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.
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.
Used to treat HTN,
HF, Diabetic
Nephropathy, Left
ventricular
dysfunction following
MI
Blocks Angiotensin 1 from converting to angiotensin
2. Causes urinary retention of K+, Urinary exception
of Na+ & Water, Arteriol Vasodilation
Do not use if: you are pregnant
( Category D), if you have
angioedema or Hypotension
Adverse effects:
sever
hypotension,
rash, Metallic
taste, dry cough,
Angioedema,
Hyperkalemia
and Neutropenia
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
Dilates arterioles.
Decreases peripheral
resistance, decreases
arterial BP
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
this drug interacts with MAOI
antidepressants b/c it can cause sever
hypotension and other antihypertensive
drugs can cause hypotension
Do not use if you have
Rhematic heart disease, MI or
Tachycardia
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,
Hydralazine
Avaliable orally, IM or IV
If take orally take with food to
enhance effectiveness If take IV
make use it is undiluted
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
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
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.
Adverse effects
include hypotension,
dizziness, braydicardia
( due to blockade of
beta 1 receptors; may
lead to reduced CO.
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.
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.
Used to treat hypertension,
HF along with Digoxin, ACE
Inhibitors and diuretics, these
types of drugs prolongs the
change of survival following
an MI
Carvedilol
Avaliable in oral dose only
Give with food to minimize orthostatic
hypotension
As a nurse monitor BP, report
hypotension and monitor HR and
report rates lower than 60/ min
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
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
This drug interacts with
CNS depressants and
Tricyclic antidepressants
Do not take if you are
on anticoagulant
therapy or using
transdermal patch with
polyarteritis nods of
scleroderma
Adverse effects include
dizziness, drowsiness, dry
mouth, rebound hypertensive
crisis if stopped abruptly
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.
Clonidine
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
As a nurse monitor the patient for
drowsiness and dizziness, when taper
does if discontinued
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
Atenolol and Metoprolol
This drug is aaliaxble in oral or IV form
Metoprolol absorption is enhanced when taken with food
Atenolol is best taken before meals and at night
As a nurse monitor Heart rate ( if
>60/ min). Monitor for HR, shortness
of breath, peripheral edema of
extremities and a night cough
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.
Used to treat Hypertension as well as angina pectoris,
decrease mortality following an MI and cardiac
Dysrthmias. Metoprolol can be used to treat HF
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.
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
Watch out if you take other antihypertensive drugs, antacids, Digoxin, Beta blockers. Also antimuscarinic
and anticholinergic drugs
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
Doxazosin
Is avaliable orally and should be given at bedtime
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
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
This drug is used to
treat hypertension
and benign
hypertrophy (BPH)
Inhibits Alpha 1 adrenergic receptors which blocks vasoconstriction. This will
lead to venous and arteriolar dilation
The adverse effects of they drug include,
orthostatic hypotension with the 1st dose and
with dosage increases, reflex tachycardia and
headaches
This drug interacts with
sildenafil (Viagra) or other
phosphodiesterase because
it will increase the risk of
vasodilation
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
Nifedipine
Is avaliable for oral use and if this drug is used to treat tachycardia it must be given with a beta blocker
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
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.
Used to treat mild to
moderate hypertension as
well as cardiac dysrhythmias
and for stable angina
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.
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
The adverse effects of this drug include reflex tachycardia,
lightheadedness, dizziness, facial flushing, peripheral edema of feet and
legs, hypotension and gum hyperplasia
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
Losartan
Avaliable by mouth only
The 1st dose is reduced for patients taking diuretics or with liver failure
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
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
Are used to treat for
Hypertension and
manage diabetic
nephropathy and is
used to prevent
strokes.
These drugs work by blocking angiotensin 2 receptors. This causes an
arterial vasodilation, urinary exception of Na+ and water and urinary
retention of K+
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
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
The adverse effects of this drug include andgioedema,
headaches, insomnia and sever hypotension may occur with
over dose or volume deletion