Quick question for you. Do you understand what's causing your blood pressure to be
elevated? Like why you have a diagnosis of high blood pressure or hypertension
as we call it? Well if you're like 90 percent of those out there who live with
this diagnosis the answer is no we don't know. It's actually what we call
essential hypertension and I've done a series of videos that talk about blood
pressure and I'll just share them here with you now. So they're all foundational
to what we're going to be covering in this video. The first is what is blood
pressure, it kind of breaks it down into the different components of systolic and
diastolic, the second one is Osmoreceptors so those are one of those
mechanisms that we have inside our body that are helping to regulate our blood
pressure along with our baroreceptors and then we also have the
renin-angiotensin-aldosterone system again one of my favorites. So these are
three mechanisms that I talked about to help people understand what's going
on inside of our body to regulate blood pressure. Now hypertension is a diagnosis
that is given when your blood pressure is elevated over a period of time. That's
all important because today we're going to start to look at the treatment
methods for high blood pressure and we've talked about the stepped
management in the hypertension video and today we're gonna look at what would
happen if you were into step two. So step one is all about diet and lifestyle
changes and step two we start to introduce pharmacological or medicine to
help manage blood pressure. Now because there are so many different sites in the
body that are regulating blood pressure we have to have medications that will
drive changes at all of those different sites and so your treatment plan may
look completely different than your neighbors treatment plan even though you
both have the same diagnosis. Now because we don't know what's driving that high
blood pressure, again essential hypertension means we don't know what
the driving force is, that means we're going to use a variety of medications to
help manage it. So there are five main categories of medications that you may
have heard of or you might be currently using to help manage high blood pressure, you
may be on one of these, you may be on a combination
of these, you might be changing one out for another and that's okay that's part
of your treatment plan. So the five categories are we have are ACE inhibitors we
then have our angiotensin receptor blockers we have our calcium channel
blockers our beta blockers and our diuretics. Now there are other categories
but those are the five main ones and we're going to start looking at ACE
inhibitors in this video right after this. Welcome back my name is Tammy and
this is NurseMinder and on this channel we do everything nursing so if you're
new here consider subscribing below so that you get the next video when it's
released. So as we begin to look at ACE inhibitors we're going to look at first
onset of action where do they work in the body, next we look at how to identify
what is an ACE inhibitor by the name then we'll look at how people take the
medication some of the side effects to look for in patient teaching. Be sure to
stay till the end because there will be an NCLEX review question to help you
put those pieces together. We're going to be talking about ACE inhibitors and how
they help us to decrease blood pressure and keep our values in a safe range. To
start though, we want to just quickly review the renin-angiotensin-aldosterone
pathway as this is important to understanding the site of action for
this medication, then you get a full review in the
renin-angiotensin-aldosterone video and I'll pop that link up here for you but
just as an overview, when the kidney senses that there's decreased volume, they like
to be fed, they like to have a lot of fluid coming to them, so when that drops
the kidneys will send up a flag yo SOS we need some help over here.
Now what's currently always available in our blood stream is called
angiotensinogen, This is readily available, it's inactive, it's not doing
anything but waiting to be called into action. So when that flag goes up the
liver is going to produce an enzyme that will convert angiotensinogen into its
first conversion because there's a couple of steps, and it's going to convert into
angiotensin 1; still in active and angiotensin 1 cannot elicit a change
on your blood pressure but it is a necessary step to creating a change in
blood pressure. When angiotensin 1 reaches the lungs there's another enzyme
reaction that happens here that converts it into angiotensin 2. So we have one
liver we have two lungs and that's one way to help remember those two.
Angiotensin 2 then is the actual thing that causes a change in your blood
pressure. When angiotensin 2 is activated our vessels will constrict and get
narrow to increase the blood pressure and it will also have an effect on the
kidney in that it will help to retain salt and water; all good things if you
have low blood pressure but now we have high blood pressure and we need to stop
this process. This is one of the ways that we can help lower blood pressure.
ACE inhibitors work here, between angiotensin 1 and angiotensin 2 they're
going to stop that conversion. So that means the vessels will stay dilated and
they will not constrict, so the result of taking ACE inhibitor means we will have
larger vessels so our blood pressure drops and we're going to excrete or pee
out more water to decrease the amount of blood the volume inside the
vessel. Now one of the first things we should know is how to identify what
medication is an ACE inhibitor and what I love about generic names of drugs is
that they give us clues a lot of the time so if you have a drug that ends in
the word PRIL; ramipril, captopril, lisinopril that ending
tells me it's an ACE inhibitor and it's going to help prevent, so here's a little
bit of a helpful memory, I'll use a little i there; P R stands for prevent
angiotension 1 from becoming angiotensin two. So there's where
it's going to work its site of action is in that conversion. Now in terms of how
much you take and how often you take that would be a decision made with your
healthcare team based on your particular circumstances. I will share though
that these are oral medications they are either in a tablet or a capsule now and
now a parenteral does have a parental route as well that's called enalaprilat
there's an "at" at the end of that word, but generally it's going to be an
oral medication and you may find you're taking it once a day, which we call OD in
medical terms twice a day is bid and three times a day is tid so again your
individual dosing will be different than those of your neighbors and your friends
because your situation is unique. Now in terms of when to take it in regards to
food that's gonna vary as well so for example captopril you'd want to take
that an hour before food because the food will actually decrease how much the
body can absorb so we want to make sure we're taking it without food. Ramipril on
the other hand doesn't have those same restrictions and you can take that with
or without food. So again you want to be making sure
you're looking at the specific drug you're taking to know how to best
administer it to get the full effect. Now of course you will be taking this
medication along with your lifestyle changes so that might be reduced salt
diet, that might be increase your activity level, it may include decreasing
alcohol consumption again personally tailored to you. BUT you recognizes this is a
stepped approach right so we always start with lifestyle changes and we add
we never get rid of in order to maximize our impact. Now let's talk about side
effects. We can probably predict some of what's
going to happen based on knowing how it acts here at preventing this conversion.
