10 L E C

Pharmacology 25
Ms. Gelianne Alba-Loquez, RN 21 O1
ANTIHYPERTENSIVES

OUTLINE BRIEF REVIEW OF ANAPHY

I Drugs Affecting the Cardiovascular System
A Antihypertensive
B Diuretics
C Anti-Anginal
D Anti-Arrhythmic
E Cardiac Glycosides
F Drugs Affecting the Blood
II Brief Review of AnaPhy
III How do baroreceptors work?
IV Hypertension
V Group of Drugs
A Angiotensin
B Angiotensin II
C Calcium Channel Blockers
D Vasodilators Brief Review of AnaPhy
 Determinants of BP
REFERENCES - Cardiac output
Is the amount of blood the heart pumps
“PROF’S PPT ON VIDEO LECTURE” through the circulatory system in a minute
- Peripheral vascular resistance
It is the resistance in the circulatory system
DRUGS AFFECTING THE CARDIOVASCULAR SYSTEM that is used to create blood pressure, the
Drugs Affecting the Cardiovascular system flow of blood, and a component of cardiac
 Antihypertensive function. When blood vessels constrict or
- ACE inhibitors what we call vasoconstriction, this led to
- Angiotensin II receptor blocker an increased in the peripheral vascular
- Calcium Channel Blocker resistance or the systemic vascular
- Vasodilators resistance
- Sympatholytic  Baroreceptors (pressure receptors) Specialized
 Diuretics cells in the arch of the aorta
- Thiazide Another factor that regulates blood pressure
- Loop  Renin – Angiotensin Aldosterone System
- Osmotic (RAAS)
- Potassium-Sparing - Compensatory mechanisms when blood
 Anti-Anginal pressure within the kidneys fall
- Nitrates - A process that is also involve in regulation
- Non-Nitrates of blood pressure would be the RAAS
 Anti-Arrhythmic
 Cardiac Glycosides
 Drugs Affecting the Blood
- Anticoagulants
- Thrombolytic
- Hemostatics

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 HOW DO BARORECEPTORS WORK?
How do baroreceptors work?
When blood enters the ventricle and pumps
blood into the aorta and carotid arteries, your
baroreceptors found in that area will measure the
pressure of the blood If its sufficient or not. Whatever
the receptor or baroreceptor detect, it will send its
signal to the brain and the brain will signal your body
to start processes or regulate blood pressure.
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Video Explanation:
The renin-angiotensin-aldosterone system
(ras) is a hormonal system that controls blood
pressure, while Barrow reflex is a short term response
to sudden changes in blood pressure, RAS is
responsible for long tern regulation.
In the kidneys, within the walls of afrine
arterial there are sprecialized cells producing pro renin
called Juxtaglomerular cells. Upon activation by a drop
in blood pressure, pro renon is cleaved to form renon
which is released into the blood
Renin converts the plasma protein called
Angiotensinogen, produce by the liver into
angiotensin 1, a peptide of 10 amino acids.
Angiotensin 1 is further converted into
angiotensin 2, an eight amino acid peptide by the
angiotensin converting enzyme ace prodiminantly
present in the luns and kidneys
Angiotensin 2 is a hormone. It binds to
angiotensin 2 receptors in tissues to exert various
effects. It stimulates visa constriction in systemic
arterials. It promotes sodium reabsorption in proximal
convoluted tubules of the kidneys. It induces the
release of aldosterone from the adrenal cortex.
Aldosterone promotes sodium and water retention in
the kidneys.
In the central nervous system, angiotensin 2
has several effects. It acts on the hypothalamus to
stimulate thirst and encourage water intake. It induces
the posterior pituitary to release anti diuretic hormone
which promotes water retention by the kidneys. It
reduces the sensitivity of barrel receptors response to
increase blood pressure so that this response would
not counteract the effects of wrath. All this action, lead
to an increase in blood volume and blood pressure
Angiotensin 2 is short lived with a half life of
one to two minutes. It is degraded into angiotensin 3
and 4, which have lesser effects
2
 Overactive or inappropriate activated RAS is a -Stepped Care Approach:
cause for hypertension. RAS is a frequent target of 1. Lifestyle modification
anthihypertensive drugs. Ace inhibitors and  It is important for patients who have
angiotensin receptors blocker are comon treatment for hypertension, to have lifestyle
hypertension modification.
 Weight reduction
Brief review of the video: -Patients who have hypertension are
When your body detects a decrease in blood advice to reduce weight or to lose weight.
pressure like for example, if the patient is experiencing  Decrease sodium intake
hypovolemia due to hemorrhage. So, there would be a
-Sodium and water attention can increase
decrease of oxygen in the body which would then
blood pressure, so we have to decrease
signal your blumeral cells in the kidneys to release
sodium intake.
renin. And your renin will stimulate your liver to release
 Moderate alcohol intake
angiotensinogen which would then trigger the release
-Client should also be taught to avoid
of angiotensin 1. It will then convert itself to
alcohol as much as possible, but if the
angiotensin 1 and this will be further developed to
patient can't really avoid alcohol then drink
angiotensin 2 by the angiotensin converting enzyme or
well moderately.
the ace, and your angiotensin 2 is a potent
 Smoking cessation
vasoconstrictor. So as we know, if the patient is
-Smoking cessation should also be done
experiencing hypovolemia or bleeding, there is
because smoking can cause further
vasodilation. So your body would want to do the
vasoconstriction.
opposite which is vasoconstriction, and angiotensin 2
 Increase physical exercise
is a potent vasoconstrictor.
-Increase in physical exercise for better
Because of angiotensin 2, there’s an intense
blood circulation and the second would be.
passive constriction, which will increased peripheral
2. + drug
resistance and increased BP and restore the blood
flow. The cells in the kidney will then detect this which  To take or comply with a drug regimen.
will in return decreased the release of renin -Health Teachings:
Angiotensin 2 will signal your adrenal cortex to  Mnemonics PRESSURE
release the hormone aldosterone. Your aldosterone  P- ressure (blood) monitor
will go the nephrons and will promote sodium and -Monitor blood pressure
water retention. Sodium and water retention would  R- ise slowly
result to increase BP and sodium of the blood. Which -Advise client not to suddenly sit or stand
will then trigger hypothalamus and your from the bed because it can cause orthostatic
osmoreceptors in the hypothalamus to release the hypertension
ADH or anti diuretic hormone which will further -A sudden the change in position may cause a
increase the blood volume therefore increased in the sudden decrease also blood pressure.
blood pressure.  E- ating must be considered
-Dietary restrictions should be applied.
HYPERTENSION -There are foods that they should not avoid
HYPERTENSION eating such as sodium rich food in order for
-“Silent Killer” them they'll have their blood pressure,
-When a person’s blood pressure is above the normal regulated and maintained at the regular
limits for a sustained period normal rate.
 As long as exceeds the borderline, it is  S- tay on medication
considered as hypertension. -Drugs are maintained.
-Types: -These are called as maintenance drunk for a
 Primary or Essential reason so they should stay on their
-No known cause medications.
 Secondary  S- kipping or abrupt stopping is NO- NO
-Has a known cause -Compliance is important.
-With co-morbidities -Skipping or abrupt stop it is a no no.

