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Medications Affecting Blood Pressure

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الكلية كلية التمريض     القسم قسم العلوم الطبية الاساسية     المرحلة 3
أستاذ المادة عمار عباس شعلان الحميري       15/03/2016 10:44:50
medications affecting blood pressure

hypertension a common, often asymptomatic disorder in which systolic blood pressure persistently exceeds 140 mm hg and/or diastolic pressure exceeds 90 mm hg.


essential hypertension elevated systemic arterial pressure for which no cause can be found also called primary or idiopathic hypertension.

secondary hypertension high blood pressure caused by another disease such as renal, pulmonary, endocrine, or vascular disease.

orthostatic hypotension a common adverse effect of adrenergic blocking drugs involving a sudden droping in blood pressure when a person changes position, especially when rising from a seated or horizontal position.

blood pressure may be controlled in a variety of ways with a variety of agents that may be used alone or in combination.

the classifications of medications used to control blood pressure include:
thiazide diuretics
angiotensin-converting enzyme (ace) inhibitors
angiotensin ii receptor blockers (arbs)
calcium channel blockers (ccb)
alpha adrenergic blockers
centrally acting alpha2 agonists
beta adrenergic blockers
vasodilators


angiotensin-converting enzyme (ace) inhibitors
angiotensin-converting enzyme (ace) inhibitors
select prototype medication: captopril (capoten)
other medications:
enalapril (vasotec)
enalaprilat (vasotec iv)
fosinopril (monopril)
lisinopril (prinivil)
ramipril (altace)
expected pharmacological action
ace inhibitors produce their effects by blocking the production of angiotensin ii, leading to:
vasodilation (mostly arteriole)
excretion of sodium and water, and retention of potassium by actions in the kidneys
reduction in pathological changes in the blood vessels and heart that result from the presence of angiotensin ii and aldosterone
therapeutic uses
hypertension
heart failure
myocardial infarction (to decrease mortality and to decrease risk of heart failure and left ventricular dysfunction)
diabetic and nondiabetic nephropathy
for clients at high risk for a cardiovascular event, ramipril can be used to prevent mi,stroke, or death.
side/adverse effects

contraindications/precautions
these medications are pregnancy risk category d during the second and third trimester, related to fetal injury.
ace inhibitors are contraindicated in clients with renal stenosis when present bilaterally or in a single remaining kidney.
these medications are contraindicated in clients with a history of angioedema following use of ace inhibitor.
use cautiously in clients with renal impairment and collagen vascular disease because they are at greater risk for developing neutropenia. closely monitor these clients for signs of infection.
interactions
nursing administration
administer ace inhibitors orally except enalaprilat, which is the only ace inhibitor for iv use.
advise clients that the medication may be prescribed as a single formulation or in combination with hydrochlorothiazide.
advise clients that blood pressure has to be monitored after the first dose for at least 2 hr to detect hypotension.
instruct clients that captopril should be taken at least 1 hr before meals. all other ace inhibitors can be taken with or without food.
advise clients to notify the provider if cough, rash, dysgeusia (lack of taste), and/or signs of infection occur.
angiotensin ii receptor blockers (arb s)

select prototype medication: losartan (cozaar)
other medications:
valsartan (diovan)
irbesartan (avapro)
candesartan (atacand)
olmesartan (benicar)
expected pharmacological action
these medications block the action of angiotensin ii in the body. this results in:
vasodilation (mostly arteriole)
excretion of sodium and water, and retention of potassium (through effects on the kidney)
therapeutic uses
hypertension
heart failure and prevention of mortality following mi
stroke prevention
delay progression of diabetic nephropathy
side/adverse effects
the major difference between arbs and ace inhibitors is that cough and hyperkalemia are not side effects of arbs.
contraindications/precautions
arbs are contraindicated in second and third trimester related to fetal injury (pregnancy risk category d).
these medications are contraindicated in clients with renal stenosis when present bilaterally or in a single remaining kidney
use cautiously in clients who experienced angioedema with ace inhibitor (not an absolute contraindication).
interactions
nursing administration
administer medications by oral route.
advise clients that medication may be prescribed as a single formulation or in combination with hydrochlorothiazide.
advise clients that arbs can be taken with or without food.
calcium channel blockers

select prototype medications:
nifedipine (adalat, procardia)
verapamil (calan)
diltiazem (cardizem)
other medications:
amlodipine (norvasc)
felodipine (plendil)
nicardipine (cardene, cleviprex)
expected pharmacological action
therapeutic uses
side/adverse effects

