Drug therapy for hypertension Ch 16

hypertension
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Terms in this set (80)
hypertension
systolic BP > 140 mm Hg and/or diastolic BP > 90 mm Hg

CAN lead to arteriosclerosis, heart attack, stroke, enlarged heart, kidney damage, blindness
Risk factors
modifiable- smoking overweight, sedentary lifestyle, diabetes, hyperlipidemia, oral contraceptives, post- menopause
non modifiable- age/gender/ family history/ race
treatment- lifestyle changes, antihypertensives
types of antihypertensive drugs
diuretics
ACE Inhibitors
ARBs
Calcium channel blockers
Beta blockers
Alpha blockers
Alpha beta blockers
Central acting adrenergic agents
Direct vasodilators
The two main types of hypertension are
primary essential
and secondary
a patient with high blood pressure should not
take over the counter allergy and cold drugs that contain phenylephrine
teach patients to take missed doses as soon as possible but if it is almost time for the next dose
skip the missed dose and return to the regular dosing schedule
patients with hypertension should not take OTC drugs
such as drugs for appetite control asthma colds and hay fever without asking their prescriber
Antihypertensive drugs will help control but will not
cure hypertension. patients may need to take these drugs for the rest of their lives
The generic name for ACE inhibitors ends in
"pril"
if a patient taking an ACE inhibitor develops a persistent dry cough the
prescriber should be notified and the drug discontinued
monitor patients for angioedemawhich is a serious adverse effect of ACE inhibitorsACE inhibitors may increase the effect of decreased blood pressure in patients who are also taking diuretics. ACEinhibitors and potassium- sparing diuretics cause much higher increase in blood potassium levelstell patient who are taking ACE inhibitors that drinking alcoholcan increase the low blood pressure effect and the risk for dizziness or faintingACE SHOULD NOT BEprescribed for women who are pregnant. They can cause low blood pressure, severe kidney failure, increased potassium and even death in a newborn when used after the first trimester of pregnancyThe generic names for ARBs END IN" sartan"Report any swelling of the face eyes lips or tongue to the prescriberimmediately. These are signs of life threatening angioedema. Do not administer the drug to the patient again because this is a life- threatening adverse reactioncalcium channel blockers can cause asevere skin disorder called stevens- johnson syndrome. Always check the patients for skin lesions, itching, fever, and achy jointsthe generic names of beta blockers end with"olol"Beta blockers can decrease or increase blood glucose levels.be sure to check blood glucose regularly in a patient with diabetesPatient should never suddenly stop taking beta blockers.this may cause unpleasant and harmful effects such as increased risk for heart attackbeta blockers can affect the results of medical test such as test that raise heart rate andblood pressureteach patients that beta blockers can cause new onsetdepression or worsening existing depressionmonitor older adults who have been prescribed beta blockers for mental confusionor changes in level of consciousness.Teach men that they should not be prescribed phosphodiesterase type 5 inhibitors ( erectile dysfunction drugs) if they arealso taking alpha blocker therapy because of the risk of severe hypotensionteach patients that weight gain and ankle swelling are signs that the body is holding extra fluid and should bereported immediately to the prescriberalpha blockers pass into breast milk. Teach women who are breastfeeding or planning to breastfeed that it may benecessary to stop breastfeeding while on alpha blockersBecause alpha-beta blockers can cause elevated blood glucose, be sure tomonitor blood glucose levels regularly in patients with diabetesmany blood pressure- lowering drugs can cause drowsiness or dizzinessteach patients taking these drugs not to drive or operate machinesoral methyldopa= central acting adrenergic agent has been used safely duringpregnancy and breastfeeding and to treat pregnancy- induced hypertensionWith vasodilator drugs report asustained increase in heart rate of moe than 20 beats per minute to the prescriber immediatelyuntreated hypertension can lead to many health problems includingheart attack/ stroke/ and kidney diseaseteach patients prescribed drugs to lower blood pressure to sit up and standslowly because dizziness and hypotension are common side effects of these drugsBeta blockers slow the heart rate and decrease the force of theContraction of the heartACE inhibitors slow the production of