HTN Meds

Pharm Class: clonidine (Catapres)

Centrally Acting Alpha 2 Agonist

Pharm Action: clonidine (Catapres)

selectively activates alpha 2 receptors in brainstem of CNS to reduce sympathetic stim of heart and associated blood vessels (treat HTN, severe pain relief, manage ADHD)

Complications: clonidine (Catapres)

drowsy, dizzy, xerostomia (dry mouth)

Contra: clonidine (Catapres)

anticougalant therapy

Precaut: clonidine (Catapres)

severe cardiac disease, cerebrovascular disease, renal disorder

Med Admin: clonidine (Catapres)

Oral: bedtime, begin with low dose

Transdermal patch: upper outer arm or anterior chest, once every 7 days, rotate and monitor for inflam/irratiton,

Nursing Inter: clonidine (Catapres)

monitor for CNS effects, tell clients dryness will decrease in few week decrease dose slowly if discontinue monitor for abuse: high doses= euphoria, sedation, hallucinations

Client Edu: clonidine (Catapres)

take at bed time, careful w/ hazardous activites till know effect dry mouth: suck on hard candy, sip water, sugarless gum dont stop abruptly

Interactions: clonidine (Catapres)

Increase sedation effects of CNS depressants (alcohol, antihistamines, opiod anaglesics)

MAOIS, tricyclic antidepressant, amphetamines decrease effects

Catergory Class: doxazosin (Cardura)

alpha 1 blockers

Pharm Action: doxazosin (Cardura)

block alpha receptors resulting in venous and arteriolar dilation (treat HTN, symptomatic BPH)

Complications:doxazosin (Cardura)

orthostatic HypoTN, reflex tachycardia, headache, dizzy

Contra: doxazosin (Cardura)

sensitivty, children, hypotension, syncope

Precautions:doxazosin (Cardura)

hepatic disease, geriatric adults

Med Admin:doxazosin (Cardura)

oral: bedtime, indiv dose based of orthostatic BP changes

Nursing Interventions: doxazosin (Cardura)

m/r frequent headaches, m/r 20 mmHg drop between lying and standing + tachycardia, m/r orthostatic hypotension and increase in pulse every 2-6 hrs (inital + ^)

Client Edu: doxazosin (Cardura)

report dizzy, palp, syncope, tachycardia, rise slowly and take at bedtime, avoid hazardous activites 12 hrs after (initial + ^) reports persistant or increased amount of headaches

Interactions: doxazosin (Cardura)

sildenafil and phosphodiesterase ^ risk of hypotension

DNTK: Catergory Class: aliskiren (Tekturna)

direct renin inhibitors

Pharm Action: aliskiren (Tekturna)

binds with renin to inhibit activation of angiotension 1

causes vasodilation and excretion of sodium and water

complications: aliskiren (Tekturna)

diarrhea, dyspepsia, abd pain

rare: hyperkalemia, cough, angioedema

Contra: aliskiren (Tekturna)

pregnancy, lactation, allergy, hyperkalemia, hypercalcemia, dehydration, under 18

Precautions: aliskiren (Tekturna)

older adults, taking anything that increases potassium, low creatinine clearance, DM, resp disorders, airway surgery history

Med admin: aliskiren (Tekturna)

oral, dont give with high fat meal, give consistent time, 1 hr before food, therp effect in 2 weeks, monitor for hypotension (inital +^)

Nursing Intervention:aliskiren (Tekturna)

m/r s/s of hyperkalemia, monitor BUN, creatinine, serum potassium levels, m/r cough angioedema GI issues, treat angioedema with epi

Client Edu:aliskiren (Tekturna)

report s/s of hyperkalemia, report cough and swelling of throat and mouth (call 911 if severe), dont take while preggers

Interactions: aliskiren (Tekturna)

antihypertensive drugs, decreases levels of furosemide, increases levels of atorvastatin irbesartan decreases levels of aliskiren (Tekturna)

Cat Class: eplerenone (Inspra)

Aldosterone Antagonist

Pharm Action:eplerenone (Inspra)

blocks aldosterone receptors to urinary excrete sodium and water, retain potassium

Compliaction:eplerenone (Inspra)

hyperkalmeia

Contra: eplerenone (Inspra)

serum potassium above 5, type 2 DM with microalbuminuria, increase serum creatinine, decrease creatinine clearance, lactation, CYP3a inhibtors

Precautions:eplerenone (Inspra)

children, history of liver failure, taking potassium raising drugs, NSAIDS

med admin:eplerenone (Inspra)

oral, 4 weeks to see therpeuatic effects

Nursing Interventions:eplerenone (Inspra)

m/r s/s of hyperkalemia, monitor potassium levels, BUN, creatinine

Client Edu: eplerenone (Inspra)

report palps, twitching, weakness, paresthesia

Interactions: eplerenone (Inspra)

increases potassium: ACE inhib, potassium sparing diuretics

lithium: increase risk of lithium toxicity

NSAID decrease antiHTN effects

Catergory Class: losartan (Cozaar)

ARB (angiotensin II receptors blockers)

Pharm action:losartan (Cozaar)

block angiotension II receptors

arteriolar vasodilation, urinary loss of sodium and water, retention of potassium (treat HTN, prevent CVA, manage diabteic neuropathy)

Complications:losartan (Cozaar)

angioedema, dizzy, hypotension, headache, insomia

Contra:losartan (Cozaar)

pregnany, allergic, under 6, low creatinine clearance

Precaution:losartan (Cozaar)

diuretics, hyperkalemia, liver and renal disorder, planning to be preggers

Med Admin:losartan (Cozaar)

oral only, can be combined with thiazine diuretic, take w/ or w/o food, expect dose for liver failure or diuertic to be reduced.

