Adams Hypertension Drugs

Risk Factors

obesity
smoking
High sodium intake
sedentary lifestyle artherosoclerosis
alcohol intake
diabetes
family history
repeated stress
ethinicity

Factors affecting bloodpressure

Blood volume, Peripherial resistance and Cardiac output

Blood Volume

Amount of fluid in the blood; when low, blood pressure low; when blood volume high, causes pressure against the blood vessel walls, high blood pressure

Peripheral Resistance

A measure of the amount of friction encountered by blood as it flows through the blood vessels.

Cardiac output

Volume of blood pumped by one ventricle per minute.
Stroke Volume X Heart Rate

Antidiuretic Hormone

Promotes water retention, in high concentrations is also a vasoconstrictor. Both of these effects raise the blood pressure. (ADH)

Renin-angiotension-aldosterone (RAAS)

Is one of the primary homeostatic mechanism controlling blood pressure and fluid balance in the body.
*Drugs that affect RAAS decrease bp and increase urine volume.
*Used in pharmacotherapy of HTN, Heart failure, and MI.

Renin

Enzyme that is produced by the kidney; important for blood pressure and volume regulation; catalyzes the conversion of circulating angiotensinogen to angiotensin I, when it passes through the lungs it's converted to angitension II (one of the most potent

Angiotension II

Raises BP and causes (stimulates) secretion Aldosterone, a hormone from the adrenal cortex. Therefore, increases bp through 2 mechanism: Direct vasoconstriction and increased water retension.

Angiotension-converting enzyme (ACE)

Inhibit angiotensin-converting enzyme, which is responsible for converting angiotensin I (through the action of renin) to angiotensin II.

Aldosterone

salt-retaining hormone" which promotes the retention of Na+ by the kidneys. na+ retention promotes water retention, which promotes a higher blood volume and pressure.

ACE Inhibitors

Block ACE, which is responsible for converting angiotensin I to angiotensin II
(? vasoconstriction and ? aldosterone production)
decrease afterload and preload in heart failure

Adverse effects of ACE

Diabetic renal disease; can produce cough, angioedema, taste changes, hypotension, pregnancy problems, rash, increased renin, lower angiotensin II, and hyperkalemia.

ARBs

Targest receptors found in vascular smooth muscle, myocardium, brain, kidney, liver, uterus, adrenal glands
indicated for HTN & tx of heart failure
side efects: orthostatic hypotension, hyperkalemia, neutropenia, nephrotoxicity.

Aldactone & Inspra

Aldactone (spironolactone) and eplerenone (inspra), are two drugs that block RAS receptors for aldosterone. By preventing aldosterone from reaching the receptors in the kidneys, less sodium is reabsorbed and bp falls.

Beta blockers

Decreased the heart rate and myocardial contractility, reducing cardiac output.

Alpha?agonist

Decrease sympathetic impulses from the CNS to the heart and arterioles, causing vasodilation.

Alpha? blockers

Inhibit sympathic activation in arterioles, lower blood pressure thru vasodilation of the blood vessel.

Calcium Channel Blockers

Agents that inhibit the entry of calcium ions in smooth heart muscle cells, causing a slowing of the heart rate, lessening the demand for oxygen and nutrients, and relaxing of the smooth muscle cells fo the blood vessels to cause dilation; used to prevent

Diuretics

Increase urine output and decrease fluid volume.

Treating Hypertension w/ Diuretics

Diuretics 1st line drug for this disease (fewer adverse se)
*Also used for HF and kidney disorders
*Many diuretics are available, all produce a similar outcome:The reduction of blood volume through urinary excretion of water and electrolytes. (Na), (Ca),

Thiazide & Thiazide- like diuretics

This diuretic is inexpensive and available in generic form. They are safe drugs, with urinary potassium loss being the primary adverse affect. Prototype drug is Hydrochlorothiazide.

Potassium-sparing diuretics

Modest diuresis, primary advantage is they do not cause potassium depletion. Benificial for patients at risk for hypokalemia. Primary concern is the possibility of retaining too much potassium, may result in dangerously ?levels in the blood (hyperkalemia)

Loop- Diuretics

Cause greater diuresis, and a greater?of bp. Not ideal for HTN. The risk of hypokalemia and dehydration is greater because of their ability to remove large amounts of fluid from the body in a short time. Also OTOTOXIC and cause deafness. Reserved for more

POTASSIUM-SPARING DIURETICS

Amiloride (Midamor)
Spironolactone (Aldactone)-*** Prototype drug
Triamterene (Dyrenium)
eplerenone (inspra)

POTASSIIUM-SPARING DIURETICS SIDE EFFECTS

Minor hyperkalemia, headache, fatigue, gynecomastia (spironolactone)
Dysrhythmias, dehydration, hyponatremia, agranulocytosis, and other blood dycrasias.

