Anti-hypertensive

• The normal response of the body to hypotension is the RAAS system, autonomic nervous sytem and less urine formed in the kidneys
• First line treatment for hypertension: ACE-1, ARB, long action calcium channel blockers, beta blocker
• Beta 1 receptors are located in the heart and kidneys
• Beta blockers blockers

  • reduce heart rate
  • reduce force of contraction
  • reduce velocity of impulse conduction though AV node
• Beta blockers end in lol. They can be cardioselective (B1 receptors) like metoprolol or non-selective (B1 and B2 receptors) like propranolol
• beta 1 blockers affect systemuc vascular resistance and HR in the BP equation
• Beta blockers adverse effects:

  • bradycardia
  • reduce cardiac output
  • AV heart block
  • rebound cardiac excitation
  • bronchoconstriction in high doses
• Beta blockers precaution is diabetes since it may mask signs of hypoglycemia
• Angiotensin most prominent actions are vasconstriction and stimulation of aldosterone release
• ACE inhibitors block the angiotensin-converting enzyme which prevents the formation of angiotensin II. This has a vasodilating effect. ACE inhibitors decrease aldosterone production which decreases sodium and water retention
• ACE inhibitors end in pril
• Ace inhibitors affect SVR (vasodilation) and stroke volume (decreased sodium and water retention = decreased blood volume)
• ACE inhibitors adverse effects

  • first dose hypotension
  • hyperkalemia
  • renal impairment
  • cough
  • angioedema
• ACE inhibitors precautions

  • hypotensive effects are often additive with those of other antihypertensive drugs
  • drugs that raise potassium levels
  • NSAID may reduce the antihypertensive effects
• ACE inhibitors can cause renal impairment which can be identified by serum creatinine. ACE inhibitors can also cause hyperkalemia so potassium levels need to be monitored
• ARB (angiotensin II receptor blocker) block access of angiotensin II to its receptors which has a vasodilating effect. It also decreases aldosterone production
• ARBs finish in sartan
• ARBs affect SVR and stroke volume
• ARBs adverse effects

  • angioedema
  • renal impairment
  • lower risk of cough
  • lower risk of hyperkalemia
  • less studied then ACE inhibitors
• Precautions for ARBs: hypotensive effects are often additive with those of other antihypertensive drugs
• CCBs end in pine
• Role of calcium

  • regulate contraction in vascular smooth muscle
  • increase force of contraction
  • increase discharge of SA node
  • increase velocity of conduction through the AV node
• CCBs block calcium channels in peripheral arterioles and arteries of the heart which causes vasodilation. At therapeutic doses, CCBs do not block channels in the heart so it cannot be used to treat dysrhythmias
• CCBs affect SVR (vasodilation)
• CCBs adverse effects

  • reflex tachycardia
  • peripheral edema
  • flushing
  • headaches
  • dizziness
• CCBs precaution: toxic doses can cause cardiac suppression
• Nursing implications for antihypertensive meds

  • health history and head to toe physical exam
  • assess for contraindications
  • educate patients about importance of not missing a dose and taking meds as prescribed
  • keep journal of regular BP checks
  • monitor for adverse effects
  • teach patients to change positions slowly
  • instruct patients to not stop taking meds abruptly
• Male patients who take antihypertensive drugs may ave erectile dysfunction and it may influence adhesion with drug therapy
• Hot tubs, showers, baths, hot weather, prolonged sitting or standing and physical exercise may aggrevate low BP