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Antihypertensive Agents

INDIAN DENTAL ACADEMY
Leader in continuing dental education
www.indiandentalacademy.com
www.india...
Hypertension
High blood pressure
 Normal:

Systolic < 130 mm
Diastolic < 85 mm Hg

www.indiandentalacademy.com

Hg
Classification of Blood Pressure
Category

Systemic BP (mm Hg)

Diastolic BP (mm Hg)

Normal

<130

<85

High normal

130-...
Classification of Blood Pressure
Primary Hypertension
 Specific cause unknown
 90% of the cases
 Also known as essentia...
Blood Pressure = CO x SVR
CO = Cardiac output
SVR = Systemic vascular resistance

www.indiandentalacademy.com
Instructors may want to insert
EIC Image #69:
Blood Pressure: Normal Regulation

www.indiandentalacademy.com
Antihypertensive Agents
Medications used to treat hypertension

www.indiandentalacademy.com
Antihypertensive Agents: Categories
Adrenergic agents
Angiotensin-converting enzyme inhibitors
Angiotensin II receptor ...
Antihypertensive Agents: Categories

Adrenergic Agents






Alpha1 blockers
Beta blockers (cardioselective and nons...
Antihypertensive Agents: Mechanism of Action
Adrenergic Agents
Alpha1 Blockers (peripherally acting)
 Block the alpha1-ad...
Antihypertensive Agents:
Adrenergic Agents
Alpha1 Blockers
 doxazosin (Cardura)
 prazosin (Minipress)
 terazosin (Hytri...
Antihypertensive Agents: Mechanism of Action
Adrenergic Agents
Central-Acting Adrenergics
 Stimulate alpha2-adrenergic re...
Antihypertensive Agents:
Adrenergic Agents
Central-Acting Adrenergics
 clonidine (Catapres)
 methyldopa (Aldomet)

(drug...
Antihypertensive Agents: Mechanism of Action
Adrenergic Agents
Adrenergic Neuronal Blockers
(peripherally acting)
 Inhibi...
Antihypertensive Agents:
Adrenergic Agents
Adrenergic Neuronal Blockers
(peripherally acting)
 reserpine
 guanadrel (Hyl...
Antihypertensive Agents:
Adrenergic Agents
Therapeutic Uses
 Alpha1 blockers (peripherally acting)




Treatment of hy...
Antihypertensive Agents:
Adrenergic Agents

Therapeutic Uses
 Central-Acting Adrenergics


Treatment of hypertension, ei...
Antihypertensive Agents:
Adrenergic Agents
Therapeutic Uses
 Adrenergic neuronal blockers

(peripherally acting)



Tre...
Antihypertensive Agents:
Adrenergic Agents
Side Effects
Most common:
dry mouth
sedation
constipation
Other:
headaches
naus...
Antihypertensive Agents: Categories
Angiotensin-Converting Enzyme Inhibitors
(ACE Inhibitors)
 Large group of safe and ef...
Antihypertensive Agents: Mechanism of Action

ACE Inhibitors
RAAS: Renin Angiotensin-Aldosterone System
 When the enzyme ...
Antihypertensive Agents: Mechanism of Action
ACE Inhibitors
 Aldosterone stimulates water and sodium resorption.
 Result...
Antihypertensive Agents: Mechanism of Action
ACE Inhibitors
 ACE Inhibitors block the angiotensin-converting enzyme,

thu...
Antihypertensive Agents
ACE Inhibitors
 captopril (Capoten)
 Short half-life, must be dosed more frequently

than others...
Antihypertensive Agents: Therapeutic Uses
ACE Inhibitors
 Hypertension
 CHF (either alone or in combination with diureti...
Antihypertensive Agents:
Side Effects
ACE Inhibitors
 Fatigue

