Pharmacotherapy of HTN Flashcards
Decrease in BP/blood volume =
Angiotensin I –> lungs, angiotensin II -(cough) –> stim. vasocortex and vasoconstricts (inc. BP)…. inc. aldosterone (sex hormones off) = inc. Na+ and water reabsorption.
Decrease in BP/blood volume =
Angiotensin I –> lungs, angiotensin II -(cough) –> stim. vasocortex and vasoconstricts (inc. BP)…. inc. aldosterone (sex hormones off) = inc. Na+ and water reabsorption.
Adrenal Glands
Sugar
Salt
Sex
JNC Guidelines
BP = <120/<80 *low = <90/<60
HTN MOST IMPORTANT
Lifestyle Interventions
First-line treatments
4 drugs… someone has been diagnosed, x3 mo’s lifestyle modifications with no change.
These drugs are used alone or in combo (additive properties):
- thiazide diuretic
- ACE-inhibitor
- Angiotensin Receptor Blocker
- CCB (Calcium Channel Blocker)
Diuretics used for
HF, renal failure, Htn, liver failure, cirrhosis, PE
Pt. receiving HCTZ, nurse has taught the client about the importance of kidney function and evaluates that learning has occurred when client makes which statments?
1–Kidneys help by balancing potassium.
3-Kidneys help regulate BP
4-
Diuretics
- Loop diuretics (strongest-closest to tubule)
- Thiazide diuretics (1st line treatment)
- Potassium-Sparing diuretics.
Thiazides
Most commonly prescribed diuretics.
HCTZ
Route: PO (non emergency
Onset: 2 hr
Action: 6-12 hr, half life 45min. (1x per day and not at night)
Indications: **htn, ascites (fluid in abdomen), edema (swelling), HF (dec. preload and dec. cardiac work), nephrotic syndrome (distal tubule).
Mechanisms: Acts on distal tubule to dec. reabsorption of Na+ (causes excretion of Na and water)
Adverse effects: Hypotension dizziness HA, electrolyte imbalances gout (pain in joints) blood dyscrasias
Contraindications: Anuria (no urine production), jaundiced neonates (high bili)
Prego: B
The PCP prescribes HCTZ for a client in chronic renal failure. The nurse suspects the client is experiencing an ineffective response to the medication. Which clinical manifestation would be the most sig?
Rales or crackles!! (Fluid in lungs)
Not htn d/t
Adrenal Glands
Sugar
Salt
Sex
JNC Guidelines
BP = <120/<80 *low = <90/<60
HTN MOST IMPORTANT
Lifestyle Interventions
First-line treatments
4 drugs… someone has been diagnosed, x3 mo’s lifestyle modifications with no change.
These drugs are used alone or in combo (additive properties):
- thiazide diuretic
- ACE-inhibitor
- Angiotensin Receptor Blocker
- CCB (Calcium Channel Blocker)
Diuretics used for
HF, renal failure, Htn, liver failure, cirrhosis, PE
Pt. receiving HCTZ, nurse has taught the client about the importance of kidney function and evaluates that learning has occurred when client makes which statments?
1–Kidneys help by balancing potassium.
3-Kidneys help regulate BP
4-
Diuretics
- Loop diuretics (strongest-closest to tubule)
- Thiazide diuretics (1st line treatment)
- Potassium-Sparing diuretics.
Thiazides
Most commonly prescribed diuretics.
Prazosin (Minipress)
Route: PO (phentolamine: IV,SQ)
Onset: 2 hrs
Indications: htn (NOT 1st line, vasodilate, dec. afterload), bph, raynauds, pheochromocytoma: benign tumors on adrenal glands.
Mechanisms of action:
Competes with NE at alpha1 receptors on vascular smooth muscle.
Adverse:
orthostatic hypotension, dizzy (dec. bp), drowsiness, fatigue, first dose phenomenon: drop in BP w/ first dose med or inc. in med dose, erectile dysfunction.
Contraindications: hypersensitivity, older adult-renal impairment, CAD
Prego: Cat. C
The PCP prescribes HCTZ for a client in chronic renal failure. The nurse suspects the client is experiencing an ineffective response to the medication. Which clinical manifestation would be the most sig?
Rales or crackles!! (Fluid in lungs)
Not htn d/t
Loop Diuretic
(Strongest)
Furosemide (Lasix)
Furosemide (Lasix)
Route: IV/IM Onset: PO-30-60 min, IV: 5 min. Duration: 6-8 hrs. Indications: acute edema (1st line) PE (1st line) HTN
Mechanism: Prevents the reabsorption of Na+ and Cl in the loop of henle.
