Week 10 Antihypertensives Flashcards
hypertension that has no know causes
essential hypertension
hypertension that has a known cause
secondary hypertension
pressure in the cardiovascular system is determined by….
HR, Stroke Volume, and total peripheral resistance
Prototype drug of Ace inhibitors
captopril
Prototype drug of angiotensin II receptor blockers
losartan
Prototype drug of calcium channel blockers
diltiazem
what class does captopril belong to
ACE inhibitors
what class does Diltiazem belong to
calcium channel blockers
what class does losartan belong to
angiotension II receptor blockers
Therapeutic Action: ACE inhibitors
- Block the conversion of angiotensin I to angiotension II
- Decrease in blood pressure and decrease in aldosterone
Indications: ACE inhibitors
- HTN, HF, diabetic neuropathy, left ventricular dysfunction after MI
pharmacokinetics: ACE inhibitors
- metabolized in liver, excreted in urine
- cross placenta/ breastmilk
- oral med; well absorbed & widely distributed
adverse effects: ACE inhibitors
- unrelenting, nonproductive cough
- effects of vasodilation and alterations in blood flow
contradictions: ACE inhibitors
- impaired renal function, Heart failure, salt/fluid volume depletion, pregnancy/ lactation
- allergy to med
Drug-drug interaction: ACE inhibitors
- Risk for decreased antihypertensive effects if taken w/ NSAIDs
- DO NOT combine w/ other RAAS altering drugs> ACE inhibitors, ect
nursing consideration: ACE inhibitors
- Assess HR, BP, ECG, perfusion, electrolytes, renal function tests
- encourage pt to implement lifestyle changes
- Administer on an empty stomach
- monitor pts closely for a drop in fluid volume to detect and treat hypotension
Therapeutic actions: Angiotensin II receptor blocker
- Selectively blocks the binding of angiotensin II to specific tissue receptors in vascular smooth muscle
- Blocks vasoconstriction and the release of aldosterone associated with the RAAS
Indications: Angiotensin II receptor blocker
- Alone as part of combination therapy for HTN
- Diabetic neuropathy in pts w/ type 2 diabetes and hypertension
pharmacokinetics: Angiotensin II receptor blocker
- Metabolized in liver, excreted in urine & feces
- crosses placenta, unknown about breastmilk
- oral med; well absorbed
Adverse effect: Angiotensin II receptor blocker
- adverse effects related to effects of decreased BP; dizziness, fainting, fever, muscle pain, diarrhea, abdominal pain, headache
- associated w/ renal failure
contradictions: Angiotensin II receptor blocker
- Allergy
- pregnancy/ lactation
- renal/ hepatic dysfunction
- hypovolemia; blocking compensatory mechanisms could lead to more complications
drug-drug interactions: Angiotensin II receptor blocker
- loss of effectiveness if taken in combination w/ phenobarbital, indomethacin, rifamycin, ketoconazole, fluconazole, or diltiazem
- DO NOT combine w/ other RAAS altering drugs
Nursing considerations: Angiotensin II receptor blocker
- Assess HR, BP, ECG, perfusion, electrolytes, renal function tests
- encourage pt to implement lifestyle changes
- Administer w/out regard to meals
- ensure females who are pregnant/ breastfeeding or may be pregnant do not start taking med
- monitor pt for drop in fluid volume/ excessive hypotension
Therapeutic actions: Calcium channel blockers
- Inhibit the mov’t of calcium ions across the membranes of myocardial and arterial muscle cells, altering the action potential and blocking muscle cell contraction
- decreased BP, cardiac workload, and myocardial oxygen consumption
indication: Calcium channel blockers
- Essential HTN in the extended- release form
pharmacokinetics: Calcium channel blockers
- Metabolized in liver, excreted in urine
- crosses the placenta/ detected in breastmilk
- oral med; well absorbed
adverse effects: Calcium channel blockers
-mostly related to the effect on cardiac output and smooth muscle; dizziness, bradycardia, AV block, flushing, n/v, peripheral edema
contradictions: Calcium channel blockers
- Heart block; could be exacerbated by slowing effect
- allergy
- renal/hepatic dysfunction
- pregnancy/ lactation
drug-drug interactions: Calcium channel blockers
- Increase in serum levels and toxicity of cyclosporine is possible if taken w/ diltiazem
nursing considerations: Calcium channel blockers
-Assess for contradictions, cautions, and adverse effects
- Assess HR, BP, ECG, perfusion, electrolytes, renal function tests
- encourage pt to implement lifestyle changes
- avoid grapefruit juice; can increase to toxic levels
- Monitor pts BP closely if the pt is also taking nitrates; increased risk of hypotensive episode
children considerations
- Institute lifestyle changes before drug therapy if possible
- Treatment should be done carefully, long-term effects of antihypertensive agents are unknown
- Safety and efficacy of ACE inhibitors and ARBs have not been established in children
- Calcium channel blockers may be a first consideration if drug therapy is needed
adult considerations
- Stress the importance of other measures to help lower BP (wt loss, diet, exercise, smoking cessation)
- Evaulate the interacting effects of other drugs they are taking
- Saftey precautions in hot weather or with conditions that cause fluid depletion(v/d)
- ACE inhibitors and ARBs should NOT be used during pregnancy
older adult considerations
- More susceptible to toxic effects
- Careful attention to drug-drug interactions
- more likely to have underlying conditions that impact metabolism and excretion
ace inhibitor suffix
“pril”
angiotensin II receptor blocker suffixes
“artans”