angiotensin II apotent vasoconstrictor by the bodyARBs BLOCK THE action ofangiotensin II, leading to increased vasodilation of arteriesangioedemaswelling of the face/ eyes/ lips and tongue is a life threatening adverse effect of ACE inhibitors and ARBscalcium channels blockers decrease theforce of ht contractions of the heart and dilate the arteriesAlpha blockers relax blood vessels, leading to arterialwidening and lower blood pressuremonitor patients with diabetes carefully when taking alpha- beta blockers because these drugscan cause hyperglycemia ( high blood sugar)Methyldopa ( Aldomet) a central- acting adrenergic drugis the drug of choice for controlling high blood pressure during pregnancyAlways check blood pressure heart rate and weight and look forswelling of the ankles or feet before and after giving antihypertensive drugsencourage patients to adopt lifestyle changes that will help control high blood pressure such as weight loss andregular exercise/ and low salt dietbe sure that patine know how to check their heart rate and blood pressure and understand theimportance of follow up care.when a patient is prescribed an antihypertensive drug for blood pressure changes that occurred after chronic kidney disease, what is the alteration in blood pressure called?secondary hypertensionA patient prescribed an angiotension 2 receptor blocker ARB for hypertension now has a blood pressure of 90/68. What side effects do you expect the patient to experience?light-headedness dizziness diarrhea abnormal potassium levelWhich action must you take before giving any antihypertensive drug?get a list of all drugs the patient is takinga patient with chronic uncontrolled hypertension is prescribed several antihypertensive drugs. The prescriber orders prazosin (Minipress). = alpha blocker When should yo administer the first dose?10 pm at bedtimeAn older adult patient with hypertension, chronic kidney disease, and liver failure is prescribed an ARB drug. what special precaution do you expect for this patient?the patient should be given a lower dose of this drugA patient who is taking an ACE inhibitor for hypertension asks how this drug lowers blood pressure. What is your best response?it blocks the conversion of angiotensin 11A patient who is taking captoril (Capoten) 25 mg twice daily develops dizziness. What is your priority action?instruct the patient to call for help when getting out of beda patient prescribed hydralazine (Apresoline) develops a severe inflammatory eruption of the skin and mucous membranes. What is your best action?hold the drug and notify the prescriberWhich statement by a patient who is prescribed metoprolol ( Lopressor) = beta blocker indicates the need for additional teaching?i will stop taking this drug if my heart rate is less than 70 beats per minuteA women is prescribed oral methylodpa (Aldomet) to control pregnancy- induced hypertension. What must you teach the patent about this drugthis drug can be used safely during pregnancy and breastfeedingA patient takes enalapril (Vasotec) 5 mg once a day to control high blood pressure. For which life- threatening adverse effect do you asses the patient?angioedemawhich signs/ symptoms must you be sure to check for every 4 to 8 hours after giving a drug to treat high blood pressure? select all that applydizziness/ hand grasp strength/ crackles in lungs/ heart ratewhich points must you be sure to teach the patient who is going home and continuing to take prazosin ( Minipres) 2 mg twice daily for blood pressure control? select all that applydo not drive or operate machines remember to change positions slowly weigh yourself twice a week report any ankle swelling to your prescribera 33- year- old female patient is currently taking captopril (capoten) 12.5 mg daily to control her high blood pressure. She tells her prescriber that she plans to become pregnant. What drug will the prescriber must likely prescribe now?methyldopa ( Aldomet)The nurse is caring for a patient on an antihypertensive drug. The nurse knows that what class of drugs causes the heart rate to slow and decreases the force of the heart's contraction?Beta blockers Beta blockers limit the activity of epinephrine (a hormone that increases blood pressure), reduce the heart rate and the force of muscle contraction, resulting in reduction of oxygen demand. Angiotensin-converting enzyme (ACE) inhibitors lower blood pressure. For people with diabetes, especially those with protein (albumin) in their urine, ACE inhibitors also help slow kidney damage. They also slow the body's production of angiotensin II, which is a potent vasoconstrictor. Angiotensin II receptor blockers (antagonists) change the