drugs for hypertension and heart failure and shock

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hypertension
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hypertension
Consistent elevation of systemic arterial blood pressure
Three Factors Responsible for Blood Pressure
•Cardiac output:Volume of blood pumped per minute
•Peripheral resistance:Friction in arteries as blood flows through vascular system
•Blood volume:Total amount of blood in vascular system
types of hypertension
•Primary hypertension—no identifiable cause
•Secondary hypertension—cause identified
-Cushing's syndrome
-Hyperthyroidism
-Chronic renal disease
-Certain drugs
First-Line Antihypertensive Drugs
-Diuretics
-Angiotensin-converting enzyme (ACE) inhibitors
-Angiotensin receptor blockers (ARBs)
-Direct renin inhibitors
-Calcium channel blockers (CCBs)
Second-Line Antihypertensive Drugs
•Beta-adrenergic receptor blockers (in heart)
•Alpha1-adrenergic receptor blockers (in arterioles)
•Alpha2-adrenergic agonists
•Direct-acting vasodilators
•Peripherally acting adrenergic neuron blockers
Mechanism of Action of Antihypertensive Drugs
Image: Mechanism of Action of Antihypertensive Drugs
diuretics
•Increase urinary excretion of water and electrolytes, thereby reducing blood volume
•Used for mild to moderate hypertension
Calcium Channel Blockers
•Used to treat hypertension and other cardiovascular diseases
•Block calcium ion channels; cause vasodilation, decreasing BP
•Adverse effects include dizziness, headache, flushing
•Some selectively target calcium channels in arterioles; others also affect cardiac muscle
Angiotensin-converting enzyme (ACE) inhibitors
•Block effects of angiotensin II a potent natural vasoconstrictor, lowering peripheral resistance and decreasing blood volume
Beta-Adrenergic Blockers
•Decrease heart rate and contractility; blockade beta1- receptors in juxtaglomerular apparatus, which inhibits the secretion of renin

•Reduce cardiac output and lower systemic B\P

•First-line drug for angina pain

•Adverse effects: fatigue, insomnia, drowsiness, impotence, bradycardia, confusion
Alpha1 Adrenergic Antagonists
•Block sympathetic receptors in arterioles leading to vasodilation
•Not first-line drugs for HTN
•Used in combination with other drugs, usually diuretics
Alpha2-Adrenergic Agonists
•Decrease outflow of sympathetic nerve impulses from CNS to heart and arterioles
Direct Vasodilators
•Cause vasodilation by direct relaxation of arterial smooth muscle
•Only for severe hypertension and hypertension crisis
•Serious adverse effects: reflex tachycardia, sodium and fluid retention
•Minor role in HF treatment
Drugs for hypertension assessment
-Take patient's BP in each arm for baseline
-Assess patient's height and weight
-Obtain blood and urine samples as ordered by physician
-Obtain nursing history, including lifestyle, current medications, dietary habits
-Assess patient's and family's knowledge of hypertension and medication regimen
Drugs for Hypertension planning
-Goals:
▪Exhibit a reduction in systolic/diastolic blood pressure
▪Be able to explain hypertension and needed medications
▪Be able to verbalize ability to follow prescribed therapy