Question

1. Using a table format, identify the three normal controls of blood pressure and how angiotensin-converting enzyme (ACE) inhibitors, angiotensin II receptor blockers (ARBs), calcium channel blockers, and vasodilator affect these controls.
2. There are several classifications of antihypertensive medications used for control of hypertension. Some classifications are more commonly used specific population. What are the common concerns with the use of specific classifications of antihypertensive across the lifespan?
3. .Many older adults are prescribed antianginal drugs. What factors make these patients, more at risk for adverse effects? what nursing measures should be implemented when using antianginal drugs in older adults?

Answer 1

a)

Angiotensin-converting enzyme (ACE) inhibitors	Angiotensin II receptor blockers (ARBs)	calcium channel blockers	vasodilator affect these controls.
Reducing angiotensin II in the body. It narrows blood vessels and releases hormones that can raise  blood pressure.	Block the effect of angiotensin II. This allows blood vessels to relax and widen, making it easier for blood to flow through artery.	It prevent calcium from entering cells of the heart and blood vessel walls, resulting in lower blood pressure.Smooth-muscle dilator	Relaxation of smooth muscle cells in arteries  causes an increase in blood flow. When blood vessels dilate, the blood flow is increased due to a decrease in vascular resistance. Therefore, dilation of arteries and arterioles leads to an immediate decrease in arterial blood pressure

b)

Diuretics are inexpensive, are generally well tolerated, and are recommended as a first-line therapy in the treatment of hypertension in the elderly population.

Calcium Channel Blockers can be used as first-line hypertension treatment , if a diuretic is contraindicated or if the patient has angina or heart rhythm/conduction problems.

ACE inhibitors lower BP by inhibiting the conversion of angiotensin I to angiotensin II, thereby preventing vasoconstriction

Angiotensin Receptor Blockers are for hypertensive patients with diabetes or HF, ARBs are considered first-line treatment and an alternative to ACE inhibitors.

Beta-blockers are not the optimal first-line treatment for elderly patients with hypertension. They are associated with more adverse events, and their evidence of benefits is weaker compared with other drug classes (ie, diuretics, ACE inhibitors, ARBs, CCBs)

C)

Constipation, nausea, dizziness, and headache are the most common adverse effects. Tinnitus, vertigo, and dry mouth may also occur. Some cardiac disorders have been reported. Ranolazine increases the QT interval of the heart.

D)

• Monitor vital signs for hypotension.
• Have the patient sit or lie down when taking a nitrate for the first time. Have patient rise slowly to a standing position.
• Offer sips of water before giving sublingual nitrates. Monitor effects of nitroglycerin. Report persistence of angina.