Hypertension Medications

- Amlodipine [Norvasc]

- Verapamil [Calan]

- Nifedipine [Procardia]

- Diltiazem [Cardizem]

Calcium channel blockers

Watch for:

- hypotension*

- peripheral edema

- flushing

- headache

- GI upset

- bradycardia

-bronchocontstiction

Calcium Channel Blockers

- Metoprolol [Lopressor]

- Atenolol [Tenormin]

- Propranolol [Inderal]

- Nadolol [Corgard]

- Sotalol [Betapace]

Beta-andrenergic blockers

- end in "olol"

Beta-andrenergic blockers

Watch for:

- bradycardia

-hypotension

-CHF

-Bronchospasms

-Impotence

Beta-Andrenergic blockers

Why do you have to worry about bronchospasms in beta blockers?

This is due to their effect on beta-2 adrenergic receptors in the lungs, which can lead to bronchoconstriction in susceptible individuals, especially those with asthma or chronic obstructive pulmonary disease (COPD).

This drug can mask the symptoms of hypoglycemia in clients with diabetes

Beta blockers

why do beta blockers mask hypoglycemia?

Beta blockers can mask symptoms of hypoglycemia, such as tachycardia and palpitations, by blocking the sympathetic nervous system response. This is particularly relevant for diabetic patients who rely on these symptoms as a warning sign.

Nursing implications

- monitor vital signs

- teach clients about OH for initial dosing and other lifestyle changes [weight reduction, sodium restriction, and daily exercise]

- monitor electrolyte, hepatic, and renal serum blood studies

- avoid abrupt withdrawals; may cause rebound phenomenon of excessive rise in BP

Antihypertensives

end in -PRIL

Ace-inhibitors

- Captopril [Capoten]

--> given oral for hypertensive crisis

- Enalapril [Vasotec]

- Benazepril [lotensin]

- Fosinopril [Monopril]

Ace-Inhibitors

ACE inhibitors

- block the conversion of angiotensin I to angiotensin II,

what effect do ACE inhibitors have on the blodo vessels?

vasodilate

what does angiotensin II do?

it constricts blood vessels, increasing blood pressure and stimulating aldosterone secretion.

prevent sympathetic stimulation of heart, thereby reducing heart rate and contractility

Beta-Adrenergic

- block calcium influx into the beta-receptors

- decreases the force of the myocardial contraction

- reduce the heart rate

- decrease PVR [peripheral vascular resistance]

Calcium-channel blockers

what physiological effect do calcium channel blockers have?

They cause vasodilation, reduce heart rate, and decrease myocardial contractility.

Order of HTN drug selection

1. thiazide diuretics

2. beta-adrenergic blockers

3. ACE inhibitors

4. CCB

Stage 1 hypertension treatment

Treatment: Thiazide diuretics and loop diuretics

Thiazide diuretic

Hydrochlorothiazide [Hydrodiuril]

what physiological effect do thiazides have on the body

Thiazides reduce blood pressure by promoting sodium and water excretion, which decreases blood volume and vascular resistance.

How do thiazide drugs work?

inhibiting sodium reabsorption in the distal convoluted tubule of the nephron - increased excretion of sodium and water, which lowers blood pressure.

Loop diuretic

- Furosemide [Lasix]

- Bumetanide [Bumex]

ototoxicity diuretics

Loop diuretics

Diuretic routes

IV, IM, PO

Treat:

- edema r/t CHF, cirrhosis, renal disease, and hypertension

Diuretics

HTN drugs to avoid in heart failure and CHF

β-blockers, and certain calcium channel blockers

Bumetanide [Bumex]

Treatment:

- edema r/t excess fluid from heart disease, liver, or kidney

- hypertension

Bumetanide [Bumex]

- enhances excretion of sodium chloride and potassium in the loop of henle and proximal tubule producing diuresis

Potassium sparking diuretic

Spironolactone [Aldactone]

Spironolactone [Aldactone]

- Save the potassium, get rid of the water

- blocks aldosterone in the kidneys

- gets rid of sodium and water

warning while taking spironolactone

hyperkalemia.

why must you watch for deepening of the voice with spironolactone?

It may cause hormonal changes due to increased androgenic effects.

Treatment:

- hypertension and edema

- reduces edema in clients with severe heart failure

Spironolactone [Aldactone]

signs of hyperkalemia

include muscle weakness, fatigue, palpitations, and numbness.

signs of hypokalemia

include muscle cramps, weakness, and arrhythmias.

Which drug requires the nurse to monitor the client for signs of hyperkalemia?

