-
What do diuretics do for HTN?
lower blood volume through urinary excretion of water and electrolytes
-
what electrolytes are affected by diuretics to treat HTN?
-
what labs are monitored in diuretic treatment
- BMP
- BUN
- LFT's
- Cholesterol panel
- Glucose
-
what is the normal adult BP range?
<120 / <80
-
what is consider prehypertensive?
120-139 / OR 80-89
-
what is considered Stage 1 hypertension?
140-159 / OR 90-99
-
what is considered Stage 2 hypertension?
≥160 / OR ≥100
-
non-pharmacological interventions to reduce or prevent HTN?
- limit ETOH
- restrict salt <1500mg/day
- reduce intake of sat fat and cholesterol
- increase fruits / vegetables
- increase aerobic activity
- d/c tobacco
- manage stress
- maintain optimal weight
- consume K+, Ca+, Mg+
-
Name the classifications of primary anti-HTN agents
- diuretics
- Ca+ Channel Blockers
- ACE Inhibitors
- ARB (Angiotensin II Receptor Blockers)
- Beta Blocker
- Alpha1 adrenergic blocker
- Alpha2 adrenergic blocker
-
With any drug that vasodilates (Ca+ channel blockers) what is a major concern?
congestive heart failure
-
which anti-HTN class of drug should be used with caution in patients with asthma (due to adverse effect of bronchoconstriction)?
Beta-adrenergic blockers (Beta-blockers)
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what is the action of Microzide (hydrochlorothiazide)?
- Diuresis via ↓ kidney absorption
- ↓BP and workload
-
what are the side effects of Microzide (hydrochlorothiazide)?
- electrolyte imbalances (Na+, K+)
- gout
- ↑lipids
- ↑BS
- blood dyscrasias
- ED
-
what are the nursing considerations of Microzide (hydrochlorothiazide)?
- I/O's
- fatigue
- vitals (BP/HR/weights)
- fall risk (dizziness)
- diuresis
- hypo/hyperkalemia s/s
-
what are the labs to monitor for Microzide (hydrochlorothiazide)?
- BMP
- BUN
- LFT's
- Cholesterol
- Glucose
- CBC
-
what is the action of Lasix (furosemide)?
- Most diuresis via ↓kidney LOOP absorption
- ↓BP and workload
-
what are the side effects of Lasix (furosemide)?
- electrolyte imbalances
- orthostatic hypotension (syncope)
- OTOTOXICITY**
- BLACK BOX: may lead to profound diuresis with water and electrolyte depletion
-
what is the normal K+ range?
3.5 - 5.0 mEq/L
-
what are the nursing considerations of Lasix (furosemide)?
- I/O's
- fatigue
- vitals (BP/HR/weights)
- fall risk (dizziness)
- diuresis
- hypokalemia s/s
-
what are the labs to monitor with Lasix (furosemide)?
- BMP
- BUN
- LFT's
- Cholesterol
- Glucose
- CBC
-
what is the action of Aldactone (spironolactone)?
- acts on distal convoluted tubule
- blocks action of aldosterone
- ↑ Na+ excretion
- ↓ K+ excretion
-
what are the side effects of Aldactone (spironolactone)?
- hyperkalemia
- arrhythmias
- HA
- fatigue
- dizziness
- blood dyscrasias
- Men-gynecomastia, impotence, ↓ libido
- Women-hirsutism, breast tenderness, menstrual irregularities, voice deepening
-
what are the nursing considerations of Aldactone (spironolactone)?
- monitor I/O's
- fatigue
- monitor vitals (BP/HR/weights)
- risk for falls (dizziness)
- diuresis
- monitor labs
- s/s of hyperkalemia
-
what are the labs to monitor for Aldactone (spironolactone)?
-
what is the action of Procardia (nifedipine)?
- causes vasodilation, decreasing BP
- works on ARTERIOLES
-
what class of drug is Procardia (nifedipine)?
Ca+ channel blocker
-
what class of drug is Microzide (hydrochlorothiazide)?
thiazide diuretic
-
what class of drug is Lasix (furosemide)?
loop diuretic
-
what class of drug is Aldactone (spironolactone)?
