PHB - WK 10 - Hypertension Flashcards
(35 cards)
Nursing Responsibilities for all Antihypertensives (BP meds)
- Take a BP & Apical Pulse BEFORE and AFTER administering
- After time - assess for dizziness / lightheadedness
- Onset time - recheck BP and Apical pulse
- Bring BP slowly to oxygenate the brain – do not want huge drops in pressure
- Know the parameters for holding
- Assess perfussion - cap refill, distal pulses, color, LOC
- Does the med have a direct effect on cardiac function? rhythm, rate, cardiac output?
- Labs? CBC, BUN, Creatinine, LFT, system labs
When using a single agent for BP control what is superior to ACE and Ca channel Blockers?
Thiazide diuretics
First line drug for hypertension
Thiazide diuretics
HTCZ
No comorbidities
What is the action of Thiazide diuretics (HTCZ)?
hydrychlorothiazide (most widely used
Reduce blood volume and vascular resistance
What are the adverse effect of Thiazide diuretics (HTCZ)?
- HYPOKALEMIA
- dehydration
- hyperglycemia
- hyperuricemia (gout)
Orthostatic hypotension
change positions slowly
check BP
Take in morning
When would you use Loop Diuretics?
not for BP control
remove water, not usually used for HTN
Used when there is a need for greater diuresis - patient with low GFR
When would you use Potassium-Sparing diuretics?
not a lot of water removed - so there would be a modest drop in BP
Watch for HYPERKALEMIA
Do NOT use with ACE, ARBS, = increase risk of HYPERKALEMIA
no K+ supp
no salt substitutes
SPIRONOLACTONE
Beta Blockers end in
-olol
metoprolol
propranolol
atenolol
Beta-Blockers action
Block beta 1 receptors (and could 2 = lungs)
⬇️ HR
⬇️ force of contraction
⬇️ slow electrical in heart
Beta-Blockers USE:
Angina
HTN
Cardiac dysrhythmias
MI
HF
Migraine prophylaxis
stage fright
glaucoma
pheochromocytoma
(⬆️ NE/E)
What do Beta blocker mask?
⬇️ Blood sugar
Adverse effects of BETA 1
⬇️ HR
NO sick sinus syndrome
NO 2° or 3° AV block
CAUTION - HF = can worsen HF
Withdraw slowly to avoid rebound cardiac excitation
Beta Blockers rarely cause HF - but watch for the signs:
SOB
Cough
Edema
Also watch for ⬇️ HR
Adverse effects of BETA 2
Causes Bronchoconstriction because blocks beta2 receptors in the lungs
AVOID with asthma patients
Can mask ⬇️ BS
Cardiac signs as beta 1
Bradycardia
ADVERSE EFFECTS in NEONATES from both BETA 1 & BETA 2
Bradycardia
Respiratory Distress
Hypoglycemia
Alpha 1 Blockers “-sin”
prevents -
vasoconstriction
opens up the tubes to lower bp
Adverse Effects of:
Alpha 1 Blockers “-sin”
Orthostatic Hypotension
syncope
especially first dose
-SIN
Prazosin use
HTN
BPH
-SIN
Prazosin Adverse Effects
Orthostatic hypotension
nasal congestion
Prazosin AE = reflex tachycardia
a rapid decrease in BP + rapid increase HR
CO drops (due to bigger hole - wider vesssels so to compensate jump in HR
Ends in -pril
Ace Inhibitors
Why are ACE drugs good for diabetics?
slows the progression of kidney injury
slows the destruction of the tiny vessels
ACE action
blocks ACE from forming Angiotensin 2
Vasodilation (arterioles)
⬇️ blood volume
⬇️ BP
good for HF - it reduces remodeling of the heart
MI
Diabetic nephropathy
prevents complications/death high CV risk
Adverse effects of -pril
ACE inhibitors
Persistent cough
first dose hypotension
A - angioedema
(swelling of tongue)
C - Cough
E - electrolyte imbalance
⬆️ K
Renal failure
⬇️ pressure in Glomerulus
NO for pregnancy
ACE drug to drug
Diuretics stop 2-3 days before starting ACE
Lithium toxicity - monitor levels
NSAIDs may ⬇️ effectiveness of ACE