Nursing Intervention:losartan (Cozaar)

monitor BP before admin, manage hypotension by IV fluids, treat angioedema with IV epi, m/r CNS effects

Client Edu:losartan (Cozaar)

report swelling of mouth and throat (911 if severe), report frequent headaches, insomina, dizzy, fainting, dont take if preggers

Interactions: losartan (Cozaar)

antihypertensives (^ effects)

NSAIDs (decrease effects, increase renal complications)

Catergory Class: captopril (Capoten), enalapril (Vasotec)

ACE inhibitors

Pharm Action: captopril (Capoten), enalapril (Vasotec)

blocks production of angiotension II, arteriolar vasodialation occurs, urinary excretion of sodium and water, potassium retains

Complications: captopril (Capoten), enalapril (Vasotec)

severe hypotension, rash, metallic taste, hyperkalemia, neutropenia, dry nonproductive cough, angioedema

nursing interventions: captopril (Capoten), enalapril (Vasotec)

start with low dose and gradually increase, manage severe hypotension with IV fluids m/r dry cough, angioedema, potassium levels, WBC (every 2 weeks for first 3 months)

Med admin: captopril (Capoten), enalapril (Vasotec)

only oral use, 2-3/daily for hypertnesion, 1 hr before meals

Contra: captopril (Capoten), enalapril (Vasotec)

preggers, lactation, angioedema history, allergic, hypotension

precuations: captopril (Capoten), enalapril (Vasotec)

decreased renal function, bone marrow depression, immunosupression, autoimmune disorder, older adults, CVD, cerebral vascualr disease, HF, hyperkalemia, hyponatremia

Client Edu:captopril (Capoten), enalapril (Vasotec)

warn hyptoension can occur, lie supine after first dose, m/r dry cough rash metallic taste decreased ability to taste sore throat, angioedma

Interactions: captopril (Capoten), enalapril (Vasotec)

antihypertensive, diuretics, nitrate

### NSAID, food (decrease effectiveness)

Caterogry class: hydralazine

direct acting vasodilators

Pharm Action:hydralazine

dilates arterioles to decrease peripheral resistance, decrease arterial BP without affecting venous pressure, increase HR, increase heart contractility

Complications: hydralazine

reflex tachycardia, dizzy, weak, fatigue, headache, fluid retention/edema, SLE (face rash, joint pain fever)

Nursing interventions: hydralazine

monitor for severe tachy, watch for hypotension, SLE symptoms, edema (crackles in lung), gradualy taper dose (dont be arupbt)

Med Admin:hydralazine

oral, IM, IV

give oral with food, gradually increase dose

IV- give undiluted with no other solutions, only to stop hypertesnive crisis

Client Edu: hydralazine

warn for headache reflex tachy, notify provider if dont subside, caution with hazardous activty, report dizzy and syncope, move slowly from lay-sit-stand, report SLE symptoms and edema

Precautions: hydralazine

CVD, cerevrovascualr disease, severe r and h impariment

Interactions: hydralazine

MAOI antidepressants ( ^ hypotension)

NSAID ( decrease effect)

Catergory Class: carvedilol (Coreg)

Alpha/Beta Blockers

Pharm Action: carvedilol (Coreg)

block both a/b receptors in heart/arterioles/kidneys to decrese blood vessel resistance, CO, and ^ excretion of water and sodium

Alpha: dilation of arterioles

Cardiac beta: decrease rate of heart and contractility

Kidney beta: decrease release renin

Complications: carvedilol (Coreg)

dizzy, hypotension, bradycardia, reduced CO, postural hypotension, exacerbation of asthma

med admin: carvedilol (Coreg)

oral, give w/food to reduce orthostatic hypotesnion

Nursing Interventions: carvedilol (Coreg)

m/r hypotension, heart rate (anything under 60)

Client Edu: carvedilol (Coreg)

report dizzy or syncope, move slowly, avoid performing hazard activity, check pulse daily

Contra: carvedilol (Coreg)

severe unstable HF, asthma, brochospastic disorder, heart block, severe bradycrdia, cardiogenic shock, preggers/lactation

