Pharmacology Blood Pressure Regulation-Olol

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Short-term BP regulation

Long term BP regulation

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sympathetic nervous system

renin-angiotensin aldosterone system

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Types of Hypertension

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1. essential (do not know what causes it)
2. Secondary (related to another disease)

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Step care approach to BP regulation

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goal of therapy is to decrease BP to below 140/90 with lowest amount of medication

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Meds used to treat Hypertension

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A ce inhibitors
B eta Blockers
C alcium Channel Blockers
D iuretics

others

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Ace - Angiotensin converting enzyme inhibiters

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used in the treatment of hypertension, heart failure, and to decrease renal impairment in diabetic pts (see flow charts)

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Side effects of Ace inhibitors

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1. persistent cough - 10-20% of pts.
2.Hyperkalemia in pts with renal dysfunction or taking K+ supplements

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ARBs - Angiotensin II receptor antagonists

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1.block angiotensin II at receptor sites
2. does not cause cough and rarely causes hyperkalemia
block at the cells
very expensive drug

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Beta Blocking agents

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propranolol/Inderal
decreases BP by decreasing HR and contractility (volume)

CO= HR x SV

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Calcium Channel Blocker Agents

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Procardia/nifedipine (diff. drug than the one for angina)
1.decreases BP primarily by dilating peripheral vessels

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What side effects will Calcium Channel Blocker Agents cause?

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hypotension (orthostatic), anytime you have a drug that directly dilates peripheral vessels your pt is at risk for hypotension

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Alpha 1 Blocking Agents

treats hypertension

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prazosin/Minipress (little pressure)
1.decrease peripheral resistance, causing dilation of blood vessels
2.first dose often causes orthostatic hypotension

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Alpha 2 blocking agents

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clodine/Catapres - agonist - indirect Alpha 1 blocker
1.stimulates alpha 2 receptors in the brain, causing less sympathetic outflow
2. this results in peripheral blood vessel dilation, decreased HR and BP

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Diurectics

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decrease blood pressure by decreasing blood volume

decrease the circulation volume of blood

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orthostatic hypotension

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low BP - dizziness upon rising - check pts BP in both sitting and standing position q4h while the client is awake

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Thiazides


diuretic

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Diuril/chlorothiazide (most common given-relatively mild)
1.inhibits NA reabsorption
2.increases K+ excretion (water follows potassium) inhibits sodium being reabsorbed in the tubules so it goes out the body in urine
need at least 30ml/hr

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Side effects of Thiazides

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1.low K+ (dig toxicity), low NA
2. Intravascular volume depletion, resulting in hypotension (mild)
*gets rid of too much K+ could cause low K+ in dig pt. Oliguic = making too little urine

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Contraindications of Thiazides (diuretic)

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Oliguria = when not producing urine -do not give or w/low K+ levels
Hypokalemia, occasional hyponatremia

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LOOP diuretics

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Lasix/furosemide - works in the loop of Henle
1.inhibits NA reabsorption
2.increases K+ excretion
Admin:
PO & IV, potent oral diuretic
only diuretic that is a little different than all of the others only because it is so powerful

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Side effects of most diuretics

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1.hypokalemia, hyponatremia
2. intravascular volume depletion, resulting in hypotension

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Aldosterone Antagonist

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K+ sparing
1.increases excretion of Na without excreting K+
2.weak diuretic
3.blocks hypokalemia when used with other diuretics- major use

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Osmotic Diuretics

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Mannitol - draws water into kidney and brings to kidney to be excreted- an ER drug
1.increases osmolality of plasma and renal tubular fluids. This results in diuresis (for intercranial pressure)
Indicated in ICP and oliguria
admin is IV only
this is ordered when pt is oliquric

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side effect of Osmotic Diuretics

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increasing intravascular system - raises BP- watch for hypotension

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Nursing interventions for Diuretics

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1. I&O (intake and output)
2.monitor labs- K+ and Na
3. monitor pts wgt (1kg = 1 L)
4.assess for S&S of hypo/hyperkalemia and hyponatremia
5. assess BP

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ANTILIPEMICS

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used to treat elevated serum lipid levels
based on personal lipid profile
serum profile goals:
low LDL
high HDL
low total Cholesterol

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Types and functions of Lipids

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LDL- carries cholesterol to tissues, which promotes athrosclerosis and CAD
HDL - carries LDL to liver to make cholesterol
Triglycerides - promotes CAD (cardiac distole) particularly in pts with DM (diabetics mell.)

