Regis College – NU-641: Quiz 1 Study Guide 2023 TERM 3 101% PASS EXAM UPDATES Regis College – NU-641: Quiz 1 Study Guide 2023 TERM 3 101% PASS EXAM UPDATES Regis College – NU-641: Quiz 1 Study Guide 2023 TERM 3 101% PASS EXAM UPDATES Regis College – NU-641: Quiz 1 Study Guide 2023 TERM ...
Clinical judgment in prescribing involves a balance between efficacy, side effects, and cost
(never neglect the cost of medication when using clinical judgment).
When evaluating a patient’s medication history, ask about non-prescription (e.g., over-
thecounter [OTC] drugs, dietary and/or herbal supplements) products the patient may be
taking.
Patient education includes discussing the prescribed drug(s), use, directions, and any potential
adverse drug reactions.
Patient education should be presented at a basic language level of a fifth- or sixth-grade reading
level, but customized according to the patient’s level of education and understanding.
Antihypertensive Agents
Alpha-1 adrenergic receptor stimulation causes vasoconstriction and an increased blood
pressure.
Alpha-1 adrenergic receptor blockade results in vasodilation and reduced blood pressure.
The only alpha-1 adrenergic receptor blocking drugs used to treat hypertension include
prazosin and alfuzin.
Orthostatic hypotension can occur with the first dose of an alpha-1 receptor blocking agent.
Beta adrenergic blocking agents: propranolol, metoprolol, esmolol (short-acting), atenolol,
nadolol.
, Beta-1 adrenergic stimulation results in increased heart rate, increased blood pressure and
increased cardiac output.
Beta-1 adrenergic blockade results in reduced heart rate, reduced blood pressure and reduced
cardiac output.
Beta blocking agents include nonselective agents (e.g., propranolol) that block beta-2 receptors
in the lungs.
Selective beta blockers block beta-1 receptors in the heart and vasculature.
Carvedilol is not used in hypertensive emergencies, it is an alpha and beta receptor blocker.
First-line therapy for hypertension include ACE inhibitors, angiotensin receptor blockers (ARBs),
and calcium channel blockers.
Beta-blockers are not considered first-line therapy in hypertension because of increased
morbidity and mortality.
Abrupt withdrawal of beta blocker therapy can be life-threatening, especially in patients with
coronary artery disease, angina, and migraine headaches.
If not selected as first-line therapy to treat hypertension, diuretics are often the second ‘add-
on’ agent used with the first-line drug.
Nonselective beta blockers can also unintentionally affect the lungs. (e.g., worsen asthma).
Beta blockers are useful in treating hypertension with coexisting chronic kidney disease.
Dihydropyridine (DHP) calcium channel blockers: amlodipine, nicardipine, isradipine, felodipine,
nifedipine.
Non-DHP calcium channel blockers: diltiazem, verapamil.
The mechanism of action of calcium channel blockers is enhancing smooth muscle dilation by
inhibiting the entry of calcium into the cell, which increases contractility.
Calcium channel blockers also reduce the amount of intracellular calcium, which reduces
vascular rigidity and lowers blood pressure.
Another action of CCBs is to increase the activity of the NA+/K+/ATPase pump indirectly.
The latest Hypertension Guideline Management algorithm recommends a calcium channel
blocker for black individuals who have normal renal function.
Calcium channel blocking agents are useful in hypertensive patients with underlying angina or
diabetes.
Adverse effects of calcium channel blocking agents include first-degree AV block, dizziness,
headache, constipation, and peripheral edema.
Dihydropyridine (DHP)-type calcium channel blockers can cause gingival hyperplasia and
peripheral edema.
The DHP-type calcium channel blocker amlodipine causes the most peripheral edema,
especially pedal edema; edema of the hands is also possible.
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