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Transcript
Chapter 23
Drugs Used to Treat Hypertension
Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
Chapter 23
Lesson 23.1
Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 2
Objectives
• Discuss blood pressure and its measurement
• Define hypertension
• Differentiate between primary and secondary
hypertension
• Summarize nursing assessments and
interventions used for the treatment of
hypertension
• State recommended lifestyle modifications for
a diagnosis of hypertension
Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 3
Hypertension
• Characterized by an elevation of systolic blood
pressure (sbp), diastolic blood pressure (dbp) or
both
 Primary hypertension: 90% of cases, unknown
cause
 Secondary hypertension: occurs after another
disorder
• Normal BP: less than 120 sbp, less than 80 dbp
• Prehypertension: 120 to 139 sbp, or 80 to 89
dbp
• Stage I: 140 to 159 sbp or 90 to 99 dbp
• Stage 2: greater than or equal to160 sbp or
greater than or equal to 100 dbp
Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 4
Major Risk Factors of Hypertension
•
•
•
•
•
•
Smoking
Obesity
Physical inactivity
Dyslipidemia
Diabetes mellitus
Microalbuminuria or estimated glomerular
filtration rate (GRF) less than 60 mL/min
• Age (older than 55 for men, older than 65 for
women)
• Family history of premature cardiovascular
disease
Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 5
Major Risk Factors
of Hypertension (cont’d)
• Target organ damage





Heart
Brain
Kidneys
Blood vessels
Eyes
Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 6
Nursing Assessments
for Patients with Hypertension
• Blood pressure sitting for 5 minutes quietly;
no recent caffeine products
• Family history and risk factors present
• Laboratory data for lipids, triglycerides,
cholesterol, renal function studies
• BMI
• Peripheral pulses
• Patient education focuses on lifestyle
modifications
Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 7
Patient Education
and Health Promotion
• Lifestyle modifications







Smoking cessation
Weight reduction
DASH diet
Physical activity
Restriction in alcohol intake
Stress reduction
Regular sleep pattern of at least 7 hours each
night
 Sodium control
Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 8
Chapter 23
Lesson 23.2
Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 9
Objectives
• Identify specific factors the hypertensive
•
•
•
•
patient can use to assist in managing the
disease
Identify 10 classes of drugs used to treat
hypertension
Review Figure 23-2 to identify options and
progression of treatment for hypertension
Develop patient education objectives for
individuals with hypertension
Summarize the action of each drug class
used to treat hypertension
Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 10
Options and Progression
of Treatment for Hypertension
• Long-term success depends on patients
understanding the characteristics and
diseases that contribute to the issue
 Demographic characteristics – age, gender,
race
 Coexisting diseases and risk factors –
migraine headaches, dysrhythmias, angina,
diabetes mellitus, previous therapy used,
concurrent therapy, cost of treatment
Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 11
Management of
Hypertension
• Lifestyle modifications are initial therapy
• If no significant effect, drug therapy is
introduced
• Start with diuretics for stage 1 hypertension
• Add beta blockers, ACE inhibitors, calcium
channel blockers, and angiotensin receptor
blockers as tolerated
• Start with two-drug combination for stage 2
hypertension
Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 12
Drug Classes Used
for Hypertension Management
• Diuretics; beta-adrenergic blocking agents
• ACE inhibitors; angiotensin II receptor
blockers (ARBs)
• Direct renin inhibitors; aldosterone receptor
antagonist
• Calcium channel blockers; alpha-1 adrenergic
blocking agents
• Central-acting alpha-2 agonists; peripheralacting adrenergic antagonists; direct
vasodilators
Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 13
Drug Class: Diuretics
• Actions
 Cause volume depletion, sodium excretion,
vasodilation of peripheral arterioles
• Uses
 Most commonly prescribed antihypertensives
 In combination with other antihypertensive
agents
 Discussed further in Chapter 29
Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 14
Drug Class:
Beta-Adrenergic Blocking Agents
• Actions
 Inhibit cardiac response to sympathetic nerve
stimulation
 Inhibit renin release from kidneys
• Uses
 Initial therapy for stage 1 and 2 hypertension
• Common adverse effects
 Bradycardia, peripheral vasoconstriction
(purple mottled skin); heart failure;
bronchospasm, wheezing; masks
hypoglycemia in diabetic patients
Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 15
Drug Class: ACE Inhibitors
• Actions
 Inhibit angiotensin I converting enzyme (ACE),
disrupting the conversion of angiotensin I to
angiotensin II
• Uses
 Single therapy for stage 1 or 2 hypertension
• Common adverse effects
 Nausea, fatigue, headache, diarrhea;
orthostatic hypotension
• Serious adverse effects
 Angioedema; neutropenia; hyperkalemia;
chronic cough; birth defects
Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 16
Drug Class: ARBs
• Actions
 Bind to angiotensin II receptor sites and block
the vasoconstrictor from binding to receptor
sites in target organs
• Uses
 Alone or in combination with other
antihypertensives to reduce blood pressure
• Common adverse effects
 Dyspepsia, cramps, diarrhea; headache;
orthostatic hypotension
• Serious adverse effects
 Birth defects; hyperkalemia
Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 17
Drug Class: Direct Renin Inhibitors
• Drug: aliskiren (Tekturna)
• Actions
 Block the first step in the RAAS cascade
preventing release of aldosterone
• Uses
 Alone or in combination with other
antihypertensives to reduce blood pressure
• Common adverse effects
 Dyspepsia, cramps, diarrhea; headache;
orthostatic hypotension
• Serious adverse effects
 Altered fluid and electrolytes, birth defects
Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 18
Drug Class:
Aldosterone Receptor Antagonist
• Drug: eplerenone (Inspra)
• Actions
 Block stimulation of aldosterone at receptor
sites, preventing sodium reabsorption
• Uses
 Alone or in combination with other
antihypertensives to reduce blood pressure
• Common adverse effects
 Nausea, diarrhea; fatigue, headache;
orthostatic hypotension
Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 19
Drug Class:
Calcium Channel Blockers
• Actions
 Inhibit movement of calcium ions across cell
membranes
• Uses
 Ideal for first- or second-line drug therapy for
hypertension
• Serious adverse effects
 Hypotension and syncope
Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 20
Drug Class: Alpha-1 Adrenergic
Blocking Agents
• Actions
 Block postsynaptic alpha-1 adrenergic
receptors to produce vasodilation, decrease
peripheral vascular resistance
• Uses
 Alone or in combination with other
antihypertensives to reduce blood pressure
 Reduce mild to moderate urinary obstruction
• Common adverse effects
 Drowsiness, headache, weakness, lethargy;
dizziness, tachycardia, fainting
Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 21
Drug Class: Central-Acting
Alpha-2 Agonists
• Actions
 Stimulate alpha-adrenergic receptors in the
brainstem, reducing sympathetic outflow from
CNS
• Uses
 Considered adjunctive therapy; used only in
combination with other antihypertensives
• Common adverse effects
 Drowsiness, dry mouth, dizziness, altered
urine color, altered rest results
• Serious adverse effects
 Depression; rash
Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 22
Drug Class: Direct Vasodilators
• Actions
 Relax arterial smooth muscle, reducing
peripheral vascular resistance
• Uses
 Treatment of stage 2 hypertension, renal
disease hypertension, toxemia of pregnancy
• Common adverse effects
 Dizziness, numbness, tingling in legs; orthostatic
hypotension, palpitations, tachycardia; nasal
congestion; hair growth
• Serious adverse effects
 Fever, chills, joint and muscle pain, skin
eruptions; gynecomastia
Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 23