Hypertension Medications
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Examples Cozaar (Losarten) Atacand (Candesarten) Diovan (Valsartan)
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MOA: Prevent action of A-II and produce vasodilation and increased salt and water excretion
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Side effects Hyperkalemia Impaired renal function
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Drug Interactions: None listed
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Nursing Implications Monitor b/p and heart rate Full effect may take 3-6 weeks Watch for hyperkalemia and renal dysfunction
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Screening B/P measurement Cardiovascular risk factors
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Therapeutic regime Lifestyle modification Medication adherence
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Assessment History and physical exam BP measurement
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Nursing Diagnoses Ineffective health maintenance Anxiety Sexual dysfunction
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Goals Lower BP and enhance patient compliance
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Interventions Early identification of medication side effects or complications Patient and family education
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Evaluation Achieve and maintain goal BP Understand, accept, and implement therapeutic plan Experience minimal or no side effects
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Examples: Diltiazem (Cardizem SR) Nifedipine (Procardia, Procardia XL, Adalat) Nicardipine (Cardene) Verapamil (Isoptin, Calan, Calan SR) Amlodipine (Norvasc)
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Mechanism of action: Blocks movement of calcium into cells Vasodilatation, ↓ SVR, ↓ contractility, ↓ HR
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Side Effects: Bradycardia, 1st degree AV heart block, nausea, headache, dizziness, peripheral edema, flushing, rash gingival hyperplasia, and constipation with verapamil.
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Adverse drug Interactions: Cautious use in patients with heart failure. Contraindicated in patients with 2nd and 3rd degree heart block.
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Avoid grapefruit juice
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Watch for bradycardia, first degree heart block
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Thiazide
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Loop
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MOA: Inhibit NaCL reabsorption in distal tubules. Initial decrease in ECF and sustained decrease in SVR. Lowers B/P over 2 -4 weeks.
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MOA: Inhibits NaCl reabsorption in the ascending limb of loop of Henle, Increase excretion NaCl.
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Chlorothiazide (Diuril), hydrochlorothiazide (Microzide)
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Furosemide( Lasix), bumetanide(Bumex)
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Side effects: fluid and E- imbalance, volume depletion, metabolic alkalosis. Vertigo, headache, weakness. Anorexia, N/V, constipation, pancreatitis, sexual dysfunction, photosensitivity, decreased glucose tolerance
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Adverse rxn: Fluid and electrolyte imbalances. Ototoxicity, vertigo, Metabolic: hyperurecemia, hyperglycemia, inc. LDL and triglycerides and dec. HDL
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Drug Interactions: Potentiate digoxin NSAIDS may decrease diuretic and antihypertensive effect
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Drug Interactions: None listed
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Nursing Considerations: Monitor VS , orthostatic hypotension, Monitor for hypokalemia. Teach about supplementation with K+ rich foods
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Nursing Interventions: Monitor fluid and E imbalances
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Potassium Sparing
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Aldosterone Receptor Blockers
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MOA: Reduce K+ and Na+ exchange distal and collecting tubules reduce excretion of K+, H+, Ca+ and Mg+
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MOA: inhibits Na+ retaining and K+ excreting effects of aldosterone in distal and collecting tubules ( K+ sparing)
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Amiloride(Midamor
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Spirolactone(Aldactone
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Side effects: Hyperkalemia: N/V, diarrhea, leg cramps, dizziness, Tall t waves
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Side effects: Hyperkalemia, gynecomastia, erectile dysfunction menstrual irregularity
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Drug interactions: Caution in pts on ACE inhibitors and Angiotensin II blockers avoid potassium supplements
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Drug Interactions: Do not combine with K+ sparing diuretics or supplements, cautious use with ACE Inhibitors or angiotensin II blockers
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Nursing Interventions: monitor for orthostatic hypotension, contraindicated in pts with renal failure and cautious use in pts on ACE inhibitors and Angiotensin II blockers. Avoid K+ supplements
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NursNursing Interactions: monitor for orthostatic hypotension and hyperkalemia.ing Interventions: Monitor fluid and E imbalances
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Examples: Hydralazine (Apresoline) Minoxidil (Loniten) Sodium nitropurusside (Nipride)
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Mechanism of action: Relax vascular smooth muscle Decrease SVR
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Often given IV for hypertensive crisis
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Side Effects: Reflex tachycardia, nausea, flushing, headache, hypotension
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Nursing Interventions: Monitor for hypotension and tachycardia
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"pril"
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Examples: Captopril (Capoten) Enalapril (Vasotec) Lisinopril (Zestril, Prinivil) Ramipril (Altace) Benazepril (Lotensin) Quinapril (Accupril)
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Mechanism of action: Inhibits angiotensin-converting enzyme Decreases vasoconstriction and water retention
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Side Effects: Cough: 1/3 will develop Hypotension, Dizziness, headache, vertigo Angioedema Photosensitivity Abdominal pain, loss of taste Hyperkalemia: inhibits aldosterone
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Drug Interactions: Diuretics enhance effect NSAIDS and ASA may reduce effect
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Nursing Implications Monitor blood pressure Monitor serum potassium Monitor renal function Antacids may decrease absorption
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Beta Blockers “-olol”
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Metropolol(Lopressor), propanolol(Inderal), carvediol(Coreg)
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Mechanism of action: Block beta receptor sites which are responsive to epinephrine and norepinephrine..
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Side Effects Hypotension Headache Fatigue Peripheral edema Erectile dysfunction Diabetics : may mask hypoglycemia Asthma: symptoms to monitor for
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Nursing Implications Monitor heart rate and blood pressure Monitor for symptoms of HF
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Drug Interactions: cautious use with diabetics and asthma patients
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Nursing Interactions: Monitor pulse and BP regularly. IV administration short onset and duration
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Sudden, severe increase in diastolic BP
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Clinical manifestations: Hypertensive encephalopathy Renal insufficiency Cardiac decompensation Neurologic compromise
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Hypertensive Crisis: Nursing-Collaborative Management
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Hospitalization IV antihypertensive drugs Intensive monitoring Invasive blood pressure monitoring Frequent physical assessments Treatment guided by MAP Use caution not to decrease BP too fast!
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Diuretics
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Beta-Blockers
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Calcium Channel Blockers
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ACE Inhibitors
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ARBs
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Vasodilators
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