Adverse: Hypotension (dec. bp w/ position) Syncope and tachycardia (thready/weak) (bp dec. and body tries to inc. HR) Dysrhythmias (hypokalemia w/ other meds ) Nausea and Vomiting Ototoxicity (hearing loss) Gout (uric acid in joints) Metabolic alkalosis
Contraindications:
hypersensitivity/anuria
Prego: C
The nurse is preparing to discharge a client who is prescribed a loop diuretic for the treatment of congestive heart failure. Which foods should the nurse encourage the client to consume to prevent serious adverse effects associated with the medication?
Bananas
Oranges
Dates
(want to excrete urine and thus help excrete K+!)
Potassium-Sparing Diuretics
(weakest) Spironolactone (Aldactone)
Spironolactone (Aldactone)
Route: PO
Onset: 2-3 days up to 2 weeks
Indications:
-mild htn, HF, nephrotic syndrome, liver disease/cirrhosis.
Mechanism: inhibits the actions of aldosterone in the distal tubule and collecting ducts (excrete Na+ and H2O and hold K+).
Adverse effects:
hyperkalemia, gynecomastia impotence and diminished libido in males, menstrual irregularities, hirsutism, breast tenderness, dec. fertility, blood dyscrasias.
Contraindications:
anuria, hyperkalemia
Prego: D (don’t want to mess w/ hormones when someone is prego)
Watch for
Low BP Low Na Low Chloride Low K hyperglycemia Low weight Is&Os Dehydration
Delivery routes for Diuretics
PO,IV,IM
Main diuretics?
HCTZ, furosemide,
Alpha 1 - Adrenergic Antagonists
Relax sphincters and Vasodilate
Alpha1-Adrenergic Antagonists
Prazosin (Minipress)
Route: PO (phentolamine: IV,SQ)
Onset: 2 hrs
Indications: htn (NOT 1st line, vasodilate, dec. afterload), bph, raynauds, pheochromocytoma: benign tumors on adrenal glands.
Mechanisms of action:
Competes with NE at alpha1 receptors on vascular smooth muscle.
Adverse:
orthostatic hypotension, dizzy (dec. bp), drowsiness, fatigue, first dose phenomenon: drop in BP w/ first dose med or inc. in med dose, erectile dysfunction.
Contraindications: hypersensitivity, older adult-renal impairment, CAD
Prego: Cat. C
Side effects of Alpha adrenergic antagonists
Orthostatic hypotension, palpitations, sexual dysfunction, vertigo.
Are alpha 1 antagonists 1st line for htn?
NO (they include Thiazide, CCB, ACE-inhibitor, ARBs)
Beta Adrenergic Antagonists
Dec. in HR/contractility/conduction.
AND
Bronchoconstrict and dec. in glucose. (antagonist)
Propanolol (inderal) nonselective.
Propanolol (inderal)
Route: PO/IV
Indications:
HTN, angina (supply/demand… helps lower demand to dec. work of heart )
Dysrhythmias (dec. conduction)
Migraine prophylaxis (dec. hr and conduction), MI prophylaxis (necrosis d/t dec. supply of O2…)
Essential tremor
Mechanism of Action:
Block beta 1 receptor in the heart and beta 2 in the lungs (dec. HR, contractility)
Adverse Effects:
Bronchospasm
Agranulocytosis: acute low WBC count., Stevens-Johnson syndrome: blisters on skin (risk for infections and dehydration), bradycardia, fatigue and impotence (dec. in CO), rebound tachycardia, myocardial ischemia IF abrupt withdrawal.
Contraindications: cardiogenic shock (dec. BP, dec. HR), severe HF (dec. HR <60), bradycardia, COPD/asthma, caution w/ dm .
The nurse would monitor a client beginning drug therapy with propanololfor which life-threatening manifestation of an adverse drug reaction?
Bradycardia and Dyspnea
Nurse is taking initial hx of a client admitted to the hospital for htn, the PCP has ordered a beta-adrenergic blocker. Which statement by the client does the nurse recognize as most significant?
“I have always had problems with my asthma.”
Asthma is a huge issue with beta adrenergic.
Beta 1-adrenergic antagonist
Metropolol (Lopressor, Toprol)
Metropolol (Lopressor, Toprol) Selective
Route: PO/IV
Duration: 13-19hrs.
Indications: Htn, chronic stable angina, stable HF, migraine prophylaxis, essential tremor, atrial dysrhythmias, acute MI.
Mech. of A: Selective beta 1 antagonist at receptors in cardiac muscle.
Adverse effects: completes heart block, dizziness, fatigue, bradycardia, agranulocytosis, rebound cardiac excitation.
Contraindications: cardiogenic shock, severe bradycardia, heart block!
Prego: C
Beta Blockers
Reduce HR/Contraction/Conduction.
