Hypertension check or plag

Hypertension Drug TherapyA. Macchia, J. Rebeck, K. Clendenon, K. StedjeAbstractThis presentation examines the tre atment of ACE inhibitors and calcium channel blockers for hypertension. The discussion of these antihypertensives includes the mode of action, cultural considerations, drug interactions, nursing considerations, patient teaching, side effects, and adverse reactions. Keywords: ACE inhibitors, calcium channel blockers, patient teaching, cultural considerations, drug interactions, side effects, adverse reactionsObjectivesUpon completion of this presentation the nurse will be able to: ● Explore unique considerations for drug therapy – special populations. ● Plan patient and family teaching. ● Examine effects of pharmacologic therapies in management of physiological/psychologicalIntroduction Hypertension is an increase in an individual’s blood pressure (BP) that is commonly seen in today’s healthcare that can cause other serious cardiovascular conditions if it is not treated. A normal BP is considered 120/80 and the JNC 8 created recommendations to provide a guideline for when providers should treat someone with hypertension with antihypertensives. These guidelines include:● Anyone under the age of 60 who has a BP >140/90 ● Anyone over the age of 60 years old who has a BP >150/90 However, it is important to mention that despite an individual’s age, a patient with a BP >140/90 should consider treatment for hypertension with nonpharmacologic or pharmacologic methods to prevent further damage ( Reisin , Harris, & Rahman, 2014).Classifications of Antihypertensives ● Diuretics ● ACE inhibitors (ACEI) ● Vasodilators ● Peripheral adrenergic inhibitors ● Combined alpha and beta – blockers ● Angiotensin II receptor blockers (ARBs) ● Alpha blockers ● Calcium channel blockers ● Alpha -2 receptor agonistsACEI – Mode of Action When the body is under certain conditions from decreased tissue perfusion, it will signal the renin -angiotensin system by: ○ Stimulation of renin the stimulation of angiotensin 1 which converts to angiotensin II ○ As a result, angiotensin II will act as a vasoconstrictor and produce the aldosterone = Increased BP Therefore, ACE inhibitors are used to combat this by: ○ Stopping the conversion of angiotensin I & II ○ Inhibit aldosterone from secretingACEI – Contraindications ● Contraindications for ACE Inhibitor use are ○ Renal insufficiency – metabolized by liver ○ Liver disease – activated in liver ○ Allergy to ACE inhibitors, including angioedema reaction previously ○ Pregnancy – can cause birth defectsACEI – Drug – Lab – Food Interactions ACEi (e.g., Lisinopril) + Potassium -sparing diuretics (e.g., spironolactone) = Hyperkalemia Foods high in potassium can increase potassium levels:•Avocados•Broccoli•Bananas•Cantaloupe•Kiwi•Oranges•Mushrooms(Ignatavicius & Workman, 2016, p. 167) POTASSIUM Drug -Drug ACEi (e.g., Lisinopril) + NSAIDs = Reduced antihypertensive effects of ACEi Drug -Lab Drug -FoodACEI – Adverse Reactions and Side Effects Primary side effect : constant, irritating cough •Nausea•Vomiting•Diarrhea•Headache•Dizziness•Fatigue•Insomnia First – dose hypotensionHyperkalemiaAngioedema (Ignatavicius & Workman, 2016, p. 645) Side Effects Adverse ReactionsACEI – Nursing Interventions, Patient Teaching, Considerations ● Patients with heart failure should consider taking an ACE inhibitor ● Assess renal function (BUN, creatinine, protein) & lab values, particularly potassium levels ● Patients with renal dysfunction should have their dosage decreased ● Monitor for a significant drop in BP during the first dose of an ACE inhibitor ● Teach patients to notify their provider if they develop a cough ● Teach patients not suddenly stop taking their medication because rebound hypertension may occur ● Advise patient to avoid foods high in potassium ● Inform pregnant women or women intending to become pregnant should not take ACE inhibitors when they are pregnant ● Inform African Americans they may not respond well to ACE inhibitorsCCB – Mode of Action ● Calcium channel blockers ( CCBs) stop or decrease the movement of calcium thro ugh the channels in the cells of the heart muscles and the muscles of the arteries. ● Inhibit calcium from entering the cells causes: ○ Relaxation of vascular smooth muscle or vasodilation ■ Resulting in decreased blood pressure ○ Slowed electrical conduction in the heart ■ Resulting in decreased cardiac contractility or force of contraction ■ Resulting in a lower heart rate ■ Resulting in a lower blood pressureCCB – Contraindications ● Contraindications of Calcium Channel Blockers ○ Aortic Stenosis ○ Bradyarrhythmia or Sick Sinus Syndrome ○ Hypotension or cardiogenic shock ○ Liver disease due to prolongs half life ○ Caution with GI strictureCCB – Drug & Food Reactions Food ● Grapefruit Juice ○ Increases levels of CCB ● High fat/ high calorie meals ○ Makes it difficult to regulate blood pressure Drug ● Fentanyl, antihypertensives, nitrates, ETOH use, quinidine ○ Decreases bp, monitor orthostatic hypotension ● Histamine 2 blocker ○ Increases CCB, monitor cerebrovascular status ● NSAIDS -decreases effectsCCB Side Effects & Adverse Reactions ● Headache ● Hypotension ● Edema ● Dizziness ● Flushing ● Constipation ● Nausea ● Rash ● Drowsiness ● Lower Urinary Tract SymptomsCCB – Nursing Interventions, Teaching, Culture/Age Considerations ● Nursing considerations ○ Monitor blood pressure, heart rate, and daily weight ○ Monitor for edema ○ Orthostatic hypotension ○ Use caution in older adults ○ Use caution in patients with kidney, liver disorders, heart failure, and GERD ● Patient teaching ○ Change positions slowly ○ Do not chew or crush extended release pills ○ How to monitor blood pressure and heart rate ○ Use caution when taking with other cardiac medications such as beta blockers ○ Notify provider if swelling occurs in the lower extremitiesUnique Considerations – Special Populations ● Geriatric○ Large percentage ○ Higher cardiac risk ○ Physiologic changesConclusionThere are several medications that can be used to treat hypertension, however, it is important to consider special patient and cultural considerations and drug interactions when choosing a particular antihypertensive. For example, it is important to recognize that ACE inhibitors may not the appropriate antihypertensive to prescribe for African Americans and patients with liver disease should avoid the use of calcium channel blockers. While antihypertensives benefit patients in many ways, it is important to inform and educate patients on the medications they are taking to treat their hypertension.ReferencesAmerican Heart Association. (October 31 st, 2017). Types of blood pressure medications. Retrieved from https://www.heart.org/en/health -topics/high -blood -pressure/changes -you -can -make -to-manage -high -blood – pressure/types -of-blood -pressure -medications?s=q%253Dblood%252520pressure%2526sort%253Drelevancy Beckerman, J. (February 12, 2018). Heart disease and calcium channel blocker drugs. Retrieved from https://www.webmd.com/heart -disease/guide/heart -disease -calcium -channel -blocker -drugs#2 Denker, M. G. & Cohen, D. L. (2015). Antihypertensive medications in end -stage renal disease. Seminars in Dialysis, 28 (4), 330 -336. http://dx.doi.org.db15.linccweb.org/10.1111/sdi.12369 Elliot, W . J. & Ram, V. S. (2011). Calcium channel blockers. The Journal of Clinical Hypertension , Vol. 13. (pp. 687 -689). https://doi.org/10.1111/j.1751 -7176.2011.00513.x Hermann, R., Derendorf, H., von Richtner, O., & Rostami -Hodjegan, A. (2018). Core entrustable professional activities in clinical pharmacology: pearls for clinical practice. The Journal of Clinical Pharmacology, 58, 704 – 716. doi:10.1002/jcph.1088Ignatavicius, D. D. & W orkman, L. M. (2016). Medical surgical nursing: patient -centered collaborative care. St. Louis, MO: Elsevier .References Kee, J. L., Hayes, E. R., & McCuistion, L. E. (2015). Pharmacology: a patient -centered nursing process approach. St. Louis, MO: Elsevier.Mayo Clinic Staff. (May 12, 2018). Angiotensin -converting enzyme (ACE) inhibitors. Retrieved from https://www.mayoclinic.org/diseases -conditions/high -blood -pressure/in -depth/ace -inhibitors/art -20047480 Patel, A. & Stewart, B. F. (2015). On hypertension in the elderly: an epidemiologic shift . Retrieved from https://www.acc.org/latest -in-cardiology/articles/2015/02/19/14/55/on -hypertension -in-the -elderly Reisin , E., Harris, R. C., & Rahman, M. (2014). Commentary on the 2014 bp guidelines from the panel appointed to the eight joint national committee ( jnc 8). Journal of the American Society of Nephrology (JASN), 25 (11), 2419 -2424. http://dx.doi.org.db15.linccweb.org/10.1681/ASN.2014040371Salman, M., Khan, A. H., Syed Sulaiman, S. A., Khan, J. H., Hussain, K., & Shehzadi, N. (2017). Effect of calcium channel blockers on lower urinary tract symptoms: a systematic review. BioMed Research International, 2017, 1-7. http://dx.doi.org.db15.linccweb.org/10.1155/2017/4269875