Drugs for Hypertension

Quickly and BRIEFLY answer the

following:
What is the physiology response to
stimulation of each of the following
receptors?
1. alpha 1
2. alpha 2
3. beta 1
4. beta 2

hypertension
A systolic blood pressure greater than 140
mm Hg or a diastolic blood pressure greater
than 90 mm Hg over a sustained period.
Primary hypertension: no known cause
(also referred to as Essential hypertension).
Secondary hypertension: has an identified
cause.

Treatment
Initial treatment depends on initial BP at
diagnosis
Life style modifications
Drug therapy

Arterial blood pressure=

Cardiac output
X
Systemic vascular resistance

Change pressure

3 parts to pressure:
Pump = heart
Fluid = blood
Pipes, tubing = blood vessels

Decrease pressure

Pump = heart - must decrease cardiac output

by decreasing stroke volume or slowing pulse
Fluid = blood - must decrease volume of
circulating fluid
Pipes, tubing = blood vessels must increase
size of vessels
Which of these results in a decrease in
cardiac output?

Decreased cardiac output

What sign and symptoms develop if
cardiac output drops below adequate
levels to meet the needs of the patient?

terminology
Contraction force = inotropic
Increased contraction = + inotropic
Decreased contraction = - inotropic
Vasodilation = decreased peripheral
resistance+ decreased vascular resistance

Angiotensin-Converting Enzyme
Inhibitors
( end in pril)
Vasotec (enalapril)
Prinivil (lisinorpil) Lotensin (benazepril HCL)
PRIMARY ACTIONS:
1. Vasodilation
2. diuresis
What nursing actions are related to these
drug actions?

Side effects ACE inhibitors

Irritating cough
Hypotension after first dose
Rash and metallic taste
Angioedema
What are the related nursing actions?

ARB angiotensin receptor

blockers

Drug actions
Vasodilation
Diuresis
Side effect: angioedema

Calcium Channel Blockers

especially useful in the elderly and African
Americans
PRIMARY ACTIONS:
1. decrease systemic vascular resistance
2. decreased cardiac out put by decreasing
cardiac contraction force
What are the nursing actins related to
these?

CCB side effects

Reflex tachycardia
Drug induced CHF
Orthostatic hypotension
Drug to know: Procardia (nifedipine)

Beta blockers 1 line drugs

st

African Americans do not respond well to

beta blockers
PRIMARY ACTIONS:
1.Decrease contraction force
2. Decrease pulse rate
These result in decreased cardiac output
Constrict airways ( non selective beta
blockers)
Decreases vasoconstriction and fluid
retetion

Side effects of beta blockers

Side effects include sexual malfunction

Bradycardia
CHF
What are the related nursing
interventions?
Coreg (carvedilol)
Tenormin (atenolol) Lopressor, Toprol
(metoprolol)
Inderol (propranolol)

Alpha - 1 Adrenergic blockers

Cardura (doxazosin)

PRIMARY ACTION:
Vasodilation
Side effects:
Orthostatic hypotension
Reflex tachycardia
Nursing actions?

Alpha 1 and beta blockers

Vasodilation
Slows pulse
Decreases contraction force
Some diuresis

Side effects of alpha/beta

blockers
Bradycardia
Decreased CO leading to CHF
What should the nurse do?

Alpha - 2 Adrenergic AGONIST

Inhibits sympathetic stimulation resulting
in:
1. Slows heart rate = decrease cardiac out
put
2. vasodilation
Catapres (clonodine HCL)

Diuretics
PRIMARY ACTION:
DECREASE FLUID VOLUME

Direct vasodilators
PRIMARY ACTION:
Relax smooth vascular muscle =
vasodilation
* TOO MANY SIDE EFFECTS TO BE
FIRST LINE DRUGS

Nursing interventions related to

drugs for HTN
Look at primary action of each drug group
The nursing interventions relate to each
action of the drug

VASODILATORS
related nursing interventions
1. Instruct patients to change positions slowly to
avoid syncope from postural hypotension.

If the drug results in a DECREASE in

Cardiac Output:
Patients should report unusual shortness of
breath; difficulty breathing; swelling of the
feet, ankles, face, or around the eyes;
weight gain or loss; chest pain; palpitations;
or excessive fatigue

If the drug directly causes a

DECREASE PULSE
check prior to administration, hold if < 60

If a drug causes a Decrease blood

volume through diuresis
monitor electrolytes ( related to specific
type of diuretic)
Many cause hyperglycemia so blood sugar
must be controlled especially in diabetics
Intake and out put
Daily weights (what is a significant weight
change?)

Sexual dysfunction
impotence is an expected effect with many
antihypertensives.
This may influence compliance with drug
therapy.

Question
Orthostatic hypotension is a potential
outcome of hypertensive drugs that places
the elderly at risk for injury from falls.
A) Take the dose at bedtime.
B) Change position slowly when rising from
bed or chair.
C) Increase fluid intake by 500 mL per day.
D) Decrease the dose until symptoms disappear.