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Explain how blood pressure works.
- Blood pressure=COxSVR
- (Cardiac output X systemic vascular resistance)
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What is considered normal BP measurements?
<120/80
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What is considered the "warning" range for BP measurements?
12-139/80-89
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Studies have shown that what conditions are associated with HTN?
HF, Stroke, Renal failure
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HTN is classified by two categories, what are they?
- By Cause: Unknown (idiopathic, essential, primary) 90% of HTN cases
- Known cause: Secondary HTN 10% of cases
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What are some cultural considerations with HTN?
- African americans ^risk of HTN
- d/t meds <effective: beta-blockers, ACE-inhibitors
- Effective meds: alpha1 blockers & Calcium channel blockers
- Asian Americans are 2xs as sensitive to beta-blockers.
- Different drugs used for different ethnicities
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What are the Anti-hypertensive Drug categories?
- Diuretics
- Sympatholytics
- Direct acting arteriolar vasodilators
- Angiotensin converting enxyme (ACE) inhibitors
- Angiotensin II receptor blockers (ARBs)
- Calcium channel blockers (CCBs)
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What is the general action of Diuretics?
- <the plasma & extracellular fluid volumes
- =<preload, cardiac output & total peripheral resistance.
- Overall effect: <workload of the heart &<BP
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What are the most commonly used diuretics for HTN?
Thiazides
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Name the Sympatholytic drugs (sympathetic depressants).
- Beta-adrenergic blockers
- Centrally acting alpha2 agonists
- Alpha-adrenergic blockers
- Adrenergic neuron blockers (peripherally acting sympatholytics)
- Alpha1 - and beta1 adrenergic blockers
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Which Sympatholytic drugs for HTN can cause the 1st dose syncope?
ALL
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The overall action of Sympatholytic drugs used for HTN is what?
<BP & HR
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How do the Beta-adrenergic blockers (sympatholytic beta-blockers) act as Antihypertensives?
<cardiac output by <HR, contractility & renin release = <BP
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What are the A/E of the Beta-adrenergic blockers (sympatholytics)?
Insomnia, depression, & impotence
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How do the Centrally acting Alpha2 agonists (sympatholytics) act as Antihypertensives?
Stimulate the alpha2 receptors= <the sympathetic response from brainstem to the peripheral vessels= <peripheral vascular resistance & ^vasodilation
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Which Centrally acting Alpha2 agonists are used to treat HTN & to manage withdrawal symptoms in opioid or nicotine dependent clients?
Clonidine (Catapres): 7 day patch
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Which Centrally acting Alpha2 agonist (sympatholytic), is used for Gestational HTN d/t it's pregnancy safety?
Methyldopa (Aldomet)
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What are the S/E of Centrally Acting Alpha2 Agonists? (sympatholytics)
Na+ & water retention, dry mouth, bradycardia
**becareful w/HF pts
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What is the general action of the Antihypertensive drugs in the Alpha-Adrenergic Blockers group? (sympatholytics)
Blocks the alpha-adrenergic receptors= vasodilation & <BP
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What are the two categories of the Antihypertensive Alpha-Adrenergic Blocker drugs & what do they treat? (sympatholytic)
- Selective Alpha1: HTN & BPH
- Non-selective Alpha blockers: HTN CRISIS
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Name the Antihypertensive Alpha-Adrenergic blockers in the Selective Alpha1 class.
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What is the action of the little used Antihypertensive Adrenergic Neuron Blocker, Resperpine?
(Peripherally acting sympatholytic)
Block norepinephrine release that results in lowering BP
**LAST CHOICE D/T ORTHO HYPOTENSION**
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The well tolerated Sympatholytic Antihypertensive class of Alpha1 & Beta1 receptor blockers are dual action drugs. Coreg, acts on the body in what way?
