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Antihypertensive Pharmacologic Agents. NUR133 Lecture #11 K Burger, MSEd, MSN, RN, CNE Referenced from: Lilley et al (2005) Pharmacology and the nursing process (4 th ed). Elsevier. Categories. Adrenergic agents -Alpha blockers -Beta blockers -Alpha/Beta blockers

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Antihypertensive pharmacologic agents

Antihypertensive Pharmacologic Agents

NUR133 Lecture #11

K Burger, MSEd, MSN, RN, CNE

Referenced from:

Lilley et al (2005)

Pharmacology and the nursing process (4th ed). Elsevier


Categories
Categories

  • Adrenergic agents -Alpha blockers -Beta blockers -Alpha/Beta blockers

  • Angiotensin-converting enzyme inhibitors

  • Angiotensin II receptor blockers

  • Calcium channel blockers

  • Vasodilators

  • Diuretics


Adrenergic agents

Alpha Blockers

(peripherally acting)

Prazosin (Minipress)

Blocks norepinephrine at receptor sites

Sympathetic Nervous System not stimulated

Blood vessel dilation results in decreased BP

Alpha Blockers

(centrally acting)

Clonidine (Catapres)

Reduces norepinephrine production

Sympathetic Nervous System not stimulated

Blood vessel dilation results in decreased BP

Adrenergic Agents


Adrenergic agents1
Adrenergic Agents

  • Beta Blockers

  • atenolol (Tenormin)

  • metoprolol (Lopressor)

  • propranolol (Inderal)

  • Block SNS stimulation of heart; reduces SA node activity

  • Reduces ventricular contraction rate

  • Reduction in cardiac output results in lower BP

  • Also used as: Antidysrhythmic, Antianginal


Adrenergic agents2
Adrenergic Agents

  • Alpha / Beta Blocker Combination

  • Carvedilol ( Coreg )

  • Dual antihypertensive effect on both CO and SVR

  • Alpha blocker promotes vasodilation; decreased SVR

  • Beta blocker reduces heart rate; decreased CO

  • Overall effect = decreased BP


Adrenergic agents nursing implications
Adrenergic AgentsNursing Implications

  • Orthostatic hypotension common;take alphas @ bedtime

  • Other side effects: fatigue, dizziness, sedation, constipation

  • Potentiates CNS depressants (Alcohol/Opiods)

  • Abrupt withdrawal of central alpha blocker causes rebound hypertension

  • Less side effects with peripheral acting and/or combination adrenergics

  • Monitor HR =>60 for beta blockers


Angiotensin converting enzyme inhibitors ace inhibitors
Angiotensin-Converting Enzyme InhibitorsACE Inhibitors

  • Inhibit the conversion of Angiotensin I to Angiotensin II resulting in:Vasodilation,decreased SVR, decreased BP Decreased aldosterone,diuresis,decreased SVR&BP

  • May be combined with a thiazide diuretic or calcium channel blocker

  • Safe and effective; often used as first line Rx

  • Used also for: CHF, post MI to stop LVH progress

  • Renal protective effects in patients with diabetes


Ace inhibitors
ACE Inhibitors

  • captopril (Capoten)Short half-life, must be dosed more frequently than others

  • enalapril (Vasotec)The only ACE inhibitor available in oral and parenteral forms

  • Newer agents, long half-lives, once-a-day dosing


Ace inhibitors nursing implications
ACE InhibitorsNursing Implications

  • Dry, nonproductive cough common

  • Other side effects: fatigue,dizziness,headache, mood changes

  • First-dose hypotensive effect may occur

  • Additive effects when given with diuretics or other antihypertensives

  • Antagonistic effects when given with NSAIDs

  • If given with K supplement may cause hyperK


Angiotensin ii receptor blockers arbs
Angiotensin II Receptor BlockersARBs

  • Losartan ( Cozaar )

  • Valsartan ( Diovan )

  • Block the binding of Angiotensin II to AT1 receptors on vessels & adrenal gland thereby:- promoting vasodilation / lower aldosterone- decreased SVR and decreased BP

  • Newer class and well-tolerated


Arb nursing implications
ARBNursing Implications

  • Common side effects:Upper respiratory infectionHeadache

  • Less likely to cause hyperkalemia (unlike ACE)

  • Can be used in pts who cannot tolerate ACE Rx

  • Do not cause coughing

  • Used cautiously in geriatric pts and impaired renal function


Calcium channel blockers ccbs
Calcium Channel BlockersCCBs

  • Diltiazem (Cardizem)

  • Verapamil ( Calan )

  • Nifedipine ( Procardia )

  • Cause smooth muscle relaxation by blocking the binding of calcium to its receptors, preventing muscle contraction

