Ch. 42 Antihypertensives
Alpha 1 adrenergic blockers
doxazosin, prazosin, terazosin
Which beta blockers could safely be prescribed to a patient with hypertension and bronchoconstriction?
- betaxolol - acebutolol - metoprolol
Alpha 1 adrenergic blocker actions
- block the alpha1 adrenergic receptors - result in vasodilation and decreased blood pressure
centrally acting alpha 2 agonists side effects
- dizziness, headache - dry mouth, bradycardia - peripheral edema avoid abruptly stopping: rebound hypertension may result
calcium channel blocker side effects
- flushing, headache, dizziness, blurred vision - peripheral edema, fatigue - nausea, constipation - bradycardia, hypotension - erectile dysfunction
Beta-adrenergic blocker side effects
- hypotension, bradycardia, dizziness - insomnia, nightmares, fatigue - depression, erectile dysfunction
Direct-Acting Arteriolar Vasodilators side effects
- hypotension, tachycardia, palpitations, edema - headache, dizziness, nasal congestion - GI bleeding, paresthesia
Angiotensin-converting enzyme (ACE) inhibitors action
- inhibits formation of angiotensin 11 - blocks release of Aldo Benazepril, Lisinopril, Quinapril
During an admission assessment, a patient states that she takes amlodipine. The nurse should inquire about which signs and symptoms to determine whether the patient has any common side effects of amlodipine?
- insomnia - dizziness - headache - ankle edema
Hypertension and treatment in older adults
- looser control - risk for fall with orthostatic hypotension
Which drugs block angiotensin 11 from angiotensin 1 receptors?
- losartan potassium - valsartan - irbesartan
Which supplement may increase bp when used with antihypertensive drugs because it reduces the effects of it?
- milk thistle - licorice
Which side effects associated with amlopidine therapy would the nurse monitor the patient for?
- nausea - dizziness, drowsiness - visual impairment - erectile dysfunction
Beta-adrenergic blockers
- non selective beta blockers - inhibit beta1 and beta2 receptors - propranolol and carvedilol - cardio selective beta blockers - mainly blocks beta1 receptors - acebutolol, atenolol, betaxolol, bisoprolol, metoprolol - preferred for long term maintainence of BP
Angiotensin-converting enzyme (ACE) inhibitors side effects
- nonproductive cough, hyperkalemia (containicated with patients who have high potassium and who are on potassium sparing meds) - insomnia, fatigue, headache, dizziness - nausea, vomiting, diarrhea - tachycardia, hypotension, angioedema
Adrenergic neuron blockers side effect
- orthostatic hypertension - dizziness, drowsiness - depression, suicidal ideation - erectile dysfunction, pseudoparkinsonism
Alpha 1 adrenergic blocker side effects
- orthostatic hypotension, bradycardia - headache, drowsiness, dizziness - nausea, nasal congestion - edema, weight gain
Angiotensin-converting enzyme (ACE) inhibitors contraindications
- pregnancy - potassium sparing diuretics - salt substitutes that contain potassium
Angiotensin 11 Receptor Blockers (ARBS) action
- prevent release of ALDO - act in Renin-angiotensin-alosterone system - blocks receptors angiotensin 11 works on and blocks conversion of angiotensin 1 to 11
Nonpharmacological control of hypertension
- stress-reduction techniques - exercise (strengthens heart muscles) - salt restriction - decrease alcohol ingestion - smoking cessation
Diuretic meds for hypertension
- thiazides (hydrochlorothiazide) - loop diuretics (furosemide) - combination of potassium-wasting with potassium-sparing diuretics - combination of thiazide with other antihypertensive drugs (ace inhibitors, beta blockers, ARBS)
Nursing Process: Beta- Adrenergic Blockers
- vital signs - lab, BUN, creatinine, AST, LDH - do not stop - avoid OTC
The nurse is caring for an 80-year-old patient who has just started a thiazide diuretic to treat hypertension. What is an important aspect of care for this patient?
initiating a fall risk protocol
Which statement is true about metoprolol tartrate?
it is a selective beta blocker that acts on beta 1 receptors
Which patient with hypertension would benefit the most from receiving an alpha 1 blocker?
the patient with benign prostatic hyperplasia
Physiologic risk factors of hypertension
- excess saturate fat and simple carbs - alcohol increases renin secretions - obesity increases cardiac output, stroke volume, and left ventricular filling
Which drug is a direct renin inhibitor?
Aliskiren
Which angiotensin-converting enzyme (ace) inhibitor should be taken on an empty stomach to ensure effective drug action?
Moexipril
Which antihypertensive helps to improve lipid abnormalities while treating high blood pressure?
Prazosin
Which statement by the nurse explains the mechanism of action for amlodipine?
