hi everybody I am net nursing Pratt and welcome to my channel in today's video we're gonna be talking about the ABCs of antihypertensives so those are the ACE inhibitors the beta blockers and the calcium channel blockers so let's jump in to our first one in alphabetical order a ACE inhibitors so ACE actually stands for angiotensin converting enzyme and if you remember back to NP the rena angiotensin aldosterone system right so if your Tennison is a hormone that causes vasoconstriction which in turn increases your blood pressure so the way these meds work is they come in and they stop this from happening so they work here and they prevent angiotensin 1 from becoming angiotensin 2 and therefore it has a basal dilating or lower blood pressure effect they also black aldosterone which causes a decrease in sodium and water retention and they also decrease peripheral vascular resistance again lowering the blood pressure all of these things work together to lower the blood pressure some special positives about ACE inhibitors is even though they do all this they do not cause an increase in cardiac output and increase in heart rate or an increase in contractility so they're not making the heart work harder which is a good thing because we don't want the heart to have to work harder when it comes to our side effects they're pretty easy to remember because we have captopril which is actually one of the ACE inhibitors that's commonly prescribed and we can use it as a device to remember the side effects c is for cough and anything underlined in green here is a common side effect anything in red is a bad thing an adverse effect dangerous okay so c is for coughs often or dry cough they will complain a bit angioedema obviously that's not good we don't want our patients to have that and as a matter of fact it is contraindicated in patients who have a history of angioedema so if you know that about your patient it's not appropriate for them to be nice inhibitors protein in the urine taste changes so I'm not being able to taste certain things as well oh is for other like headaches potassium increased so hyperkalemia RS for renal impairment is for itching or rashes and then L is for low blood pressure or orthostatic hypotension now I always think this is kind of funny because the job is to lower the blood pressure right that's the goal of this so how is low blood pressure a side effect and when I say this I mean like dangerously low blood pressure orthostatic hypotension this is when our patient goes from like sitting to a standing position and their blood pressure drops too quickly and they feel dizzy and faint and they might even pass out the labs we're monitoring with these patients our potassium and white blood cell counts so our potassium of course they're at risk for a hyperkalemia so too much potassium and then their white blood cell count neutropenia so lower neutrophils can be a side effect in some of these medications so we need to be a little bit more careful about monitoring our patients for that these are just some examples of commonly prescribed ACE inhibitors and you know what they have something in common right they all end in PR aya so that's one of the little triggers when a little tricks you can remember too if you're not sure if it's an ACE inhibitor or not so if you see a question on an exam and you see that it ends in PR IL that's probably a pretty good clue that it's an ACE inhibitor so if you know what ACE inhibitors work then you'll know what that meant does and then finally I wanted to discuss our nursing interventions so that nurses responsibility when taking care of a patient who is on an ACE inhibitor aside from monitoring their labs of course we're going to mine us with your blood pressure help them rise slowly so preventing orthostatic hypotension we should give this medication on an empty stomach and we need to use caution patients who are using lithium and who are on insects if given with patients who are in the field can actually increase the dose of dangerous amount increase the effects of the lithium and then on NSAIDs you can actually decrease the effects so avoid salt substitutes that contain potassium because again we're at risk for hyperkalemia here so we need to be careful when it comes to giving them extra potassium so this was ace inhibitors let's move on to beta blockers now let's talk about beta blockers so beta blockers work by blocking sympathetic stimulation on the heart so they block the effects of epinephrine which is a hormone rate if we remember that so they block epinephrine which causes a decrease in the person's heart rate and contractility and also decreases the rate of AV conduction there is beta 1 and beta 2 so when we talked about the heart we're talking about beta 1 and then we're talking about the lungs which is my terrible drawing on the lungs is beta 2 you can remember this because you have one art in two lungs the big thing when it comes to this is bronchoconstriction that's something we want to keep an eye out for some side effects when it comes to beta blockers our bradycardia it again anything underlined in green is coming anything underlined in red is dangerous so bradycardia so a really slow heart rate too slow lethargy congestive heart failure weakness and then run feel constriction which I talked about because of the beta 2 because of the bronchial constriction this type of medication is contraindicated in people who already have respiratory problems like COPD and asthma one random other