CSN Nurs 125 Final
Blood pressure - ANS CO × SVR
Essential, idiopathic, or Primary hypertension - ANS Unknown cause: 30% of US adult
population has it
90% of cases of htn
Secondary hypertension - ANS Known cause
factors include:
pregnancy
diabetes
cushings diseas
Chronic renal failure
Centrally acting alpha2-receptor agonists - ANS Adrenergic drug
clonidine (Catapres)
Results in vasodilation, ↓CO and ↓BP
Peripheral alpha1-blockers/antagonists - ANS Adrenergic drug
Results in vasodilation and ↓ peripheral resistance and venous return and results in ↓ BP
doxazosin (Cardura)
terazosin (Hytrin)
Beta-blockers - ANS Adrenergic Drug
Result: decreased blood pressure
propranolol (Inderal), atenolol (Tenormin),
Newest: nebivolol (Bystolic)—beta1-selective
Dual-action alpha1- and beta1-receptor blockers - ANS Adrenergic
Promotes vasodilation of arterioles and veins
Reduction of heart rate and contractility
carvedilol (Coreg)
labetalol
Adrenergic Neuron Blockers - ANS reserpine
Centrally acting alpha2-receptor agonists - ANS Clonidine
Usually used after other drugs have failed because of adverse effects
Peripherally acting alpha1-receptor agonists - ANS Some used to relieve symptoms of BPH
tamsulosin (Flomax)
,Adrenergic Drugs:
Adverse Effects - ANS High incidence of orthostatic hypotension
Most common
Dry mouth
Drowsiness, sedation
Constipation
Other
Headaches
Sleep disturbances
Nausea
Rash
Cardiac disturbances (palpitations), others
Angiotensin Converting
Enzyme (ACE) Inhibitors - ANS Often used as first-line drugs for HF
and hypertension
Large group of safe and effective drugs
May be combined with a thiazide diuretic or calcium channel blocker
Renin-Angiotensin-Aldosterone System - ANS leads to an increased blood volume, increased
preload, and increased BP
ACE Inhibitors:
Mechanism of Action - ANS ACE Inhibitors block angiotensin-converting enzyme, thus
preventing the formation of angiotensin II
ACE Inhibitors - ANS enalapril (Vasotec)
Available in oral and parenteral forms
Is a Prodrug, patient needs a functioning liver
lisinopril (Prinivil and Zestril) and quinapril (Accupril), others
Newer drugs, long half-lives, once-a-day dosing
captopril (Capoten)
Very short half-life
ACE inhibitors - ANS "pril"s
Captopril and lisinopril - ANS are NOT prodrugs
ACE Inhibitors: Adverse Effects - ANS Dry, nonproductive cough, which reverses when therapy
is stopped
Headache
Fatigue
NOTE: First-dose hypotensive effect may occur!
, Angiotensin II Receptor Blockers - ANS Newer class
Well tolerated
Do not cause a dry cough
Angiotensin II Receptor Blockers - ANS losartan (Cozaar, Hyzaar)
valsartan (Diovan)
eprosartan (Teveten)
irbesartan (Avapro)
ARB's - ANS "sartan"s
Angiotensin II Receptor Blockers - ANS Used primarily in patients who cannot tolerate ACE
inhibitors
Calcium Channel Blockers Mechanism of Action - ANS Cause smooth muscle relaxation
lower heart rate
Results in
Decreased peripheral smooth muscle tone
Decreased systemic vascular resistance
Decreased blood pressure
Calcium Channel Blockers - ANS Dihydropyridines:
nifedipine (Procardia)
Phenylalkylamines:
verapamil (Calan, Isoptin)
Benzothiazepines:
diltiazem (Cardizem, Dilacor
Diuretics - ANS
ACE Inhibitor Nursing teaching - ANS take 1 hr before meal
limit Potassium intake
DO Not abruptly stop, may cause rebound htn
Diuretics - ANS Decreased workload of the heart, and decreased blood pressure
Thiazide diuretics are the most commonly used diuretics for hypertension
Vasodilators: Mechanism of Action - ANS Directly relax arteriolar and/or venous smooth muscle
Diabetics on Beta blockers must - ANS closley monitor glucose because beta blockers mask
symptoms of hypoglycemia, such as tachychardia
