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Easy Learning 2016

This document summarizes several classes of antihypertensive medications, including their therapeutic actions, common side effects, drug interactions and nursing considerations. It describes how angiotensin-converting enzyme inhibitors work to lower blood pressure by blocking the conversion of angiotensin I to angiotensin II. It also outlines calcium channel blockers which inhibit the movement of calcium ions to relax arteries and lower blood pressure, and beta blockers which block beta-adrenergic receptors in the heart to reduce its workload and lower blood pressure. Common side effects among the drug classes include dizziness, headache and fatigue. Nurses should monitor patients for hypotension, electrolyte imbalances and other side effects when using these anti

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Jhon Jade Palagtiw
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85 views

Easy Learning 2016

This document summarizes several classes of antihypertensive medications, including their therapeutic actions, common side effects, drug interactions and nursing considerations. It describes how angiotensin-converting enzyme inhibitors work to lower blood pressure by blocking the conversion of angiotensin I to angiotensin II. It also outlines calcium channel blockers which inhibit the movement of calcium ions to relax arteries and lower blood pressure, and beta blockers which block beta-adrenergic receptors in the heart to reduce its workload and lower blood pressure. Common side effects among the drug classes include dizziness, headache and fatigue. Nurses should monitor patients for hypotension, electrolyte imbalances and other side effects when using these anti

Uploaded by

Jhon Jade Palagtiw
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOC, PDF, TXT or read online on Scribd
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Medication

Therapeutic Actions

Side Effects

Hypertension

Gastric irritation, peptic


ulcer, orthostatic
hypotension

*If taken with

Tachycardia

*Risk of decreased
antihypertensive
effects if taken with
nonsteroidal antiinflammatory drugs;

ANTIHYPERTENSIVES
Angiotensin-ConvertingEnzyme Inhibitors (ACE
Inhibitors)
benazepril (Lotensin)
Captopril (Capoten)
quinapril (Accupril)
enalapril (Vasotec)
enalaprilat (Vasotec IV)

Angiotensin IIReceptor
Blockers

Blocks ACE in
the lungs from
converting
angiotensin 1 to
angiotensin
11(powerful
vasoconstrictor);
causes decreased
BP, decreased
aldosterone
secretion, sodium
& fluid loss

*Bind with the


angiotensin II receptors

candesartan (Atacand)

in vascular smooth

eprosartan (Teveten)

muscle and in the adrenal

irbesartan (Avapro)
losartan (Cozaar)

cortex to block

CHF

Myocardial infarction
Proteinuria

allopurinol risk of
hypersensitivity

Rash, pruritus

Contraindications
and Cautions
*Impaired renal
function
* pregnancy

Nursing
Consideration
* Decreased
absorption if taken
with food give 1 h
ac or 2 h pc
*Small, frequent
meals
*Frequent mouth
care
*Change position
slowly
*Can be used with
thiazide diuretics

Hypertension

GI complaints
diarrhea
abdominal
pain

nausea

dry mouth

tooth pain

vasoconstriction and the


release of aldosterone.

DrugDrug
Interactions

Indications

* The risk of
decreased serum levels
and loss of
effectiveness increases
if the ARB is taken
in combination
with phenobarbital,

indomethacin, or
rifamycin.

*Encourage patient to

implement lifestyle
changes, including
weight loss, smoking
cessation, decreased
alcohol and salt in the
diet, and increased
exercise, to increase
the effectiveness of
antihypertensive

olmesartan (Benicar)

Cough

therapy.

telmisartan (Micardis)

Rash

valsartan (Diovan).

Dry skin

*Administer with
food to decrease GI
distress if needed.

alopecia

diltiazem (Cardizem,Dilacor
CR)

Inhibit the
movement of
calcium ions
across the
membranes of
myocardial and
arterial muscle
cells, altering
the action
potential and
blocking
muscle cell
contraction.

nifedipine (Procardia XL)

Net effects:

nisoldipine (Sular)

depresses
myocardial
contractility

Calcium Channel Blockers


amlodipine (Norvasc)
felodipine (Plendil)
isradipine(DynaCirc,
DynaCirc CR)
nicardipine (Cardene,
Cardene SR).

verapamil (Calan SR)

slows cardiac
impulse
formation in

Angina

Dizziness

Hypertension

Headache

Dysrhythmias

Nervousness

Intestinal
cystitis

Peripheral edema

migraines

Angina
Bradycardia
AV block
Flushing, rash
impotence

*Heart block or sick


sinus syndrome
*Used cautiously to
patients with CHF,
acute MI,
hypotension

* Advise patient to
avoid use of grapefruit
juice , to prevent the
risk of toxic levels of
calcium channel
blockers
* Should be taken on
an empty stomach, 1
hour before or 2 hours
after meal
*Give with food if GI
upset occurs
*Monitor vital signs
*Do not chew or divide
sustained release
tablets
*Medications also have

the conductive
tissues

antianginal actions

Relaxes and
dilates arteries,
causing a fall in
blood pressure
and a decrease
in venous
return.