action of the renin-angiotensin-aldosterone system and block the activation of angiotensin II type 1 receptors by increasing vasodilation of arteries. Angiotensin II receptor antagonists are mainly used in the treatment of hypertension when the patient is intolerant of ACE inhibitor therapy. Calcium channel blockers slow the movement of calcium into the cells of the heart and blood vessels. This relaxes the blood vessels, increases the supply of oxygen-rich blood to the heart, and reduces the workload of the heart.The nurse is caring for a patient with high blood pressure. The nurse knows that what antihypertensive drug class blocks the body's production of angiotensin II?Angiotensin-converting enzyme (ACE) inhibitors ACE inhibitors block an enzyme in the body that is necessary for production of angiotensin II (a substance that causes blood vessels to tighten or constrict). The result is that blood vessels relax and blood pressure is decreased. This drug decreases heart workload and increases the blood flow and oxygen to the heart and other organsThe nurse is about to administer an antihypertensive drug to a patient. The nurse knows that what antihypertensive drug class blocks the effects of angiotensin II leading to increased vasodilation of arteries?Angiotensin II receptor antagonists Angiotensin II receptor blockers (antagonists) block the activation of angiotensin II type 1 receptors by increasing vasodilation of arteries. ACE inhibitors block the production of angiotensin II (potent vasoconstrictor) and help blood vessels relax and decrease blood pressure. Beta blockers reduce the heart rate and the force of muscle contraction, resulting in reduction of oxygen demand. Calcium channel blockers relax the blood vessels, increase the supply of oxygen-rich blood to the heart, and reduce the workload of the heart.A patient took a dose of lisinopril (Zestril), an ACE inhibitor. The patient phones the nurse and reports sudden onset of swelling of the eyes and lips. What should the nurse do next?Tell the patient to call 911 immediately. 911 must be called immediately. Angioedema is a diffuse swelling of the eyes, lips, and tongue and signals a life-threatening, emergency situation and a serious adverse effect of ACE inhibitors. It can quickly lead to swelling of the trachea (windpipe/airway) and interfere with breathing.The nurse is giving an antihypertensive drug to a patient. The nurse knows that what antihypertensive drug class causes the force of the heart's contractions to decrease and the arteries to dilate?Calcium channel blockers Calcium channel blockers block calcium from entering the muscle cells of the heart and arteries, causing a decrease in the contraction of the heart and also dilating (widening) the arteries. This results in a decrease in blood pressure and reduces the workload of the heartA patient who is taking antihypertensive drugs asks the nurse why over-the-counter (OTC) medications for colds, allergies, or appetite control are not allowed to be taken without checking with their prescriber. What is the nurse's best response?"Many of those drugs contain ingredients that can increase your blood pressure." A patient with high blood pressure should not take OTC drugs that contain phenylephrine such as drugs for allergy, cold, appetite control, asthma, and hay fever because these drugs can increase and not decrease blood pressure. Some drugs may contain caffeine and other cardiac stimulants. Before taking any OTC drugs, the patient needs to check with their prescriber first. The nurse needs to obtain a complete list of any OTC drugs that the patient is currently using, including herbal drugs. OTC and herbal medications are not controlled and FDA approved.A patient is scheduled for a cardiac stress test. The nurse knows that what class of drug the patient is taking may affect the results of this medical test?Beta blockers Beta blockers can affect the results of cardiac stress tests and other medical tests that raise heart rate and blood pressure. Direct vasodilators, ACE inhibitors, and diuretics do not affect the results of a stress test.The nurse is discharging a newly diagnosed patient with diabetes. The nurse tells the patient that it is very important to regularly monitor the blood glucose when taking what category of drugs?Alpha-beta blockers Alpha-beta blockers can cause elevated blood glucose, so make sure to monitor blood glucose levels regularly in patients with diabetes. Other common side effects of alpha-beta blockers include dizziness, fatigue, weakness, orthostatic hypotension, diarrhea, and impotence. ACE inhibitors, direct vasodilators, and calcium channel blockers do not