Blood pressure - ANS CO × SVR
Essential, idiopathic, or Primary hypertension - ANS Unknown cause: 30% of US adult
population has it
90% of cases of htn
Secondary hypertension - ANS Known cause
factors include:
pregnancy
diabetes
cushings diseas
Chronic renal failure
Centrally acting alpha2-receptor agonists - ANS Adrenergic drug
clonidine (Catapres)
Results in vasodilation, ↓CO and ↓BP
Peripheral alpha1-blockers/antagonists - ANS Adrenergic drug
Results in vasodilation and ↓ peripheral resistance and venous return and results in ↓ BP
doxazosin (Cardura)
terazosin (Hytrin)
Beta-blockers - ANS Adrenergic Drug
Result: decreased blood pressure
propranolol (Inderal), atenolol (Tenormin),
Newest: nebivolol (Bystolic)—beta1-selective
Dual-action alpha1- and beta1-receptor blockers - ANS Adrenergic
Promotes vasodilation of arterioles and veins
Reduction of heart rate and contractility
carvedilol (Coreg)
labetalol
Adrenergic Neuron Blockers - ANS reserpine
Centrally acting alpha2-receptor agonists - ANS Clonidine
Usually used after other drugs have failed because of adverse effects
Peripherally acting alpha1-receptor agonists - ANS Some used to relieve symptoms of BPH
tamsulosin (Flomax)
,Adrenergic Drugs:
Adverse Effects - ANS High incidence of orthostatic hypotension
Most common
Dry mouth
Drowsiness, sedation
Constipation
Other
Headaches
Sleep disturbances
Nausea
Rash
Cardiac disturbances (palpitations), others
Angiotensin Converting
Enzyme (ACE) Inhibitors - ANS Often used as first-line drugs for HF
and hypertension
Large group of safe and effective drugs
May be combined with a thiazide diuretic or calcium channel blocker
Renin-Angiotensin-Aldosterone System - ANS leads to an increased blood volume, increased
preload, and increased BP
ACE Inhibitors:
Mechanism of Action - ANS ACE Inhibitors block angiotensin-converting enzyme, thus
preventing the formation of angiotensin II
ACE Inhibitors - ANS enalapril (Vasotec)
Available in oral and parenteral forms
Is a Prodrug, patient needs a functioning liver
lisinopril (Prinivil and Zestril) and quinapril (Accupril), others
Newer drugs, long half-lives, once-a-day dosing
captopril (Capoten)
Very short half-life
ACE inhibitors - ANS "pril"s
Captopril and lisinopril - ANS are NOT prodrugs
ACE Inhibitors: Adverse Effects - ANS Dry, nonproductive cough, which reverses when therapy
is stopped
Headache
Fatigue
NOTE: First-dose hypotensive effect may occur!
, Angiotensin II Receptor Blockers - ANS Newer class
Well tolerated
Do not cause a dry cough
Angiotensin II Receptor Blockers - ANS losartan (Cozaar, Hyzaar)
valsartan (Diovan)
eprosartan (Teveten)
irbesartan (Avapro)
ARB's - ANS "sartan"s
Angiotensin II Receptor Blockers - ANS Used primarily in patients who cannot tolerate ACE
inhibitors
Calcium Channel Blockers Mechanism of Action - ANS Cause smooth muscle relaxation
lower heart rate
Results in
Decreased peripheral smooth muscle tone
Decreased systemic vascular resistance
Decreased blood pressure
Calcium Channel Blockers - ANS Dihydropyridines:
nifedipine (Procardia)
Phenylalkylamines:
verapamil (Calan, Isoptin)
Benzothiazepines:
diltiazem (Cardizem, Dilacor
Diuretics - ANS
ACE Inhibitor Nursing teaching - ANS take 1 hr before meal
limit Potassium intake
DO Not abruptly stop, may cause rebound htn
Diuretics - ANS Decreased workload of the heart, and decreased blood pressure
Thiazide diuretics are the most commonly used diuretics for hypertension
Vasodilators: Mechanism of Action - ANS Directly relax arteriolar and/or venous smooth muscle
Diabetics on Beta blockers must - ANS closley monitor glucose because beta blockers mask
symptoms of hypoglycemia, such as tachychardia
