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20.3 Treatments and Nutrition

4 min read•june 18, 2024

ARBs are a powerful class of drugs that lower blood pressure by blocking angiotensin II receptors. They relax blood vessels, reduce fluid retention, and ease strain on the heart, making them effective for treating hypertension and related conditions.

Compared to other blood pressure medications, ARBs are well-tolerated with fewer side effects. They work similarly to ACE inhibitors but don't cause the dry cough some patients experience. Proper monitoring and patient education are key for safe, effective use.

Mechanism of Action and Efficacy of ARBs

Mechanism of action for ARBs

ARBs selectively block angiotensin II type 1 (AT1) receptors prevents angiotensin II from binding to AT1 receptors and inhibits angiotensin II-mediated vasoconstriction (narrowing of blood vessels) and aldosterone secretion (hormone that promotes sodium and water retention)
Reduces peripheral vascular resistance decreases arterial pressure and lowers blood pressure by allowing blood vessels to relax and widen
Promotes vasodilation increases blood flow to tissues (muscles, organs) and reduces cardiac workload (strain on the heart)
Decreases sodium and water retention reduces plasma volume (fluid in the bloodstream) and contributes to blood pressure reduction by preventing the body from holding onto excess salt and water

ARBs vs other antihypertensive drugs

ARBs have similar efficacy to ACE inhibitors (lisinopril, enalapril) in lowering blood pressure as both classes target the renin-angiotensin-aldosterone system (RAAS) which regulates blood pressure
ARBs have fewer side effects compared to ACE inhibitors with a lower incidence of dry cough and angioedema (swelling of face, tongue, or throat) making them better tolerated by patients who experience these side effects with ACE inhibitors
ARBs have comparable efficacy to other antihypertensive classes such as calcium channel blockers (amlodipine), diuretics (furosemide), and beta-blockers (metoprolol) with the choice depending on patient characteristics (age, race) and comorbidities (diabetes, kidney disease)
Side effects of ARBs are generally mild including dizziness, headache, and fatigue but can cause hyperkalemia (high potassium levels) and renal dysfunction (decreased kidney function) in high-risk patients (elderly, diabetic, or those with pre-existing renal impairment)

Pharmacokinetics and Adverse Effects of ARBs

Pharmacokinetics: ARBs are generally well-absorbed orally, with peak plasma concentrations reached within 1-4 hours
Most ARBs have a long half-life, allowing for once-daily dosing
ARBs are primarily metabolized by the liver and excreted through bile and urine
Adverse effects: Common side effects include dizziness, headache, and fatigue
Serious adverse effects may include hyperkalemia, hypotension, and impaired renal function (especially in patients with pre-existing kidney disease)
ARBs are contraindicated during pregnancy due to potential fetal harm

Nursing Considerations and Patient Education

Nursing considerations for ARB administration

Monitor blood pressure and heart rate regularly assess for orthostatic hypotension (drop in blood pressure upon standing), especially in elderly or volume-depleted patients (dehydrated) and adjust dosage as needed to achieve target blood pressure
Monitor renal function and electrolytes check serum creatinine (waste product filtered by kidneys) and potassium levels periodically and use caution in patients with renal impairment or at risk for hyperkalemia
Be aware of potential drug interactions avoid concomitant use with potassium-sparing diuretics (spironolactone) or potassium supplements due to increased risk of hyperkalemia and use caution when combining with NSAIDs (ibuprofen), as they may attenuate the antihypertensive effect and increase the risk of renal dysfunction
Administer ARBs at the same time each day for consistent timing helps maintain stable blood levels and improves efficacy with some ARBs taken with or without food, while others have specific recommendations (take on an empty stomach)

Patient education for ARB use

Educate patients on the purpose and benefits of ARB therapy emphasize the importance of long-term adherence for blood pressure control and cardiovascular risk reduction (heart attack, stroke) and discuss potential side effects and when to seek medical attention
Encourage patients to take ARBs as prescribed advise patients not to skip doses or stop taking the medication without consulting their healthcare provider and suggest strategies to improve adherence, such as using pill boxes or setting reminders (phone alarms)
Promote lifestyle modifications to enhance the effectiveness of ARB therapy recommend a low-sodium diet (limit salt intake) to help control blood pressure, encourage regular physical activity (brisk walking, swimming), as it can improve cardiovascular health and aid in weight management, and advise patients to maintain a healthy weight and quit smoking, if applicable
Instruct patients to monitor their blood pressure at home teach proper technique for measuring blood pressure (seated, arm supported, cuff at heart level) and provide guidance on interpreting results and when to report abnormal readings to their healthcare provider
Emphasize the importance of regular follow-up visits ensure patients understand the need for periodic monitoring of blood pressure, renal function, and electrolytes and encourage patients to discuss any concerns or questions with their healthcare provider
Explain that ARBs are primarily used to treat hypertension and may also be beneficial for patients with certain cardiovascular diseases or diabetes

