Chapter 43

Drugs Affecting Blood Pressure

Copyright © 2008 Lippincott Williams & Wilkins.

BP HRxc0 candic output
=

91 95.1,
Elements Determining Blood Pressure
contraction Primary is
• -Bit
Heart rate mperfesionsecenderly. E
• Stroke volume -> Rightventrical
1,89819.
– Amount of blood that is pumped out of the
ventricle with each heartbeat
misistance
• Total peripheral resistance Vasoconstractice BPI
– Resistance of the muscular arteries to the
blood being pumped through them

Copyright © 2008 Lippincott Williams & Wilkins.

Control of Blood Pressure

Copyright © 2008 Lippincott Williams & Wilkins.

 *

Categories Rating the

Severity of Hypertension

120/80
<20-131/00-81
140-151/90-99
160/7
=>
100

therapy.. NoWMal:2-
Pre:changes lifestyle, 51-55;Nisko,s
statel:they need only one medication.
stayed they Copyright © 2008 Lippincott Williams & Wilkins.
 Diwali, hypertesions8 5!
Risks for Coronary Artery Disease
·

Related to Hypertension

• Thickening of the heart muscle

• Increased pressure generated by the muscle on

contraction
↳pefesion. 41:1
• Increased workload on the heart ↑15;
Dil 5,
-iss.,85

Copyright © 2008 Lippincott Williams & Wilkins.

 Conditions Related to
Untreated Hypertension
whatare the main complication ofPerfesion
• CAD and cardiac death
• Stroke
• Renal failure - kidney disease
• Loss of vision

Copyright © 2008 Lippincott Williams & Wilkins.

 Potential Causes of Hypotensive States
BP4, 1951 is? Iheart is
• Heart muscle is damaged and unable to pump
effectively
Bleeding ->
BPL
• Severe blood loss; blood volume drops dramatically

• Extreme stress when body’s level of norepinephrine

is depleted
– Body is unable to respond to stimuli to raise
blood pressure

Copyright © 2008 Lippincott Williams & Wilkins.

 Stepped Care Approach to
Treating Hypertension
• Step 1: lifestyle modifications are instituted
• Step 2: drug therapy is added if the measures in
step 1 are insufficient
increase thedose
• Step 3: drug dose or class may be changed or
another drug added if the patient’s response is
inadequate
zdNGYs
=>

• Step 4: includes all of the above measures with

the addition of more antihypertensive agents until
blood pressure is controlled
Copyright © 2008 Lippincott Williams & Wilkins.
 Types of Drugs Used to Control
i Blood Pressure
151s!, BPR 15.99918d bass. 1st
• Diuretic: decreases serum sodium levels and blood
volume
• Beta-blocker: leads to a decrease in heart rate and
strength of contraction as well as vasodilation
• ACE inhibitor: blocks the conversion of angiotensin I
to angiotensin II; an angiotensin II receptor blocker;
blocks effects of angiotensin on blood vessels
• Calcium channel blocker: relaxes muscle contraction
or other autonomic blockers
Copyright © 2008 Lippincott Williams & Wilkins.
Sympathetic Nervous System Blockers

• Beta-blockers -> BP458.

• Alpha-blockers -> vasodulation

• Alpha-adrenergic blockers
• Alpha1-blockers
• Alpha2-agonists
BP $Newre end -Sh
isNotephifren;it
·
s
Copyright © 2008 Lippincott Williams & Wilkins.
 ~;;es,so5, it's afirstchoce in
ises ↳Perteseite medication
Ys
=

17:152x ACE Inhibitors :Enalapril, captopril, RamipWil

angiotensing
gUP: Phil 8,
• Action angiotensint Actangiotensint
– Block ACE from converting angiotensin I to
angiotensin II, leading to a decrease in blood
pressure, a decrease in aldosterone production,
and a small increase in serum potassium levels
along with sodium and fluid loss
• Indications ④ ② ③
– Treatment of hypertension, CHF, diabetic
nephropathy, and left ventricular dysfunction
following an MI

Copyright © 2008 Lippincott Williams & Wilkins.

 ACE Inhibitors (cont.)
• Pharmacokinetics
– Well absorbed, widely distributed, metabolized in the liver,
and excreted in the urine and feces

• Contraindications
– Allergies
– Impaired renal function -19.1 . yds
– Pregnancy and lactation &
$1;
• Caution je5.
&.
– CHF

Copyright © 2008 Lippincott Williams & Wilkins.

 ACE Inhibitors (cont.)
• Adverse effects
– Related to the effects of vasodilation and
alterations in blood flow
– 2) GI irritation

– Renal insufficiency 3 hpofesion

– 13 Cough any cough in hyperkalemia

• Drug-to-drug interaction X
– Allopurinol

Copyright © 2008 Lippincott Williams & Wilkins.

 iss189

~;;es,so5, it's afirstchoce in

ises ↳Perteseite medication
valsartan, losartan, condisantart"
Angiotensin II Receptor Blockers
• Actioniangiotensinrecepotervaso vasodilation - > BPI

– Selectively bind with angiotensin II receptor sites in vascular

⑳
smooth muscle and in the adrenal gland to block
vasoconstriction and the release of aldosterone -> Blood volumet
-

• Indications ⑤:2, sodium Water retetion. 13P1

– Hypertension, CHF, slow progression of renal disease in patients

with hypertension, and type 2 diabetes
same
• Pharmacokinetics
– Well absorbed and undergo metabolism in the liver
– Excreted in the urine and feces

Copyright © 2008 Lippincott Williams & Wilkins.

