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Hypertension Consistent elevation of systemic systemic arterial blood pressure (high Blood pressure)
Factors responsible for blood pressure Cardiac output peripheral resistance bld volume
Cardiac output volume of blood pump per minute. stroke volume (blood pump by a ventricle in 1 contraction). stroke volume- preload, contractility and afterload Heart rate- sympathetic nervous system activity, parasympathetic nervous system activity & epinephrine
peripheral resistance friction and arteries as bld flows through vascular system greater resistance increased BP. Meds that affect vascular smooth muscles may lower or raise BP autonomic nervous system plays role in controlling peripheral resistance
Blood volume- diuretics Total amount of blood and vascular system increase blood volume increases blood pressure meds that affect blood volume may lower or raise BP diuretics would decrease blood volume and may lower BP
Physiological regulation of blood pressure Central and autonomic nervous system maintain BP. Vasomotor center regulates BP through: baroreceptors measures the amount of pressure in the blood vessels chemoreceptors recognize the levels of oxygen, carbon dioxide and pH in the blood
Emotions affect blood pressure Stress and anger increase BP depression and lethargy decrease BP
Hormones that affect blood pressure Natural hormones epinephrine and norepinephrine increase BP antidiuretic hormone (ADH) raise BP renin angiotensin aldosterone system (RAAS)
Organs affected by HTN Heart failure TIA and/or cerebral vascular accident (stroke) renal failure visual impairment and blindness
Nonpharmacologic tx of HTN Limit alcohol use restrict sodium consumption reduce saturated fat and cholesterol increase fresh fruit and vegetables increased aerobic physical activity stop smoking reduce stress maintain optimal weight
BP ranges Normal- 100/50 - 119/79 pre-hypertension: 120/80 - 139/89 stage I hypertension: 140/90 - 159/99 stage II hypertension: 160 or higher - 100 or higher
Syncope Temporary loss of consciousness and posture due to insufficient blood flow to the brain
Bradycardia Known as Bradyarrhythmia. Heart rate is under 60 bpm
Tachycardia Heart rate of more than 100 bpm
Anti-hypertensive Maintains blood pressure within normal ranges and reduce the risk of HTN related diseases. hrt rate- 60/100 BP 100/50-119/79 labs: K+, BUN, glucose, LFT's, Renal, Lipids, (+) anti-nuclear antibody titer
Anti-hypertensive drugs Diuretics angiotensin converting enzyme inhibitors (ACE) angiotensin II receptor blockers (ARB's) calcium channel blockers beta- adrenergic blockers alpha1- adrenergic blockers
Anti-hypertensive common side effects Headache, dizziness, orthostatic, hypotension, angioedema, decreased heart rate,Fatigue, nausea, constipation, musculoskeletalt or weakness
captopril/ Capoten enalapril/ Vasotec lisinopril/ Prinivil Class: ace inhibitor blocks formation of angiotensin II causing vasodilation and block aldosterone secretion decreasing fluid volume. Usually ends in pril action: antihypertensive & hrt failure admin: 1st-dose phenomenon, no pregnancy, preg cat D
Ace inhibitors- adverse/contraindictions/ ineractions w/ drugs Hyperkalemia rash cough neutropenia agranulocytosis. warning: fetal injury or death contrain: hypersensitivity pregnancy lactation inter: antiHTN ^ effects on BP, thiazide ^ K+ loss K+ supp or sparing ^ hyperkalemia aliskiren renal tox NSAIDs - hypo
Ace inhibitors Labs: increase values in BUN, alkaline phosphatase, serum potassium, serum creatinine, Alanine aminotransferase (alt), aspartame aminotransferase (AST), may cause a positive anti-nuclear antibody titer