Key Terms to Review (31)

Alendronate: Alendronate is a bisphosphonate medication used to treat and prevent osteoporosis by inhibiting bone resorption and promoting bone formation, thereby increasing bone mineral density and reducing the risk of fractures.

Antacids: Antacids are over-the-counter medications that help neutralize stomach acid, providing relief for conditions like heartburn, acid reflux, and indigestion. They work by counteracting the effects of excess stomach acid, which can irritate the esophagus and stomach lining.

Antibiotics: Antibiotics are medications used to treat bacterial infections by either killing bacteria or inhibiting their growth. They are not effective against viral or fungal infections.

Antiseizure medications: Antiseizure medications, also known as anticonvulsants, are drugs used to manage and treat epileptic seizures. They help stabilize electrical activity in the brain to prevent abnormal bursts of neuronal firing.

Bisphosphonates: Bisphosphonates are a class of drugs that prevent the loss of bone density by inhibiting osteoclast-mediated bone resorption. They are commonly used to treat osteoporosis and other conditions that cause bone fragility.

Bisphosphonates: Bisphosphonates are a class of medications primarily used to treat and prevent conditions related to abnormal bone metabolism, such as osteoporosis, Paget's disease, and certain types of cancer that affect the bones. These drugs work by inhibiting the activity of osteoclasts, the cells responsible for breaking down bone tissue, thereby slowing the rate of bone loss and increasing bone density.

Bone Mineral Density: Bone mineral density (BMD) refers to the amount of mineral matter per square centimeter of bones. It is a measure of the strength and health of an individual's bones, which is crucial for maintaining musculoskeletal and integumentary wellness, as well as managing various health conditions through appropriate nutritional treatments.

Bumetanide: Bumetanide is a potent loop diuretic medication used to treat fluid retention and edema associated with various medical conditions, including heart failure, liver disease, and kidney disease. It works by inhibiting the reabsorption of sodium, chloride, and water in the thick ascending limb of the loop of Henle in the kidneys, leading to increased urine output and fluid loss.

Corticosteroids: Corticosteroids are a class of steroid hormones that are produced naturally in the body by the adrenal glands. They are also available as synthetic medications used to treat a wide range of medical conditions, including neurological disorders, pulmonary diseases, and inflammatory conditions.

Depot medroxyprogesterone acetate: Depot medroxyprogesterone acetate (DMPA) is a long-acting injectable contraceptive that contains the hormone progestin. It is administered every three months to prevent pregnancy by inhibiting ovulation and altering the uterine lining.

Dexamethasone: Dexamethasone is a synthetic glucocorticoid medication used to treat a variety of conditions, including inflammation, autoimmune disorders, and certain types of cancer. It works by mimicking the effects of the natural hormone cortisol, which is produced by the adrenal glands and plays a crucial role in regulating the body's stress response and immune function.

Dietary Supplements: Dietary supplements are products intended to supplement the diet and provide additional nutrients, vitamins, minerals, herbs, botanicals, or other substances to support overall health and wellness. These supplements can be taken in various forms, such as pills, capsules, tablets, powders, or liquids, and are often used to address specific nutritional needs or deficiencies.

Doxycycline: Doxycycline is a broad-spectrum antibiotic belonging to the tetracycline class of drugs. It is commonly used to treat a variety of bacterial infections and has applications in the context of treatments and nutrition.

Drug Metabolism: Drug metabolism is the process by which the body breaks down and eliminates pharmaceutical compounds. It involves a series of chemical reactions that transform drugs into more water-soluble forms, facilitating their excretion from the body. This process is crucial in determining the duration, intensity, and safety of drug effects within the body.

Drug-food interactions: Drug-food interactions occur when food and drink affect the absorption, metabolism, or efficacy of a medication. These interactions can lead to reduced therapeutic effects or increased risk of side effects.

Electrolyte Imbalances: Electrolyte imbalances refer to disruptions in the normal balance of essential minerals, such as sodium, potassium, calcium, and magnesium, within the body's fluids. These imbalances can have significant impacts on various bodily functions and overall health, particularly in the context of treatments and nutrition.

