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Anti hypertensives

An introduction to anti hypertensives for nursing students

Erika Heilig

on 13 July 2010

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Transcript of Anti hypertensives

Ca channel blockers Classified into groups
according to
Site of Action PRECAUTIONS Some cause sodium and H2O retention
and may be combined with a diuretic. INTERACTIONS Antihistamines
Appetite Suppressants
MAO inhibitors Negate the effectiveness
of antihypertensives Angiotensin-Converting Enzyme ACE Inhibitors Therapeutic Classification: Antihypertensive
Pharmacologic Classification: ACE inhibitor
Pregnancy Catagory C (1st trimester)
Pregnancy Catagory D (2nd & 3rd t-mesters) Inhibitors Currently TEN drugs available benazepril
Pharmacokinetics: Absorption: Depends on drug
Distribution: All cross placenta,
Some enter breast milk,
Minimal on CNS
Metabolism: Depends on drug
Excretion: Depends on drug Contraindications/Precautions History of angioedema with previous use of ACE Inhibitors
Can cause injury or death in fetus
Appears in breast milk
EXTREME CAUTION in family history of angioedema Adverse Reactions/
taste disturbances Peripherally-acting Antiadrenergics
Centrally Acting Alpha Adrenergics
Beta Blockers
Angiotensin II antagonists
ACE inhibitors
Calcium Channel Blockers Used to lower blood pressure to <90 mm Hg diastolic
and prevent end-organ damage Block the conversion of angiotensin I to the vasoconstrictor angiotensin II,
Prevent the degradation of bradykinin and other vasodilatory prostaglandins,
Increase plasma renin levels and rescue aldosterone levels,
Net result is systemic vasodilation. lisinopril: Prinivil, Zestril Therapeutic Classification: Antihypertensive
Pharmacologic Classification: ACE inhibitor
Pregnancy Catagory C (1st trimester)
Pregnancy Catagory D (2nd & 3rd t-mesters) Nursing Alerts Use extreme caution when administering to renal impaired patients It should be started at a low dose 2.5mg to 5mg and titrated up to 40mg a day Geriatric patients should be started at a low dose as well due to age related decline in renal function Contraindicated for children with renal impairment Blood pressure and pulse should be monitored closely during initial dose adjustment and throughout therapy Patient Teaching Educate patient of serious side effects:
mouth sores
sore throat
swelling of hands or feet
irregular heart beat
chest pain
dry cough
swelling of face, eyes, lips or tongue
Any difficulty swallowing or breathing
avoid salt substitutes
standing for long periods
hot weather

http://video.google.com/videoplay?docid=-3655803825264921076# inform your doctor if nausea, diarrhea or vomiting develops

advise your patient to comply with follow up exams to monitor progress

warn patients to immediately stop use and to see there doctor if they believe they may be pregnant
Encourage them to manage their CHF through other means as well such as:
stress management,
limiting alcohol consumption,
stopping smoking,
low sodium diet,
and weight loss

diltiazem Cardizem CD, Cardizem LA, Cardizem S Therapeutic Classification: antianginal, antiarrhythmic, antihypertensive
Pharmacologic Classification: calcium channel blocker
Not a controlled substance.
Pregnancy Category C
Belongs to the Benzothiazepine class of calcium channel blockers.
Acts as a cardiac depressant and a systemic vasodilator in order to reduce arterial pressure. Pharmacokinetics:
Well absorbed, fast acting after oral administration. Protein binding 70-80%.
Mostly metabolized in the liver
Excreted through urine and feces.
Half-life is 3.5-9 hours. Contraindications:
Hypersensitivity; sick sinus syndrome; 2nd or 3rd degree AV block ( unless an artificial pacemaker is in place); severe hypotension; acute MI; pulmonary congestion.
Use cautiously with geriatric patients , pregnant and lactating women, as well as children. Adverse Reactions/Side Effects
CNS: abnormal dreams, anxiety, dizziness, headache, weakness.
Resp: cough, dyspnea.
EENT: blurred vision.
CV: ECG abnormalities, peripheral edema, hypotension, chest pain, bradycadia.
GI: anorexia, constipation, diarrhea.
Endo: hyperglycemia.
Derm: dermatitis, rash
Life Threatening Side Effects:
CV: arrhythmia, CHF

