Chapter 43:

Drugs Affecting Blood Pressure

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 Blood Pressure Control
 BP determined by
o Heart Rate
o Stroke Volume: Amount of blood pumped out of the
ventricle with each heartbeat
o Total Peripheral Resistance: Resistance of the
muscular arteries to the blood being pumped through
 Baroreceptors
 Renin-angiotensin-aldosterone system

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Blood Pressure Control

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Blood Pressure Control
 https://www.youtube.com/watch?v=j2n3xA8lLtI
 BP regulation/…..

 https://www.youtube.com/watch?v=OQHkGZjfuc8&t=567
s
 Sarah, talking on antihypertensives…

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Atherosclerosis

Figure 16-1. Atherosclerosis.

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Stepped Care Management of
Hypertension
 Step 1: Lifestyle modifications are instituted
o Weight reduction, smoking cessation, moderation of
alcohol intake, reduction of dietary salt, increase in aerobic
physical activity
 Step 2: Inadequate response
o Drug therapy added
 Step 3: Inadequate response
o Consider change in drug dose or class, or addition of
another drug for combined effect
 Step 4: Inadequate response
o Second or third agent or diuretic is added if not already
prescribed

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General Issues for Antihypertensive
Therapy
 Check before:
o Baseline vital signs
 Check after:
o Vital signs every 4 to 8 hours
o Orthostatic vital signs

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Patient Teaching for Antihypertensive
Drugs
 Proper techniques to check BP/pulse; record keeping
 Change positions slowly
 Follow-up appointments
 Take missed dose when remembered unless next dose is in
less than 4 hr; no double dose
 No OTC diet pills, respiratory drugs without consulting
prescriber
 Lifestyle changes must be continued
 Importance of compliance; drugs control, not cure
 These will not cure the HTN, they need to maintain other
healthy measures: prevent organ disease

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ACE Inhibitors Lisinopril: ends in “pril”

 Actions
o Blocks 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;
o Often prescribed along with diuretics
o Lower doses may be given for pts with renal disease or
those pairing a diuretic with the med.
 Indications
o Treatment of hypertension, congestive heart failure (CHF),
diabetic nephropathy, left ventricular dysfunction following
an MI

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ACE Inhibitors

 Intended responses—vasodilation of blood vessels,

diuresis, lowered blood pressure, decreased workload of
heart
 Side effects: Hypotension, taste disturbances,
hyperkalemia, headache, persistent dry cough
 Adverse effects: Fever/chills; hoarseness; swelling in face,
hands, feet; trouble swallowing or breathing; stomach
pain; chest pain; rashes and itching skin; yellow eyes or
skin
o Angioedema: Diffuse swelling of eyes, lips, tongue

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Nursing Considerations for ACE Inhibitors

 Assess:
o History and Physical Exam
o Known allergy
o Impaired kidney function, pregnancy and lactation
o Salt/volume depletion and heart failure
o Baseline status before beginning therapy, including
o VS, LS, BS, weight, skin, ECG, CBC with differential
and electrolytes

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Administering ACE Inhibitors
Check before:
o If also taking diuretics, greater effect on BP will occur
o Ask about allergies to foods, dyes, drugs, etc
Check after:
o Potassium levels, I&O, weight
o Monitor for allergic reactions, infections
Patient teaching:
o Take drug at same time each day
o Do not drink alcohol (unless prescriber approved)
o Avoid salt substitutes
o Report side effects
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Prototype ACE Inhibitors

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Angiotensin II Receptor Blockers:
Losartan ends in :”artan”
 Actions
o Blocks the binding of angio II to their cell receptors.
Leading to Vasodilation
 End in “-sartan” (losartan)
 Pharmacokinetics
o Well absorbed and undergo metabolism in the liver.
They are excreted in the feces and urine
 Intended responses same as ACE inhibitors with slightly
different action
 Fewer side effects than ACE inhibitors; better tolerated
 All other ACE-inhibitor information applies!

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Angiotensin II Receptor Blockers

 Contraindications
o Allergy, pregnancy, and lactation
 Caution
o Hepatic or renal dysfunction, and hypovolemia
 Adverse Effects
o Headache, dizziness, syncope, weakness
o GI complaints
o Skin rash or dry skin
 Drug-Drug Interactions
o Phenobarbital

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Nursing Considerations for Angiotensin II
Receptor Blockers
 Assess:
o History and Physical Exam
o Known allergy
o Impaired renal and hepatic function, pregnancy and
lactation
o Hypovolemia, assess baseline status before
beginning therapy including, skin, VS, LS, baseline
ECG and renal and function tests

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Administering ARBs
 Check before:
o BUN and creatinine levels
o Kidney or liver problems
 Check after:
o Swelling
o Urine output and weight
o Potassium levels
 Patient teaching:
o Hypotension risk
o Report any facial swelling!

