Discussion 1 (Everton)

Module 2 Discussion

Hypertension & Teaching Points of Antihypertensive Drugs

Briefly describe the therapeutic actions of drugs affecting blood pressure (diuretics, ACE inhibitors, ARBs, CCB, sympathetic nervous system drugs).

High blood pressure medications are medications that are prescribed and used to lower a patient’s blood pressure by dilating the blood vessels, reducing the amount of pressure it takes for the blood to flow through the body by making it easier for the heart to pump blood (Cleveland Clinic 2022). There are many types of high blood pressure medications, each brings the blood pressure down in its own specific ways. For instance, angiotensin- converting enzyme inhibitors are high blood pressure medications that stop the body from making angiotensin II, which constricts the blood vessels (Cleveland Clinic, 2022). According to Cleveland Clinic (2022), another form of high blood pressure medication is angiotensin II receptor blockers which are similar to angiotensin- converting enzyme inhibitors but instead keep angiotensin II from constricting the blood vessels. There are also three types of diuretics, loop, thiazide, and potassium- sparing, which all assist the kidneys in excreting extra fluid and salt into the urine which in turn helps dilate the blood vessels (Cleveland Clinic, 2022). Calcium channel blockers are blood pressure medications that keep calcium out of the blood vessels which help the heart muscle relax (Cleveland Clinic, 2022).

What important teaching points should be addressed for patients receiving antihypertensive drugs?

When teaching a patient about high blood pressure medications, it is important that the patient understands the side effects of taking them in order to prevent any complications. According to the American Heart Association (2021), angiotensin- converting enzyme inhibitors can cause angioedema, skin rash, and a hacking cough. Therefore, it is important to educate the patient on going to the emergency room if they are have symptoms of an allergic reaction, such as swelling to the mouth, tongue, or throat. With this medication, it is also important to teach not to eat or drink things with too much potassium as this angiotensin- converting enzyme inhibitors can increase potassium in the body. As high blood pressure medications are intended to lower the patient’s blood pressure, it is also important to educate the patient and family on not getting up or making sudden movements too fast within the hour of taking the medications as they can cause dizziness due to a sudden drop in the blood pressure with these movements. Due to the excess excretion of fluids from the body, diuretics can specifically cause a patient to become dizzy. If a patient needs assistance with ambulating, it is important to educate the family on ensuring someone is available to assist the patient to the rest room and keeping them close to one due to the increased risk of falling when having to constantly urinate. As high blood pressure medications could also be used for other medical conditions, it is also very important to educate the patient and their families on a strict medication schedule. Taking high blood pressure medications too close together can cause the blood pressure to drop significantly in a short time frame, leading to a sudden decrease in the blood pressure resulting in dizziness as well. In addition, it is important to emphasize not to suddenly stop taking these high blood pressure medications, as well as not changing the regimen on taking them without speaking with the primary care provider (American Heart Association, 2021).

References:

Types of blood pressure medication (antihypertensives). Cleveland Clinic. (2022, April 29). Retrieved June 30, 2022, from https://my.clevelandclinic.org/health/treatments/21811-antihypertensives 

Discussion 2 (Maria)

Diuretics

Diuretics act by removing sodium and chloride ions from the body in the urine. This process helps remove water from the blood, thus lowering the blood pressure.  Thiazide diuretics not only decrease fluids but also cause blood vessels to relax.  This class of diuretics is commonly used as the first-line treatment for hypertension.  Additionally, we find that loop diuretics are the most potent type of diuretic but should not be used as a first-line treatment (Arcangelo et al., 2017, p. 267). Their mechanism action lowers the fluid buildup in the body by reducing sodium reabsorption in the loop of Henley causing water and sodium excretion. Loop diuretics are used to manage fluid overload in conditions such as heart failure and edema. Furthermore, we find potassium-sparing diuretics, which can clear sodium and water out of the body, but spare potassium. This class of medication is considered weaker and is usually prescribed as a second-line drug in patients taking other diuretics. It is used in the management of congestive heart failure (Burnier et al., 2019).

Angiotensin-Converting Enzyme Inhibitors

ACE inhibitors prevent an enzyme in the body from producing angiotensin II, a substance that releases hormones that raises blood pressure by narrowing blood vessels. The tightening of the blood vessels forces the heart to work harder. These medications are indicated for coronary artery disease, heart failure, and certain chronic kidney diseases (Arcangelo et al., 2017, p. 266)

Angiotensin Receptor Blocker

            ARBs are a newer class of antihypertensive that reduce the action of angiotensin II to widen the veins and arteries thus lowering blood pressure and making it easier for the heart to pump blood. They are usually used to treat kidney disease in people with diabetes (Arcangelo et al., 2017, p. 266).

Calcium Channel Blocker

            CCBs are a well-established class of medications that are recommended to treat hypertension and prevent angina.  They work by blocking calcium ions from going into the muscles, this prevention in the entry of calcium into the heart and blood vessels allows the dilation of the arteries, thus decreasing elevated blood pressure. (Arcangelo et al., 2017, p. 267)

Sympathetic Nervous System Drugs

            As we know our sympathetic nervous system controls the body’s “fight or flight” during this response the heart rate, breathing, and blood pressure go up. Sympathetic nervous system drugs such as alpha and beta-blockers work by inhibiting receptors in the sympathetic nervous system.  These drugs are the beta-blockers that work by blocking the effects of the hormone epinephrine causing the heart rate to slow down, and are used in arrhythmia, heart failure, and heart attacks. Additionally, the alpha-blockers work by preventing norepinephrine from constricting the walls of arteries and veins. Furthermore, the anticholinergic drugs block the activity of acetylcholine causing relaxation in the airways and controlling heart rate (Arcangelo et al., 2017, p. 267).

Important teaching points should be addressed for patients receiving antihypertensive drugs

            It is crucial for the patient to understand that healthy lifestyles help increase the effectiveness of the medications.  Losing weight, smoking cessation, low sodium intake, and regular exercise should be implemented in the plan of care for hypertensive patients.  The medication should be taken every day as prescribed on empty stomach for better absorption. Potassium and alcohol intake should also be limited (Dezsi, 2016). Patients need to understand that some people respond to one drug and not another. Although, these drugs can cause side effects but are usually well tolerated. Patients will probably try different medications until finding the appropriate in treating their condition.

References

Arcangelo, V.P., Peterson, A.M., Wilbur, V., & Reinhold, J. A. (2017). Pharmacotherapeutics for advanced practice: A practical approach (4th ed.). Wolters Kluwer.

Burnier, M., Bakris, G., & Williams, B. (2019). Redefining diuretics use in hypertension: Why select a thiazide-like diuretic? Journal of hypertension, 37(8), 1574-

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