Hypertension Medications (Exam 1) Flashcards
Diuretics
Potassium-Sparing: Mild
Thiazide (thiazide-like): Mild
Loop: Moderate to profound
General Diuretics
MOA: Increasing urinary output, Decreasing circulating volume, Decreasing arterial resistance
-Lower BP by decreasing CARDIAC OUTPUT. (Block Sodium and Chloride reabsorption)
-Can enhance effects of other anti-hypertensives
Cardiac Output
Amount of blood the heart is pumping out. Calculated by HR x SV
Thiaziaide (Thiaziade like) Diuretics
Hydrocholorothiazide [HCTZ] (HydroDiuril)
-1st line management of mild hypertension
Thiazaide Diuretics: MOA
-Works on the distal convoluted tubule to inhibit resorption of sodium/potassium/ and chloride = decreases Cardiac Output
-Results in water loss
-Also relaxes arterioles = decreased in (PVR)
-Can be used alone or in combination with other anti-hypertensives
Thiazide Diuretics: Side Effects
-Electrolyte and Metabolic disturbances. HYPOKALEMIA (low potassium)
-Orthostatic Hypotension
-May worsen renal insufficiency
-Hyperuricemia — watch out with gout patients
-Can elevate levels of glucose, cholesterol, and triglycerides
Thiazide Diuretics: Nursing Actions
Monitory Potassium Levels
HYPOKALEMIA (low potassium) can lead to issue with our cardiac rhythms
Loop Diuretic Medication
Furosemide
(very strong)
(PO or IV)
Loop Diuretics: MOA
-Inhibit the kidneys ability to reabsorb sodium in the LOOP OF HENLE
-Makes kidneys put more sodium in the urine. (Water follows sodium so you pee more)
-Decreases fluid in the blood vessels—-decreases cardiac output—-decrease blood pressure
-PROFOUND DIURESIS POSSIBLE
Loop Diuretic: Side effects
-HYPOKALEMIA
-Other electrolyte abnormalities
-Dehydration (Strong Medication)
-Hypotension
-Otooxicity — Causing hearing problems
Loop Diuretics: Nursing Considerations
-Monitor potassium levels. Patients typically receive KCL supplements with their Lasix doses
Hypokalemia
-Low Potassium (Normal 3.5-5)
-Loop and Thiazide diuretics can cause potassium loss in the blood
Potassium-Sparing Diuretics (Aldosterone Antagonist)
-Spironolactone
-Spare potassium
-ONLY given PO
Potassium-Sparing Diuretics: MOA
-Block the action of aldosterone (Sodium and water retention) = potassium retention and excretion of sodium and water
P-S Diuretics: Side Effect
-HYPERkalemia
-Endocrine effects: Deepened voice, impotence, irregular menstrual cycles, gynecomastia, hirsutism
5 classes of types of medications that treat hypertension
Diuretics
Sympathetic Nervous system blockers
Beta Blockers
Calcium Channel Blockers
Vasodilators
Sympatholytics
Alpha-adrengic blockers
Centrally acting alpha 2 agonists
Beta adrenergic blockers
Sympatholytics
-Sympathetic nervous system blockers
-SNS usually VASOCONSTRICTS, when it is BLOCKED = decreased vasoconstriction
-Decrease blood pressure by decreasing PERIPHERAL VASCULAR RESISTANCE
Beta adrenergic blockers (Beta-Blockers) (Sympatholytic)
-Metoprolol
-Propranolol
-Carvedilol
Beta Adrenergic Blockers
-Block 2 types of receptors
-Beta 1 receptors found in the heart (Cardioselective beta receptors) (One Heart)
-Beta 2 receptors: Found in lungs (focus on beta 1) (Two Lungs)
-OLOL = Beta Blocker
Which Beta Blocker is non-selective?
Propanolol
Which beta blocker blocks both alpha receptors and beta blockers?
Carvedilol
Which beta blockers only works on Beta 1 receptors in the heart?
Metoprolol (Selective)
Beta-Blockers: MOA
Works by decreasing force, rate, and rennin secretion.
