NUR 144 Module C

How many times would a nurse take a patients blood pressure who has suspected orthostatic hypotension?

3 times -While the patient is lying down, sitting, & standing

Common side-effect

A *minor* reaction to a drug that self resolves

Toxic effect

A drug effect that occurs due to high levels of drug build-up in the blood

Adverse effect

A reaction that *worsens* with time and may be harmful

indications of calcium channel blockers

Angina (chest pain) Hypertension Dysrhythmias Raynaud's disease Migraines *May cause significant peripheral edema*

ACE inhibitors

Angiotension Converting Enzyme inhibitors -Large group of safe effective drugs -Often used as second-line drugs for HF & hypertension -May be combined with thiazide diuretic or CCB

ACE inhibitors MOA

Blocks ACE in lungs from converting angiotensin I to angiotensin II -Decreased Aldosterone secretions -decreased SVR (afterload) -vasodilation -results in decreased BP

Beta Blockers

Blocks beta receptors in the heart causing: -Decreased heart rate -Reduces renin production from kidneys -Reduces preload and after-load -Reduces cardiac output -Reduces Stroke volume -INCREASES ejection fraction

CCB MOA

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

orthostatic hypotension

Decrease in blood pressure related to positional or postural changes from lying to sitting or standing positions

How does furosemide work?

Diuretic -works on the loop of Henle to increase urine production -Excretes more *potassium*

What is the gold standard for measuring heart efficiency?

Ejection fraction

What should you avoid if you're taking a CCB (calcium channel blocker)?

Grapefruit

What is the SECOND cause of kidney failure?

High BP!

When should you not give a patient beta blockers? (Already prescribed and taking)

If their pulse rate is below 60.

What is blood pressure?

Measurement of force applied to artery walls.

Antihypertensive drugs

Medications used to treat hypertension

Angioadema

Swelling of the mouth and tongue rare but potentially fatal

Autonomic nervous system responses

Sympathetic response *fight or flight* Parasympathetic response *rest & digest*

What does high blood pressure mean?

The blood is pushing too hard against the artery walls

What is the most commonly used diuretic for hypertension?

Thiazide -Excretes more *salt*

Does your body need stress?

Yes, your body needs a minimal level of stress to keep your body engaged and going.

Beta blockers MOA

blocking adrenaline from attaching to smooth muscle + renin blocking from the kidneys resulting in massive VASODILATION

Vasodilators

directly relax arteriolar and venous smooth muscle (or both) -decrease SVR -decreased afterload -peripheral vasodilation

Adrenergic drugs

drugs that work to block or inhibit adrenaline or norepinephrine *BETA BLOCKERS*

scharosis

hardening of the artery cause by high blood pressure scarring the artery walls

Beta 1 receptors

responsible for heart muscle contraction

Beta 2 receptors

responsible for smooth muscle contraction in the lungs

What is ejection fraction?

stroke volume/end diastolic volume percentage of oxygen-rich blood being pumped out of the heart

Angiotensin

"Angio-" = relating to the blood vessels "-tensin" = tension or stress *A major vasoconstrictor*

Hypertension of unknown cause

-Essential/ idiopathic/ primary hypertension -90% of cases

Risk for coronary artery disease(CAD) related to hypertension

-Thickening of the heart muscle -Increased pressure generated by the muscle on contraction -Increased workload on the heart

ARBs MOA

-block Angiotensin II receptor to cause VASODILATION -Blocks adrenal glands from making more aldosterone *Affect primarily vascular smooth muscle and the adrenal gland*

beta blockers end in

-olol

ACE inhibitors end in?

-pril

ARBs end with

-sartans

ABCD

*A*CE/ARB *B*eta-Blocker *C*alcium channel blocker *D*iuretic

Contraindicated

*Do not administer*

What are the 3 elements of blood pressure?

*HR* x *SV* x *TR* Heart rate X Stroke volume X Total resistance(peripheral/systemic)

PRESSURE

*P*ressure (blood) monitor *R*ise slowly to reduce orthostatic hypotension *E*ating must be considered (diet) *S*tay on medications *S*kipping or stopping is a no-no *U*ndesirable responses *R*emind to excercise, reduce alcohol *E*liminate smoking, educate

Calcium channel blockers

*Treatment of hypertension and angina* *Results in continuous vasodilation all day & lowered BP* -decreased SVR -relaxed heart

Vasodilator indications

-*Emergency hypertension treatment* -Rapid vasodilators -May be used as a daily drug -Work quickly but do not last long in the body(very short half life) --multiple doses a day may be needed to obtain desired BP -May be used in combination with other drugs

What is hypertension?

-150/90 (persistently) for patients older than 60 -140/90 (persistently) for patients under 60 and those who have chronic kidney disease or diabetes

Antihypertensive drug categories

-Adrenergic drugs (5 classes) -Angiotensin-converting enzymes (ACE) inhibitors -Angiotensin II receptor blockers (ARBs) -Calcium channel blockers (CCBs) -Diurectics -Vasodilators

Conditions related to untreated hypertension

-CAD and Cardiac Death -Stroke -Congestive heart failure -Renal Failure -Loss of Vision (capillaries behind the eyes burst)

Primary effects of the ACE inhibitors

-Cardiovascular and renal -reduce BP by decreasing SVR -HF -Prevent sodium and water resorption by inhibiting aldosterone secretion -*Diuresis: decreases blood volume and return to the heart -Decreases preload, or the left ventricular end-diastolic volume -Decreases work required of the heart

ARB side effects

-Chest pain -Fatigue -Hypoglycemia -GI upset - instruct client to take with food *UTI* -Anemia -Weakness *Peripheral Edema*

Cardio-protective effects of ACE inhibitors

-Decrease SVR (a measure of afterload) and preload -Used to prevent complications after MI *Drugs of choice for hypertensive patients with HF and DIABETES*

Renal Protective Effects of ACE Inhibitors

-Drugs of choice for patients with diabetes *Can cause renal impairment in people with normal kidney function*

ACE inhibitors side effects

-Fatigue -Dizziness -Headaches -Mood changes -Impaired taste *Possible hyperkalemia *Dry nonproductive cough* *Angioedema

Diuretics

-First drug class to be prescribed- *Decrease plasma and extracellular fluid volumes* -Least invasive -Least side effects -Decreased workload on heat and decreased BP -No vasodilation

ARBs indications

-Hypertension -HF -May be used alone or with other drugs such as diuretics

Indications of ACE inhibitors

-Hypertension -HF (either alone or in combination with diuretics or other drugs) -Slow progression of left ventricular hypertrophy after myocardial infarction (MI) (cardio-protective)

Hypertension of known cause

-Nonessential/Secondary hypertension -10% of cases

Angiotensin II Receptor Blockers (ARBs)

-Well tolerated -Do not cause dry cough

vasodialators adverse effects

-bradycardia -decreased platelet aggregation -rash -hypothyroidism -severe hypotension

Side effects of beta blockers

-bradycardia -lethargy -GI disterbance -CHF -depression -can aggravate diabetes -may make asthma worse -can cause sexual dysfunction *do not stop taking abruptly*

beta blockers used to treat

-hypertension -heart failure

Angiotensin cycle

1. Aldosterone release from adrenals -> 2. Renin release from kidneys -> 3. Angiotensin 1 release from liver -> 4. Angiotensin converting enzyme released from lungs 5. ACE converts angiotensin 1 into angiotensin 2 -> 6. Angiotensin 2 raises BP by connecting to smooth muscle and causing vasoconstriction