I’m working on a nursing discussion question and need an explanation to help me study.
White, Heather
Hypertension Medications
Hypertension is classified as a cardiovascular disease process (CVD). This classification of diseases makes up the number one cause of death around the world, (Mc Namara et el., 2018). It is a common affliction managed in the primary care setting. Therefore, it is important that the advanced practice nurse (APN) understand the pharmacological interventions available to treat this disease.
Diuretics are a hypertension pharmacological intervention class whose primary mechanism of action is to initiate diuresis in the patient. When a patient has increased urination, the plasma volume will begin to lower, which decreases stroke volume and cardiac output, (Arcangelo et al., 2016). One point of patient education would be to not take the diuretic late in the day if possible in order to avoid nocturia, (Oelke et al., 2017). Another teaching point for the APN to address with the patient is to rise slowly in order to avoid orthostatic hypotension (Arcangelo et al., 2016).
Angiotensin Converting Enzyme (ACE) inhibitors are another hypertension pharmacological intervention. This class of medication works by interfering with the conversion of Angiotensin I to Angiotensin II. It inhibits the enzyme needed to complete the process. Therefore, Angiotensin II is unable to work to constrict the blood vessels in the body or increase pressure or volume, (Arcangelo, 2016). A very important teaching for the APN to address with the patient is to monitor for swelling of the lips when the drug is initiated. This can be a sign of angioedema; a dangerous allergic reaction, that should be reported to the healthcare provider (Hallberg et al., 2017). Another class of medication is recommended if this occurs.
Angiotensin II Receptor Blockers (ARBs) are another medication the prescriber can utilize for treating hypertension. This class of medication works by blocking Angiotensin II at the receptor site. Therefore, vasoconstriction does not occur, aldosterone is not triggered, which means sodium and water is not held on to, so increase in volume occurs. One teaching point for this medication class is to avoid a high potassium diet, (Arcangelo, 2016).
Calcium channel blockers work by blocking calcium channels in smooth muscle, such as that found in the heart and arteries. This decreases the strength of the contraction, which decreases pressure. Blocking the calcium channels in the arteries allows the vessels to dilate, which also decreases pressure, (Sueta et al., 2017). One important teaching point for this class of hypertension medication is it has been shown to be very effective among the African-American population, (Arcangelo et al., 2016).
One hypertension sympathetic nervous system drug type is beta blockers. This class works by blocking norepinephrine and epinephrine from binding to beta receptors. Beta-1 receptors, in particular are found in the heart muscle and kidneys. Blocking the receptors in the heart muscle decrease force of the contraction of the heart. Whereas by blocking the receptors in the kidney, renin is not released, Angiotensin II is never created through the RAAS, so vessels are not constricted and pressure is not elevated, (Cruickshank, 2016). An important teaching point is to not discontinue this medication suddenly, (Arcangelo, 2016).
References
Arcangelo, V. P., Peterson, A. M., Wilbur, V., & Reinhold, J. A. (2016). Pharmacotherapeutics for advanced practice (4th ed.). Lippincott Williams and Wilkins.
Hallberg, P., Nagy, J., Karawajczyk, M., Nordang, L., Islander, G., Norling, P., … & Wadelius, M. (2017). Comparison of clinical factors between patients with angiotensin-converting enzyme inhibitor–induced angioedema and cough. Annals of Pharmacotherapy, 51(4), 293-300.
Mc Namara, K., Alzubaidi, H., & Jackson, J. K. (2019). Cardiovascular disease as a leading cause of death: how are pharmacists getting involved?. Integrated pharmacy research & practice, 8, 1–11. https://doi.org/10.2147/IPRP.S133088
Oelke, M., De Wachter, S., Drake, M. J., Giannantoni, A., Kirby, M., Orme, S., … & Everaert, K. (2017). A practical approach to the management of nocturia. International journal of clinical practice, 71(11), e13027.
Sueta, D., Tabata, N., & Hokimoto, S. (2017). Clinical roles of calcium channel blockers in ischemic heart diseases. Hypertension Research, 40(5), 423-428.
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