Hypertension Medications and Diuretics

what are beta blockers NOT used for?

cardiac decompensation, uncompensated CHF

what are the side effects for beta blockers?

hypotension, orthostatic hypotension, dizziness, wheezing, fatigue

what type of beta blocker should be used for patients with COPD or Asthma?

Cardio selective

Use metoprolol (lopressor, toprol) with caution in patients with?

hepatic and renal failure
thyroid dysfunction
asthma
PVD
diabetes

metoprolol (lopressor, toprol) side effects and adverse reactions?

S/E: fatigue, weakness, N/V/D, mental changes, impotence, decreased libido, depression

A/E: bradycardia, thrombocytopenia, complete heart block, bronchospasm, agranulocytosis

Nursing considerations for beta blockers?

obtain vitals before administering medication

check lab values before administration

taper down dose as rebound effect can occur with rapid W/D

instruct patient to rise slowly due to orthostatic hypertension

teach patients how to take radial pulse and BP

how do central acting alpha 2 agonists work ?

stimulate alpha 2 receptors --> decreased vagus activity --> decreased CO, PVR, increased vasodilation

*** think sedation

How do alpha 1 adrenergic blockers decrease BP?

cause vasodilation, decreased renal blood flow, decrease LDL and HDL

Prazosin (minipress) drug class, pregnancy category, indications and route?

class: anti-hypertensive. alpha adrenergic blocker

category C

indicationsL HTN, refractory HR, BPH

PO

Prazosin (minipress) MOA?

dilation of peripheral vessels via blocking alpha adrenergic receptors

prazosin (minipress) contraindications?

renal disease

przosin (minipress) side effects and adverse effects?

S/E: dizziness, drowsiness, HA, NVD, impotence, vertigo, urinary frequency

A/E: orthostatic HTN, palpitations, tachycardia, pancreatitis

prazosin (minipress) drug interactions?

increased hypotensive effects with other antihypotensives, nitrates, and etoh

Nursing Considerations prazosin (minipress)?

•Monitor vital signs

Monitor Creatine

•Desired effects may take 4 weeks

•Any sudden decreases in BP should be reported

•May cause sodium and water retention check for edema

•Change position slowly may cause orthostatic hypotension

•Impotence may occur tell pt to report to provider

how do adrenergic neuron blockers work ?

potent vasodilators, block NE release to cause a decrease in BP

Reserpine class and side effects?

adrenergic neuron blocker

orthostatic hypertension *, vivid dreams, nightmares, suicidal ideation

Na+ and water retention, may be taken alone or with diuretics

alpha and beta 1 adrenergic blockers examples ?

Normodyne (Labetalol), carteolol (Cartrol), Carvedilol (Coreg)

effects of blocking alpha 1 adrenergic receptors ?

vasodilation, decreased BP, S/E dizziness, fatigue, hypotension

effects of blocking beta 1 adrenergic receptors?

decreases HR, lowers BP, S/E hypotension, bradycardia, dizziness, SOB

Direct-Acting Arteriolar Vasodilators examples?

Hydralazine and Minoxidil

Direct Acting arteriolar vasodilators function ?

causes relaxation of smooth muscles of the blood vessels; promotes blood flow to the brain and kidneys

Direct Acting arteriolar vasodilators side effects

peripheral edema, tachycardia, palpitations, edema, nasal congestion, H/A

ACE inhibitors MOA, indications, and side effects

Inhibit the angiotensin converting enzyme which then inhibits angiotensin II ( a potent vasoconstrictor) and blocks the release of aldosterone; cause vasodilation with little effect on HR or CO

treatment of HTN

orthostatic hypotension, cough***, hyperkalemia, angioedema (aka allergic reaction)

suffix for ACE inhibitors

-pril

ACE inhibitors examples

benazepril(lotensin), captopril (Capoten), enalapril (vasotec),
Fosinopril (monopril), ramipril (altace)

ACE inhibitors are K sparing or wasting?

K sparing, so risk for hyperkalemia and kidney damage (higher than 1.2)

Angiotensin II receptor Blockers (ARB) are ?

the exact same as ACE inhibitors EXCEPT don't cause cough and are teratogenic
** patient education about teratogenic

what do ARBs cause?

vasodilation and decreased PVR

suffix for ARBS?

-sartan

Diovan (valsartan) class, indication, contraindication?

