Renin angiotensin aldosterone system RAAS Psychological factors Stress and

Renin angiotensin aldosterone system raas

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Renin-angiotensin-aldosterone system (RAAS) Psychological factors Stress and anger ( ↑ BP) Depression and lethargy ( ↓ BP)
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COMPLICATIONS OF HYPERTENSION Cardiovascular system Heart failure Atherosclerosis Nervous system Cerebral vascular accident (CVA) Transient ischemic attack (TIA) Renal system Kidney failure Sensory implications Visual impairment and blindness
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TREATMENT OF HYPERTENSION Nonpharmacological treatment Limit alcohol and quit smoking Limit sodium consumption and fat intake Increased intake of fresh fruits and veggies Exercise regularly and reduce stress Maintain healthy weight Pharmacological treatment Individualized regimen (often combo therapy) Numerous drug therapy Prototypes
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ACE INHIBITORS captopril (Capoten) INDICATIONS Hypertension, heart failure, diabetic neuropathy, left ventricular dysfunction (post-MI) DRUG CLASS ACE inhibitors; includes enalapril (Vasotec), lisinopril (Prinivil) CONTRAINDICATIONS Pregnancy, allergy to ACE inhibitors, hypotension, liver disease MOA Blocks the production of angiotensin II arterial vasodilation, increased excretion of sodium and water, and potassium retention ADVERSE EFFECTS First-dose hypotension, nonproductive cough (discontinue), angioedema (swelling of the mouth and throat), hyperkalemia, neutropenia (rare) NURSING CONSIDERATIONS Given orally, usually 2-3x daily Start low and titrate up, monitor for first-dose hypotension (diuretics and other antihypertensives can increase effect) Discontinue medication if cough or angioedema develop (IV epinephrine) Monitor potassium levels (avoid salt substitutes) and renal function (caution) May cause lithium toxicity
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ANGIOTENSIN II RECEPTOR BLOCKERS (ARBs) losartan (Cozaar) INDICATIONS Hypertension, prevents stroke (losartan only), heart failure, migraine headaches, second-line therapy if intolerant of ACE inhibitors DRUG CLASS ARB; includes valsartan (Diovan), irbesartan (Avapro), candesartan (Atacand) CONTRAINDICATIONS Pregnancy, allergy, children < 6 years, caution with renal impairment MOA Blocks angiotensin II receptors arterial vasodilation, excretion of sodium and water, and potassium retention ADVERSE EFFECTS Angioedema (less common with ARBs), HA, dizziness, hypotension, insomnia NURSING CONSIDERATIONS Given orally with or without food Monitor for angioedema (discontinue and treat with IV epinephrine) Monitor potassium levels
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ACE INHIBITORS ARBs
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CALCIUM-CHANNEL BLOCKERS verapamil (Calan), nifedipine (Adalat) INDICATIONS Hypertension, angina pectoris, cardiac dysrhythmias (verapamil and diltiazem) DRUG CLASS Calcium-channel blocker; includes diltiazem (Cardizem), amlodipine (Norvasc), nicardipine (Cardene) CONTRAINDICATIONS AV heart block, shock, hypotension, intestinal obstruction MOA Blocks calcium uptake into muscle and cardiac cells leads to vascular smooth muscle relaxation (vasodilation) and lowers HR ADVERSE EFFECTS Reflex tachycardia, peripheral edema, constipation, dizziness, HA, flushing NURSING CONSIDERATIONS Given IV (slowly, continuous monitoring) or orally (do not crush or chew)
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