Hypertension Drugs

Ace Inhibitors
1. Captopril
  1. Available only by mouth. Give X2-X3 Daily for HTN
    1. Give 1 hr before Meals
  2. As a nurse Start with low dose and increase gradually. Stop diuretics temporarily before the 1st dose, monitor BP, dry cough, RASH, Metallic taste, angioedema, K+ levels and White blood cell count.
  3. Make sure your patient knows that Hypotension may occur, monitor for swelling in the mouth and throat, refrain from K+ supplements, report palpitations, muscle twitch, weakness, paresthesia. Report sore throat or other signs of infection.
2. Used to treat HTN, HF, Diabetic Nephropathy, Left ventricular dysfunction following MI
3. Blocks Angiotensin 1 from converting to angiotensin 2. Causes urinary retention of K+, Urinary exception of Na+ & Water, Arteriol Vasodilation
  1. Do not use if: you are pregnant ( Category D), if you have angioedema or Hypotension
  2. Adverse effects: sever hypotension, rash, Metallic taste, dry cough, Angioedema, Hyperkalemia and Neutropenia
  3. This drug interacts with K+ sparing diuretics or K+ supplements salt substitutes, Antihypertensive drugs, diuretics, nitrates. NSAIDS decrease effectiveness, Food decreases absorption and lithium.
Direct Acting Vasodilator
1. Dilates arterioles. Decreases peripheral resistance, decreases arterial BP
  1. Adverse effects: headache, palpitations, Tachycardia,a systemic lupus erythematous like syndrome may occur, facial rash, joint pain, fever, nephritis, pericarditis and fluid retention, edema, abrupt withdrawal may cause hypertensive crisis and HF
  2. this drug interacts with MAOI antidepressants b/c it can cause sever hypotension and other antihypertensive drugs can cause hypotension
  3. Do not use if you have Rhematic heart disease, MI or Tachycardia
2. Used to treat moderate to sever hypertension, used in a hypertensive crisis. if used with digitalis and vasodilators to treat HF on a short term basis,
3. Hydralazine
  1. Avaliable orally, IM or IV
    1. If take orally take with food to enhance effectiveness If take IV make use it is undiluted
  2. As a nurse know that Headaches and palpitations may occur. Monitor orthostatic BP and Tachycardia, beta blocker may be added to decrease tachycardia, . Monitor and report rash, joint pain edema and crackles in the lungs. Taper drug
    1. Make sure your client knows that headache and palpitations may occur during 1st dose, to report dizziness, syncope and rapid heart beat, move slowly when switching positions and to report a rash on the face, joint pain an unexplained fever, chest pain, fatigue and edema. DO NOT STOP ABRUPTLY
Alpha/ Beta blocker
1. Blocks alpha 1, Cardiac beta 1 receptors and Kidney beta 1 receptors. This causes arterial vasodilation, decrease in HR, contractility of the heart and decrease release of Renin.
  1. Adverse effects include hypotension, dizziness, braydicardia ( due to blockade of beta 1 receptors; may lead to reduced CO.
  2. Watch out for an increased risk of hypoglycemia with insulin or oral hypoglycemic. There is an increased risk for digoxin toxicity. MAOI antidepressants may cause braydicardia or hypotension. Cimetidine increases blood levels. Use with other antihypertensive drugs may increase the risk of hypotension.
  3. Do not use if in sever unstable Heart Failure, If you have asthma or chronic respiratory disease. If you have a heart block or sever Bradycardia. If you are cariogenic shock or if you are breastfeeding.
2. Used to treat hypertension, HF along with Digoxin, ACE Inhibitors and diuretics, these types of drugs prolongs the change of survival following an MI
3. Carvedilol
  1. Avaliable in oral dose only
    1. Give with food to minimize orthostatic hypotension
  2. As a nurse monitor BP, report hypotension and monitor HR and report rates lower than 60/ min
    1. Make sure your client know to report dizziness and syncope, to move slowly from lying down to standing position, not to perform hazardous activities until effects are known , to check pulse daily bore taking the drug,
Central Acting Alpha 2 Agonists
1. Inhibits the innervation of sympathetic neurons in the CNS. This causes a decrease in stimulation of peripheral Alpha and Beta receptors in the heart and Blood vessels
  1. This drug interacts with CNS depressants and Tricyclic antidepressants
  2. Do not take if you are on anticoagulant therapy or using transdermal patch with polyarteritis nods of scleroderma
  3. Adverse effects include dizziness, drowsiness, dry mouth, rebound hypertensive crisis if stopped abruptly
2. Treats Hypertension. Can be used for sever pain relief, migraine headaches, withdrawal from alcohol, opioids, nicotine, dysmenorreal and menopausal hot flashes, ADHD in children and tourttes syndrome.
3. Clonidine
  1. This drug is avaliable in oral or transdermal patch. If given orally give at night timed start at a low dose and gradually increase. If using the patch make sure to remove the old patch first apply it to a dry hairless area and rotate patch sites
    1. As a nurse monitor the patient for drowsiness and dizziness, when taper does if discontinued
      1. Make sure the client knows to take the drug at night time. Warn against driving until effects are known. Suck on hard candies, chew sugarless gum, sip water to minimize dry mouth and DO NOT STOP ABRUPTLY
Beta Adrenergic Blockers
1. Atenolol and Metoprolol
  1. This drug is aaliaxble in oral or IV form
    1. Metoprolol absorption is enhanced when taken with food
    2. Atenolol is best taken before meals and at night
  2. As a nurse monitor Heart rate ( if >60/ min). Monitor for HR, shortness of breath, peripheral edema of extremities and a night cough
  3. Make sure the patient knows to taper the dose if discontinued , check pulse rate daily before drug administration, and to report shortness of breath extreme edema a night cough and if there is an increase in angina or new chest pain.