THIAZIDE DIURETCS

chlorothiazide (Diruril)**Prototype drug
chlorthalidone (Hygroton)
hydrochlorothiazide (microzide) **Prototype drug
indapamide (Lozol)
methyclothiazide (Enduron)
metolazone (Zaroxolyn)

Thiazide Side effects

Minor hypokalemia, fatigue
***Signifcant hypokalemia, electrolyte depletion, dehydration, hypotension, hyponatremia, hyperglycemia, coma, blood dycrasias (Blood Dyscrasias is a condition which occurs when one part of the blood is not present in the normal

LOOP/HIGH-CEILING DIURETICS

bumtanide (Bumex)
furosemide (Lasix) Prototype drug
torsemide (Demadex)

LOOP/HIGH-CEILING DIURETICS SE

Minor hypokalemia, postural hypotension, tinnitus, nausea, diarrhea, dizziness, fatigue
***Significant hypokalemia, blood dycrasias, dehydration, ototoxicity, electrolyte imbalance, circulatory collapse.

Primary Antihypertensive Agents

Diuretics
Angiotensin-converting enzyme (ACE) inhibitors
Angiotensin II receptor blockers
Beta-adrenergic antagonists
Calcium channel blockers

Secondary Antihypertensive Agents

Alpha1-adrenergic antagonist
Alpha2-adrenergic agonists
Direct-acting vasodilators

Prototype drug: hydrochlorothiazide (HydroDiuril).

Prototype drug: hydrochlorothiazide (HydroDiuril).
Mechanism of action: to increase amount of urine produced and excreted
***Primary use: for mild to moderate hypertension
Adverse effects: electrolyte imbalances, especially loss of potassium
***Because hy

Patients receiving Diuretic therapy

Include the following points when teaching
clients about diuretics:
? Keep all scheduled laboratory visits for electrolyte levels
and organ function tests.
? Do not use salt substitutes (which contain potassium) or
sports drinks when taking potassium-spar

Calcium Channel Blockers for hypertension

Calcium channel blockers exert beneficial effects on the
heart and blood vessels by blocking calcium ion channels.
They are used in the treatment of HTN and other cardiovascular
diseases.Contraction of muscle is regulated by the amount of calcium ion insi

CALCIUM CHANNEL BLOCKERS

amiodipine (Novasc)
felodipine (Plendil)
isradipine (DyanaCirc)
Nifedipine (Adalat, Procardia) ***Prototype drug
nisoldipine (Nisocor)

CALCIUM CHANNEL BLOCKERS (SE)

flushed skin, headache, dizzy, peripheral edema, light-headedness, nausea, constipation, fatigue, weakness, myalgia, arthralgia, impotence, and sexual dysfunction.
**Hepatotoxicity, MI,CHF, confusion, mood changes, angioedema (particularily of face area).

CCB'S for both blood vessels and ?

diltiazem (Cardiazm, Dilacor, Tiamate) **prototype drug
verapamil (Calan, Isoptin, Verelan) **Prototype drug

CCB'S for both blood vessels and ? /SE

flushed skin, headache, dizzy, peripheral edema, light-headedness, nausea, constipation, fatigue, weakness, myalgia, arthralgia, impotence, and sexual dysfunction.
**Hepatotoxicity, MI,CHF, confusion, mood changes, angioedema (particularily of face area).

Nifedipine (Adalat, Procardia) ***Prototype drug

Mechanism of action: to cause vasodilation, decreasing B/P
Actions and uses:Nifedipine is a CCB generally prescribed for HTN and variant or vasospastic angina. It is occasionally used to treat Raynaud's phenomenon and hypertrophic cardiomyopathy. Acts by

diltiazem (Cardiazm, Dilacor,Tiamate) **prototype drug

Non-DHP Ca-blocker(Non- Dihydropyridine Calcium Channel Blockers). Acts on HEART AND VESSELS. Decreases contractility and causes smooth muscle relaxtion (veins). Use: hypertension, arrthmias. SE: Cardiac depression, AV block, edema, dizziness.

verapamil (Calan, Isoptin, Verelan) **Prototype drug

Primary use: HTN, arrhythmias, angina, prophylaxis of paroxysmal supraventricular tachycardia (PSVT) Class/Mech: Vasodilator and cardiac depressant, Ca Channel blker (L type Ca channels) Side Effects: Strong neg inotropic effects, Hypotension, AV block, h

Nursing Process CCB's/ teaching

Monitor blood pressure and ensure the proper use of home equipment.
? Stop medication if blood pressure is 90/60 mm Hg or below, and immediately notify the healthcare provider.
? Immediately report palpitations or rapid heartbeat.
? Instruct client to rep

ACE inhibitors

benazepril (Lotensin) PO; 10-40 mg in a single dose or divided doses (max: 40 mg/day)
captopril (Capoten) PO; 6.25-25 mg tid (max: 450 mg/day)
*enalapril (Vasotec) PO; 5-40 mg in a single dose or 2 divided doses (max: 40 mg/day)
fosinopril (Monopril) PO;

