anti-hypertensive
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| Hypertension | Consistent elevation of systemic systemic arterial blood pressure (high Blood pressure)
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| Factors responsible for blood pressure | Cardiac output
peripheral resistance
bld volume
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| 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
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| 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
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| 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
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| 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
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| Emotions affect blood pressure | Stress and anger increase BP
depression and lethargy decrease BP
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| Hormones that affect blood pressure | Natural hormones
epinephrine and norepinephrine increase BP
antidiuretic hormone (ADH) raise BP
renin angiotensin aldosterone system (RAAS)
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| Organs affected by HTN | Heart failure
TIA and/or cerebral vascular accident (stroke)
renal failure
visual impairment and blindness
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| 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
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| 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
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| Syncope | Temporary loss of consciousness and posture due to insufficient blood flow to the brain
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| Bradycardia | Known as Bradyarrhythmia. Heart rate is under 60 bpm
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| Tachycardia | Heart rate of more than 100 bpm
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| 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
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| Anti-hypertensive drugs | Diuretics
angiotensin converting enzyme inhibitors (ACE)
angiotensin II receptor blockers (ARB's)
calcium channel blockers
beta- adrenergic blockers
alpha1- adrenergic blockers
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| Anti-hypertensive common side effects | Headache, dizziness, orthostatic, hypotension, angioedema, decreased heart rate,Fatigue, nausea, constipation, musculoskeletalt or weakness
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| 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
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| 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
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| 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
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| 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
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| 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
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| 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
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| 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
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| 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
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| 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
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| Beta-adrenergic blockers effects | Side: fatigue insomnia drowsiness importance decreased libido Brady confusion agranulocytosis laryngospasm Stevens-Johnson syndrome anaphylaxis palpitations rebound HTN dysrhythmia MI
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| 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
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| 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
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| 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
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| 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
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| 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
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| 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
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| 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
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| 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
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