losartan/ Cozaar valsartan/ Diovan Class: angiotensin II receptor blocker (ARB) prevents angiotensin II from reaching its receptors & cause vasodilation which decrease the bld pressure and increase urine volume action: anti-HTN side: diarrhea URI fetal tox neonatal mortality renal tox
Amlodipine/ Norvasc nifedipine/ Procardia XL verapamil/ calan Class: calcium channel blocker (CCB) block & inhibits ca+ ion channels entering the cell in arterial smooth muscle causing vasodilation & limiting contraction. Lowers peripheral resistance & decrease BP Action: anti-HTN angina pectoris dysrhythmias
CCBs effects Admin: no immediate release possible/confirmed MI w/in 2 wks no chew crush or divide Preg Cat C side: peripheral edema flushing tacky ^ anginal pain sexual dysfunction lt-headedness MI HF confusion mood change hepatotoxicity contrain: hypersensitivity
CCB's interactions/labs/herbal/food inter: give w beta blocker ^ risk of HF ^ digoxin -Brady & tox alcohol -syncope & drop BP labs: ^ alkaline phosphatase lactate dehydrogenase ALT creatinine phosphokinase (CPK) AST food/Herbal: grapefruit juice ^ absorption melatonin ^ BP & Hrt rate
Atenolol/ Tenormin metoprolol/ Lopressor Class: beta-adrenergic blockers decreases the heart rate and myocardial contractility reducing cardiac output and lowering BP decrease cardiac workload ease angina pectoris slowing conduction through myocardium treats dysrhythmias Usually ends w olol
Beta-adrenergic blockers action: HF HTN MI angina sometimes combine w ace inhibitors admin: during IV check ECG BP pulse, bp & pulse before oral no crush or chew sustained-release safety under 6 not established Preg cat C reduced dose in older pts risk of dizziness & falls
Beta-adrenergic blockers effects Side: fatigue insomnia drowsiness importance decreased libido Brady confusion agranulocytosis laryngospasm Stevens-Johnson syndrome anaphylaxis palpitations rebound HTN dysrhythmia MI
Beta adregeneric blockers warnings/contraindictions Warning: Do not stop abruptly reduce over 1 to 2 weeks restart if angina sx develop Contrain:pt's w/ cardiogenic shock, sinus bradycardia, heart block over 1st degree, hypotension, overt cardiac failure. caution in pt's w/ asthma or hx of bronchial spasm
Beta adregeneric blockers interactions/ labs Given with the digoxin - Bradycardia, BC ^ effects, alcohol or anti-HTN ^ hypotension. meds ^ hypoglycemic effects. Given with verapamil ^ risk of heart block and bradycardia labs: ^ uric acid lipids K+ bilirubin, alkaline phosphatase, creatinine ANA
doxazosin/ Carura Class: alpha1- adreneregic blockers block sympathetic receptors in the arterioles to dilate vessels given with other anti-HTN diuretics action: HTN benign prosthetic hyperplasia
alpha- adrenegeric blockers Admin: monitor for hypotension and syncope for 2-6 hr few doses 1st dawn phenomenon after withdrawl/ 6 dose swallow whole Preg Cat B side: dyspnea asthenia somnolence contrain: hypersensitivity to alpha blockers
alpha- adrenegeric blockers Inter: given w anti-HTN ^ effect on BP oral cimetidine ^ half-life Viagra ^ BP lowering effects. Do not give with boceprevir ^ of serum levels
Assessments for antihypertensive drugs Complete medical history vitals – BP (Lying sitting standing) and pulse breath sounds pulse ox ECG Edema- location and amount labs- electrolytes glucose liver and renal function studies and lipids
Antihypertensive adverse effects to report immediately all- Brady hypotension reflex tachy decreased urinary output seizures wt gain/loss 2lb w/in 24 hr ^ chest pain SOB frothy sputum ACE/ARBs- angioedema (face) CCBs- myalgia arthralgia edema significant constipation decrease ADLs numbness/tingling
Antihypertensive Lifespans Older adults increased risk for hypotension falls and injury. (First dose given at HS to observe drowsiness) stop med in BP is 90/60 or below not checked in 6 and under for safety and effectiveness check for preg or lactation Dont stop med abruptly
Created by: bryant-41892