affect blood glucose levels.A patient reports difficulty having an erection and asks to be prescribed sildenafil (Viagra), which he saw advertised on television. The nurse indicates that this is not a good idea because the patient is also taking what type of medication?alpha-blocking agents Men on alpha blocker therapy should not take sildenafil (a phosphodiesterase type 5 inhibitors for erectile dysfunction) because of the risk of severe hypotension. The following combination of drugs would not result in an adverse reaction: beta blockers and sildenafil; calcium channel blockers and sildenafil; and direct vasodilators and sildenafil.The nurse is admitting a patient who has been taking transdermal clonidine (Catapres) at home. What comment by the patient requires immediate intervention?"The little patch with the medicine won't stay on." When administering a clonidine patch, be aware that it is packaged with two patches. The smaller patch contains the drug, and the larger patch is used to cover the drug patch. If the patch falls off, a new patch should be placed on the patient. Be sure to record the date and time and initial the patch before placing it on the patient. This patient would need immediate instruction in order to receive the best results from the medication. Dry mouth, drowsiness and lethargy, and nasal congestion are normal side effects of central-acting adrenergic agents.A patient reports experiencing skin lesions and achy joints to the nurse. This is of particular concern to the nurse when it is revealed that the patient is taking what kind of antihypertensive drug?Calcium channel blockersA patient's blood pressure is 145/92 mm Hg. Which blood pressure classification is correct for this patient?Stage 1 hypertension Stage 1 hypertension blood pressure range is between 140/90 and 159/99 mm Hg.The nurse is volunteering at a blood pressure clinic. The nurse knows that what blood pressure reading indicates hypertension? (select all that apply)150/90 mm Hg 150/85 mm Hg 135/90 mm Hg Hypertension is defined by the American Heart Association as a systolic blood pressure (SBP) of 140 to 159 mm Hg and/or a diastolic blood pressure (DBP) of 90 to 99 mm Hg. There are five classifications for blood pressure: normal, prehypertension, stage 1 hypertension, stage 2 hypertension, and hypertensive crisis. According to the Center for Disease Control (CDC), in the United States alone there are around 67 million people (one in every three adults) with hypertension. Blood pressure readings of 150/90, 150/85, and 135/90 all fit within the parameters of hypertension. A blood pressure of 120/80 mm Hg is a normal reading. A blood pressure of 90/60 mm Hg is considered a hypotensive reading.The nurse is admitting a patient with a diagnosis of untreated hypertension. What health problems can result from this condition? (select all that apply)Kidney failure heart attack stroke Specific conditions related to untreated hypertension include kidney failure, heart attack, and stroke. Untreated hypertension can damage the heart and arteries, kidneys, and brain, as well as decreasing life expectancy in adults. Cancer is not caused by hypertension. Syncope (fainting) is usually a symptom of hypotensionThe nurse is ordered to give an antihypertensive drug to a patient. The nurse knows that before administering any type of antihypertensive drug to a patient, what must always be checked first? (select all that apply)Blood pressure Heart rate Complete drug listThe nurse is about to give an angiotensin-converting enzyme (ACE) inhibitor to a patient. What side effects are specific to (ACE) inhibitors? (select all that apply)Protein in the urine Persistent dry cough Hypotensiona patient is taking a calcium channel blocker. Which best describes how this medication lowers blood pressue?it relaxes the bodys blood vesselsa patient has been taking captopril for several weeks when severe swelling of the lips and difficulty breathing develop. THIS IS RECGOGNIZED AS WHICH AE?angioedemaafter administering losartan the patient is monitored for which condition ?potassium level higher than 5.5which statement about ACE and pregant women are true>ACE inhibitors are category D drugs that ca cause brith defectsa patient who s taking atenolol a beta blocker should be monitored for which SE?difficulty breathing/ fever or sore throat/ dizziness when standing upa patient who has been taking calcium channel blockers should be monitors for which symptoms of stevens johonsons sydnrome?skin lesionsmales patients who are taking which antihypertensive drug should be instructed not to take durgs for erectile dysfunction?alpha beta blockers alpha blockers