"This drug inhibits the calcium channel in the vascular smooth muscle."
Which rationale would the nurse provide when teaching a patient about how a calcium channel blocker lowers BP?
"this drug will dilate your blood vessels"
The nurse is teaching a patient who has hypertension about long-term management of the disease with alpha blocker therapy. The patient reports typically consuming 1 to 2 glasses of wine each evening with meals. How will the nurse respond?
"wine can increase the hypotensive effects of alpha blockers"
Direct-Acting Arteriolar Vasodilators
*Hydralazine, minoxidil* -Action: Relax smooth muscles of blood vessels, especially arteries causing vasodilation
Sympatholytics
- Beta-adrenergic blockers - Centrally acting alpha2 agonists - Alpha-adrenergic blockers - Adrenergic neuron blockers - Alpha1- and beta1-adrenergic blockers
Which drugs is a central alpha 2 agonist?
- CLONIDINE - guafacine HCI - methyldopa
ARBS side effects
- Dizziness, hypotension, headache - hyperkalemia, hyperglycemia, edema
Alpha adrenergic blockers nursing interventions
- Monitor vital signs. - Check daily for fluid retention in extremities and weight gain. - Advise patients to comply with the drug regimen. - Inform patients that orthostatic hypotension may occur. - Teach patient to monitor daily weights.
What hormones regulate blood pressure?
- antidiuretic hormone (ADH) posterior pituitary gland (retain fluid) - atrial natriuretic peptide (ANP) - brain natriuretic peptide (BNP)
Regulators of blood pressure
-Kidneys -Catecholamines -Baroreceptors in aorta and carotid sinus -Vasomotor center in medulla oblongota - hormones
Direct Renin Inhibitor side effects
-cough, pharyngitis -hypotension, peripheral edema - hyperkalemia, diarrhea -hyperuricemia
ARBS end in
-sartan
During hypotensive conditions 1. renal cells secrete renin which causes the production of angiotensin 11, a potent vasocontrictor 2. angiotensin 11 stimulates the release of ALDO, which promotes the retention of sodium and water
3. sodium and water retention causes fluid volume to increase which increases BP
Which time describes the elimination of half life of valsartan?
6 hours
african americans adults and older adults do not respond to
ACEI monotherapy
Cultural responses to antihypertensive agents
African Americans; Asian Americans
Direct Renin Inhibitor
Aliskiren Action: -bind with renin causing a reduction of angiotensin I, angiotensin II, and aldosterone levels
Losartan is an
Angiotensin Receptor Blocker
Captopril is an
Angiotensin-converting enzyme
An African American patient has developed hypertension. The nurse is aware that which group(s) of antihypertensive drugs are less effective in African American patients?
Beta blockers and angiotensin-converting enzyme inhibitors
Which antihypertensive drug may also be used to treat glaucoma?
Bexatolol - indicated for both the management of hypertension and glaucoma
Adrenergic neuron blockers action
Block norepinephrine release from the sympathetic nerve endings, result lower BP
Which mechanism of action describes how minoxidil lowers blood pressure?
By relaxing the smooth muscles of blood vessels
Which angiotensin-converting enzyme (ACE) inhibitor is used to treat hypertension and diabetic nephropathy?
Captopril
Which hypertensive may cause swelling of the face, tongue, lips, mucous membranes, larynx and may occur along with peripheral edema requiring emergency attention?
Captopril
Which beta blocker is non selective?
Carvedilol - inhibits beta1 and 2 receptors
Which of thefollowing calcium channel blockers can be used to treat dysrhythmias in addition to hypertension?
Diltiazem -Diltiazem and verapamil are non-dihydropyridine calcium channel blockers that can be used for thetreatment of hypertension in addition to managing cardiac dysrhythmias.
Which statement is true regarding diuretics?
Diuretics decrease the extracellular fluid volume
How often would a patient be instructed to apply a transdermal clonidine patch?
Every week
Alpha 1 and Beta 1 adrenergic blockers
Labetalol Action: blocks alpha 1 and beta 1 receptors
Centrally acting alpha2 agonists
Methyldopa, Clonidine, Guanfacine Action: stimulate alpha 2 receptors - decrease cardiac output - decrease epinephrine, norepinephrine, and renin release - increase vagus activity
Hormone released by kidneys
Renin- angiotensin system - goes to the liver and leads to increase angiotensin 1, then taken to the lung converted into angio 11 by ACE, and now a vasoconstrictor; leads to peripheral vasoconstriction and stimulates release the ALDO > stimulate sodium retention (increase sodium retention and water and chloride) leading to increase BP
Adrenergic neuron blockers
Reserpine
Which patient can safely receive metoprolol tartrate?