PC: carvedilol (Coreg)

under 18 yo, DM, r/h disorders, PVD

Interactions: carvedilol (Coreg)

alter effectiveness of insulin/hypoglycemic meds

^ bradycardia: digoxin, MAOIS

^ blood levels of med and hypotension: Cimetidine

Catergory Class: atenolol (Tenormin), metoprolol (Lopressor)

beta blockers

pharm action: atenolol (Tenormin), metoprolol (Lopressor)

decrease heart rate and contractility, decrease CO, suppress reflex tachycardia, decrease release of renin to decrease vasoconstriction and fluid retention

complicatiosn: atenolol (Tenormin), metoprolol (Lopressor)

bradycardia, reduced CO, heart failure, SOB,e dema, coughing (esp nightime), rebound excitation (anginal pain, MI) in CHD (corn heart dis) if disrupt stop

Med Admin: atenolol (Tenormin), metoprolol (Lopressor)

oral, IV

metoprolol enhanced with food, atenolol before meals or bedtime take same time every day

Nursing Interventions: atenolol (Tenormin), metoprolol (Lopressor)

m/r HR (below 60), m/r s/s heart failure, dont stop suddenly, taper over 1-2 weeks

Client Edu: atenolol (Tenormin), metoprolol (Lopressor)

check pulse daily, dont stop abruptly, report increase in angina, SOB, edema, night coughing

contra: atenolol (Tenormin), metoprolol (Lopressor)

sinus bradycardia, greater than first degree heart block, moderate-severe HF, cardiogenic shock

A: PVD, Raynaud disease

M: under 6

PC: atenolol (Tenormin), metoprolol (Lopressor)

heart failure contrilled by digitalis and diuretics, asthma, COPD, chronic resp disorder, R/H disorder, mysasthenia gravis, hyperthyroidism, DM, depression, pheochormocytoma

Interactions: atenolol (Tenormin), metoprolol (Lopressor)

other antihypertensive drugs, digoxin, anti-acids, oral hypoglycemia, neuromuscular blockers, antimuscarinic/anticholinergic

Cat class: propranolol (Inderal LA)

Class II Beta Andrenegic BLocker

Pharm Action: propranolol (Inderal LA)

non-selective beta blocker that decreases sympathetic nervous system effect, slows HR, prolong PR interval, decreases contractility and closes calcium channel blockers

Complication: propranolol (Inderal LA)

bradycardia, reduced CO, heart failure, angina pain and MI (if stop abrupt), peripheral arterial insuff, central nervous system effects

Contra:propranolol (Inderal LA)

sinus bradycardia, 2-3 degree heart block, pulm edema, mitral/aortic valve disease, cardiogenic shock, PVD, asthma, COPD,

PC: propranolol (Inderal LA)

hyperthyroidism, r/h disorders, myasthenia gravic, cerbrovascualr disorders, DM, hypoglycemia, allergic to stinging instencts, older adults, surgery

Nursing Inter:propranolol (Inderal LA)

monitor HR, HF (SOB, peripheral edema, night cough), avoid stopping suddenly (taper 1-2 weeks), monitor for color/temp/pulses in extremties and for CNS effects

Client Edu: propranolol (Inderal LA)

check pulse daily, report HF, report angina pain, cold sensations, numbess, CNS effects

Med Admin: propranolol (Inderal LA)

oral or IV (for life threatning dysrthemmias), give at consistent times, take BP and HR before, notify if BP is less than 90

give IV bolus over 1 min or intermettint over 15-20 min

Interactions: propranolol (Inderal LA)

antihypertesnive drugs, antacids, digoxin, oral hypoglycemic, neuromuscular blockers, anti-cholingeric

Cat class: nifedipine (Adalat/Procardia)

calcium channel blocker

Pharm Action: nifedipine (Adalat/Procardia)

block calcium channels in vascular smooth muscle resulting in vasodilation and lower BP. Increases HR

complications: nifedipine (Adalat/Procardia)

reflex tachycardia, anginal pain, headache, lighthead, dizzy, facial flush, perception of heat, peripheral edema, arrhythmias, gingival hyperplasia

Contra: nifedipine (Adalat/Procardia)

children, hypersensitivty, systolic lower than 90, 2/3 degree heart block, sick sinus syndrome

refer to interactions

PC: nifedipine (Adalat/Procardia)

severe r/h impairments, HF history, geriatric

Med Admin nifedipine (Adalat/Procardia)

oral in capsules ,ER tablets, IV, likely also receiving beta blocker

Nursing Interventions: nifedipine (Adalat/Procardia)

monitor HR, lighthead, dizzy, peripheral edema, BP assist w/ambulation, inform facial flushing can occur, regular dental checkups and hygiene

Client Edu: nifedipine (Adalat/Procardia)

report rapid HR, anginal pain, swelling of feet, dizzy, syncope. Prepare for facial flushing and feeling of heat. Dental hygeien and avoid grapefruit juice

interactions: nifedipine (Adalat/Procardia)

CONTRA: concurrent use w/ grapefruit, rigamipin, rifabutin, phenobarbital, phenytoin, carbamezepin, St John wort

Cat class: furosemide (lasix)

loop diuretic

Pharm Action:furosemide (lasix)

act on asceding loop of Henle, block reabsopr of sodium and chloride