ARB

for HTN, MI, stroke prevention; HF, delay progression of diabetic nephrology

pregnancy and breastfeeding are contraindications

caution for Diovan (valsartan)?

can cause renal and hepatic impairment --> may increase creatinine, AST, ALT, bilirubin

Valsartan (Diovan) side effects and adverse reactions?

dizziness, drowsiness, hyperkalemia

orthostatic HTN, Hypoglycemia

renal dysfunction

Valsartan (Diovan) drug interactions

Anti-HTN, MAOI, ETOH may increase hypotensive effects, ACE inhibitors and ASA may increase hyperkalemia and renal dysfunction, NSAID may increase renal dysfunction, may increase lithium toxicity

Calcium channel blockers used to treat angina, HTN, cardiac dysrhythmias, afib?

verapamil (calan) and diltiazem (Cardizem)

side effects of verapamil (Calan) and
diltiazem (Cardizem)?

bradycardia, dizziness, hypotension, constipation*

calcium channel blockers used to treat angina and htn?

amlodipine (Norvasc) and
nifedipine (Procardia)

Side effects of amlodipine (Norvasc) and
nifedipine (Procardia)

dizziness, hypotension, ankle edema **

nifedipine causes reflux tachycardia

how do calcium channel blockers work?

dilate coronary arteries and decrease oxygen command

what are the K wasting diuretics?

Thiazide and thiazide-like
Loop or high-ceiling
Osmotic
Carbonic-anhydrase inhibitor

Carbonic Anhydrase Inhibitors (CAI) function

Decreases availability of H+

Can induce metabolic acidosis (prevention of seizures)

Can induce respiratory acidosis (increasing oxygenation during hypoxia by increasing ventilation)

sometimes used with glaucoma patients, helps reverse metabolic alkalosis

Acetazolamide (Diamox) indications

Treatment of Glaucoma

Edema (CHF), less potent than loop diuretics, or Thiazide.

High altitude sickness (symptoms : H/A,N, SOB, dizziness and fatigue)

Antiepileptic (rarely)

Metoprolol: drug class, pregnancy category, dosage a per cart?

beta-1 blocker antihypertensive

category C/D in second and third trimester

dosage 44-1

Metoprolol (Lopressor, Toprol) indications?

HTN, angina, MI, etc

Metoprolol absorption and onset?

PO 95% protein bound 12%

onset PO 15 mins, IV immediate

What metoprolol is long acting and which is short acting?

metoprolol succinate for long acting

metoprolol tartrate for short acting

contraindications for metoprolol (lopressor, toprol)

2nd and 3rd degree heart block

cariogenic shock

decompensated heart failure

bradycardia

metoprolol (lopressor, toprol) interactions?

digoxin (bradycardia)
anti-hypertensives
ethos (hypotension)

what is methyldopa (aldomet) used for?

centrally acting alpha 2 agonist to treat pregnancy induced HTN or chronic HTN

what needs to me monitored when a patient is on Aldomet?

liver function tests, avoid in hepatic dysfunction

What is Clondine (catapress)'s class, indications, route, and pregnancy category?

Indications: HTN
class: centrally acting alpha 2 agonist
route: PO or transdermal patch
pregnancy category C

can help with menopausal symptoms, anxiety

Clondine (catapress) side effects?

drowsiness*, dizziness, dry mouth

what is the suffix for alpha 1 blockers?

-azosin (except tamsulosin)

kidney function ?

1. maintain fluid balance
2. maintain acid base balance
3. excrete metabolic wastes

purpose of diuretics?

lower BP and decrease edema

What are risk factors for Primary HTN?

family history
hyperlipidemia
African American race
diabetes
obesity
aging
stress
excessive smoking/vaping/alcohol consumption

What regulates blood pressure?

Kidneys (volume and renin angiotensin-aldosterone system), blood vessels, hormones

how does the renin angiotensin-aldosterone system work ?

1. Renin converts angiotensinogen to angiotensin I
2. ACE converts angiotensin I to Angiotensin II
3. Angiotensin II coverts to aldosterone which leads to vasoconstriction and vascular remodeling

How is low BP regulated by blood vessels and hormones?

blood vessel's baroreceptors sense low BP --> release catecholamines (Epi/NE) --> vasoconstriction and increased BP

ADH released when low BP is sensed

What medications are more effective to treat HTN in African Americans?

Ca+ blockers and diuretics

low renin HTN does not respond well to BB or ACE inhibitors

What is a cultural response to HTN medications for Asian Americans and Indian Americans?

Asian Americans have a higher response to BB and may require lower doses

Indian Americans have a resistance to BB

How does HTN meds help prevent stroke and MI?

decreases risk of stroke by 34% and MI by 19%

How can you regulate HTN without medication?

stress reduction, low salt diet, exercise, decrease alcohol consumption, reduce weight

SBP over 140 requires medication

How do diuretics lower BP?

promote Na+ depletion leading to the loss of fluid volume

what is Hydrochlorothiazide typically used for?

first line treatment for mild HTN in individuals with no other diseases. Also beneficial for African American patients

what are beta blockers used for?

HTN, angina, MI, dysrhythmias

can be used in conjunction with diuretics

Acetazolamide (Diamox) adverse effects?