ACE SE

Headache, dizziness, orthostatic hypotension,
rash
***Angioedema, acute renal failure, first-dose
phenomenon

Angiotension II Receptor Blockers Drugs

candesartan (Atacand) PO; start at 16 mg/day (range: 8-32 mg divided once or twice daily)
eprosartan (Teveten) PO; 600 mg/day or 400 mg qid-bid (max: 800 mg/day)
irbesartan (Avapro) PO; 150-300 mg/day (max: 300 mg/day)
losartan (Cozaar) PO; 25-50 mg in a

ARB SE

Headache, dizziness, orthostatic hypotension,
rash
****Angioedema, acute renal failure, first-dose
phenomenon

ARB Nursing process/ teaching

? Observe for hypersensitivity reaction, particularly angioedema. (Angioedema may occur at any time during ACE inhibitor therapy, but is generally expected shortly after initiation of therapy.)
? Monitor for neutropenia and signs of infection. (ACE inhibi

Beta-Adrenergic blockers

Agents that inhibit responses to sympathetic adrenergic nerve activity, causing a slowing of electrical conduction and heart rate and a lowering of the pressure within the walls of the vessels, they ? cardiac workload and used to treat angina pectoris, hy

Alpha?-Adrenergic Blocker Drugs

*doxazosin (Cardura) PO; 1 mg at bedtime; may increase to 16 mg/day in a single dose or 2 divided doses (max: 16 mg/day)
*prazosin (Minipress) PO; 1 mg at bedtime; may increase to 1 mg bid-tid (max: 20 mg/day)
(see page 141 for the Prototype Drug )
terazo

Alpha? SE

Orthostatic hypotension, dizziness, headache,
fatigue
***First-dose phenomenon, tachycardia, dyspnea

Alpha? Drugs

clonidine (Catapres) PO; 0.1 mg bid-tid (max: 0.8 mg/day)
guanabenz (Wytensin) PO; 4 mg bid; may increase by 4-8 mg/day q1-2 wk (max: 32 mg bid)
methyldopa (Aldomet) PO; 250 mg bid or tid (max: 3 g/day)

Alpha? SE

Peripheral edema, sedation, depression,
headache, dry mouth, decreased libido
**Hepatotoxicity, hemolytic anemia,
granulocytopenia

BETA-ADRENERGIC ANTAGONISTS DRUGS

atenolol (Tenormin): beta1 PO; 25-50 mg/day (max: 100 mg/day) (Prototype Drug )***
bisoprolol (Zebeta): beta1 PO; 2.5-5 mg/day (max: 20 mg/day)
metoprolol (Toprol, Lopressor): beta1 PO; 50-100 mg/day-bid (max: 450 mg/day)
propranolol (Inderal): beta1 and

BETA-ADRENERGIC ANTAGONISTS/ SE

Fatigue, insomnia, drowsiness, impotence or
decreased libido, bradycardia and confusion.
Agranulocytosis, laryngospasm, Stevens-Johnson syndrome, anaphylaxis; if the drug is abruptly withdrawn, palpitations,
rebound hypertension, dysrhythmias, MI.

ALPHA1- AND BETA-BLOCKERS (CENTRALLY ACTING)

carteolol (Cartrol, Ocupress) PO; 2.5 mg/day; may increase to 5-10 mg if needed
(max: 10 mg/day)
labetalol (Trandate, Normodyne) PO; 100 mg bid; may increase to 200-400 mg bid
(max: 1200-2400 mg/day)
carvedilol (Coreg) PO; 3.125 mg bid (max:50 mg/day)

enalapril (Vasotec) ***Prototype drug/ ACE Inhibitor

HTN, heart failure; ACE inhibitor
-reduces angiotensin II and aldosterone levels to significantly reduce B/P
-adverse: hyperkalemia, ortho hypotension, rapid fall in B/P may occur after dose 1, angioedema, neutropenia, agranulocytosis
-contra: pregnancy/l

doxazosin (Cardura)/ alpha?adrenergic, Prototype

highly selective a1 antagonist
*produces less reflex tachycardia
-relaxes arteriole and venous vascular smooth muscle
- relaxes smooth muscle in prostate
+HTN
+BPH
Side effect: can cause 1st dose orthostatic hypotension

prazosin (Minipress) alpha?adrenergic, Prototype

- ?1 antagonist; relaxes vascular smooth muscle and prostate gland smooth muscle (BPH); SE: orthostatic hypotension, syncope, rebound nasal stuffiness (allow vessels to dilate)

ALPHA1- AND BETA-BLOCKERS / SE

Headache, drowsiness, anxiety, depression, lethargy, impotence
***Bradycardia, may worsen heart failure and mask symptoms of hypoglycemia