-Increases nitric oxide = vasodilation response
-Blocks stimulation of beta-1 receptors = decreases HR and contractility
Beta-Blockers: Side Effects
-Fatigue/Lethargy
-Bradycardia
-Hypotension
-Mask hyopglycemia —– prevents tachycardia which is a common sign of DM
Beta Blockers: Nursing Considerations
-Wean patients off
-Possible rebound HTN if discontinued abruptly—-critical rise in BP, high risk for CVA
-If non selective beta blocker——do not use with patients who have asthma or other breathing conditions
-RECONGIZE THE RISK FOR HYPOTENSION AND BRADYCARDIA. MEASURE HR AND BP EVERYTIME BEFORE GIVING MED
Alpha-2 Adrenergic Agonist
clonidine
Typically not first-line treatment because of high side effects.
A2AA’s: MOA
Decrease sympathetic outflow resulting in decreased stimulation of adrenergic receptors (both alpha AND beta receptors)
Can be given PO or Transdermal (patch)
A2AA: Side effects
-Drowsiness—-most common. (given at night)
-Rebound HTN
-Pre-existing liver disease
Selective Alpha-1 Blockers
doxazosin
Selective Alpha 1 Blocker: MOA
-Directly blocking sympathic NS. Blocking A1 receptors
SA1 Blocker: Side effect
-Hypotension
-Dizziness
RAAS Blockers
-ACE inhibitors
-ARB’s
-Renin inhibitor
Where do ACE inhibitors work?
Between Angiotensin I and Angiotensin II
What does ARBS block?
ATII receptor
When is the RASS system activated?
Loss of blood volume
Drop of BP
ACE Inhibitors
-captopril
-lisinopril
Safe medication and first line therapy for HTN and HF
-Ends with -pril
ACE-pril
ACE inhibitors: MOA
-Block angiotensin-converting enzyme
-Inhibits production of Angiotensin-2 (powerful vasoconstrictor)
-Inhibits aldosterone secretion—less water retention
-Slows progression of left ventricular hypertrophy associated with HTN
-Drug choice for DM— has some renal protective effects
ACE inhibitor: side effects
-First dose hypotension—common, 15-20% drop in 6-8 hours
-Dry non productive and persistent cough—largest complaint from patients
-ANGIODEMA—rare but more common in blacks (Swelling of face)
-DO NOT USE IF PREGNANT
-Do not take if you are driving or during something active. Take at night
ACE Inhibitors: Nursing Considerations
-Renal insufficincy—-use cautiously in patients with history of renal disease
-Captopril can cause neutropenia—monitor WBC
Angiotensin Receptor Blockers
-ARBS
-Iosartan
-SARTAN suffix
ARBS: MOA
-Block the action of angiotensin 2 after it is formed
-Causes vasodilation
-Increased sodium and water excretion
-Does not affect the HR or Cardiac issues
ARBS: Side Effects
-Well tolerated
-Some risk of angioedema. No racial disparity like ACEi
-Do not use in someone who is pregnant and should be prescribe a contraceptive if in childbearing age
Renin Inhibitor
aliskiren
Renin Inhibitor: MOA
-Direct inhibition of Renin
-Induces vasodilation, decrease blood volume, decrease SNS, and inhibitors cardiac and vascular hypertrophy
Renin Inhibitor: Side effects
-GI discomfort
-When given with ACEi watch for hyperkalemia, especially in patients with diabetes
Renin inhibitor: Nursing considerations
-Takes several weeks to see fell effect (half-life)
-Do NOT take pregnant
Calcium Channel Blockers
nifedipine
nicardipine
verapamil
diltiazem
(More common for heart rythym disorders)
-Block Ca channels which cause Vasodilation of Smooth muscle. Arterial vasodilation
What is given when trying to treat for crisis refractive HTN IV
Calcium channel blocker (Nicardipine)
Calcium Channel Blockers: Side Effects
-Orthostatic Hypotension
-Peripheral edema
Calcium Channel Blocker: Nursing Considerations
-CCB are best for elderly and AA’s
-Diurectics with to adress edma that comes along with
Vasodilators
Hydralazine
Vasodilators: MOA
Work directly on arterial and venous smooth muscles and cause relaxation
-Direct vasodilation cause decreased systemic and pheripheral vascular resistance
PO and IV (Emergnecy)
Vasodilators: Side Effect
Hypotension
dizziness, headache, tachy, edema, dyspnea.