Metabolic acidosis (could be beneficial)

Hypokalemia

Drowsiness

Paresthesia

Hematuria

Urticaria

Photosensitivity

melena

Loop diuretic function?

potent diuretic, chemically related to sulfonamide abc

K wasting so worried about hypokalemia

loop diuretics MOA

Block Cl-, and Na+ reabsorption in the loop of Henle

Active renal prostaglandins resulting in dilation of blood vessels of kidney, lungs

loop diuretic examples

Furosemide, torsemide, bumetanide

loop diuretics indications

Manage edema associated with CHF

Control HTN

Increase renal excretion of Ca+ in pts with hypercalcemia

loop diuretics contraindications

known drug allergy, hepatic coma, and severe electrolyte loss

loop diuretic adverse effects

Hypokalemia

Hypotension

Dehydration, hyponatremia

Photosensivity

Ototoxicity (IV given to rapidly)

Toursemide may cause thrombocytopenia, leukopenia, neutropenia

Loop diuretics interactions

Neurotoxic and Nephrotoxic effects, increased when combined with drugs that do the same

Aminoglycosides, Vancomycin additive effect

Corticosteroids, digoxin: Hypokalemia

Lithium: decreased renal excretion

NSAIDS: Inhibition of prostaglandins

Sulfonylureas : decreased glucose tolerance

Digoxin - highly protein bound. Hypokalemia - digoxin more likely to reach toxic levels

Lasix (Furoemide) indications and contraindications?

indicated for pulmonary edema, edea of CHF, Liver disease, nephritic syndrome, ascites

contraindicated in hypersensitivity, anuria, hypovolemia, electrolyte depletion

Po onset 30-60 minutes
IV onset 5 mins (K+ level, check BP before administration

Hydrochlorothiazide (Hydodiuril) MOA

inhibits the reabsorption of Na+, K+, and Cl-, resulting in osmotic water loss

Direct relaxation of arterioles causing decreased PVR (afterload)

Decreased preload

K wasting

Hydrochlorothiazide (Hydodiuril) indicatons and adverse effects

HTN, CHF indications

A/E dizziness, dehydration, hypokalemia, hyponatremia

Hydrochlorothiazide (Hydodiuril) interactions

Corticosteroids, diazoxide, digoxin, lithium, NSAIDS, oral hypoglycemic

special consideration about Hydrochlorothiazide(Hyrodiuril)

Doses over 50mg have no increased results, may increase drug toxicity (ceiling effect)

Metalazone (Zaroxolyn) function?

Thiazide-like diuretic

More potent than Thiazide diuretics especially in pt with renal insufficiency

Given in combination with Loop diuretics to produce potent diuresis in severe CHF

Mannitol (Osmitrol) MOA

osmotic diuretic
Inhibits tubular reabsorption of H2O and solutes producing rapid diuresis

Reduces cellular edema and increases urine production

Small loss of Na+ not useful in peripheral edema

Induces vasodilation, increases GFR, and renal plasma blood flow

Mannitol (Osmitrol) indications?

Treatment of early oliguric acute renal failure (increased Renal BF)

Reduce intracranial pressure, treat cerebral edema

contraindications for Mannitol (Osmitrol) ?

Drug allergy

Severe renal disease

Pulmonary edema

Active intracranial bleeding bc icnrease bleeding rate

adverse effects Mannitol (osmitrol)?

Convulsions

Thrombophlebitis

Pulmonary congestion

HA/fever/chills/ chest pain/tachycardia/blurred vision

Nursing considerations Mannitol (osmitrol)?

•Discontinue treatment if severs cardiac or renal impairment occurs after initiation of therapy
•
May crystallize when exposed to low temperature. Always use filter when administering
•
Inspect for crystals prior to starting

•IV

Spironolactone (Aldactone) MOA and indication

blocks aldosterone receptors

to treat ascites,reduces morbidity and mortality in patients with severe Heart failure, children with heart failure. Increase Urine Output

Spironolactone (Aldactone) S/E and A/E

N/V/D, rash, HA, weakness, dry mouth, gynecomastia

hyperkalemia, gynecomastia, H/A, dizziness, cramps

severe hyperkalemia and thrombocytopenia

Spironolactone (Aldactone) contraindication and drug interactions

contraindicated for severe kidney dx, severe hyperkalemia

interacts with K+ sparing drugs risk increased K+, increased Hypotensin with Anti-hypertensive

nursing consideration for diuretics

Monitor I/O watch for overdiuresis (dec urine output)

Monitor BP (lower BP bc lowering volume )

Watch for orthostatic hypotension (lowering BP and dehydration)

Monitor electrolytes (K+ then Na+)

When giving furosemide IV slow injection to prevent ototoxicitygiven slowly over 1-2 minutes