Therapeutic Actions of Drugs Affecting Blood Pressure

The advanced practice nurse is updating the plan of care of nursing home patients with hypertension.

1. Briefly describe the therapeutic actions of drugs affecting blood pressure (diuretics, ACE inhibitors, ARBs, CCB, sympathetic nervous system drugs).
2. What important teaching points should be addressed for patients receiving antihypertensive drugs?

Submission Instructions:

• Your initial post should be at least 500 words, formatted and cited in current APA style with support from at least 2 academic sources.

Therapeutic Actions of Drugs Affecting Blood Pressure:

1. Diuretics: Diuretics are commonly used in the treatment of hypertension to reduce blood volume and lower blood pressure. They work by increasing urine production, which helps eliminate excess sodium and water from the body. The main types of diuretics used for hypertension include thiazide diuretics, loop diuretics, and potassium-sparing diuretics. Thiazide diuretics, such as hydrochlorothiazide, are often used as first-line treatment for hypertension. They inhibit sodium reabsorption in the distal convoluted tubules of the kidneys, leading to increased urine output and reduced blood volume. Loop diuretics, such as furosemide, act on the ascending loop of Henle and are more potent than thiazide diuretics. Potassium-sparing diuretics, like spironolactone, promote sodium excretion while conserving potassium.
2. ACE Inhibitors: Angiotensin-converting enzyme (ACE) inhibitors are medications that inhibit the conversion of angiotensin I to angiotensin II. Angiotensin II is a potent vasoconstrictor and stimulates the release of aldosterone, resulting in sodium and water retention. By blocking the production of angiotensin II, ACE inhibitors reduce vasoconstriction and promote vasodilation, thereby lowering blood pressure. Examples of ACE inhibitors include lisinopril, enalapril, and ramipril. These medications are often recommended for patients with hypertension, especially those with coexisting conditions such as heart failure or diabetes.
3. ARBs: Angiotensin II receptor blockers (ARBs) work by blocking the action of angiotensin II on its receptors. Like ACE inhibitors, ARBs promote vasodilation and reduce the effects of angiotensin II on blood pressure. They are commonly prescribed alternatives to ACE inhibitors for patients who cannot tolerate the side effects of ACE inhibitors, such as cough. Examples of ARBs include losartan, valsartan, and irbesartan.
4. Calcium Channel Blockers (CCBs): Calcium channel blockers inhibit the influx of calcium into smooth muscle cells of the heart and blood vessels. By doing so, they reduce the contractility of the heart and relax arterial smooth muscle, leading to vasodilation and decreased peripheral resistance. This results in lower blood pressure. There are two main types of CCBs: dihydropyridines and non-dihydropyridines. Dihydropyridine CCBs, such as amlodipine and nifedipine, primarily act on arterial smooth muscle, while non-dihydropyridines, such as diltiazem and verapamil, also have effects on cardiac muscle.
5. Sympathetic Nervous System Drugs: Sympathetic nervous system drugs, such as beta-blockers and alpha-blockers, act on adrenergic receptors to modulate the effects of sympathetic stimulation. Beta-blockers, such as metoprolol and propranolol, block the beta-adrenergic receptors in the heart, leading to decreased heart rate and contractility, as well as reduced renin release from the kidneys. This results in decreased cardiac output and lowered blood pressure. Alpha-blockers, such as doxazosin and prazosin, block the alpha-adrenergic receptors on arterial smooth muscle, causing vasodilation and reduced peripheral resistance.

Teaching Points for Patients Receiving Antihypertensive Drugs:

1. Medication Adherence: It is crucial for patients to understand the importance of taking their antihypertensive medications as prescribed. They should be advised to take the medication at the same time each day and not to skip doses. It may be helpful to use pill organizers or reminders to ensure adherence.
2. Potential Side Effects: Patients should be educated about the possible side effects of their medications. For example, diuretics may cause increased urination or potassium imbalances, ACE inhibitors and ARBs may lead to a persistent dry cough, and calcium channel blockers can cause constipation or peripheral edema. They should be encouraged to report any new or worsening symptoms to their healthcare provider.
3. Lifestyle Modifications: Antihypertensive medications are most effective when combined with healthy lifestyle changes. Patients should be encouraged to maintain a balanced diet low in sodium, engage in regular physical activity, manage stress levels, limit alcohol consumption, and avoid tobacco use. These lifestyle modifications can help optimize the effects of the medications and improve overall cardiovascular health.
4. Blood Pressure Monitoring: Patients should be instructed on the importance of monitoring their blood pressure regularly. They should be advised to keep a record of their readings and share them with their healthcare provider during follow-up visits. This allows for ongoing assessment of the medication’s effectiveness and any necessary dosage adjustments.
5. Orthostatic Hypotension: Some antihypertensive medications, such as alpha-blockers or diuretics, can cause a drop in blood pressure upon standing up, leading to dizziness or fainting. Patients should be informed about this potential side effect and instructed to rise slowly from a sitting or lying position to minimize the risk. It may also be helpful to check their blood pressure in different positions (lying, sitting, and standing) to assess for orthostatic changes.
6. Medication Interactions: Patients should be aware of potential interactions between their antihypertensive medications and other drugs, including over-the-counter medications, herbal supplements, and certain foods. They should be advised to consult with their healthcare provider or pharmacist before starting any new medications or supplements.

In conclusion, educating patients about the therapeutic actions and potential side effects of antihypertensive medications is crucial for their effective management of hypertension. By providing comprehensive information and addressing their concerns, healthcare providers can promote medication adherence and empower patients to actively participate in their own care.