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6c - Cardiovascular Drugs - Antihypertensives
Jun 17, 2024
Lecture Notes: Cardiovascular Drugs - Pharmacology for Nursing (Professor Hoffman)
Topic 6C: Antihypertensives
Learning Objectives:
ACE inhibitors
ARBs
Beta blockers
Calcium channel blockers
Key Topics
ACE Inhibitors
Suffix
: '-pril' (e.g., Lisinopril)
Mechanism
: Angiotensin-converting enzyme inhibitor (Blocks conversion of Angiotensin I to Angiotensin II)
Effects
:
Causes vasodilation
Reduces blood pressure
Decreases workload on the heart
Uses
:
Hypertension
Heart failure
Side Effects
:
Hypotension
Cough
Neutropenia, agranulocytosis
Angioedema
Hyperkalemia
Nursing Considerations
:
Contraindicated in pregnancy (black box warning)
Monitor blood pressure
Persistent cough may require switching to ARBs
Watch for facial swelling or airway pressure (angioedema)
Monitor potassium levels due to risk of hyperkalemia
ARBs (Angiotensin Receptor Blockers)
Suffix
: '-sartan' (e.g., Losartan)
Mechanism
: Block receptor sites for Angiotensin II
Effects
:
Similar to ACE inhibitors but without causing a cough
Vasodilation
Decrease aldosterone leading to potassium retention
Uses
:
Hypertension
Heart failure
Side Effects
:
Hypotension
Angioedema
Hyperkalemia
Nursing Considerations
:
Still a black box warning for pregnancy
Similar monitoring as ACE inhibitors
Calcium Channel Blockers
Mechanism
: Block calcium movement into cells, affecting both heart and arterial muscles
Effects
:
Reduces heart rate (slows conduction)
Decreases contractility (strength of contractions)
Causes arterial dilation
Uses
:
Hypertension
Angina
Tachycardia
Side Effects
:
Hypotension
Bradycardia
Edema
Liver damage
Nursing Considerations
:
Monitor blood pressure and heart rate
Teach dosing compliance
Avoid grapefruit juice (can cause drug toxicity)
Beta Blockers
Suffix
: '-olol' (e.g., Atenolol, Propranolol)
Mechanism
: Block beta-1 receptors, reducing sympathetic nervous system effects on the heart
Effects
:
Decrease heart rate
Decrease contractility
Uses
:
Hypertension
Tachyarrhythmias
Angina
Side Effects
:
Hypotension
Bradycardia
Worsening heart failure
Bronchoconstriction (especially in non-selective beta blockers)
Nursing Considerations
:
Monitor blood pressure and heart rate
In diabetic patients, monitor blood glucose levels (affect glucose release from the liver)
Ensure patient compliance
Teach patients to check their own pulse
Taper dose slowly if discontinuing
Summary
Each class of antihypertensive drugs works via different mechanisms but has common goals of reducing blood pressure and cardiac workload.
Understanding side effects and nursing considerations is crucial for safe and effective patient care.
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