Angiotensin II Receptor Blockers (cont.)
• Contraindications same
– Allergy, pregnancy, and lactation
• Cautions
– Hepatic or renal dysfunction and hypovolemia
• Adverse effects same Act
– Headache, dizziness, syncope, and weakness
– GI complaints
hypotension, hyperkalmemia
– Skin rash and dry skin isse·dry coughs
• Drug-to-drug interaction
– Phenobarbital

Copyright © 2008 Lippincott Williams & Wilkins.

 icontractionist,
I ca Ca
8ex118

85. Calcium Channel Blocker

-

mucle
cadi; I
• Pharmacokinetics Relaxationsexchannels, contraction s
– Well absorbed, metabolized in the liver, and excreted in the
urine
• Action
– Inhibits the movement of calcium ions across the membranes
of cardiac and arterial muscle cells, depressing the impulse and
leading to slowed conduction, decreased myocardial
contractility, and dilation of arterioles, which lowers blood
pressure and decreases myocardial oxygen consumption
• Indication
– Treatment of essential hypertension in the extended release
form

Copyright © 2008 Lippincott Williams & Wilkins.

 Calcium Channel Blocker (cont.)
only nondehydeto
• Contraindications Is
– Allergy, heart block or sick sinus syndrome, renal or hepatic
dysfunction, pregnancy, and lactation
-
• Adverse effects
– Related to effects on cardiac output Hypotension
–
–
GI symptoms
Cardiovascular symptoms
reflax tachycardia
periphral edema
• Drug-to-drug interaction
– Cyclosporine

Copyright © 2008 Lippincott Williams & Wilkins.

 amecop

E
like /3 Relaxation- Vasdile
Blocket BPU
sa
calis
vasodulation
↳ 2 s Fforemerangy
Vasodilators
• Diazoxide (Hyperstat): increases blood glucose
levels; used IV for hospitalized patients with
severe hypertension
• Hydralazine (Apresoline): maintains increased
renal blood flow
• Minoxidil (Loniten): used only for severe and
unresponsive hypertension
• Nitroprusside (Nitropress): maintains hypertension
during surgery; used for hypertensive crisis
Copyright © 2008 Lippincott Williams & Wilkins.
 Vasodilators (cont.)
• Action
– Act directly on vascular smooth muscle to
cause muscle relaxation, leading to vasodilation
and drop in blood pressure
• Indication
– Severe hypertension StaleIt ollzo
->

• Pharmacokinetics ↳PetesiocasiVeUE
– Rapidly absorbed and widely distributed,
metabolized in the liver, and primarily excreted
in the urine
Copyright © 2008 Lippincott Williams & Wilkins.
 Vasodilators (cont.)
• Contraindications
– Allergy, pregnancy, lactation, and cerebral insufficiency
• Cautions
– Peripheral vascular disease, CAD, CHF, and tachycardia
• Adverse effects
– Related to changes in blood pressure sever hypotention
– GI upset
– Cyanide toxicity -> Nitropresside
• Drug-to-drug interactions
– Based on individual drugs

Copyright © 2008 Lippincott Williams & Wilkins.

 Midodrine alpha (WecPow alolist
vasoconstractiolt- BPT
• Action
– Activates alpha-receptors in arteries and veins to enhance
vascular tone and increase blood pressure

• Indication
– Symptomatic treatment of orthostatic hypotension

• Pharmacokinetics
– Absorbed from the GI tract, metabolized in the liver, and
excreted in the urine

Copyright © 2008 Lippincott Williams & Wilkins.

 Midodrine (cont.)
• Contraindications
– Supine hypertension, CAD, pheochromocytoma, and urinary
retention
• Cautions
– Pregnancy and lactation
– Visual problemsmerfesion s -

• Adverse effect mycrisis, urinary refesions

– Related to stimulation of alpha-receptors
• Drug-to-drug interactions
– Cardiac glycosides, beta blockers, alpha-adrenergic agents, and
corticosteroids

Copyright © 2008 Lippincott Williams & Wilkins.

Use of Drugs Affecting Blood Pressure
Across the Lifespan

Copyright © 2008 Lippincott Williams & Wilkins.

Prototype ACE Inhibitor

Copyright © 2008 Lippincott Williams & Wilkins.

Prototype Angiotensin II Receptor
Blockers

Copyright © 2008 Lippincott Williams & Wilkins.

Prototype Calcium Channel Blocker

Copyright © 2008 Lippincott Williams & Wilkins.

Prototype Vasodilators

Copyright © 2008 Lippincott Williams & Wilkins.

Nursing Considerations for ACE Inhibitors

• Assessment (history and physical exam)

• Nursing diagnosis
• Implementation
• Evaluation

Copyright © 2008 Lippincott Williams & Wilkins.

Nursing Considerations for Angiotensin II
Receptor Blockers

• Assessment (history and physical exam)

• Nursing diagnosis
• Implementation
• Evaluation

Copyright © 2008 Lippincott Williams & Wilkins.

Nursing Considerations for Calcium
Channel Blocker

• Assessment (history and physical exam)

• Nursing diagnosis
• Implementation
• Evaluation

Copyright © 2008 Lippincott Williams & Wilkins.

Nursing Considerations for Vasodilators

• Assessment (history and physical exam)

• Nursing diagnosis
• Implementation
• Evaluation

Copyright © 2008 Lippincott Williams & Wilkins.

Nursing Considerations for Midodrine

• Assessment (history and physical exam)

• Nursing diagnosis
• Implementation
• Evaluation

Copyright © 2008 Lippincott Williams & Wilkins.