Discuss the blood pressure goals for the geriatric population
> 60 years blood pressure goal is higher there is more wiggle room
blood pressure goal for geriatrics is:
SBP <150 mmHg
DBP <90 mmHg
Identify which antihypertensive medications would NOT be ideal for the geriatric population
?lpha Antagonists (Terazosin) most common adverse side effect is orthostatic hypotension which puts elderly pt's at greater risk for falls
centrally acting ?lpha2 agonists (Clonidine) should also be avoided in elderly due to side effects of orthostatic hy
Identify which medications may raise blood pressure
? NSAIDs ~ COX-2 inhibitors
? Corticosteroids
? Cocaine, Amphetamines
? Cyclosporine, Tacrolimus
? SNRIs - serotonin norepinephrine inhibitors
? Sympathomimetics
(decongestants, anorexiants, caffeine)
? Erythropoietin Stimulating Agents (ESAs)
? increase
For Hydrochlorothiazide know dosing, medication class, mechanism of action, indications, adverse effects, contraindications, special considerations, monitoring, patient education
12.5mg or 25mg PO qday
Thiazide Diuretic (HCTHZ)
acts at distal tubule in kidney to ? Na+ excretion,
? plasma volume, ? extracellular fluid volume (as sodium leaves the DCT to be excreted, the plasma volume & extracellular fluid is thereby decreased)
? on
For Spironolactone know medication class, mechanism of action, indications, adverse effects, contraindications, special considerations, monitoring, patient education
Potassium Sparing K+ Diuretic and Aldosterone Antagonist
weak diuretic acting at collecting duct & distal tubule to conserve potassium to offset HCTHZ.. spironolactone competes with aldosterone (has opposite effect as aldosterone) for binding sites by dir
For Lisinopril know dosing, medication class, mechanism of action, indications, adverse effects, contraindications, special considerations, monitoring, patient education
5mg, 10mg, 20mg, 40mg PO qday
(10mg most common low dose to start pt's on)
ACE Inhibitor = Angiotensin Converting Enzyme
ACE-I drugs end in '-pril'
By inhibiting ACE in the lungs, Lisinopril blocks formation of Angiotensin II (inhibits RAAS renin-angioten
For Losartan know dosing, medication class, mechanism of action, indications, adverse effects, contraindications, special considerations, monitoring, patient education
25mg, 50mg, 100mg PO qday
ARB - Angiotensin II Receptor Blocker
ARB drugs end in '-sartan'
Losartan blocks Angiotensin II receptors in RAAS thereby causing vasodilation and decreased ? Aldosterone = Na+ ? decreased sodium retention
? indicated in pt's who
BOTH ARBs and ACE-I's increase ? K+ and Cr ?
ACE-Is and ARBs should NOT both be used at the same time, it's one or the other!
Lisinopril & Losartan should NOT both be used together simultaneously, pick one!
BOTH are contraindicated in Pregnancy
For Amlodipine know dosing, medication class, mechanism of action, indications, adverse effects, contraindications, special considerations, monitoring, patient education
2.5mg, 5mg, 10mg PO qday (dosing typically started at 5mg, 2.5 dose not really used)
Dihydropyridine Calcium Channel Blocker
DHP CCBs end in '-dipine'
Blocks intracellular influx of calcium thereby preventing vascular smooth muscle contraction
? Dihydropy
For Metoprolol succinate know medication class, mechanism of action, indications, adverse effects, contraindications, special considerations, monitoring, patient education
All ?eta Blockers end in '-olol'
?eta-Blocker (Cardioselective BB)
selectively blocks ?1 adrenergic receptors [prevents epi- & norepi- from binding] in Heart & Kidney to decrease ? HR ? CO resulting in decreased ? BP
decreased plasma ? renin activity (inh
For Terazosin know medication class, mechanism of action, indications, adverse effects, contraindications, special considerations, monitoring, patient education
?lpha-1 receptor blocker
end in '-osin'
Blocks ?-1 adrenergic receptors thereby acting peripherally to dilate BOTH arterioles and veins causing relaxation of smooth muscle
Indications: HTN pt's who also have BPH (benign prostatic hyperplasia) Terazosin al
For Clonidine know medication class, mechanism of action, indications, adverse effects, contraindications, special considerations, monitoring, patient education
Centrally Acting ?lpha-2 Antagonist
Clonidine stimulates central ?-2 receptors that work to decrease ? peripheral sympathetic activity thereby decreasing ? blood pressure
Indications:
comes in both tablets & transdermal patches and most often used in sett
For Hydralazine know medication class, mechanism of action, indications, adverse effects, contraindications, special considerations, monitoring, patient education
Direct Vasodilator
Hydralazine increases cyclic GMP levels leading to DIRECT arteriolar smooth muscle relaxation. It helps to relax smooth muscle and decrease peripheral resistance to reduce afterload and lower ? blood pressure
Indications:
directly relax