1 Furosemide (Lasix)

2 Metolazone (Zaroxolyn)

3 Spironolactone (Aldactone)

4 Hydrochlorothiazide (HydroDIURIL)

3

Spironolactone [Aldacton]

contraindicated in patients with renal failure

Loop diuretics warning

--> COULD HAVE CARDIAC DYSRHYTMIAS WHEN POTASSIUM IS LOW

what drug class is hydralazine

vasodilator often prescribed in conjunction with other antihypertensive agents.

Warning with hydralazine

may cause reflex tachycardia and headache due to vasodilation.

Vasodilators

- Hydralazine [Apresoline]

- Isosorbide dinitrate [Isordil]

- Minoxidil [Loniten]

Minoxidil [Loniten]

Side effects:

- reflex tachycardia

- marked sodium and fluid renention

- hirsutism

- change in ECG not related to eschemia

Alpha1 blockers

- Doxazosin [cardura]

- Prazosin [Minipress]

- Terazosin [hytrin]

alpha 1 blockers end in?

-zosin

why are alpha 1 blockers recommended in patients with BPH

rapidly relax the smooth muscle in the prostate and bladder neck, which quickly relieves urinary blockages and improves urine flow and overall urinary symptoms. This mechanism enhances bladder outlet obstruction, making them effective in treating BPH.

warning for alpha 1 blockers

May cause orthostatic hypotension and dizziness, especially after the first dose. Monitor for potential interaction with other antihypertensive medications.

Alpha1 blockers

Side effects:

- OH

- Vertigo

- Sexual dysfunction

- Palpitations

- nasal congestion

- dry mouth

- tachycardia

Alpha1 blockers

Teaching:

- take at night to avoid daytime drowsiness

- discontinue slowly to stop rebound hypertension

- teach client about first dose effect of severe OH to avoid hazardous activity and driving for 12-24 hrs

- may cause dry mouth -- give with gum or hard candy

Alpha2 blockers

- Clonidine [Catapres]

- Methyldopa [Aldomet]

benefit of clonidine over other blood pressure meds

is its ability to lower blood pressure without causing reflex tachycardia.

Alpha 2 blockers

Side effects:

- anemia

- OH

- sedation

- fatigue

- decreased libido

- erectile dysfunction

- DRY MOUTH

- hepatoxicity

- sodium and water retention

- depression

Alpha 2 blockers

DO NOT:

- go in hot tubs or alcohol due to vasodilation

- discontinue BP meds suddenly -- rebound hypertension

- used for pregnancy [ALDOMET]

Fosinopril [Monopril]

Monitor for:

- hypertension

- decreased peripheral arterial resistance

- pulmonary capillary wedge pressure

ACE inhibitor

Monitor for:

- WATCH FOR HYPOTENSION

- CAUSES A HORRIBLE DRY HACKING COUGH BECAUSE OF THE INHIBITION OF THE BREAKDOWN OF BRADYKININ

---> CONTRAINDICATED IN HEART FAILURE OR ASTHMATICS

- IF THEY ARE HAVING PROBLEMS, THEY WOULD MOVE TO THE R'S

- GIVE ON AN EMPTY STOMACH

- CONTRAINDICATED IN PATEINTS WITH HISTORY OF ANGIOEDEMA

ACE inhibitor contraindication

heart failure, angioedema

Angiotensin II receptor blockers (ARBS)

Losartan [Cozaar]

Valsartan [Diovan]

Angiotensin II receptor blockers

Treatment for:

- for hypertension, adjunctive drugs for treatment of HF, may be used alone or with other drugs such as diuretics, used primarily in patients who cannot tolerate ACE inhibitors

- May cause occasional dizziness, inability to sleep, diarrhea, dyspnea, heartburn, nasal congestion, back pain, fatigue

- hyperkalemia much less likely to occur

- should be used cautiously in elderly patients and in patients with renal dysfunction

- increases sensitivity to the drug's effects and increases risk for adverse effects

Angiotensin II receptor blockers

side effects:

- URI

- headache

warning for ARBs

Should be used cautiously in elderly patients and those with renal dysfunction due to increased sensitivity and risk of adverse effects.

Metoprolol [Lopressor]

Treatment:

- angina

- hypertension

** HOLD IF HR <50

** CONTRAINDICATED IN PATIENTS WITH SINUS BRADYCARDIA B/C BETA BLOCKERS SLOW THE HR

- treats SINUS TACHYCARDIA

- assess apical HR before giving it

metoprolol contraindication

bradycardia and severe asthma or COPD.