So we know when angiotensin 2 is working it makes our vessels really small and
that's going to shoot up our blood pressure but when we stop it, this is
going to lower blood pressure, so now our side effects are always related to
therapeutic dosing and then what happens if there's too much like the body does
not or the body over responds to it so if I have a decreased blood pressure
I might have symptoms of feeling dizzy, faint, confused, weak, tired, and when that
happens there's another compensatory mechanism in our body and that's the
heart. That means the heart is going to start
to kick into overdrive and it's going to pump harder so another side effect would
be a high heart rate. We call it a reflexive tachycardia. The heart responds
because of the lower amount of blood coming to it and it likes to also be fed
so it's gonna kick it up because it's responsible for feeding the rest of the
body. With that heart having to work harder that means the muscles might get
larger and we can end up having a cardiac hypertrophy which means the
muscles are bigger, we can have chest pain because the heart's working pretty
hard, we can have arrhythmia because when the heart is stressed then there can be
changes in the way that it works so a lot of cardiac side effects related to
ACE inhibitors. Now of course when we have a low blood pressure we can also
feel nauseous so there's another side effect with an
ACE inhibitor is nausea. Of course that's also related to just putting anything in
the stomach, any time you take a medication it's possible you're gonna
feel nauseous but it's also related to the risk of a decreasing blood pressure.
Two potential reasons why our patient may feel nausea. Now if we go back
angiotensin 2 also impacts aldosterone release from the adrenal cortex and when
we stop aldosterone from being released we actually
increase the amount of potassium that is reabsorbed into the body so we end up
having a risk for hyperkalemia or increased potassium in our bloodstream
which is another factor for arrhythmias in the heart. Now there are two side
effects that we want to make sure we're educating our patients on and one is
they may have this unrelenting cough this dry cough it's common with ACE
inhibitors the second is a diagnosis called pancytopenia
and that is where we have low red blood cells, low white blood cells, and low
platelets. Important because if we have low platelets they're not going to be
able to prevent bleeding as easily as those on as those not on ACE inhibitors.
So if they start to bruise easily they should come back in. If they are really
short of breath that might be a result of the decrease red blood cells which
means decreased hemaglobin which means decreased oxygenation. Really
important side effects to be talking to your patients about to make sure they
know when to come back. One last consideration is the patient's current
health status. Now in terms of the medication and how it gets through our body
and out of our body it is metabolized largely by the liver so if you have a
patient that has liver disease or liver pathology we may need to adjust the
dosing because it's not being metabolized in the way that our research
shows it should be or could be based on a healthy individual. The second thing is
it's excreted by the kidneys and if you have anybody who's got kidney disease
they may not be getting rid of that medication in their body which means
there will be a buildup and if there's a buildup of the medication that can be
utilized at the cellular level we can have profound hypotension as a result we
can have profound hyperkalemia as a result cardiac issues. So we want to be
monitoring our lab work in our patients who have those coexisting morbidities in
terms of kidney and liver disease to make sure that we have no essential
we're not adding any risk factors to them. Well we have covered a lot of
information. We started out with looking at how ACE
inhibitors work in the body, fascinating stuff to me, we then went into a whole
host of information about how to name them and identify them, how to take them,
what side effects and patient teaching we need to be considering, and our
patients personal conditions in terms of how healthy their body is to
let this medication work to its full capacity. Now it's time for our NCLEX
review. So here's a typical question. The nurse is talking to a patient about
their new prescription for captopril which statement made by the patient
demonstrates that the teaching has been effective? I can assess the effectiveness
of this dose by watching for signs of hypertension. Should I notice bruises or
a change in my energy level I'll call the doctor.
Taking this medication at nighttime it's just going to cause me to stay up and
pee all night. I will increase my dietary intake of sodium. Take a moment now and
select your answer. Hey guys if you selected that they should come back when
they get bruises you'd be correct and that's related to their pancytopenia. Now
the reason a is incorrect is because we would want to look for signs of
hypotension not hypertension and we know hypertension is the silent killer so
there's not likely to be any signs and symptoms but hypotension is a side
effect of the medication. Now C is not correct because it's not going to make
them stay up all night and pee it's not a diuretic it's just going to prevent
the reabsorption of water and D is not correct because we don't want to
increase dietary sodium that's going to increase blood pressure. We actually want
to decrease dietary sodium. So well done. So now is your turn to let me know how
this is working for you. Give it a thumbs up if you liked this video, make sure you
subscribe and hit the button so you get the notification for the next video and
in the comment section below absolutely put your thoughts in there
let me know what you're thinking. Do you have any analogies that you use? Do you
have any other information you'd like to add? Now if you're not quite ready to go
back to work or you want to binge a little bit more I've got a ton of videos
popping up here that will keep you entertained for hours. Take care guys and
make it a great day :)