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 -Patient must stay on the medication unless -If taken with Probenecid, the drug may
changed by the doctor. decrease the elimination of your ace inhibitors.
 U- ndesirable responses  + potassium supplement & diuretics =
-You should be able to teach your patient hyperkalemia
about the other effects or side effects and -If taken with potassium supplements and
adverse reactions of the drugs so that the diuretics it may lead to hyperkalemia or
patient will be aware of what to lookout for. potassium above normal levels.
 R- emind to exercise, decrease alcohol  + NSAIDS = decrease hypotensive effect
 E- liminate smoking -If taken with NSAIDS, it will decrease the
hypertensive effect of your ace inhibitor
-You don't want that to happen so as much as
GROUP OF DRUGS
possible, do not give your ace inhibitors with
ANGIOTENSIN
NSAIDS if you really want to lower the blood
-Converting Enzyme (Ace) Inhibitors (“Pril’)
pressure.
 Considered as Ace Inhibitors
 + Antacids = decrease absorption of the drug
 Drugs that ends with ”Pril” -If taken with antacids, it will cause a decrease
-Mode Of Action: Blocks the conversion of angiotensin in absorption of the drug
I to angiotensin II thus preventing further  + tetracycline = decrease absorption of tetra
vasoconstriction -If they get a tetracycline it causes decrease
-Uses: hypertension, Myocardial Infection (MI)
absorption of tetracycline.
-Examples:
-Contraindication:
 Generic Name (Brand Name)
 These drugs should not be given to patients
–benazepril (Lotesin) –moexipril (Univasc) with:
–captopril (capoten) –perindopril (Aceon)
 renal disease
*Most common
 severe sodium (Na) depletion
–enalapril maleate (Vasotec) –lisinopril
 Congestive Heart Failure (CHF)
–quinapril (Accupril –ramipril
–fosinopril (Prinivil) –trandorapril  Pregnant and lactating women
-Side Effects: cough, hypotension, head ache (HA), -Nursing Considerations:
dysgeusia (any perversion of taste perception/ having  Encourage implement lifestyle changes
a bad taste), insomia, nausea and vomiting (N/V), -As we all know, hypertension, in general, we
diarrhea should be able to convince our patients to
-Adverse Effects: modify their lifestyles for a healthy way of
 reflex tachycardia living.
-Your body automatically increases the blood  Administer on an empty stomach
pressure, in response to the low blood -Studies show that if you take ace inhibitors
pressure that your body is experiencing at the with food, it will decrease the bioavailability of
moment. the drug into the system.
 chest pain -So it is best taken without food, to increase
 angina the concentrations of the bioavailability of
 Congestive Heart Failure (CHF) drug in your body.
 Alert if patient is for surgery/ dialysis /
 cardiac arrhythmias
situations which may drop the fluid volume
 Ulcers
-If your patient has to undergo a procedure
 liver & renal problem
that may decrease the blood volume, do not
 photosensitivity
give ace inhibitors to your client since it may
 hyperkalemia
worsen the condition.
 neutropenia  Parenteral form only if oral form is not
 angioedema available
-Drug Interactions:  Adjust dose if with renal failure
 + probenecid = decrease elimination
-As much as possible, these drugs are not given
to patients with renal failure but if they have to