contraindications/precautions
pregnancy risk category c
use cautiously with women who are lactating.
these medications are contraindicated in clients who have heart block, hypotension, bradycardia, aortic stenosis, or severe heart failure.
use verapamil and diltiazem cautiously in clients receiving digoxin and beta-blockers.
use cautiously in older adults and clients who have kidney disorders, liver disorders, or mild to moderate heart failure.
interactions
nursing administration
advise clients not to chew or crush sustained-release tablets.
for intravenous administration, administer injections slowly over a period of 2 to 3 min.
advise clients who have angina to record pain frequency, intensity, duration, and location. the provider should be notified if attacks increase in frequency, intensity, and/or duration.
teach clients to monitor blood pressure and heart rate, as well as keep a blood pressure record.
alpha adrenergic blockers (sympatholytics)

alpha1 blockers drugs that primarily cause arterial and venous dilation through their action on peripheral sympathetic neurons.

select prototype medication: prazosin (minipress)
other medication: doxazosin mesylate (cardura)
expected pharmacological action
selective alpha1 blockade results in:
venous and arterial dilation
smooth muscle relaxation of the prostatic capsule and bladder neck
therapeutic uses
primary hypertension.
doxazosin mesylate (cardura) may be used to decrease symptoms of benign prostatic hypertrophy (bph), which include urgency, frequency, and dysuria.
side/adverse effects
contraindications/precautions
pregnancy risk category c
contraindicated in clients with hypersensitivity to medication
interactions
nursing administration
obtain baseline blood pressure and heart rate.
instruct clients that the medication can be taken with food.
recommend that clients take the initial dose at bedtime to decrease “first-dose” hypotensive effect.
centrally acting alpha2 agonists

centrally acting adrenergic drugs drugs that modify the function of the sympathetic nervous system in the brain by stimulating alpha2 receptors.
alpha2 receptors are inhibitory in nature and thus have a reverse sympathetic effect and cause decreased blood pressure.

select prototype medication: clonidine (catapres)
other medications: guanfacine hcl (tenex), methyldopa (aldomet)
expected pharmacological action
these medications act within the cns to decrease sympathetic outflow resulting in decreased stimulation of the adrenergic receptors (both alpha and beta receptors) of the heart and peripheral vascular system.
decrease in sympathetic outflow to the myocardium results in bradycardia and decreased cardiac output (co).
decrease in sympathetic outflow to the peripheral vasculature results in vasodilation, which leads to decreased blood pressure.
therapeutic uses
primary hypertension (administered alone, with a diuretic, or with another antihypertensive agent)
severe cancer pain (administered parenterally by epidural infusion)
investigational use
migraine headache
flushing from menopause
management of adhd and tourette’s syndrome
management of withdrawal symptoms from alcohol, tobacco, and opioids
side/adverse effects
contraindications/precautions
clonidine is pregnancy risk category c.
avoid use during lactation.
this medication is contraindicated for clients taking anticoagulant medications
avoid use of transdermal patch on affected skin in scleroderma and systemic lupus erythematosus (sle).
use cautiously in clients with cerebrovascular disease, recent mi, diabetes mellitus, major depressive disorder, or chronic renal failure.
interactions
nursing administration
administer medication by oral, epidural, and transdermal routes.
medication is usually administered twice a day in divided doses. take larger dose at bedtime to decrease the occurrence of daytime sleepiness.
transdermal patches are applied every seven days. advise clients to apply patch on hairless, intact skin on torso or upper arm.
beta adrenergic blockers (sympatholytics)