K+ sparing diuretic
-
what are the side effects of Procardia (nifedipine)?
↓peristalsis of bowels=constipation
- dizziness
- HA
- arrhythmias
- peripheral edema
- brady or tachy
- flushing
- Nausea (GI upset)
- possible male infertility
- sexual difficulties
-
what are the nursing considerations of Procardia (nifedipine)?
- monitor BP/HR (REPORT <90/60
- falls risk due to dizziness
- monitor labs
- daily weights
- safe and well tolerated by elderly and afro-american
-
what are the labs to monitor for Procardia (nifedipine)?
-
what is the action of Vasotec (enalapril)?
- reduces levels of angiotensin II (vasoconstrictor) and aldosterone
- ↓BP and workload lowering peripheral resistance & blood volume
-
what class of drug is Vasotec (enalapril)?
ACE inhibitor (prils)
-
what are the adverse effects of Vasotec (enalapril)?
- cough
- postural hypotension
- hyperkalemia
- angioedema (↑ risk with AfroAmerican)
- renal failure
- agranulocytosis
-
what are the nursing considerations of Vasotec (enalapril)?
- monitor BP/HR
- falls risk (dizziness)
- monitor labs
- daily weights
-
what are the labs to monitor for Vasotec (enalapril)?
-
what is the action of Coreg (carvedilol)?
- block cardiac contractility
- slows HR and BP
- reduces workload of the heart
-
what class of drug is Coreg (carvedilol)?
beta-blocker
-
what are the adverse effects of Coreg (carvedilol)?
- fluid retention
- worsening of heart failure
- fatigue
- hypotension
- bradycardia
- heart block
- ↓ libido
- impotence
- depression
- lethargy
- DMI ↓BS / DMII ↑BS
-
what are the nursing considerations of Coreg (carvedilol)?
- Hold if HR <60
- monitor BP/HR
- falls risk (dizziness)
- monitor labs
- daily weights
-
what are the labs to monitor Coreg (carvedilol)?
- BUN
- cholesterol panel
- BMP (K+)
- uric acid
-
what does the acronym "A Boy Has Kicking Legs" stand for?
- Alpha 1 - ARTERIOLE smooth muscle (vasoconstrict to ↑BP)
- Alpha 2 - BRAIN inhibits (regulates) CNS output of epinephrine
- Beta 1 - HEART rate and strength of contraction; KIDNEYS release renin
- Beta 2 - LUNGS (bronchioles) bronchodilate and skeletal muscle
-
Alpha 1 - affects what receptors?
- ARTERIOLE
- vasoconstricts to ↑BP
-
Alpha 2 - affects what receptors?
- BRAIN
- regulates CNS output of EPI
-
Beta 1 - affects what receptors?
- HEART - rate and strength of contraction
- KIDNEYS - release of renin
-
Beta 2 affects what receptors?
LUNGS - bronchodilation of bronchioles and skeletal muscle
-
What drugs affect the RAAS system?
(Renin-angiotensin-aldosterone-system)
- Diuretics
- ACE inhibitors
- ARB's
-
What class of drugs inhibit the sympathetic nervous system?
- Beta blockers
- Alpha blockers (alpha adrenergic agonists)
- Ca+ channel blockers
-
what role does aldosterone play in our system?
retains sodium and water follows
Angiotensin II triggers release of aldosterone
-
Angiotensin II is known as one of the most potent...?
VASOCONSTRICTORS
↑BP
-
ACE inhibitors are what nickname?
- "prils"
- lisinopril
- enalapril
-
ARB's (Angiotensin II Receptor Blockers) are what nickname?
- "sartans"
- valsartan
- losartan
-
Beta Blockers are what nickname?
- "olols"
- metoprolol
- propranolol
-
Alpha adrenergic blockers are what nickname?
- "zosins"
- doxazosin
- prazosin (Minipress)
-
Ca+ channel blockers are what nickname?
- "dipines"
- nifedipine
- amlodipine
ALSO diltiazem and verapamil
-
Vasodilation does what?
- relaxes smooth muscles of blood vessels
- drops BP
- increases water and Na+ retention
-
what is the drug of choice in a hypertensive emergency?
Nipride (sodium nitroprusside)
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