Dizziness

 Headache

Mood changes

 Impaired taste
Dry,...
Antihypertensive Agents: Categories
Angiotensin II Receptor Blockers
Blockers or ARBs)
 Newer class
 Well-tolerated
 Do...
Antihypertensive Agents: Mechanism of Action
Angiotensin II Receptor Blockers
 Allow angiotensin I to be converted to ang...
Antihypertensive Agents:
Angiotensin II Receptor Blockers
 losartan (Cozaar)
 eposartan (Teveten)
 valsartan (Diovan)
...
Antihypertensive Agents: Therapeutic Uses
Angiotensin II Receptor Blockers
 Hypertension
 Adjunctive agents for the trea...
Antihypertensive Agents:
Side Effects
Angiotensin II Receptor Blockers
 Upper respiratory infections
 Headache
 May cau...
Antihypertensive Agents: Categories
Calcium Channel Blockers
 Benzothiazepines
 Dihydropyridines
 Phenylalkylamines

ww...
Antihypertensive Agents: Mechanism of Action
Calcium Channel Blockers
 Cause smooth muscle relaxation by blocking the bin...
Antihypertensive Agents
Calcium Channel Blockers
 Benzothiazepines:


diltiazem (Cardizem, Dilacor)

 Phenylalkamines:
...
Antihypertensive Agents: Therapeutic Uses
Calcium Channel Blockers
 Angina
 Hypertension
 Dysrhythmias
 Migraine heada...
Antihypertensive Agents:
Side Effects
Calcium Channel Blockers
 Cardiovascular


hypotension, palpitations, tachycardia
...
Antihypertensive Agents: Diuretics

Decrease the plasma and extracellular fluid volumes
Results:

decreased preload
decr...
Antihypertensive Agents: Mechanism of Action

Vasodilators
 Directly relaxes arteriolar smooth muscle
 Result:

decrease...
Antihypertensive Agents
Vasodilators
 diazoxide (Hyperstat)
 hydralazine HCl (Apresoline)
 minoxidil (Loniten, Rogaine)...
Antihypertensive Agents: Therapeutic Uses
Vasodilators
 Treatment of hypertension
 May be used in combination with other...
Antihypertensive Agents: Side Effects
Vasodilators
Hydralazine:


dizziness, headache, anxiety, tachycardia, nausea and
...
Antihypertensive Agents:
Nursing Implications
Before beginning therapy, obtain a thorough health

history and head-to-toe...
Antihypertensive Agents:
Nursing Implications
 Educate patients about the importance of not missing a

dose and taking th...
Antihypertensive Agents:
Nursing Implications
 Instruct patients that these drugs should not be stopped

abruptly, as thi...
Antihypertensive Agents:
Nursing Implications
 Remind patients that medications is only part of therapy.

Encourage patie...
Antihypertensive Agents:
Nursing Implications
 Instruct patients to change positions slowly to avoid

syncope from postur...
Antihypertensive Agents:
Nursing Implications
 Men taking these agents may not be aware that impotence

is an expected ef...
Antihypertensive Agents:
Nursing Implications
 Hot tubs, showers, or baths; hot weather; prolonged sitting

or standing; ...
Antihypertensive Agents:
Nursing Implications
 Monitor for side/adverse effects

(dizziness, orthostatic hypotension, fat...
Thank you
Leader in continuing dental education
www.indiandentalacademy.com

www.indiandentalacademy.com
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Anti hypertensives / /certified fixed orthodontic courses by Indian dental academy

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Anti hypertensives / /certified fixed orthodontic courses by Indian dental academy

