Therapeutic Care of Hypertension, Chapter 51

Question 1

4. Identify drug classes used for treating hypertension.

Answer 1

• Diuretics
• Calcium channel Blockers
• Ace Inhibitor
• Angiotensin Receptor 2 Blocker
• Adrenegic agent, particularly beta blocker
• Direct vasodilators

Question 2

Diuretics

Answer 2

Often first choice because of few side effects

Indications: Hypertension, heart failure

Mechanism of action: Reduce blood volume by the increased excretion of electrolytes and water, lowering pressure

Therapeutic action: Diuretics help lower blood pressure, reduce swelling, prevent or treat heart failure, manage glaucoma, and treat certain kidney conditions by increasing urine production to remove excess fluid and salts from the body.

Adverse effects:
- Increased urination
- Electrolyte imbalance
- Dizziness and headaches
- Muscle cramps

Question 3

Calcium channel Blockers

Answer 3

Arteriole selective drugs (ie. nifedipine)
- Relax arterial smooth muscle
- Indicated for hypertension, angina, Raynaud’s

Cardioselective drugs (ie. diltiazem)
- Decrease heart rate and force of contraction
- Indicated for hypertension, angina, atrial dysrhythmias

Non-selective drugs (ie. Verapamil)
- Affect arterial smooth muscle and heart
- Indicated for hypertension, angina, certain dysrhythmias

Therapeutic action: Calcium channel blockers lower blood pressure by preventing calcium from entering the cells of the heart and arteries, which relaxes and widens blood vessels, making it easier for the heart to pump blood.

Adverse effect:
Dizziness, flushing, hypotension
Reflex tachycardia (with nifedipine)
Peripheral edema
Dysrhythmias
Exacerbation of heart failure why?

Question 4

Ace Inhibitor

Answer 4

• Indications:
  Hypertension, heart failure
• Mechanism of action:
• Reduce production of angiotensin II, which is a potent vasoconstrictor, by blocking angiotensin-converting enzyme (ACE)
• Promotes vasodilation, reducing peripheral resistance and blood pressure
• Reduces secretion of ADH and aldosterone, increasing urine output, decreasing blood volume and decreasing blood pressure
• Enhances effects of diuretics
• Adverse effects:
  Adverse Effects of ACE Inhibitors:

Persistent dry cough

Low blood pressure (dizziness)

High potassium levels

Headaches

Loss of taste

Question 5

Angiotensin Receptor 2 Blocker

Answer 5

Same indications as ACE inhibitors

*Mechanism of action:
Inhibit effects of angiotensin II, producing similar antihypertensive effects to ACE inhibitors

*Adverse effects:
Orthostatic hypotension, hypotension
First-dose phenomenon
Dizziness, headaches
Hyperkalemia

Question 6

Direct vasodilators

Answer 6

• Indication: Hypertension
• Mechanism of action: Relax arterial smooth muscle directly causing vasodilation
• Adverse effects:
  Dizziness

Headaches

Flushing

Nausea and vomiting

Question 7

5. Describe general principles guiding the pharmacotherapy of hypertension.

Question 8

6. Explain the therapeutic action of each class of antihypertensive drug in relation to the pathophysiology of hypertension. (Diuretics, Calcium Channel Blockers, Ace Inhibitors, Angiotensin Receptor 2 Blockers, Adrenergic Agents particularly Beta Blockers, Direct Vasodilators

Question 9

7. Describe the nurse’s role in the pharmacological management of clients who are receiving drugs for hypertension

Question 10

8. For each of the drug classes listed go over the Prototype drugs in purple), and explain the mechanism of action, therapeutic action, and important adverse effects. However, in adrenergic agents focus on Metoprolol not Doxazosin)

Question 11

9. Describe and explain, based on pharmacological principles, the rationale for nursing assessment, planning, and interventions for clients with hypertension.

Question 12

For this exam you will need to know the mechanism of action, therapeutic benefit, 2-3 adverse effects and an example medication for each class of antihypertensive drugs in relation to the pathophysiology of hypertension and heart failure. (Diuretics, Calcium Channel Blockers, Ace Inhibitors, Angiotensin Receptor 2 Blockers, Adrenergic Agents particularly Beta Blockers and Direct Vasodilators, for ex. Lasix is from the diuretic class)