some renal protective effects
What are side effects of Captopril and Lisinopril?
First dose hypotension
Dry, non-productive, PERSISTENT cough
Dizziness
Rash
Serious: ANGIOEDEMA
Why is Captopril and Lisinopril not appropriate for pregnant women?
Teratogenic
What nursing considerations do we need to think about when a patient is on Captopril or Lisinopril?
Renal insufficiency- use cautiously in patients with a history of renal disease
Captopril can cause neutropenia- monitor WBC
Risk of hyperkalemia- especially if on K supplements
What medication are ACE-inhibitors often given in conjunction with?
Thiazide diuretics
What medication is an angiotensin receptor blocker (ARBs)?
Losartan
What is the suffix for angiotensin receptor blockers (ARBs)?
-sartan
What is the mechanism of action for Losartan?
Blocks the action of angiotensin 2 AFTER it has formed. Causes vasodilation and increased sodium and water retention.
What are indications for Losartan?
Hypertension
Heart failure
Stroke progression
Many more
What are side effects of Losartan?
Well tolerated
Some risk of angioedema
Use cautiously in patients with renal problems
What is very important for women when taking ARBs (Losartan)?
Requires the use of contraception if of childbearing age. Do not use if pregnant.
What medication is ARBs never given with?
ACE inhibitors
What medication is a renin inhibitor?
Aliskiren
What is the mechanism of action of Aliskiren?
Direct inhibition of renin.
What are side effects of Aliskiren?
Relatively well tolerated
GI discomfort
When given with ACE inhibitors, watch for hyperkalemia, especially in patients with diabetes
What nursing considerations do we need to take with patients taking Aliskiren?
Takes several weeks to see full effect
Do NOT take when pregnant
What medications are calcium channel blockers?
Nifedipine, amlodipine, nicardipine, verapamil, and diltiazem.
What two calcium channel blocker medications are more common to work on rhythm disturbances, not hypertension?
Verapamil and diltiazem
What is the mechanism of action of calcium channel blockers?
Blocks calcium access to cells causing decreased contractility and decreased conductivity of the heart and decreases the demand for oxygen
What are side effects of calcium channel blockers?
Orthostatic hypotension
Peripheral edema
What are nursing considerations for patients currently taking calcium channel blockers?
Often best for elderly and African Americans
Diuretics can be given for peripheral edema
What medication is a vasodilator?
Hydralazine
What is the mechanism of action of Hydralazine?
Vasodilators work directly on arterial and venous smooth muscles and cause relaxation.
Direct vasodilation causes decreased systemic and peripheral vascular resistance
What are side effects of Hydralazine?
HYPOTENSION
Dizziness, headache, tachycardia, edema, dyspnea, GI upset