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HMG-COA Reductase Inhibitors
Cholesterol Synthesis inhibitors

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"statins" most common
Mevacor/lovastatin
1.blocks enzyme required for hepatic synthesis of cholesterol
2.reduces LDL cholesterol after 4-6 wks of therapy - inhibits chol. synthesis

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Side effects of HMG-COA-
Reductase Inhibitors- Cholesterol Synthesis Inhibitors

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1.common: nausea, abdominal cramps, diarrhea
2.severe effects: hepatotoxicity and muscle destruction (draw AST or ALT)
3.monitor liver function studies

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Bile Sequestering Agents

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cholestyramine/Questran
1.binds with bile acids in the intestines and is excreted with the feces. Bile acids stimulate the production of cholesterol
2.reduces LDL cholesterol
3.often used with statins to further reduce LDL cholesterol
keeps bile from being absorbed & prevents bile from turning into cholesterol

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Side effects of Bile Sequestering Agents

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1.abdominal bloating, flatulence, constipation
2.decreases the absorption of many oral meds b/c of binding actions

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Fibrates

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gemfibrozil/Lopid
1.decreases production of triglycerides
2.side effects- GI discomfort, diarrhea
3. may cause gallstones-

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Niacin

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B vitamin
1. decreases cholesterol and triglycerides
2. effective only with high doses which often cause skin flushing, pruritus and gastric irritation
3.most effective when combined with another antilipemic
this is the only OTC that decreases cholesteral but cannot be used alone b/c amt. needed alone to be effective would cause too many side effects

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Hematology Agents

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Iron Preparations
1. used to treat iron deficiency anemia caused by gradual loss of blood (i.e gastritis, peptic ulcer or cancer of the intestines) or lack of dietary intake

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Administration methods for Hematology agents

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1.oral is convenient but contraindicated in pts with Peptic ulcers or inflammatory intestinal disorders
2. should be admin via straw to prevent discoloration of teeth
3.may cause dark stools and constipation
4. IM injections should be admin. via Z-tract to prevent discoloration of skin
5. because it bypasses the GI tract it may be given to pts with PUD and GI disorders

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Vitamin B12

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1. IV admin
2.used to treat pernicious anemia -from pts with gastrectomy or chronic small bowel disease or strict vegetarians
3.IM injections are required monthly during the life of pts who have had a gastrectomy. they no longer have the gastric cells which secrete instrinsic factor which is required for GI adsorption of B12

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Vitamin B

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1. Thiamine (B1) is often given to patients who are diagnosed with alcohol abuse. Thiamine is used in alcohol metabolism
2. folic acid is often supplemented in pts who are pregnant -stops neural tube defects in infants

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Anticoagulants

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(does not break up clots)
Heparin-parenteral(IV,SQ)
1.to prevent thrombosis formation or enlargement and embolization - used in acute (hospital) situations
2.can be given IV or SQ
3.works by inactivating thrombin
4.used short-term
5.IV-immediate onset
6. always us controller (pump) when giving as a continous infusion
7. takes 20-30 min onset
8. give in abdomine if SQ
9. give low doses SQ (ie 5000 units bid)

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Heparin order

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10,000 in 100ml to infuse at 1000 units per hr. How many ml/hr should you infuse? 10 ml/hr

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Contraindications of Heparin

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PUD, inflammatory bowel disease, severe hypertension and conditions which might precipatate bleeding

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Major side effects of Heparin

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1.bleeding gums, GI tract, nose, IV sites, excessive menstrual flow
2. thromobocytopenia (HITS)- low platelet count check to be done. Heparin induced thromebocytopenia
3. monitor PTT- bleeding count time
4. has a short half life

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Antidote to Heparin

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Protamine Sulfate

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Lovenox/enoxaparin

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cousin to Heparine
1.used to prevent thrombosis formation in knee and hip surgeries
2.frequently used for other conditions which make pt at risk for thrombosis
3.much lower risk of bleeding/labs not monitored
4.given only SQ
5.onset of action is longer than heparin
6.parenteral anticoagulants should not be concurrently taken

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Coumadin/warfarin

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by PO-can stay on for life
1.for long-term thrombosis formation prevention- atrail fib, thromboembolic disorders, prosthetic heart valves
2. onset of action 2-7 days
3. acts as a vit. K antagonist (causes clotting), preventing synthesis of V K depending clotting factors
4.used long term

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Side effects of Coumadin/warfarin

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1. bleeding
2. highly protein bound/many drug interactions (watch for toxicity)
3.monitor lab Pt and/or INR (international normalized Ratio) data
a. PT should be 1.5 X's the control
b. INR should be 2-3 X's to be therapeutic - want it to be high- b/c you are creating coagulation -anything above 1 is considered high

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Antidote to Coumadin/warfarin

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Vitamin K or fresh frozen plasma(contains active clotting factors)

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Nursing Implications of Coumadin/warfarin

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1.pt should use electric razor
2.soft toothbrush
3.no IM injections
4.notify MD b4 giving ASA or NSAIDS (aspirin products)
5.limit physical activities and procedures causing physical trauma (NG intubation)
6.Limit dietary intake of green leafy vegs.(or must eat them every day)