- Block the a1-adrenergic receptor
- <HR (b1-receptor blocker)
- Vasodilation (a1-receptor blocker)
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What patients are the Sympatholytic Antihypertensive Alpha1 & beta1 receptor blockers contraindicated in?
COPD clients d/t bronchial constriction
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What are the A/E of the Sympatholytic Antihypertensive drugs?
- ** dry mouth, drowsiness, sedation, constipation**
- HA, Nausea, sleep disturbances, rash, cardiac disturbances (palpitations)
- ^incidence of orthostatic hypotension
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Name the Direct-acting Vasodilators used as Antihypertensives.
- Hyperstat
- Apresoline
- Loniten
- Nipride, Nitropress
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With the Direct-Acting Arteriolar Vasodilator Nipride/Nitropress, what are the NEED to know items?
- Constantly monitor BP
- Light sensitive drug
- Can cause cyanide toxicity
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What is the action of the Direct-Acting Arteriolar Vasodilators like Nipride?
- Directly relax arteriolar &/or venous smooth muscle
- = <systemic vascular response, <afterload, & peripheral vasodilation
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What are the A/E of the Direct-Acting Arteriolar Vasodilator Hydralazine?
Dizziness, HA, anxiety, tachycardia, N/V/D, anemia, dyspnea, edema, nasal congestion
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What are the A/E of the Direct-acting Arteriolar Vasodilators Sodium Nitroprusside (Nitropress)?
Bradycardia, hypotension, possible cyanide toxicity (rare)
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What are the A/E of the Direct-acting Arteriolar Vasodilator Diazoxide?
dizziness, HA, anxiety, orthostatic hypotension, dysrhythmias, Na+ & water retention, N/V, hyperglycemia in DM pts
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Name the Angiotensin Converting Enzyme Inhibitors (ACE inhibitors) that are safe and used a lot.
- Captrpril: very short half-life
- Enalapril
- Lisinipril, prinivil, accupril: long half-lives
- **HTN & types of HF
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What is the mechanism of action for the ACE Inhibitors?
- Block the angiotensin converting enzyme, thus preventing the conversion of angiotensin II from angiotensin I.
- Blocks release of Aldosterone
- **result: <systemic vascular resistance (afterload), vasodilation= <BP
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What are the A/E of ACE Inhibitors?
Fatigue, HA, dizziness, mood changes, impaired taste, hyperkalemia, dry nonproductive cough
*1st dose hypotension may occur
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What are the Angiotensin II Receptor Blockers (ARBs) drug names?
- Losartan
- Diovan
- Eprosartan
- Irbesartan
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How do the Angiotensin II Receptor Blockers (ARBs) work?
Allow angiotensin I to be converted to angiotensin II, but block receptors that recieve the angiotensin II
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What are the A/E of Angiotensin II Receptor Blockers (ARBs)?
- ^resp infections
- HA
- dizziness, inability to sleep, diarrhea, dyspnea, heartburn, nasal congestion, back pain, fatigue
- Hyperkalemia MUCH less likely to occur
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What can Calcium Channel Blockers be used to treat?
- Anti-anginals
- Anti-dysrhythmics
- Anti-hypertensives
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Name the Calcium Channel Blockers used as Anti-hypertensives.
- Bezothiazepines: Diltiazem
- Phenylalkamines: Verapamil
- Dihyropyridines: Amlodipine
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How do the Calcium Channel Blockers cause an Anti-hypertensive effect?
<peripheral smooth muscle tone & <systemic vascular resistance = <BP
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What are the critical assessments before administering Anti-hypertensives?
BP & PULSE
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What are the nursing implications with Anti-hypertensives?
- do NOT miss a dose, NEVER double dose
- TELL MD IF DOSE IS MISSED
- do NOT abruptly stop taking
- change positions slowly
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What client teaching should be done with Anti-hypertensive meds?
- Impotence is expected
- Life-style changes: <Na+, <fat, <Wt, <alcohol
- avoid smoking
- exercise
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