  • This causes decreased peripheral smooth muscle tone, decreased SVR and BP

  • Slows cardiac conduction; decreases HR&CO&BP

  • Also used as : antidysrythmic, antianginal


Calcium channel blockers nursing implications
Calcium Channel BlockersNursing Implications

  • Considered safe with limited side-effects

  • First line drug choice

  • More effective in geriatric and African-American patients

  • Possible side effects:hypotension, dysrythmias, constipation, nausea,rash,peripheral edema, dermatitis


Vasodilators
Vasodilators

  • hydralazine HCl (Apresoline)

  • sodium nitroprusside (Nipride, Nitropress)

  • Directly relaxes arteriolar smooth muscle vasodilation; decreased SVR; decreased BP

  • May be used in combination with other agents

  • Sodium nitroprusside is reserved for the management of hypertensive emergencies


Vasodilators nursing implications
VasodilatorsNursing Implications

  • HydralazineSide Effects: dizziness, headache, anxiety, tachycardia

  • Sodium Nitroprusside Side Effects: bradycardia, hypotensionControlled administration/IV infusion pump


Antihypertensive agents general nursing implications
Antihypertensive Agents General Nursing Implications

  • Educate patients about the importance of not missing a dose, taking the medications exactly as prescribed, never doubling up on doses, and not stopping abruptly

  • Patients should not take any OTC drugs without first checking with MD

  • PO meds should be taken with meals

  • Educate patient on concurrent lifestyle modifications:Diet, Exercise, Stress Reduction

  • Instruct patients on how to monitor their own BP


Antihypertensive agents nursing implications
Antihypertensive AgentsNursing Implications

  • Instruct patients that these drugs should not be stopped abruptly, as this may cause a rebound hypertensive crisis, and perhaps lead to CVA.

  • Oral forms should be given with meals so that absorption is more gradual and effective.

  • Administer IV forms with extreme caution and use an IV pump.


Antihypertensive agents general nursing implications1
Antihypertensive Agents General Nursing Implications

  • Instruct patients to change positions slowly

  • Hot showers, tubs, weather, exercise, alcohol, prolonged sitting/standing may cause hypotension, dizziness, fainting

  • Patients should report: SOB, dyspnea, peripheral and/or angioedema, excessive weight gain, chest pain, palpitations

  • Men may experience impotence as expected SE


Diuretics
Diuretics

Main classifications:

  • Thiazide and thiazide-like

  • Loop

  • Potassium-sparing

    Others:

  • Osmotic

  • Carbonic Anhydrase Inhibitors


Thiazide diuretics
Thiazide Diuretics

  • Hydrochlorothiazide ( HydroDIURIL )

  • Inhibits Na reabsorption at distal tubule resulting in diuresis; decreased SVR & BP

  • Also acts to relax arterioles;decrease SVR

  • First line medication regimen for HTN

  • Safe for most patients; inexpensive

  • Often used in combination w/ other drugs


Loop diuretics
Loop Diuretics

  • Furosemide (Lasix)

  • Blocks Cl and Na reabsorption at Loop of Henle resulting in diuresis; decreased SVR and decreased BP

  • Stimulate prostaglandins; vasodilation ofrenal, lung, system vessels

  • Rapid onset and most potent diuretic

  • Can be given once daily

  • Effective even in renal impaired patients


Thiazide and loop diuretics nursing implications
Thiazide and Loop DiureticsNursing Implications

  • Monitor K levels closely for hypokalemia

  • Teach patient to eat high K foods

  • Cross allergies may exist to sulfonamides

  • Concurrent digoxin Rx may lead to digoxin toxicity

  • NSAIDS may decrease diuretic effect

  • Concurrent antiglycemic Rx may lead to hyperglycemia


Potassium sparing diuretics
Potassium-sparing Diuretics

  • Spironlactone ( Aldactone )

  • Works in the collecting duct

  • Binds and blocks aldactone receptors resulting in blocked Na water reabsorption;decreased SVR and BP

  • Considered a weak diuretic

  • Often used in conjunction with more potent K depleting diuretics


Potassium sparing diuretic nursing implications
Potassium-sparing DiureticNursing Implications

  • Monitor K levels closely for hyperkalemiaEspecially with renal impairment, use of potassium supplements, or ACE drugs

  • May cause gynecomastia, amenorrhea, and post-menopausal bleeding

  • Other side effects: dizziness, ha, cramps, nausea,diarrhea.


Diuretics general nursing implications
DiureticsGeneral Nursing Implications

  • Instruct patient to take early in the day to avoid sleep disturbances

  • Geriatric patients more sensitive to fluid balance changes; caution for postural hypotension

  • Monitor weights, potassium levels as well as Na and Cl

  • Instruct patients to notify MD if ill with vomiting and/or diarrhea