thing I put with a little asterisks here stiring types of beta blockers should not be used if the patient is diabetic and those are antenna walls and then approval law because they decrease the patient's salamé levels they black insulin production from the pancreas and that in turn decreases their overall insulin levels and if you're a diabetic that's a course very dangerous so contraindicated and people who have respiratory disorders like this and possibly diabetics depending on which specific one is being ordered and then you'll see here for the examples they also have a little something in common the ending is LOF so this is the generic name of these medications so if you're having trouble remembering always this meant a beta blocker ACE inhibitor at calcium channel blocker if it ends in lol it's probably a beta blocker so what are nursing interventions when it comes to beta blockers of course we're going to be checking our blood pressure on our patients but now we're actually going to be very diligent about checking their heart rate as well so we're gonna hold this type of medication if their blood pressure and/or their heart rate is too low we're gonna assess for overall weakness dizziness and possible fainting and important teaching that we want to tell our patient is to never abruptly stop taking it so they wake up one day and say I've been having really good blood pressures lately I just don't think I'm gonna take it anymore that's not a good idea because it can cause rebound hypertension now let's move on to calcium channel blockers now we've made it to see calcium channel blockers so the way calcium channel blockers work they block calcium influx into the heart and arteries and if you remember calcium is what forces the heart to be even stronger right so if we're blocking it we're decreasing the force of contraction which will decrease the heart rate and then we're also decreasing peripheral vascular resistance and all of this is a good thing because it causes the blood vessels to relax which causes a decrease in our blood pressure and it decreases the hearts demand for oxygen which is good especially if your patient has hypertension and like a CHF or something something is special about calcium channel blockers is they are often the first choice medication by the doctor so if you are newly diagnosed with hypertension and they're trying to figure out what med to put you on it might be a calcium channel blocker that they start you up besides the beta blockers of ACE inhibitors they go let's see how this works first to remember the name of some commonly prescribed calcium channel blockers it's very nice drugs so verapamil is v nifedipine is in and then that's hi Azam is deep so very nice drugs and you'll see what I get here is I underlined P I and II we talked in ace inhibitors how a lot of them engine PRI L and beta blockers engine lol some calcium channel blockers will in in P I and II not all of them of course as you can see these two don't so don't think of this as like a hard and fast rule every single one of them will end in PID but a lot of them do so that's something that can help you remember some nursing interventions things the nurse needs to know about this is that they should be given before meals of course we're gonna monitor their blood pressure these patients also need to be wait because they are at risk for fluid overload gaining too much weight because of the edema and then random but still important is there to avoid grapefruit and grapefruit juice some side effects of calcium channel blockers include edema and remember anything in green is common and anything in red is dangerous so swelling especially at the lower extremities nausea headaches breda cardia constipation and then the scary one is arrhythmia and think about that think about why that's happening because we are blocking calcium so we are changing the contractility of the heart so that might throw them in to a different rhythm right so this is important you need to know this about calcium channel blockers and then this little thing here is just a little way to remember some important things about calcium channel blockers if you see how a lot of them end in IPIN d so we have di pind here D is for dizziness it can cause dizziness I is it improves your blood pressure it improves your hypertension that's a good thing that's the reason they're taking it P is for people of color so people of color and the elderly actually really benefit from calcium channel blockers so that's why it's one of the most commonly prescribed and first choice meds I is for intense headaches so it can cause intense headaches for our patients and is for our no grapefruit juice to remember when I've given them that and then e is for the edema the edema in the lower extremities that's common a common side effect of calcium channel blockers now I know in this video we talked about a bunch of different types of meds and they are used for other things some of these are used for CHF and engine hood but this video really was more focused on how they work in preventing hypertension how are they used as antihypertensives so our ABCs ACE inhibitors beta blockers and calcium channel blockers I know it's hard sometimes we get a little mixed up and get them confused so I hope this video was helpful and you kind of distinguishing between the three don't forget to Like and subscribe thank you for watching if you have any questions or comments let me know and if not I'll see you on the next one