  1. 1. Antihypertensive Agents INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com
  2. 2. Hypertension High blood pressure  Normal: Systolic < 130 mm Diastolic < 85 mm Hg www.indiandentalacademy.com Hg
  3. 3. Classification of Blood Pressure Category Systemic BP (mm Hg) Diastolic BP (mm Hg) Normal <130 <85 High normal 130-139 85-89 Hypertension Stage 1 Stage 2 Stage 3 Stage 4 140-159 160-169 180-209 ≥ 210 90-99 100-109 110-119 ≥ 120 www.indiandentalacademy.com
  4. 4. Classification of Blood Pressure Primary Hypertension  Specific cause unknown  90% of the cases  Also known as essential or idiopathic hypertension Secondary Hypertension  Cause is known (such as eclampsia of pregnancy, renal artery disease, pheochromocytoma)  10% of the cases www.indiandentalacademy.com
  5. 5. Blood Pressure = CO x SVR CO = Cardiac output SVR = Systemic vascular resistance www.indiandentalacademy.com
  6. 6. Instructors may want to insert EIC Image #69: Blood Pressure: Normal Regulation www.indiandentalacademy.com
  7. 7. Antihypertensive Agents Medications used to treat hypertension www.indiandentalacademy.com
  8. 8. Antihypertensive Agents: Categories Adrenergic agents Angiotensin-converting enzyme inhibitors Angiotensin II receptor blockers Calcium channel blockers Diuretics Vasodilators www.indiandentalacademy.com
  9. 9. Antihypertensive Agents: Categories Adrenergic Agents      Alpha1 blockers Beta blockers (cardioselective and nonselective) Centrally acting alpha blockers Combined alpha-beta blockers Peripheral-acting adrenergic agents www.indiandentalacademy.com
  10. 10. Antihypertensive Agents: Mechanism of Action Adrenergic Agents Alpha1 Blockers (peripherally acting)  Block the alpha1-adrenergic receptors  The SNS is not stimulated Result: DECREASED blood pressure  Stimulation of alpha1-adrenergic receptors causes HYPERtension  Blocking alpha1-adrenergic receptors causes decreased blood pressure www.indiandentalacademy.com
  11. 11. Antihypertensive Agents: Adrenergic Agents Alpha1 Blockers  doxazosin (Cardura)  prazosin (Minipress)  terazosin (Hytrin) www.indiandentalacademy.com
  12. 12. Antihypertensive Agents: Mechanism of Action Adrenergic Agents Central-Acting Adrenergics  Stimulate alpha2-adrenergic receptors  Sympathetic outflow from the CNS is decreased Result: decreased blood pressure www.indiandentalacademy.com
  13. 13. Antihypertensive Agents: Adrenergic Agents Central-Acting Adrenergics  clonidine (Catapres)  methyldopa (Aldomet) (drug of choice for hypertension in pregnancy) www.indiandentalacademy.com
  14. 14. Antihypertensive Agents: Mechanism of Action Adrenergic Agents Adrenergic Neuronal Blockers (peripherally acting)  Inhibit release of norepinephrine  Also deplete norepinephrine stores  SNS (peripheral adrenergic nerves) is not stimulated Result: decreased blood pressure www.indiandentalacademy.com
  15. 15. Antihypertensive Agents: Adrenergic Agents Adrenergic Neuronal Blockers (peripherally acting)  reserpine  guanadrel (Hylorel)  guanethidine (Ismelin) www.indiandentalacademy.com
  16. 16. Antihypertensive Agents: Adrenergic Agents Therapeutic Uses  Alpha1 blockers (peripherally acting)    Treatment of hypertension Relief of symptoms of BPH Management of of severe CHF when used with cardiac glycosides and diuretics www.indiandentalacademy.com
  17. 17. Antihypertensive Agents: Adrenergic Agents Therapeutic Uses  Central-Acting Adrenergics  Treatment of hypertension, either alone or with other agents  Usually used after other agents have failed due to side effects  Also may be used for treatment of severe dysmenorrhea, menopausal flushing, glaucoma  Clonidine is useful in the management of withdrawal symptoms in opioid- or nicotine-dependent persons www.indiandentalacademy.com
  18. 18. Antihypertensive Agents: Adrenergic Agents Therapeutic Uses  Adrenergic neuronal blockers (peripherally acting)   Treatment of hypertension, either alone or with other agents Seldom used because of frequent side effects www.indiandentalacademy.com
  19. 19. Antihypertensive Agents: Adrenergic Agents Side Effects Most common: dry mouth sedation constipation Other: headaches nausea rash disturbances (palpitations) drowsiness sleep disturbances cardiac HIGH INCIDENCE OF ORTHOSTATIC HYPOTENSION www.indiandentalacademy.com