Propranolol [Inderal]

Treatment:

- used for angina, hypertension, and dysrhythmias

- given for hyperthyroidism in response to tachycardia

- contraindicated for a person with asthma

- DECREASES HR

- HELPS WITH DYSRHYTHMIAS

- HELPS WITH HTN

- SLOWS DOWN THE HR WITH THRYID STORM

- HELPS WITH MIGRAINES

- CAN PRECIPITATE ASTHMA ATTACK DUE TO THE BRONCHIOCONSTRICTIONS

Sotalol [Betapace]

Treatment:

→used to decrease HR and contractility, decrease velocity of impulse conduction at the AV node, and dysrhythmias (suppress sinus and atrial tachydysrhythmias)

→ caution with diabetes**: may interact with hypoglycemic agents leading to heart failure

→blocks SNS catecholamines, resulting in reduced rennin and aldosterone release and fluid balance

⇒ Vasodilation of arterioles leads to a

decrease in pulmonary vascular resistance and blood pressure

→take medication before meals

→assess vital sign; monitor closely if given with a CCB

→hold if BP is <90 and HR is <60 (SOME SAY <50)***

→Masks some symptoms of hypoglycemia

sotalol warning

bradycardia, hypoglycemia. Use caution in patients with diabetes and monitor closely for adverse effects.

CCBs

treatment:

- contraindicated in 2nd or 3rd degree heart block

- decrease contractility, decrease conductivity of the heart, decrease demand for oxygen

- USED FOR ANGINA

what are ccb’s

Calcium channel blockers (CCBs) are medications that decrease contractility and conductivity of the heart, reducing oxygen demand and are primarily used for the treatment of angina. They are contraindicated in patients with 2nd or 3rd degree heart block.

Verapamil [Calan, Isoptin]

- for supraventricular tachycardia

• VERY NICE DRUGS

• CAUSES DECREASED HEART CONDUCTIVITY

• CAUSE CAUSE DRY COUGH

• CAN CAUSE BRADYCARDIA

• CAN CAUSE EXACERBATION OF HEART FAILURE

o WATCH FOR LUNG CRACKLES AND HEART FAILURE SIGNS

• CONTRAINDICATED WITH GRAPEFRUIT OR GRAPEFRUIT JUICE

o INCREASES SERUM LEVELS OF CA, BECAUSE IT CAUSES SEVERE HYPOTENSION

• CONTRAINDICATED IN 2ND OR 3RD DEGREE HEART BLOCK!!!

• CAN CAUSE FIRST DEGREE AV BLOCK

specific verapamil use

primarily used for supraventricular tachycardia.

verapamil contraindication

Contraindicated in patients with 2nd or 3rd degree heart block and those taking grapefruit juice.

Nitrates [Nytroglycerin]

- Nitro ointments/patches [Nitro-Bid]

- Nitro sustained release tablets

- NTG sublingual tabs

- NTG translingual spray

- Sodium nitroprusside [Nipride]

nitrate MOA

Nitrates work by dilating blood vessels, increasing blood flow and decreasing myocardial oxygen demand.

Nitro ointments/patches [Nitro-Bid]

side effects:

- severe headache [due to complete vasodilation]

Nitro ointments/patches [Nitro-Bid]

Instructions:

• WEAR GLOVES WHEN GIVING IT

• CAN CAUSE A HORRIBLE HEADACHE

• ACTIVE THE PATCH BY WARMTH SO PUT YOUR HANDS OVER IT→BUT PROTECT YOURSELF BY WEARING GLOVES

• VASODILATOR

• BP WILL DROP→ MAY CAUSE A HEADACHE

NTG sublingual tabs

--> quick release

• SENSITIVE TO LIGHT

• GIVEN IN A BROWN BOTTLE

• DISCARD BOTTLE AFTER 3-6 MONTHS

• SHOULD FIZZ UNDER TONGUE

• DROPS THE BP

• DO NOT CHEW OR SWALLOW

• HAS TO SIZZLE UNDER THE TONGUE

NTG translingual spray

side effects:

- severe hypotension

- tachycardia

- dizziness

- headache and snycope

- dry mouth

- blurred vision

NTG translingual spray

-- used for relief of angina pain and (with BB and CCB) suppress tachycardia

→don't rub in for patches or ointment, will absorb in skin too quickly.

→after opened 6 mons, toss it

→brown bag over IV nitro to keep the light out (which deactivates it)**

→vasodilates coronary arteries

→1 nitro (5 mins pass) call 911 and take another nitro (5 mins pass) take another nitro, 3 nitros don't fix pain give morphin IM, if these don't work set on IV nitro**

→don't take with VIAGRA or other vasodilators (BP will drop too low) or with severe anemia

do not take nitrates with

erectile dysfunction medications

Sodium Nitroprusside [Nipride]

side effects:

- acute hypertension

- nausea

- vomiting

- muscle twitching

- signs of thiocyanate toxcity including anorexia, nausea, fatigue, disorientation

Sodium Nitroprusside [Nipride]

NO GRAPFRUIT JUICE