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Prototype Angiotensin II Receptor
Blockers

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Renin Inhibitor Aliskiren
 New class of drugs for treating hypertension which directly
inhibits renin, leading to decreased plasma renin activity and
inhibiting the conversion of angiotensinogen to angiotensin I
 Pharmacokinetics- slowly absorbed from the GI tract, with peak
levels in 3 hours. It is metabolized in the liver, with a half-life of
24 hours, and is excreted in the urine
 Contraindications- Pregnancy and lactation
 Adverse effects- Risk of hyperkalemia
 Drug-Drug Interactions- Furosemide and ACE Inhibitors

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Sympathetic Nervous System Blockers
Beta Blockers
 Block effects of epinephrine (adrenaline) on
cardiovascular system
o Think of how your heart responds when you are
startled!
 Decreases heart rate and force of contractions
o Lowers pulse and blood pressure.
 End in “-olol” (e.g., metoprolol

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Beta Blockers
 Cardio selective: Metoprolol
 Non cardio selective: propranolol
 Intended responses—decreased heart rate, force of heart
contraction, workload of heart; lowered BP
 Common side effects:
o Impotence, dizziness, light-headedness, insomnia,
lethargy, weakness

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Beta Blockers
 Less common side effects:
o Dyspnea or wheezing, cold hands or feet, mental
depression, shortness of breath, bradycardia, edema
 Adverse effects:
o Very slow heart rate, chest pain, severe dizziness or
fainting, fast or irregular heart rate, dyspnea,
cyanotic nail beds, seizures
o Affect diabetic patients’ blood glucose levels
o Cause or exacerbate asthma or congestive heart
failure

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Administering Beta Blockers
 Check before:
o Heart rate, blood pressure
o Daily weights
o Blood glucose levels
o History of asthma
 Check after:
o Heart rate
o Monitor for shortness of breath, edema

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Administering Beta Blockers (Cont.)
 Patient teaching:
o Techniques to take pulse and BP
o Report signs and symptoms
o Avoid orthostatic hypotension
o Do NOT discontinue suddenly—may cause heart
attack

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Calcium Channel Blockers Diltiazem
 Decrease BP, cardiac workload, and myocardial oxygen
consumption

 Actions
o Block calcium from entering muscle cells of heart and
arteries; dilate arteries and decrease strength in
heart contractions
o
 Indications
o Treatment of essential hypertension in the extended
release form

 Intended responses: (lowering BP)

o Decreased heart rate
o Dec. force of heart contraction
o Dec workload of heart
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Calcium Channel Blockers
 Contraindications
o Allergy, heart block or sick sinus syndrome, renal or
hepatic dysfunction, pregnancy, and lactation

 Side effects: Constipation, nausea, headache, flushing, rash,

edema (legs), hypotension, drowsiness, dizziness

 Adverse effects: Dysrhythmia, worsening

heart failure (with verapamil and diltiazem), Stevens-Johnson
syndrome

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Nursing Considerations for Calcium
Channel Blocker

 Assess:
o History and Physical Exam
o Known allergy
o The main use of calcium-channel blockers is for the
treatment of angina. See Chapter 46 for the nursing
considerations of calcium channel blockers

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Prototype Calcium Channel Blockers

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Nursing Considerations for Patients
Receiving Antihypotensive Drugs

 Assess:
o History and Physical Exam
o Known allergy
o Impaired kidney or liver function, pregnancy and
lactation
o CV dysfunction; visual problems; urinary retention;
and pheochromocytoma
o Baseline to include, VS, skin, weight, respirations and
LS, appropriate lab values

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Alpha Blockers
 Also known as “alpha adrenergic blockers”
 End in “-zosin” (e.g., prazosin
 Intended responses:
o Artery relaxation and dilation
o Increase blood flow
o Lower blood flow
 Side effects
o Dizziness, drowsiness, fatigue, headache,
nervousness, irritability, stuffy or runny nose, nausea,
pain in arms/legs, hypotension, weakness

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Alpha Blockers (Cont.)
 Adverse effects
o Lower blood pressure too much
o Fainting
o Shortness of breath or difficulty breathing
o Irregular heart rhythm, chest pain
o Swollen feet, ankles, or wrists

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Alpha Blockers Administration
 Check before:
o Males taking any phosphodiesterase type 5 inhibitor
erectile dysfunction drugs
 Check after:
o General responsibilities
 Patient teaching:
o Do not drive or use machines for 24 hours after first
dose
o Weigh self twice a week, report gain

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Life Span Considerations for Alpha
Blockers
 Older adult considerations:
o Lower doses

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Central-Acting Adrenergic Agents
 Stimulate CNS receptors to decrease constriction of blood
vessels; lead to dilation of arteries and lower BP
 Examples: Clonidine
 Intended responses:
o Vasodilation, lower blood pressure, decrease heart
workload
 Side effects: Drowsiness, lethargy, dry mouth, nasal
congestion
 Adverse effects: Myocarditis rare

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Administration of Central-Acting
Adrenergic Agents
 Check before:
o Baseline weight
o Clonidine patch comes with patch and larger one to
cover medication
 Check after:
o Input and output, feet and ankle swelling, mental
status, lung sounds, depression
 Patient teaching:
o Discontinue gradually, dry mouth prevention, patch
may get wet

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Life Span Considerations for Central-
Acting Adrenergic Agents

 Older adult considerations:

o Increased risk of orthostatic hypotension
o Lower doses

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