Folate: Folate, also known as vitamin B9, is an essential nutrient that plays a crucial role in various physiological processes in the body, including neurological, hematological, and cardiovascular wellness. It is particularly important during periods of rapid growth and development, such as pregnancy and early childhood.

Gonadotropin-releasing hormone agonists: Gonadotropin-releasing hormone agonists (GnRH agonists) are synthetic peptides that mimic the natural GnRH produced by the hypothalamus. They are often used to manage hormonal conditions, including certain cancers and reproductive health issues.

Ibandronate: Ibandronate is a bisphosphonate medication used primarily in the treatment and prevention of osteoporosis. It works by inhibiting the activity of osteoclasts, the cells responsible for breaking down bone, thereby slowing the rate of bone loss and increasing bone density.

Loop Diuretics: Loop diuretics are a class of medications that work by inhibiting the reabsorption of sodium, chloride, and potassium in the thick ascending limb of the loop of Henle in the kidneys. This leads to increased excretion of these electrolytes, as well as water, making loop diuretics an effective treatment for conditions like edema, hypertension, and heart failure.

Malnutrition: Malnutrition refers to a state of nutritional imbalance, where an individual's intake of nutrients is either insufficient, excessive, or imbalanced, leading to adverse effects on their health, growth, and overall well-being. This term is particularly relevant in the context of nursing practice, population health, and the care of vulnerable populations.

Metabolism: Metabolism is the sum of all chemical reactions that occur within the body to sustain life. It encompasses the processes of breaking down nutrients to release energy (catabolism) as well as the synthesis of complex molecules from simpler ones (anabolism). Metabolism is a crucial concept that underpins various aspects of nutrition, including energy balance, chronic illnesses, endocrine function, renal health, and treatment strategies.

Minocycline: Minocycline is a tetracycline antibiotic used to treat a variety of bacterial infections. It works by inhibiting bacterial protein synthesis, effectively preventing the growth and spread of certain bacteria. Minocycline is commonly prescribed for conditions related to 20.3 Treatments and Nutrition.

Nutrient Absorption: Nutrient absorption is the process by which the body takes in and utilizes the essential nutrients from the food we consume. It involves the complex mechanisms within the gastrointestinal system that facilitate the transport of macronutrients, micronutrients, and other compounds from the digestive tract into the bloodstream for distribution and use throughout the body.

Osteoporosis: Osteoporosis is a chronic, progressive skeletal disorder characterized by a decrease in bone mass and deterioration of bone tissue, leading to an increased risk of fractures. This condition is closely linked to various aspects of nutrition, including protein, vitamins, minerals, and supplements, as well as its impact on the musculoskeletal and integumentary systems across the lifespan.

Phenobarbital: Phenobarbital is a barbiturate medication primarily used as an anticonvulsant and sedative. It is commonly prescribed to manage seizure disorders and can also be used to treat insomnia and alcohol withdrawal symptoms.

Prednisone: Prednisone is a synthetic corticosteroid medication used to treat a wide range of inflammatory and autoimmune conditions. It functions by mimicking the effects of the natural hormone cortisol, which is produced by the adrenal glands and plays a crucial role in the body's stress response and immune system regulation.

Risedronate: Risedronate is a bisphosphonate medication used primarily in the treatment of osteoporosis, Paget's disease of bone, and other conditions characterized by excessive bone loss or abnormal bone metabolism. It works by inhibiting osteoclast activity, the cells responsible for breaking down bone, thereby helping to maintain or increase bone density.

Tetracycline: Tetracycline is a broad-spectrum antibiotic that is effective against a wide range of bacteria. It works by inhibiting protein synthesis in bacterial cells, preventing them from reproducing and causing infections. Tetracycline is commonly used in the treatment of various bacterial infections and can also have implications for nutrition.

Tetracycline antibiotics: Tetracycline antibiotics are a class of broad-spectrum antibiotics effective against a range of Gram-positive and Gram-negative bacteria. They are commonly used to treat skin infections, respiratory tract infections, and other bacterial diseases.

Vitamin D: Vitamin D is a fat-soluble vitamin that plays a crucial role in maintaining overall health and wellness. It is often referred to as the 'sunshine vitamin' because the body can synthesize it when the skin is exposed to sunlight. Vitamin D is essential for the regulation of calcium and phosphorus levels in the body, supporting strong bones and teeth, and it also has important functions in various other physiological processes.

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