Side effects: Bradycardia, hypotension, symptoms of CHF, drowsiness/depression. dec. BP, GI disturbance, CHF, depression
CCB!!!
-causes muscles to contract (blocking channels and dec. in contractility)
Nifedipine (adalat, procardia)
(CCB - dihydropyridine)
dec. afterload/dec. contractility by dec. work of heart/dec. SVR
Route: PO
Indications: HTN, Chronic stable angina (provides heart w/ more blood)
M of A: Blocks Calcium channels in vascular smooth muscle, including coronary arteries (vasodilator).
Adverse:
hypotension, dizziness, HA, flushing (d/t dilated arteries), peripheral edema (d/t dilated arteries).
Contraindications: Hypersensitivity.
Prego: C
Verapamil (calan, isoptin, verelan)
(CCB - non-dyhydropyridine)
Verapamil does a better job at contractility and conduction, not as good at vasodilation.
Route: PO/IV
Indication:
antidysrhythmic, htn, angina (dec. work of heart and dec. contractility and dec. afterload)
M of A: inhibits flow of calcium into cardiac muscle and vascular smooth muscle cells (vasodilation and reduces contractility of myocardium)
Adverse Effects: worsening HF, irregular HR, AV block, peripheral edema (vasodilates)
Contraindications:
AV block, SSS (arrhythmias), severe hypotension.
Prego: Cat. C
CCB
“very nice drugs”
Dec. Contractility/conductivity/dec. demand for O2.
Side Effects: Dec. bp, bradycardia, may precipitate A-V Block, HA, abdominal discomfort, peripheral edema.
ACE inhibitors
Angiotensin-converting enzyme inhibitors… Watch for hypotension, fatigue, renal insufficiency, cough.
The nurse is caring for a client diagnosed with htn. The client is currently taking a CCB. Which adverse reactions should the nurse monitor for while the client is taking this med??
Myalgia (less Calcium channels...forcing them) Facial edema (vasodilation) Sig constipation (Dec. in contractility)
Drugs that affect RAAS
Angiotensinogen (liver), Renin (kidneys), Angiotensin I (convert in lungs) Angiotensin II, both inc. afterload (constriction) and inc. preload (inc. water and sodium retention)
ACE-inhibitor
“-PRIL”
Inhibits angiotensin converting enzyme (lungs)
Lisinopril (Privinil)
dec. production of angiotensin II = dec. aldosterone (excretion of sodium and water and hold onto K) and vasodilation
Route: PO
Indications: HF, HTN (dec. preload/afternolad/svr), acute MI (dec. preload/afterload/BP)
Mechanisms of Action: Binds to and inhibits action of ACE (dec. BP and peripheral resistance, dec. aldosterone)… thus dec. blood volume.
Adverse Effects: -hepatotoxicity cough dizzy orthostatic hypotension rash hyperkalemia angioedema blood dyscrasias
Contraindications: Pregnancy, hyperkalemic, angioedema.
Prego: C first, D for 2nd and on!!
Which is a priority nursing intervention for a client who is prescribed lisinopril for antihypertensive treatment?
Monitor their blood pressure. Watch for hyperkalemia
If someone is on a diuretic will they be given another?
No, that would cause hypotensive crisis and they can’t lose so much fluid. Give another mechanism of action.
If pt. has htn?
ACE inhib, ARB, thiazide, CCB
What to give pt in emergency w/ acute edema?
Loop diuretic!! Furosemide.
Pt. with benign prosthetic hyperplasia?
Give pt. alpha 1 blocker!
Pt. with angina?
Give pt. CCB! B/c these will vasodilate.
ACE inhibitors
Angiotensin-converting enzyme inhibitors… Watch for hypotension, fatigue, renal insufficiency, cough.
Angiotensin II Receptor Blocker (ARBS)
Blocks adrenal glands and blocks blood receptors.
Losartan (Cozaar)
ARBS
Route: PO
Indication: htn - first line, stroke prophylaxis, prevention of Type II diabetic neuropathy (vasodilation… )
M of A: Blocks Angiotensin receptors (causing vasodilation, reduced peripheral resistance, dec. BP, prevents aldosterone, promotes water and Na+ excretion by kidneys)
Adverse Effects:
Dizzy, fatigue, angioedema, acute renal failure, hypotension, inc. in K+
Contraindication:
hypersensitivity and prego/lactation
Prego: C (first tri), D @ 2nd and on
Pt. with HF and hypertension
EITHER ACE-inhibitor or ARBs
Nurse knows it is essential to monitor which laboratory values while a client is being treated with ACE inhibitors and ARBS?
-electrolyte levels
-liver function
(not BUN/creatinine and not ECG - not lab value)
Would anyone ever be put on an ACE inhibitor and ARB at the same time?
No, mechanism of action is the same…
