Hey there future nurses, it's Christine from Nurse in the Making and today we're going to talk about anti-hypertensive medications. But before we dive in, don't forget to subscribe to my YouTube channel for weekly videos, daily nursing school questions, and all things to help you pass nursing school. So as we dive- into antihypertensives, I always love to begin by breaking down the word.
Anti means against or opposite and hypertension is high blood pressure. So an antihypertensive medication would be a medication that does the opposite of high blood pressure, which is to lower blood pressure. These drugs also manage chronic hypertension and decrease the workload of the heart.
Antihypertensives is an umbrella term to describe different groups of drugs and depending on their category, their mechanism of action, or the way that they work will be different. But they all target the same issue and have the same goal, which is to lower blood pressure. You can remember all the antihypertensive medications.
by the memory trick as easy as A, B, C, D. A, B, C. The first A is for ACE inhibitors. ACE stands for angiotensin converting enzyme. So ACE inhibitors is angiotensin converting enzyme inhibitors.
Since this is a mouthful, we just say ACE inhibitors. To inhibit means to stop or hold back. These drugs inhibit the enzyme, which converts angiotensin 1 to angiotensin 2. There.
The reason we want to stop it from getting to angiotensin 2, because angiotensin 2 is known to constrict the vessels, which we clearly don't want because this causes blood pressure to rise. So as we inhibit or stop this from working, we are able to keep those vessels dilated and keep blood pressure down. ACE inhibitors also prevent the secretion of a hormone called aldosterone. This hormone causes our bodies to retain water and sodium, which makes our blood pressure high. But since ACE inhibitors prevent aldosterone secretion, the body doesn't hold on to sodium in water, which helps maintain a safe blood pressure.
Now for the medication names of ACE inhibitors. These are easy to remember because we are saved by the suffix. PRIL is the suffix for ACE inhibitors. Here are a few to know.
Enalapril, lisinopril, and captopril. These all end in the suffix PRIL. Here is a pharmacology tip.
Instead of remembering all the medication names for ACE inhibitors, just remember ACE inhibitors end in the Suffolk prill. Since these are prescribed so frequently, we have to know the side effects. These are easy to remember by using the memory trick ACE.
A stands for angioedema. This is swelling of the lips, eyes, or face. C is for cough. This is usually a very dry cough.
And E is for elevated potassium levels. Something to note here is that the NCLEX likes to assess your knowledge on normal findings and dangerous findings. So angioedema and an elevated potassium levels are very dangerous. Swelling of the face and neck can cause the airway to be cut off and elevated potassium levels can cause cardiac dysrhythmias.
Both are very dangerous, but as annoying as a dry cough is, it's a normal and very common side effect of ACE inhibitors. So it's not considered dangerous. Next, we're going to cover ARBs. ARBs are almost like a cousin to ACE inhibitors. ARBs stands for angiotensin 2 receptor blockers.
Remember, angiotensin 2 constricts the blood vessels. So by blocking the receptor, we cut off angiotensin II's ability to narrow the vessels. Again, we are saved by the suffix.
You can remember the ARBs medication by the suffix sartan. Some examples are candesartan, losartan, omasartan, and valsartan. So again, instead of trying to memorize all these, just know the medication class for ARBs ends in sartan.
Since these drugs are similar to ACE inhibitors, we want to watch for the similar side effects. But these are often used for patients who can't take ACE inhibitors and are less likely to have a cough or angioedema. Okay, so we covered A, which is ACE. inhibitors and ARBs.
But next is B which stands for beta blockers. Beta blockers block beta-1 receptors. Beta-1 receptors are needed for the function of the sympathetic nervous system. The memory trick is sympathetic think stress. This system would kick in if you are running away from a bear.
This system is called the fight-or-flight system which increases your heart rate, increases your blood pressure, and increases your respiratory rate. But beta blockers block this system which causes a system to relax, which lowers the workload of the heart decreasing our heart rate and blood pressure. Once again, instead of memorizing every single medication, we look at our suffixes.
Olol is the suffix associated with these. So when you see olol or lol, think beta blockers, because the heart is not a laughing out loud matter. So we have metoprolol, natolol, propanolol, and carbetolol.
For the side effects of beta blockers, you can think of the Bs. The first B is bradycardia and heart blocks. The next B is for breathing problems. Beta blockers can cause bronchospasms, which is why we want to ban these medications from asthma patients.
So beta blockers think ban from asthma patients. The next B is for bad for heart failure patients in acute settings. The next B is for blood sugar masking. Beta blockers can mask or hide signs and symptoms of hypoglycemia, which is low blood sugar.
And the last B is of course blood pressure lowered. we want these patients blood pressures to be lowered but beta blockers can cause blood pressure to be lowered too much causing hypotension if you need more help on antihypertensive and other medications you can grab the complete NCLEX pharmacology flashcards it contains over a hundred of the most common medications seen on the NCLEX and on your nursing school exams these flashcards have been used by hundreds of thousands of nursing students to help them pass their pharmacology class. You can find the link in my bio to the pharmacology flashcards and a ton of other nursing school resources. Next on to C, which stands for our calcium channel blockers.
These medications lower heart rate and blood pressure. They do this by blocking the movement of calcium throughout the body. Calcium causes the heart to contract stronger. Calcium think contract.
But this medication is blocking the channels that calcium travels through, which relaxes the contraction of the heart. So these medications decrease the heart's workload, increase the supply of the oxygen to the heart, and relax the vessels. Some medications don't have any suffixes.
We call these outliers, but here's a memory trick to remember the medications. Calcium channel blockers are very nice drugs. V is for verapamil, N is for nifedipine, and D is for diltiazam.
Okay, so A, B, C, D. The D stands for diuretics and digoxin, which I'll cover in a different video because there's a lot to be covered in these. Let's talk about some nursing considerations for antihypertensives. These nursing considerations relate to all antihypertensives in general.
You want to monitor for hypotension and orthostatic hypotension. Orthostatic hypotension is a drop in blood pressure with position change. This can cause dizziness, so we wanna educate our patients to change their positions slowly. You wanna tell them to dangle their feet on the side of the bed or the chair before getting up. If they get up too quickly, it can cause a lot of dizziness.
it can cause their blood pressure to drop, making them become dizzy and possibly leading to a fall. Next is monitor for electrolyte levels, mainly potassium and sodium. Educate your patient to report any muscle cramping, weakness, rapid heart rate, or unusual symptoms. Assess for angioedema, which I mentioned previously, is most commonly associated with ACE inhibitors. This is swelling just below the skin, and this is very dangerous.
when it appears near the eyes, face, and mouth because this could block off the patient's airway. Educate your patient to take the medication as ordered, meaning they should not stop taking their medication suddenly. This can lead to something called rebound hypertension. The best way to think of this or the best way to teach your patient is thinking of a rubber band.
Pulling a rubber band tightly back and suddenly releasing it will make it snap sharply in the opposite direction. direction. Meaning rebound hypertension is stopping the medication all of a sudden and snap. The blood pressure shoots back up.
If they need to stop taking their antihypertensives it needs to be tapered. You will see the word tapered on the NCLEX a lot. In other words the rubber band or medication should be released in a controlled and slowed way. This method will help the patient avoid rebound hypertension. That's all for antihypertensives.
Remember to use the memory trick as easy as ABCD. A-B-C. ACE inhibitors and ARBs, beta blockers, calcium channel blockers, and digoxin and diuretics.
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