Misc: Stevens-Johnson Syndrome.
30-120 mg 3-4 times daily,
60-120 mg twice daily as SR capsules,
180-240 mg once daily as CD,
360 mg/day of LA tablets.
0.25 mg/kg; may repeat in 15 minutes with 0.35 mg/kg. (range 5-15mg/hour). Availability: Nursing Implications Assessment:
Monitor blood pressure and pulse before and during therapy.
Monitor input and out put ratios and daily weigh. (Watch for signs of CHF)
Implementation: Alerts
Do not confuse Cardizem with Cardene.
May be given without regard to meals.
Do not open, crush, break or chew sustained-release tablets. Patient/Family Teaching: Take missed doses as soon as possible and do not double doses. Do not share.
Call your doctor if heart rate is < 50 bpm. May cause drowsiness and dizziness. Avoid driving until response to the medication is known.
Contact your healthcare professional if experiencing irregular heartbeat, dyspenea, swelling of hands and feet, pronounced dizziness, nausea, constipation, or hypotension.
Wear protective clothing and sunscreen outside to avoid photosensitivity reaction.
Monitor BP weekly for any significant changes.
Evaluation of Therapy:
-decrease in high blood pressure
-decrease anginal attacks
-increase activity tolerance and well being
-prevention of rapid irregular heart beat CLASSES OF CCBs Dihydropyridine - Targets blood vessels only.

Phenylalkylamine - Targets cardiac muscles only.

Benzothiazepine - Targets cardiac muscles & blood vessels.

Therapeutic Classification: Antihyperstensive
Pharmacologic Classification: Calcium Channel Blockers
Pregnancy Category C
May cause birth defects.
May pass into breast milk.
Absorption: Absorbed well orally or intravenously.
Distribution: Unknown
Metabolism and Excretion: Mostly metabolized by the liver.

Muscle contractions are controlled by cycling levels of calcium.
CCB’S block calcium channels within muscle cells.
Manipulating levels of calcium levels control the force of a contraction.
Within the heart a decrease in calcium levels leads to a decrease in cardiac out. A decrease in in cardiac out leads to decrease in blood pressure
Within the blood vessels a decrease in calcium levels leads to vasodilation. Vasodilation leads to a decrease in peripheral resistance and leads to decrease in bp.
ACE inhibitors slow enzyme ACE, decreasing production of angiotensin II.
CCB’S block calcium channels that control contractions and vasodilation.
Both promote vasodilation decreasing peripheral resistance and lower blood preassue.
Patients may have hypersensitivity to individual agents.
Pregnant and lactating women should use caution with ACE inhibitors and Angiotensin II antagonist.
Patients taking digoxin should use caution with CCB’S.
Alpha-adrenergic agonists and beta-blockers should be used only with patients who will comply.
Thiazide diuretics may increase the need for treatment of diabetes.
Vasodilators may cause tachycardia.
Some antihypertensives cause sodium and water retention.

Therapeutic effectiveness of antihypertensives can be affected by many drugs such as:
Sympathomimetic bronchodilators
Appetite suppressants
Hypokalemia caused from diuretics may increase the risk of digoxin toxicity.
Potassium supplements and potassium-sparing diuretics may cause hyperkalemia when used with ACE inhibitors.
Do not eat grapefruit or drink grapefruit juice. PATIENT/FAMILY TEACHING
Continue taking medication even if feeling better.
Show patient how to take blood pressure.
Change position slowly.
Check with physician before taking any OTC medication.
Do not take this medication with grapefruit or grapefruit juice.

sphygmomanometer instruct patient and family on how to monitor blood pressure, it should be checked at least weekly throughout treatment Encourage patient to use interventions for hypertension.
Lose weight.
Eat health.
Exercise regularly.
Quit smoking. ANTI-HYPERTENSIVES Absorption:
25% absorbed after oral administration (much variability)
cross the placenta, minimal penetration of CNS
Metabolism and Excretion:
100% eliminated by the kidneys
Evaluation of Therapy
Decrease in blood pressure without appearance of excessive side effects
Decrease in signs and symptoms of CHF
Reduction of risk of death or development of CHF following MI
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