The purpose of diuretics is to Increase the flow of urine. These medications work by removing sodium and chloride from the body in the urine, and the sodium and chloride, in turn, draw excess water from the body. Blood pressure is decreased with the resultant loss of serum sodium and fluid, but with a slight increase in serum potassium when angiotensin-converting enzyme (ACE) inhibitors assist in lowering blood pressure.

Please construct a peer reply to the two followings discussion. Each reply should be 150 words minimum and use at least 1 academic source where relevant.

Case study 1: LP

The purpose of diuretics is to Increase the flow of urine. These medications work by removing sodium and chloride from the body in the urine, and the sodium and chloride, in turn, draw excess water from the body. Blood pressure is decreased with the resultant loss of serum sodium and fluid, but with a slight increase in serum potassium when angiotensin-converting enzyme (ACE) inhibitors assist in lowering blood pressure. Angiotensin II is a powerful vasoconstrictor and an aldosterone stimulator, which these inhibitors prevent. ARBs selectively block angiotensin II receptors, causing vasoconstriction and aldosterone release. It also blocks the blood pressure-raising effect of the renin-angiotensin-aldosterone system (RAAS). Calcium channel blockers are medications that can inhibit the movement of calcium ions across myocardial and arterial muscle cell membranes (Arcangelo, et al., 2017).

Consequently, these cells’ action potentials have changed, and their contractions have slowed. Resultant effects include depressed myocardial contractility, slow cardiac impulse in conductive tissues, and arterial dilation and relaxation. Sympathetic nervous system drugs such as Alpha blockers reduce blood pressure by preventing a hormone called norepinephrine from contracting the muscles in the interior of smaller arteries and veins. As a result, the blood vessels remain open, relax the blood flow, and lower blood pressure (Arcangelo, et al., 2017).

Patients receiving antihypertensive drugs may have orthostatic hypotension, and postion changes should be slow. The patients must report weight gain of more than three pounds daily to their healthcare provider. The patients should also be encouraged to enjoy potassium-rich foods during loop diuretic drug therapy. It is essential to follow the instructions on the label when taking ACE inhibitors. Patients taking ACE inhibitors should understand that they need to avoid salt substitutes or foods high in potassium (Arcangelo, et al., 2017).

Additionally, the medication may alter the sense of taste, but this generally resolves within two or three months of medication therapy. It is essential to take your ARB medication simultaneously each day as directed. Patients should avoid foods high in potassium and salt substitutes. Patients taking ARBs should change positions slowly. CCBs teaching stresses the importance of preventing grapefruit products while taking certain calcium channel blockers. Grapefruit juice interacts with the drug and can affect heart rate and blood pressure and cause symptoms such as headaches and dizziness. Advise the patient who takes alpha-blockers to change positions slowly because the drug may cause orthostatic blood pressure changes. The patient needs to be aware of the importance of taking the medication at the same time each day, and the patient should follow up with their healthcare provider to assess the effectiveness of the medicine (Centers for Disease Control and Prevention, 2020).

Case study 2: LR

Therapeutic actions of blood pressure medications

Diuretics cause diuresis which decreases plasma volume, stroke volume, and cardiac output. There are five categories of diuretics: thiazides, loop diuretics, potassium sparing diuretics, thiazide-like diuretics, and carbonic anhydrase inhibitors (Arcangelo, Peterson, Wilbur, & Reinhold, 2017). Thiazide diuretics inhibit reabsorption of sodium and chloride in ascending limb of the loop of Henle and early distal tubules, which in turn can cause elevated levels of potassium, uric acid, and bicarbonate (Arcangelo, Peterson, Wilbur, & Reinhold, 2017). Loop diuretics inhibit reabsorption of sodium and chloride in the distal, proximal, and in the loop of Henle (Arcangelo, Peterson, Wilbur, & Reinhold, 2017). Potassium sparing diuretics cause increase reabsorption of potassium versus sodium which can help correct hypokalemia but cause hyponatremia (Arcangelo, Peterson, Wilbur, & Reinhold, 2017).

Beta-adrenergic blockers are divided in two categories beta-1 blocking receptors proximal to the heart and kidney and beta-2 blocking receptors proximal to lung, liver, pancreas, and arteriolar smooth muscle, regulate bronchodilation, and vasodilation (Arcangelo, Peterson, Wilbur, & Reinhold, 2017).

ACE inhibitors has effects on the vasoconstriction by inhibiting the conversion of angiotensin I to angiotensin II, increasing vasodilating prostaglandins (Arcangelo, Peterson, Wilbur, & Reinhold, 2017).

Angiotensin II receptor blockers (ARBs) blocks angiotensin from binding to angiotensin receptor site (Arcangelo, Peterson, Wilbur, & Reinhold, 2017).

Calcium channel blockers (CCB) blocks the movement of calcium across the cell membrane, causing muscle relaxation and vasodilation (Arcangelo, Peterson, Wilbur, & Reinhold, 2017).

Sympathetic nervous system drugs such as central alpha-2 receptor agonist causes the alpha-2 agonist to stimulate alpha-2 adrenergic receptors decrease the blood pressure by decreasing sympathetic outflow; causing fluid retention which is why these medications are usually paired with diuretics (Arcangelo, Peterson, Wilbur, & Reinhold, 2017).

Patient education for patients taking diuretics

Hypertensive drugs are mostly avoided in pediatrics, if use the National High Blood Pressure Education Working Group for Hypertension Management Children and Adolescents is managing their care (Arcangelo, Peterson, Wilbur, & Reinhold, 2017). Geriatric patients would benefit from a low sodium diet and weight loss (Arcangelo, Peterson, Wilbur, & Reinhold, 2017). Geriatric patient is at higher risk of dehydration with this medication so increasing fluid intake is vital (Arcangelo, Peterson, Wilbur, & Reinhold, 2017). Decreased renal and hepatic function will need regular monitoring so educating patient to keep all follow appointment for close monitoring is important with hypertensive medication (Arcangelo, Peterson, Wilbur, & Reinhold, 2017). Educate geriatric patients for signs and symptoms of stroke and postural hypotension (Arcangelo, Peterson, Wilbur, & Reinhold, 2017). Women with hypertension should be educated on smoking cessation and monitoring blood pressure while taking contraceptives (Arcangelo, Peterson, Wilbur, & Reinhold, 2017). If a woman is diagnosed with hypertension prior to pregnancy medication needs to be taken throughout pregnancy consult OBGYN for the appropriate medication needed for pregnancy (Shumran, Abded, & Ahmed, 2021). Angioedema needs to be monitor in black patient with hypertension taking ACEIs (Shumran, Abded, & Ahmed, 2021). Black patients need to increase physical activity, decrease sodium intake, and increase potassium intake (Arcangelo, Peterson, Wilbur, & Reinhold, 2017). Diabetic patients that are hypertensive are encouraged to modify lifestyle, decrease sodium intake, lose weight, and exercise often (Arcangelo, Peterson, Wilbur, & Reinhold, 2017).