Drug effects

Mannitol (Osmitrol) - General info

Osmotic Diuretic

Pulls water from throughout the body and back into the bloodstream

Must be given with filter needle

Risk of edema, especially in heart failure patients

Causes fluid & electrolyte imbalance

IV administration only

Furosemide (Lasix) - General info

Loop Diuretic

Used for instances of pulmonary edema and general edema

Causes MASSIVE fluid loss

↓ blood pressure

Causes electrolyte imbalance (sodium, chloride, potassium)

Is an ototoxic risk

Adverse effects of dehydration and risk for thrombosis

Hydrochlorothiazide (HCTZ)

Similar to loop diuretics

Used for hypertension, edema caused by heart failure, help with osteoporosis bone loss in postmenopause

electrolyte imbalance ( Na+ , K + Cl- )

First-line diuretic for adults under 60 and most common PO

Aliskiren (Tekturna)

Direct Renin Inhibitor (DRI):

Used for hypertension

Binds to renin to stop angiotensinogen → angiotensin 1

Not a first-line drug

Do not combine with other RAAS

Dangerous to fetuses

take on empty stomach

monitoring of I/O, vital signs, weight, and electrolytes, Especially if on ACEs, ARBs, etc.

Lisinopril (Zestril)

ACE Inhibitor

Used for hypertension, heart failure, prevents MI, CVA (stroke)

Blocks conversion of Angiotensin Converting Enzyme (ACE) → Angiotensin II

Monitor electrolytes, b/p, and cough

Adverse effects:

• Dry cough, hyperkalemia, Angioedema, First-dose postural hypotension, Fetal injury

Losartan (Cozaar)

Angiotensin Receptor Blocker (ARB)

Used for hypertension, reduces MI and strokes, and help nerve damage

Used when patients get ACE coughs (Think cough = Cozaar)

Blocks angiotensin II receptors to stop aldosterone

Do not combine with ACE inhibitors

Adverse effect:

• angioedema and fetal injury

Dihydropyridines (Calcium Channel Blocker )

Nifedipine, Amlodipine, Nicardipine

Effective for vasodilation; not effective for heart

Non-dihydropyridines (Calcium Channel Blocker )

Phenylalkylamine (Verapamil) and Benzothiazepine (Diltiazem)

Effective on heart function; not effective on Vasodilation

Nifedipine (Procardia)

CCB (Dihydropyridine class)

Blocks calcium channels on vascular smooth muscles

Used for Angina pectoris and hypertension

Beta-blockers help will metigate the reflex tachycardia

Adverse effects:

• Peripheral edema, reflex tachycardia, Orthostatic hypotension

Verapamil (Calan), Dilitazem

CCB (Non-Dihydropyridine class)

Used for Angina pectoris, hypertension, and dysrhythmias

Adverse effects: constipation, Orthostatic hypotension, decreased contractility, bradycardia, hypotension, ↑ digoxin levels

Watch interactions with grapefruit, digoxin, and beta-blockers

Hydralazine (Apresoline)

direct-acting vasodilator

Used for hypertension, Hypertensive crisis, Heart failure

adverse effects: Reflex tachycardia, ↑ blood volume, muscle/joint pain

Co-administer with beta blocker to reduce of reflex tachycardia, or with a diuretic to reduce risk of sodium and water retention

Combined with isosorbide dinitrate when used for
treatment of heart failure

Nitroprusside (Nipride/Nitropress)

causes both venous and arteriolar dilation to decrease blood pressure

Drug of choice for surgeries and hypertensive emergencies (SBP>180, DBP>120)

Adverse effects: Hypotension, Cyanide and thiocyanate toxicity (in patients receiving prolonged infusion and/or with hepatic/ renal impairments)

nitial IV infusion rates range from 0.3-0.5 mcg/kg/min

Digoxin (Lanoxin)

Used for atrial dysrhythmias and heart failure

Adverse effects: hyperkalemia, Digoxin Toxicity, N/V/D, anorexia, fatigue, blurry vision (yellow-green halos), confusion, arrhythmias

Monitor digoxin and potassium levels (K+ levels should be 3.5 to 5.0 mEq/L, check EKG and vital signs (ex: apical pulse >60 bpm)

Digoxin range is typically 0.5-0.8 ng/mL