a patient with elevated serum renin levels
Ending "pril" means
ace inhibitor
The nurse is caring for an African-American patient who has been taking a beta blocker to treat hypertension for several weeks with only slight improvement in blood pressure. thenurse will contact theprovider to discuss which of thefollowing?
adding a diuretic medication
The nurse is administering a beta blocker to a patient. Which is the most important assessment to perform before administration?
apical pulse
The nurse is caring for a 70-year-old patient who has recently begun taking amlodipine 5 mg/day to control hypertension. The nurse notes mild edema of the patient's ankles, a blood pressure of 118/70 mm Hg, and a heart rate of 80 beats per minute. The patient reports flushing and dizziness. The nurse will notify the provider and
ask to decrease the dose to 2.5 mg/day
calcium channel blocker actions
block calcium channels in vascular smooth muscle cells promoting vasodilation - does not fall under RAAS system
A patient is prescribed losartan. The nurse teaches the patient that an angiotensin II-receptor blocker acts by doing what?
blocking angiotensin 11 from angiotensin 1 receptors
Which outcome would demonstrate a therapeutic response in a patient who has received clonidine?
blood pressure decrease from 150/100 to 110/70
Verapamil is a
calcium channel blocker
the suffix "idipine" identifies as
calcium channel blocker for blood pressure control
The nurse is preparing to care for a Native American patient who has hypertension. The nurse understands that which antihypertensive medication would be most effective in this patient?
captopril
Captopril has been prescribed for a patient. The nurse should teach the patient that the most commonly occurring side effect of an angiotensin-converting enzyme drug is which of the following?
constant, irritating cough
The nurse is performing an assessment on a patient who will begin taking propranolol to treat hypertension. The nurse learns that the patient has a history of asthma and diabetes. The nurse will take which action?
contact the provider to discuss another type of antihypertensive med
The nurse is caring for a patient who will begin taking lisinopril for hypertension. The nurse reviews the patient's laboratory test results and notes increased BUN and creatinine. Which action will the nurse take?
contact the provider to discuss changing to fosinopril
Diuretics
decrease in blood volume
A patient has developed mild hypertension. The nurse acknowledges that the first-line drug for treating this patient's blood pressure might be which drug?
diuretic
The nurse is preparing to administer an ACE inhibitor to a patient who has hypertension. The patient started the ACE inhibitor the day prior. The nurse notes peripheral edema and swelling of the patient's lips. The patient has a blood pressure of 160/80 mm Hg and a heart rate of 76 beats per minute. What is the nurse's next action?
hold the dose and notify the provider and request an order for a diuretic medication
The nurse knows that which diuretic is most frequently combined with an antihypertensive drug?
hydrochlorothiazide
Alpha 1 and Beta 1 adrenergic blockers side effects
hypotension and bradycardia
centrally acting alpha 2 agonists contraindications
impaired liver function
Which description is accurate regarding the action of angiotensinconverting enzyme inhibitors (ACEIs)?
inhibit formation of Angiotensin II and block the release of aldosterone
Which statement about moexipril is true?
lithium toxicity is an adverse effect of moexipril
Which diuretic would a nurse expect to be prescribed to a patient with a creatinine clearance of 22 mL/min?
loop diuretic
ARBS medications
losartan, valsartan, irbesartan, telmisartan
Which action is best for the nurse to take when the nurse notices peripheral edema in a patient who has been receiving prazosin for 4 weeks?
monitor, as this is an expected side effect
in mild hypertension, diuretics alone can be used as
monotherapy
The nurse is caring for a hospitalized patient who experiences an acute spike in blood pressure. The nurse will expect an order to administer which medication?
nifedipine
Which drug may be immediately administered to a patient who suddenly develops an acute rise in BP while in a hospital setting?
nifedipine
Calcium channel blockers meds
non-dihydropyridines: Verapamil, diltiazem (more selective to the heart muscles; dysrhtyhmias) dihydropyridines: amlopdipine, felodipine (more selective to vasculatures; arteries: promote vasodilation; treats BP)
Which side effect of antihypertensive drugs does a nurse recognize as a priority among older patients?
orthostatic hypotension
Which beta blocker is contraindicated in a patient with COPD?
propranolol
nonselective beta blockers
propranolol, carvedilol, labetalol
Which antihypertensive drug lowers BP by causing a decrease in norepinephrine release and is associated with orthostatic hypotension and vivid nightmares?
reserpine
A patient who has recently begun taking captopril to treat hypertension calls a clinic to report a persistent cough that started right after starting the captopril. The nurse will perform which action?
schedule an appointment with the provider to evaluate the cough and discuss changing to an ARB
Angioedema
swelling of the face, tongue, lips, mucous membranes, larynx and may occur along with peripheral edema