2. Used to treat Hypertension as well as angina pectoris, decrease mortality following an MI and cardiac Dysrthmias. Metoprolol can be used to treat HF
3. Blocks cardiac Beta 1 receptors and Renal Beta 1 receptors. This causes a decrease in Heart Rate and Contractility which leads to a decrease in cardiac output and surpasses the tachycardia reflex. It also decreases the release of renin which causes a decrease in angiotensin 1 and aldosterone. There is also a decrease in peripheral resistance of Blood volume.
  1. Adverse effects include bradycardia which may lead to reduced cardiac output. Heart Failure, shortness of breath,edema and coughing at night. With sudden withdrawal may cause rebound excitation causing angina pain of MI
  2. Watch out if you take other antihypertensive drugs, antacids, Digoxin, Beta blockers. Also antimuscarinic and anticholinergic drugs
  3. Do not take if you have sinus bradycardia (greater than the 1st degree heart block)., Moderate to sever Heart Failure, Cariogenic Shock, You cannot take Atenolol,: if you have a peripheral disease or Raynaud disease.. You cannot take Metorprolol if you are a child younger than 6.
Alpha 1 Adrenergic Blockers
1. Doxazosin
  1. Is avaliable orally and should be given at bedtime
    1. As a nurse monitor and report frequency of headaches, tachycardia or a significant drop of >20 mmHg btw changing positions and monitor orthostatic BP and pulse 2-6 hrs after the 1st dose or dosage increases
      1. Make sure the patient knows to report dizziness, syncope rapid HB or palpitations. Take the drug at bedtime and to rise slowly when changing positions. DO not perform any hazardous activity until the effect of the drug is known and report the frequency of headaches
2. This drug is used to treat hypertension and benign hypertrophy (BPH)
3. Inhibits Alpha 1 adrenergic receptors which blocks vasoconstriction. This will lead to venous and arteriolar dilation
  1. The adverse effects of they drug include, orthostatic hypotension with the 1st dose and with dosage increases, reflex tachycardia and headaches
  2. This drug interacts with sildenafil (Viagra) or other phosphodiesterase because it will increase the risk of vasodilation
  3. Do not take this drug if you are allergic to any Alpha 1 Adrenergic blockers, Hypotension, have a history of syncope or if you are a child
Calcium Channel Blocker
1. Nifedipine
  1. Is avaliable for oral use and if this drug is used to treat tachycardia it must be given with a beta blocker
    1. As a nurse monitor HR, lightheadedness, dizziness, edema and BP. Facial swelling, inspect the gums and advise regular dental care. With hold the dose if BP is below 90 mmHg
      1. Make sure the patient knows to report rapid Heart beat and if there is an increase in anginal pain. Avoid driving until the effects of the drug are known. To report facial flushing, swelling of the feet and legs., dizziness or syncope. Report bleeding of the gums or gum tissue growth.
2. Used to treat mild to moderate hypertension as well as cardiac dysrhythmias and for stable angina
3. Tis drug works by blocking the Calcium channels in smooth muscle cells of peripheral and cardiac arterioles and arteries. This causes arterial vasodilation, a decrease in BP and an increase in Coronary perfusion and HR.
  1. What out if you take this drug with beat blockers because it can cause an increase risk of Heart failure. Melatonin increase BP and Pulse rate, Ginkgo Biloba and Ginseng increases Blood Levels. St. Johns Wort decreases Blood Levels and Grape fruit Juice increase Blood Levels
  2. The adverse effects of this drug include reflex tachycardia, lightheadedness, dizziness, facial flushing, peripheral edema of feet and legs, hypotension and gum hyperplasia
  3. DO NOT TAKE IF you have acute MI, if angina is unstable if you have Aortic Stenosis, have an obstructed GI or if you are a child.
ABRs
1. Losartan
  1. Avaliable by mouth only
  2. The 1st dose is reduced for patients taking diuretics or with liver failure
  3. As a nurse monitor BP before administering the drug, be ready to treat for Angioedema, discontinue if angioedema occurs, monitor for headaches and insomnia and magi sever hypotension by increasing the blood volume
  4. Make sure the patient knows to report minor swelling in the mouth or throat. Note the frequency of headaches or insomnia. Report episodes of fainting or dizziness
2. Are used to treat for Hypertension and manage diabetic nephropathy and is used to prevent strokes.
3. These drugs work by blocking angiotensin 2 receptors. This causes an arterial vasodilation, urinary exception of Na+ and water and urinary retention of K+
  1. Drugs that interfere with this drug include Hypertensive drugs bc they increase the risk of hypotension and Phenobarbital b bc it decreases serum levels of Losartan
  2. DO NOT TAKE if Pregnant )category D) for 2nd and 3rd trimesters. Children younger than 6 years old or children great er than 6 who have a low CLcr
  3. The adverse effects of this drug include andgioedema, headaches, insomnia and sever hypotension may occur with over dose or volume deletion

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