  20. 20. Antihypertensive Agents: Categories Angiotensin-Converting Enzyme Inhibitors (ACE Inhibitors)  Large group of safe and effective drugs  Often used as first-line agents for CHF and hypertension  May be combined with a thiazide diuretic or calcium channel blocker www.indiandentalacademy.com
  21. 21. Antihypertensive Agents: Mechanism of Action ACE Inhibitors RAAS: Renin Angiotensin-Aldosterone System  When the enzyme angiotensin I is converted to angiotensin II, the result is potent vasoconstriction and stimulation of aldosterone  Result of vasoconstriction: increased systemic vascular resistance and increased afterload  Therefore, increased BP www.indiandentalacademy.com
  22. 22. Antihypertensive Agents: Mechanism of Action ACE Inhibitors  Aldosterone stimulates water and sodium resorption.  Result: increased blood volume, increased preload, and increased B www.indiandentalacademy.com
  23. 23. Antihypertensive Agents: Mechanism of Action ACE Inhibitors  ACE Inhibitors block the angiotensin-converting enzyme, thus preventing the formation of angiotensin II.  Also prevent the breakdown of the vasodilating substance, bradykinin Result: decreased systemic vascular resistance (afterload), vasodilation, and therefore, decreased blood pressure www.indiandentalacademy.com
  24. 24. Antihypertensive Agents ACE Inhibitors  captopril (Capoten)  Short half-life, must be dosed more frequently than others  enalapril (Vasotec)  The only ACE inhibitor available in oral and parenteral forms  lisinopril (Prinivil and Zestril) and quinapril (Accupril)  Newer agents, long half-lives, once-a-day dosing  Several other agents available www.indiandentalacademy.com
  25. 25. Antihypertensive Agents: Therapeutic Uses ACE Inhibitors  Hypertension  CHF (either alone or in combination with diuretics or other agents)  Slows progression of left ventricular hypertrophy after an MI  Renal protective effects in patients with diabetes Drugs of choice in hypertensive patients with CHF www.indiandentalacademy.com
  26. 26. Antihypertensive Agents: Side Effects ACE Inhibitors  Fatigue Dizziness  Headache Mood changes  Impaired taste Dry, nonproductive cough, reverses when therapy is stopped NOTE: first-dose hypotensive effect may occur!! www.indiandentalacademy.com
  27. 27. Antihypertensive Agents: Categories Angiotensin II Receptor Blockers Blockers or ARBs)  Newer class  Well-tolerated  Do not cause coughing www.indiandentalacademy.com (A II
  28. 28. Antihypertensive Agents: Mechanism of Action Angiotensin II Receptor Blockers  Allow angiotensin I to be converted to angiotensin II, but block the receptors that receive angiotensin II  Block vasoconstriction and release of aldosterone www.indiandentalacademy.com
  29. 29. Antihypertensive Agents: Angiotensin II Receptor Blockers  losartan (Cozaar)  eposartan (Teveten)  valsartan (Diovan)  irbesartan (Avapro)  candesartan (Atacand)  telmisartan (Micardis) www.indiandentalacademy.com
  30. 30. Antihypertensive Agents: Therapeutic Uses Angiotensin II Receptor Blockers  Hypertension  Adjunctive agents for the treatment of CHF  May be used alone or with other agents such as diuretics www.indiandentalacademy.com
  31. 31. Antihypertensive Agents: Side Effects Angiotensin II Receptor Blockers  Upper respiratory infections  Headache  May cause occasional dizziness, inability to sleep, diarrhea, dyspnea, heartburn, nasal congestion, back pain, fatigue www.indiandentalacademy.com
  32. 32. Antihypertensive Agents: Categories Calcium Channel Blockers  Benzothiazepines  Dihydropyridines  Phenylalkylamines www.indiandentalacademy.com
  33. 33. Antihypertensive Agents: Mechanism of Action Calcium Channel Blockers  Cause smooth muscle relaxation by blocking the binding of calcium to its receptors, preventing muscle contraction  This causes decreased peripheral smooth muscle tone, decreased systemic vascular resistance  Result: decreased blood pressure www.indiandentalacademy.com
  34. 34. Antihypertensive Agents Calcium Channel Blockers  Benzothiazepines:  diltiazem (Cardizem, Dilacor)  Phenylalkamines:  verapamil (Calan, Isoptin)  Dihydropyridines:  amlodipine (Norvasc), bepridil (Vascor), nicardipine (Cardene)  nifedipine (Procardia), nimodipine (Nimotop) www.indiandentalacademy.com
  35. 35. Antihypertensive Agents: Therapeutic Uses Calcium Channel Blockers  Angina  Hypertension  Dysrhythmias  Migraine headaches www.indiandentalacademy.com
  36. 36. Antihypertensive Agents: Side Effects Calcium Channel Blockers  Cardiovascular  hypotension, palpitations, tachycardia  Gastrointestinal  constipation, nausea  Other  rash, flushing, peripheral edema, dermatitis www.indiandentalacademy.com
