Htn Pt 4 Htn Meds

Front 1

Antihypertensives

Back 1

1. Diuretics
2. Beta-adrenergic blockers
3. Angiotensin-converting enzyme (ACE) Inhibitors
4. Angiotensin II Receptor Blockers (ARBs)
5. Calcium Channel Blockers

Front 2

1. Diuretics

Wave= decreases Blood Volume

Back 2

MOA: act primarily on the ascending loop of Henle in the kidneys. They block chloride and sodium reabsorption resulting in diuresis. This decreased fluid volume reduces blood pressure, systemic vascular and pulmonary vascular resistance, central venous pressure and left ventricular end-diastolic pressure. Useful when reapid diuresis is needed because of their rapid onset of action and lasts at least 2 hours. Their diuretic action continues even when the creatinine clearance decreases below 25ml/min.

Front 3

-Diuretics Contraindications:

Back 3

-allergy to sulfonamide antibiotics
-severe electrolyte loss
-hypersensitivity
-hepatic coma.

Front 4

-Diuretics Drug and lab interactions:

Back 4

-Increased effect with thiazide diuretics.
-Decreased effect with NSAIDS
-Increased risk of neurotoxicity w/ aminoglycosides.
-Increased risk of digoxin and lithium toxicity.
-Decreased effects of sulfonylureas.
-Increased risk of hypokalemia with corticosteroids.
-Increased serum uric acid, glucose, alanine aminotransferase (ALT) and aspartate aminotransferase (ALT)

Front 5

****-Diuretics Adverse Effects:

Back 5

dizziness, HA, tinnitus-ringing in ears-(ototoxicity), nausea/vomiting, blurred vision, hyperglycemia, hyperuricemia, hypokalemia, bone marrow suppression.
-dysrhythmias/leg cramps due to hypokalemia

Front 6

***Nursing Diuretics:

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-I&O, daily weights and report greater than 2lb/day
-VS, monitor electrolytes (esp. potassium) teach pt to monitor for s&s of hypokalemia (leg cramps, dysrhythmias)
-teach client to eat K+ (potassium) rich foods
-administer in a.m. to prevent nocturia
-evaluate effectiveness of diuretic (decreased edema, htn, heart failure)
-monitor for orthostatic hypotension. BUN and creatinine.

Front 7

***Vit k/potassium rich foods include:

Back 7

apricots, avacados, bananas, cantaloupes, carrots, dried beans, peas, dried fruits, melons, oranges, orange juice, peanuts, potatoes (white or sweet), prune juice, spinach, swiss chard, tomatoes (juice sauce), winter squash.

Front 8

Common thiazide-type Diuretics

Back 8

hydrochlorothiazide

Front 9

Common K+ sparing diuretic

Back 9

spironolactone, amiloride, triamterene beware of elevated K+ with these K+ sparing diuretics.

Front 10

*Common loop diuretics

Back 10

"Mide" furosemide, torsemide, bumetanide

Front 11

2. Beta-adrenergic blockers MOA:

Pump Pic= decreases Heart rate

Back 11

-block the sympathetic nervous system stimulation of the beta-adrenergic receptors by competing with endogenous epinephrine and norepinephrine. Beta1
receptors are primarily on the myocardium and Beta 2 receptors are located on smooth muscle in the bronchioles and blood vessels.

Front 12

**Beta-adrenergic blockers Non-selective forms may potentially lead to*****

Back 12

bronchospasm

do not use in asthmatic pt or pt with hx of lung disorders/ pulmonary edema

Front 13

Beta-adrenergic blockers Contraindications:

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*bradycardia*, *severe pulmonary dz*., Raynaud’s Dz., pregnancy, cardiogenic shock, heart block, uncompensated heart failure.

Front 14

Beta-adrenergic blockers Interactions:

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-Increased hypotensive effect w/ other antihypertensive drugs & diuretics
-Decreased effect w/ anticholinergics & antacids.
-Decreased hypoglycemic effect w/ other hypoglycemic drugs.

Front 15

**Beta-adrenergic blockers Adverse Effects:

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Bradycardia, depression, dizziness, heart failure, lethargy, thrombocytopenia, agranulocytosis, dry mouth, constipation/diarrhea, impotence, rash, alopecia , bronchospasm, ischemic colitis

Front 16

***Nursing w/ Beta-adrenergic blockers:

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-apical pulse, resp. status and BP prior to administration.
**Hold if sbp < 100mm Hg & HR <60bpm.
-Do not abruptly stop- cause htn rebound
-Get up slowly to prevent postural hypotension,
-avoid caffeine
- report any signs of edema, SOB or wt. gain > 2pound. I&Os. Avoid caffeine.

Front 17

**Special consideration when administering Beta-adrenergic blockers:

Back 17

Assess apical pulse, resp. status and BP prior to administration

**Hold if sbp < 100mm Hg & HR <60bpm**

Front 18

Common Beta-adrenergic blockers:

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"LOL"s atenolol (Tenormin); carvedilol (Coreg); propranolol (Inderol); metroprolol (Lopressor, Toprolol XL)

Front 19

3. Angiotensin-converting enzyme (ACE) Inhibitors
MOA:

Pump & Hose pic= decreases heart rate + causes vasodilation

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-Prevents angiotensin I from converting to angiotensin II , a potent vasoconstrictor.
-Vasodilation causes a drop in BP.
-The lack of angiotensin II prevents the secretion of aldosterone (reabsorption of sodium and water).
-Lack of aldosterone allows diuresis of sodium and water.