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 give it to patients with renal failure, they have POTENT
to have a paper or adjust the dose. nicardipine (Cardene)
 Do not give if BP is below 90/70, monitor BP nifedipine (Procardia)
especially for 2 hours after the first dose verapamil ( Calan)
(hypotension) -USES: Angina, hypertension, atrial fibrillation
- Do not give if BP is below 90 over 70. You *Any problems with atrio or atria*
don't want to kill your patient and you don't -SE/AD: HA, dizziness, hypotension, syncope, reflex
want to cause further hypotension so do not tachycardia, constipation, Atrioventricular block,
give if it is already below 90 over 70. bradycardia, peripheral edema
-Monitor blood pressure, especially for two -Nursing Considerations:
hours after the first dose.  Monitor ECG, CR, BP
 Avoid ambulation (dizziness)  Have “E” cart available with IV administration
-It can cause dizziness  Position to decrease peripheral edema
 Report cough / angioedema  Protect drug from light and moisture
 Report dysgeusia if more than 1 month  Increase OFI and fiber in the diet
 Avoid overexertion when anginal pain is
ANGIOTENSIN II relieved
-Receptor Antagonist (“Sartan”)  May give paracetamol if with HA
-Selectively bind the angiotensin II receptors in the  Take with meals or milk
blood vessels and adrenal cortex.  No not chew or crush sustained released
*Thereby blocking the angiotensin II or attaching to its *These drugs are coated so that the drug will only be
receptors therefore not causing increase in blood released when it reaches the GI or the stomach*
preasure* *If you crush it, you will defeat its purpose*
-Examples:
Telmisartan (Micardis) Verapamil
Losartan (Diovan) Nifedipine
Irbesartan (Aprovel) Diltiazem
Candesartan (Blopress) Action: Blocks calcium access to cells
Valsartan (Cozaar) Causing:  Contractility +
Eprosartan (Teveten)  Conductivity of the heart
-USES: when ACE inhibitors are not tolerated
 Demand for Oxygen
-Side Effect: HA, diarrhea, dyspepsia, cramps *kaya pag mataas ang levels nito, it may cause
-Adverse Effect: angioedema, hyperkalemia intraventricular block kasi nagdedecrease siya ng
-Contraindication: nephro dysfunction, CHF, contractility*
pregnancy
*angiotensin to antagonist is under is under pregnancy
Side Effects:
category C during the first trimester and pregnancy
-  BP
category D during the second and third trimester.
- Bradycardia
-Nursing Considerations:
- May precipitate AV block
 Ensure female patient is not pregnant - Headache
 Take without regard to food - Abdominal discomfort (constipation, nausea)
- Peripheral edema
CALCIUM CHANNEL BLOCKERS
-MOA: prevents movement of calcium ions in the VASODILATORS
myocardium and vascular smooth muscles. -MOA: relaxes smooth muscles of blood vessels esp the
-Normally: Calcium increases muscle contractility, arteries; promotes increase blood flow to the brain &
peripheral resistance and BP kidney
-Examples: -EG:
amlodipine ( Norvasc) hydralazine ( Apresoline)
nimodipine (Nimotopp) minoxidil (Loniten)
diltiazem (Cardizem)
felondipine (Plendil)

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 POTENT
diazoxide ( Hyperstat)
nitroprusside ( Nitropress)
-USES: severe hypertension, emergencies
-SE/ AE:
- hydralazine: tachycardia (beta blockers) *If
you’re giving hydralazine tapos nagkaroon ng
tachycardia, then give beta blockers*,
palpitations, edema (diuretics), HA, dizziness,
GI bleed, lupus like and neurologic symptoms
- minoxidil: similar effects, excess hair growth,
precipitates angina
- Nitroprusside & diazoxide may cause
(hyperglycemia)
-Nursing Considerations:
D – irectly acts on vascular smooth muscle
I – ncrease renal and cerebral blood flow
L – upus like reaction ( fever, facial rash, muscle and
joint pain, spleenomegaly)
A - ssess peripheral edema
T – ake with food
O – ther side effects (headache, dizziness, anorexia,
Inc. Cardiac, Dec. Blood pressure)
R – eview BP (orthostatic hypotension), blood glucose
*Advice patient not to suddenly rise from bed. Dapat
slowly. Turn to the side then upo muna, down the legs
before standing up*

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