  37. 37. Antihypertensive Agents: Diuretics Decrease the plasma and extracellular fluid volumes Results: decreased preload decreased cardiac output decreased total peripheral resistance Overall effect: decreased workload of the heart, and decreased blood pressure www.indiandentalacademy.com
  38. 38. Antihypertensive Agents: Mechanism of Action Vasodilators  Directly relaxes arteriolar smooth muscle  Result: decreased systemic vascular response, decreased afterload, and PERIPHERAL VASODILATION www.indiandentalacademy.com
  39. 39. Antihypertensive Agents Vasodilators  diazoxide (Hyperstat)  hydralazine HCl (Apresoline)  minoxidil (Loniten, Rogaine)  sodium nitroprusside (Nipride, Nitropress) www.indiandentalacademy.com
  40. 40. Antihypertensive Agents: Therapeutic Uses Vasodilators  Treatment of hypertension  May be used in combination with other agents  Sodium nitroprusside and diazoxide IV are reserved for the management of hypertensive emergencies www.indiandentalacademy.com
  41. 41. Antihypertensive Agents: Side Effects Vasodilators Hydralazine:  dizziness, headache, anxiety, tachycardia, nausea and vomiting, diarrhea, anemia, dyspnea, edema, nasal congestion Sodium nitroprusside:  bradycardia, hypotension, possible cyanide toxicity www.indiandentalacademy.com
  42. 42. Antihypertensive Agents: Nursing Implications Before beginning therapy, obtain a thorough health history and head-to-toe physical examination. Assess for contraindications to specific antihypertensive agents. Assess for conditions that require cautious use of these agents. www.indiandentalacademy.com
  43. 43. Antihypertensive Agents: Nursing Implications  Educate patients about the importance of not missing a dose and taking the medications exactly as prescribed.  Patients should never double up on doses if a dose is missed; check with physician for instructions on what to do if a dose is missed.  Monitor BP during therapy. Instruct patients to keep a journal of regular BP checks. www.indiandentalacademy.com
  44. 44. Antihypertensive Agents: Nursing Implications  Instruct patients that these drugs should not be stopped abruptly, as this may cause a rebound hypertensive crisis, and perhaps lead to CVA.  Oral forms should be given with meals so that absorption is more gradual and effective.  Administer IV forms with extreme caution and use an IV pump. www.indiandentalacademy.com
  45. 45. Antihypertensive Agents: Nursing Implications  Remind patients that medications is only part of therapy. Encourage patients to watch their diet, stress level, weight, and alcohol intake.  Patients should avoid smoking and eating foods high in sodium.  Encourage supervised exercise. www.indiandentalacademy.com
  46. 46. Antihypertensive Agents: Nursing Implications  Instruct patients to change positions slowly to avoid syncope from postural hypotension.  Patients should report unusual shortness of breath; difficulty breathing; swelling of the feet, ankles, face, or around the eyes; weight gain or loss; chest pain; palpitations; or excessive fatigue. www.indiandentalacademy.com
  47. 47. Antihypertensive Agents: Nursing Implications  Men taking these agents may not be aware that impotence is an expected effect. This may influence compliance with drug therapy.  If patients are experiencing serious side effects, or believe that the dose or medication needs to be changed, they should contact their physician immediately. www.indiandentalacademy.com
  48. 48. Antihypertensive Agents: Nursing Implications  Hot tubs, showers, or baths; hot weather; prolonged sitting or standing; physical exercise; and alcohol ingestion may aggravate low blood pressure, leading to fainting and injury. Patients should sit or lie down until symptoms subside.  Patients should not take any other medications, including OTC drugs, without first getting the approval of their physician. www.indiandentalacademy.com
  49. 49. Antihypertensive Agents: Nursing Implications  Monitor for side/adverse effects (dizziness, orthostatic hypotension, fatigue) and for toxic effects.  Monitor for therapeutic effects  Blood pressure should be maintained at less than 140/90 mm Hg www.indiandentalacademy.com
  50. 50. Thank you Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com

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