Front 20

(ACE) Inhibitors Contraindications/precautions

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hyperkalemia, kidney disease, allergy

Front 21

(ACE) Inhibitors Drug interactions:

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increased effects with other antihypertensives and diuretics. Lithium toxicity with lithium and hyperkalemia with supplements.

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** (ACE) Inhibitors Adverse Effects:

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-HA
-dry non-productive cough
-fatigue, dizziness, pruritis, anemia, neutropenia, thrombocytosis, agranulocytosis, hyperkalemia, rash, proteinuria, mood changes, loss of taste.
**Angioedema

Front 23

"big thing to watch for" contradictions of (ACE) Inhibitors

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**Angioedema don't give if s/s are present edema of dermis, subcutaneous tissue, mucosa and submucosal tissues

Front 24

**(ACE) Inhibitors Nursing:

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-Do not stop abruptly=b/c htn rebound
-apical pulse and bp prior to administration.
-Possible anorexia r/t loss of taste.
-Postural hypotension.
-Do not use with K+ supplements, hold if K+>5mEq/L
-Lozenges for cough.

Front 25

*Common (ACE) Inhibitors

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"PRIL"s captopril (Capoten, Capozide); enalapril (Vasotec, Vaseretic)

Front 26

4. Angiotensin II Receptor Blockers (ARBs)
MOA:

Pump & Hose pic= decreases heart rate + causes vasodilation

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-block angiotensin II binding with type 1 angiotensin II receptors.
-block vasoconstriction & secretion of aldosterone

Front 27

*Angiotensin II Receptor Blockers (ARBs) are better for s/s:

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They have a decreased risk of nonproductive cough and hyperkalemia than ACE inhibitors.

Front 28

*Angiotensin II Receptor Blockers (ARBs) Contraindications/prec.:

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-drug allergy, pregnancy, renal disease, elderly.
-Adverse Effects: HA. Dizziness, nasal congestion, fatique, resp. infection, hearburn, cough, diarrhea, insomnia, angioedema, muscle pain

Front 29

Nursing: Angiotensin II Receptor Blockers (ARBs)

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-Do not stop abruptly=b/c htn rebound
-report SOB, wt gain, chest pain, palpitations.
-Report dizziness, orthostatic hypotension, may reduce dose r/t hypovolemia and hepatic dysfunction

Front 30

common Angiotensin II Receptor Blockers

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"TAN's losartan (Cozaar); valsartan (Diovan)

Front 31

5. Calcium Channel Blockers MOA:


Pump & Hose pic= decreases heart rate + causes vasodilation

Back 31

-cause smooth muscle relaxation by blocking the binding of calcium to its receptors, preventing contraction.
-Subsequent dilation of peripheral arteries decreases afterload, leading to a decrease in BP and a reduction in myocardial workload and O2 demand.

Front 32

*Calcium Channel Blockers: Contraindications/Prec:

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hypersensitivity, acute MI, pulm. Congestion, W-P-W syndrome, severe hypotension, cardiogenic shock, SSS, and 2nd&3rd degree AV block.

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*Calcium Channel Blockers drug interactions:

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-increased effect with other antiarrhythmic drugs, cimetidine, and ranitidine "DINE"s
-Decreased effect with phenytoin and rifampin.
-Possible toxicity of anesthetics, doxorubicin, benzodiazepines, buspirone, carbamazepine, digoxin statins, steroids, tacrolimus, sirolinus, theophylline, and vincristine when given concurrently with a CCB

Front 34

*Calcium Channel Blockers food interactions:

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-Grapefruit juice may increase serum levels

*Avoid concurrent use of antacids and grapefruit juice*

Front 35

*CCB Adverse Effects:

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hypotension, palpitations bradycardia, heart failure, constipation, nausea, dermatitis, dyspnea, rash, flushing, peripheral edema and wheezing.

Front 36

CCB Nursing

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-Hold med. per parameters
-IV infusion needs continuous ECG monitoring- may prolong PR interval or AV block.
-Assess for toxicilty-hypotension, bradycardia, heart failure and conduction disorders.
-Monitor I&Os and report >2# wt. gain/day or 5# wt. gain/week.Ex: diltiazem (Cardiazem, Dilacor, Tiazac); nifedipine

Front 37

CCB Nursing: Evaluate effectiveness

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as evidenced by decreased chest discomfort and fatigue, improved VS, skin color, and U/O.

Front 38

Common CCB meds

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diltiazem (Cardiazem, Dilacor, Tiazac)

nifedipine

Front 39

***to Monitor K is specified in***

Back 39

-Diuretics=hypo (leg cramps, dysrhythmias) increase in diet
-(ACE) Inhibitors: Hyper: Do not use with K+ supplements, hold if K+>5mEq/L
- K+ sparing diuretics=beware of elevated K+ with these