select prototype medications:
cardioselective: beta1
metoprolol (lopressor)
atenolol (tenormin)
metoprolol succinate (toprol xl)
esmolol hcl (brevibloc)
nonselective: (beta1 and beta2)
propranolol (inderal)
nadolol (corgard)
labetalol (normodyne)
expected pharmacological action
in cardiac conditions, the primary effects of beta-adrenergic blockers are a result of beta1-adrenergic blockade in the myocardium and in the electrical conduction system of the heart.
decreased heart rate (chronotropic [rate] action)
decreased myocardial contractility (inotropic [force] action)
decreased rate of conduction through the av node
therapeutic uses
primary hypertension (exact mechanism unknown: may be related to long-term use causing reduction in peripheral vascular resistance)
angina, tachydysrhythmias, heart failure and myocardial infarction.
other uses may include:
treatment of hyperthyroidism, migraine headache, stage fright, pheochromocytoma, and glaucoma
side/adverse effects
side/adverse effects
contraindications/precautions
beta-adrenergic blockers are contraindicated in clients with av block and sinus bradycardia.
nonselective beta-adrenergic blockers are contraindicated in clients with asthma, bronchospasm, and heart failure.
use cardioselective beta-adrenergic blockers cautiously in clients with heart failure, asthma, bronchospasm, diabetes, with history of severe allergies, and depression.
interactions
nursing administration
administer medications orally, usually once or twice a day.
administer the following medications by iv route: atenolol, metoprolol, labetalol, propranolol.
advise clients not to discontinue medication without consulting the provider.
advise clients to avoid sudden changes in position to prevent occurrence of orthostatic hypotension.
instruct clients not to crush or chew extended release tablets.
teach clients to self monitor heart rate and blood pressure at home on a daily basis.
nursing evaluation of medication effectiveness
absence of chest pain.
absence of cardiac dysrhythmias.
normotensive blood pressure readings.
control of heart failure signs and symptoms.
medications for hypertensive crisis

select prototype medication: nitroprusside sodium (nitropress)
other medications:
nitroglycerin (nitrostat iv)
nicardipine (cardene)
clevidipine (cleviprex)
enalaprilat (vasotec iv)
esmolol hcl (brevibloc)
expected pharmacological action
direct vasodilation of arteries and veins resulting in rapid reduction of blood pressure (decreased preload and afterload).

therapeutic uses
hypertensive emergencies
side/adverse effects
contraindications/precautions
pregnancy risk category c
use cautiously in clients who have liver and kidney disease or fluid and electrolyte imbalances, and in older adults.
interactions
nitroprusside should not be administered in the same infusion as any other medication.
nursing administration
prepare medication by adding to diluent for iv infusion.
note color of solution. solution may be light brown in color. discard solution of any other color.
protect iv container and tubing from light.
discard medication after 24 hr.
monitor vital signs and ecg continuously.
nursing evaluation of medication effectiveness
decrease in blood pressure and maintenance of normotensive blood pressure.
improvement of heart failure such as ability to perform activities of daily living, improved breath sounds, absence of edema.
improvement in renal function and delay of further progression of renal disease.
case study
hypertension was diagnosed in g.s., who is 30 years old. both her mother and sister have hypertension, and both were also in their thirties when it was diagnosed.
g.’s most current blood pressure reading is 150/96 mm hg, and for this reason the nurse practitioner has recommended therapy with captopril (capoten), light exercise in the form of walking, and relaxation therapy. after 1 month of therapy, g.’s blood pressure is 145/86 mm hg.
stress reduction has been the biggest obstacle in her treatment, because she is a lawyer with a prominent law firm and has found that her blood pressure is consistently elevated (160/100 mm hg) whenever she measures it at work. at this follow-up visit, she is also given a prescription for a diuretic to help with her blood pressure control.

what type of diuretic was probably prescribed for g.s. at this time? explain your answer.
what possible adverse effects does g. need to be aware of while taking captopril?
g. tells you that she uses an over-the-counter pain reliever for occasional headaches. what potential interaction is of concern?
g.s. states that she and her husband are planning to start a family in 1 year. what will you, as her nurse, tell her about pregnancy and therapy with these drugs?
what lifestyle changes would you, as her nurse, recommend that she make, and, even more important, what information would you give her to help her change her lifestyle and more effectively reduce the stress in her life?
case study
a 56-year-old man started antihypertensive drug therapy 3 months earlier and is in the office for a follow-up visit. while the nurse is taking his blood pressure, he informs the nurse that he has had some problems with sexual intercourse. which would be the most appropriate response by the nurse?

“not to worry. eventually, tolerance will develop.”
“the physician can work with you on changing the dose and/or drugs.”
“sexual dysfunction happens with this therapy, and you will learn to accept it.”
“this is an unusual occurrence, but it is important to stay on your medications.”


المادة المعروضة اعلاه هي مدخل الى المحاضرة المرفوعة بواسطة استاذ(ة) المادة . وقد تبدو لك غير متكاملة . حيث يضع استاذ المادة في بعض الاحيان فقط الجزء الاول من المحاضرة من اجل الاطلاع على ما ستقوم بتحميله لاحقا . في نظام التعليم الالكتروني نوفر هذه الخدمة لكي نبقيك على اطلاع حول محتوى الملف الذي ستقوم بتحميله .
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