Direct Acting -Vasodilators


diazoxide (Hyperstat)
hydralazine (Apresoline)
minoxidil (Loniten)
nitroprusside (Nitropress)

*Act directly on
vascular smooth muscle
to cause muscle
relaxation, leading to
vasodilation and drop
in blood pressure.

Reserved for use


in severe
hypertension
or hypertensive
emergencies

Dizziness
Anxiety
headache
reflex tachycardia
heart failure
chest pain,
edema;
skin rash
Abnormal hair growth
(Minoxidil)
Drowsiness, sedation
Orthostatic hypotension

Dont discontinue
abruptly

Centrally Acting Alpha


ADRENERGICS
Clonidine
Methyldopa

*Stimulates alpha
receptors in medulla,
causing reduction in
sympathetic action in
heart;

Hypertension

Drowsiness, sedation
Orthostatic
hypotension
CHF

*Dont discontinue

abruptly
*Monitor for fluid
retention

*Decreases rate & force


of contraction,
decreasing cardiac
output
Beta Adrenergic
Blockers)
Atenolol
Nadolol
Propanolol
Timoptic

Blocks beta
adrenergic receptors in
heart; decreases
excitability of heart;
reduces cardiac workload
& oxygen consumption;
decreases release of
renin; lowers BP by
reducing SNS stimuli

Hypertension
(used with
diuretics)
Angina
Supraventric
ular
tachycardia
Prevent
recurrent MI
Migraine
headache
Stage fright
(propranolol)

Gastric pain
Bradycardia/
tachycardia
CHF
Cardiac dysrhythmias
Impotence
Decreased exercise
tolerance
nightmares

Do not discontinue
abruptly, taper
gradually over 2 weeks
Take with meals
Provide rest periods
For diabetic patients,
blocks normal signs of
hypoglycemia
(sweating,
tachycardia);monitor
blood glucose
Medications have
antianginal &
antiarrhythmic actions

Peripheral Acting Alpha


Adrenergic -Blockers)
Reserpine

Diuretics
Thiazides diuretics

Depletes stores of
norepinephrine in
sympathetic nerve
endings, reducing
sympathetic tone

Hypertension

Inhibits reabsorption of
sodium & chloride in
distal renal tubule

Hypertension

Drowsiness, sedation
Orthostatic
hypotension
CHF

Bendroflumethiazide
(Naturetin)
chlorothiazide (Diuril)

Monitor for fluid


retention

Hyperglycemia

Monitor electrolytes
especially
potassium

Blurred vision

I&O

Loss of sodium

Monitor BUN &


creatinine

Hypokalemia

Dry mouth

Hydrochlorothiazide
(HydroDIURIL

Dont discontinue
abruptly

hypotension

hydroflumethiazide
(Saluron)

Dont give at hs
Weigh patient daily
Encourage
potassium
containing foods

Methyclothiazide(Enduron)
trichlormethiazide (Generic)
chlorthalidone (Hygroton)
Potassium sparing diuretic
Spironolactone (Aldactone)

Blocks effect of
aldosterone on renal
tubules, causing loss of
sodium & water &
retention of potassium.

Hypertension

Hyperkalemia
Hyponatremia
Hepatic & renal damage

Used with other


diuretics
Give with meals
Avoid salt
substitutes

Tinnitus
rash
Loop Diuretic
Furosemide (Lasix)

Inhibits reabsorption of
sodium & chloride in loo
of Henle & distal renal
tubule.

Hypertension

Hypotension

CHF

Hypokalemia
Hyperglycemia
GI upset
weakness

containing
potassium
Monitor I& O
Monitor BP,pulse
rate,& I & O
Monitor potassium
Give IV dose over 12 minutes- diuresis
in 5 10minutes
After PO dose
diuresis in about 30
minutes
Weigh patent daily
Dont give at hs
Encourage
potassium
containing foods

Osmotic Diuretic
Mannitol

Pulls water from tissues


due to hypertonic effect.

Dry mouth
Thirst

Monitor BP,pulse
rate,& I & O
Monitor for electrolyte
imbalance

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