perfusion presentation

1. PERFUSION Antihypertensives

2. HYPERTENSION
What is hypertension?
Classifications:
�Normal – SBP less than 120 and DBP less than 80
�Prehypertension – SBP 120-139 or DBP 80-89
�Stage 1 hypertension – SBP 140-159 or DBP 90-99
�Stage 2 hypertension – SBP over 160 or DBP 100 or more
Types of Hypertension:
�Primary or essential
�Secondary

3. PATHOPHYSIOLOGY
High blood pressure initially leads to:
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Stuff that regulates BP:
�RAAS
�ADH
�Vascular Remodeling

4. PATHPHYSIOLOGY
Symptoms of hypertension
�Very few at first
�Later ….
Potential complications?
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5. NON-DRUG MANAGEMENT OF
HTN
Dietary:
�Dietary Approaches to Stop Hypertension (DASH) diet
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Lifestyle changes:
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6. GOALS OF DRUG
MANAGEMENT
Many classes of drugs
Drug choice depends on:
�Age
�Gender
�Level of hypertension
�Race and ethnicity
Holistic approach
Prevention of adverse outcomes

7. CAPTOPRIL (CAPOTEN)
An ACE Inhibitor
How do ACE inhibitors work?
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Uses:
�Lower blood pressure
�Prevention of cardiac and vascular remodeling
�Prevention of kidney damage in hypertensive diabetics
�Post MI survival

8. CAPTOPRIL (CAPOTEN)
Adverse Effects:
�Kidneys
�Cough
�Angioedema
�First dose hypotension
�Hyperkalemia
�Fetal harm
Interactions:
�Other antihypertensives
�Potassium supplements
�Diuretics

9. CAPTOPRIL (CAPOTEN)
Nursing care:
�What might you like to know before you administer captopril?
�Any reason you might not give it?
�What are you expecting to happen when you give it?
�What might suggest there is a problem?
Patient Education:
�What to report to the provider?
�What needs emergent help?
�Monitoring BP
�what about orthostatic changes?

10. LOSARTAN (COZAAR)
An Angiotensin Receptor Blocker
How does it work?
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Uses:
�hypertension
�In cases of ACE cough
�Diabetic nephropathy

11. LOSARTAN (COZAAR)
Adverse effects:
�Dizziness
�Muscle cramps/weakness
�Decreased sensitivity to touch
�Angioedema
�Fetal harm
Interactions:
�Other antihypertensives
�Diuretics
�Rifampin

12. LOSARTAN (COZAAR)
Nursing Care:
�What would you need to know before giving it?
�What are you expecting to happen?
Patient teaching:
�Monitoring BP
�Use of effective contraception
�Avoiding excessive potassium

13. AMLODIPINE (NORVASC)
A Calcium Channel Blocker
How does it work?
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�
�
Uses:
�Hypertenion
�Coronary Artery Disease (CAD)

14. AMLODIPINE (NORVASC)
Adverse effects:
�Headache
�Dizziness
�Fatigue
�Edema of the lower extremities
�Flushing
Interactions:
�Other anti-hypertensives…. Sound familiar?
�Rifampin
�Phenytoin

15. ALISKIREN (TEKTURNA)
A Renin Inhibitor
How does it work?
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Uses:
�Hypertension
Contraindications:
� Ace inhibitors
� ARBs

16. PRAZOSIN (MINIPRESS)
An alpha 1 blocker
How does it work?
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Uses:
�Hypertension
�BPH
Adverse effects:
� first dose hypotension
� fluid retention
�Difficulty with ejaculation

17. VASODILATORS
Hydralazine (Apresoline)
�Fluid retention
�Rebound tachycardia
Minoxodil
�Sort of like hydralazine but more potent
�Hair growth
Nitroprusside
�Emergent hypertension
�IV drip
�Cyanide poisoning