Download Medications used to Manage Hypertension

Medications used to Manage Hypertension
Five main classes ( we will presently discuss four):
Drugs are divided into drugs that:
1. Drugs that improve heart function ( i.e. betablockers, cardiac glycosides
(digitalis digoxin)
2. Drugs that improve blood vessel diameter (i.e. alpha receptors, ACE
inhibitors, calcium channel blockers, vasodilators -which we will discuss when
we talk about angina pectoris
3. Drugs that reduce total blood volume (Diuretics)
4. Drugs that decrease platelet activation/blood coagulation
5. Drugs that reduce blood lipid levels (which we will discuss with C.A.D)
Diuretics

act on kidneys (nephrons) to increase production of urine/ decrease blood
volume and therefore hydrostatic pressure
o Caution/side-effects: leaches electrolytes (potassium and
magnesium) from system, causing a risk of cardiac dysrhythmia,
sluggish reflex response, and irritable/spasm reaction.
o Usually the first drug of choice, generally well tolerated
Beta blockers and Glycosides
o Beta-blockers modify sympathetic nervous system reactivity
o (Basically block the sites of the sympathetic neuro – transmitters on
the heart and systemic blood vessels, thereby decreasing
sympathetic stimulation of the heart and improving heart function)
o Beta-blockers block sympathetic neurotransmitters (adrenaline,
norepinephrine) from synapsing on the heart. decreasing the
hearts rate of contraction and increasing its force of contraction the
decreased rate allows for longer refill time and increased strength
of subsequent contraction- Frank/Starling law)
o Caution/side-effects: breathing difficulties, parasthesia and
decrease in sensation, dysrhythmia,
o Glycosides slow down the heart rate causing similar results as
above
 alters sodium/potassium pump with in cardiac muscle cell
and decreases neural firing rate.
o Caution/side-effects: toxicity ( leading to visual disturbance,
confusion, GI irritation, dysrhythmia)
Alpha receptor
o alpha receptors either block sympathetic neurotransmitters from
synapsing on the smooth muscle of the arterial system or decrease
the number of sympathetic neurotransmitters impulses emitted from
the vasomotor center in the brain. Either way the goal with either
Mechanism of action is to decreaseTPR
Calcium antagonists/calcium channel blockers
o Modify the uptake and utilization of calcium in the smooth muscle
cells of the blood vessel wall (thereby decreasing the tone of the
smooth muscle in the blood vessel walls and improve the
contractile properties of the cardiac muscles)
o Caution/Side-effects: swelling in distal extremities, especially feet
and ankles (dependent edema)
A.C.E. inhibitors (angiotensin converting enzyme)
o Modifies production of angiotensin II by suppressing A.C.E. and
decreasing vasoconstriction
 Renin (enzyme) is produced in the kidneys and released into
circulation when blood pressure decreases.
 in normal circumstances say an injury to the body
causing excessive bleeding and drop in overall blood
pressure the renin – angiotensin system acts to
constrict the blood vessel and thus decrease the
excessive bleeding)
 Acts on angiotensin, which is made in liver and circulates in
blood, converts it (angiotensin) to angiotensin 1
 In the lungs A.C.E. converts angiotensin 1 into angiotensin
11
 Angiotensin 11 is a strong systemic vasoconstrictor
o ACE inhibitors also reduce the action of hormone Aldosterone
*(causes retention of Na and H20 which inturn increases the overall
level of blood volume, should be covered when you study the
kidney)
o Caution/Side-effects: dry cough which usually subsides in a few
weeks of initiating treatment.
Anticoagulants
 most common is Warfarin (rat poison?) taken orally (reduces the effect of
vitamin K on blood coagulation, and Heparin (taken parenterally – injected)
 both prevent thrombin from forming (thrombin is used to convert fibrinogen to
fibrin, – think of what a thrombus is formed by)
Antithrombotics
 help to prevent platelet formation
 most common type is aspirin
there are also drugs called thrombolytics – break down thrombi and clots
Step up method of high blood pressure treatment:
The normal progression is to try lifestyle modifications ( decrease weight,
increase physical activity, moderate sodium and alcohol intake, stop smoking) if
not responding;
continue lifestyle modifications and incorporate a drug (usually a diuretic initially)
INR;
increase or change drug or add a second drug INR: add a third or fourth drug.
Because regular massage can decrease blood pressure a regular client whose
taking blood pressure medications may experience enough of a blood pressure
drops to make their medication dose to high.
Sign and symptoms include – headache, dizziness, nausea, and disorientation
Signs and symptoms of hypertension
 0ften none!(hence the term the silent killer)
 If present:
o Headaches
o Nose bleeds
o Dizzines
 More intense:
o Diplopia (double vision)
o Fainting
o Pronounce
o Altered central nervous system functions
o Convulsions
o Evidence of cardio – vascular and kidney distress
Treatment approach/adaptations for hypertension
Critical – focus on relaxation response before beginning more standard
massage approaches
 i.e. diaphramatic breathing
 Stroking, vibrations
 Gentle rocking and shaking
 Comfortable warm environment
 Gentle foot massage
Modify venous return (especially in client with weakened heart) by:
o Modifying drainage including lymphatic drainage
o Employ modified segmental techniques (wringing/muscle
squeezing) vs. effleurage or long petrissage (increases venous
return)
o Modify hydro, elevation, limb mobilization (increases venous return)
Stimulate more rapid /effective decrease in total peripheral resistance by:
o Treating the limbs first, trunk last (promotes peripheral vasodilation)
Avoid compressing the aorta
o Prone positions increase the compression
o Modify abdominal treatments to avoid direct pressure
Avoid bilateral compression of the neck (carotid arteries)
Put the above in conjunction with guidelines for treatment of clients with chronic
heart failure in order to make treatment plan for clients with weakened heart.
If in doubt consult with their physician.