hypertensive medications

what does the Diuretic: hydrochlorothiazide treat?

treats hypertension and reduces edema

actions of hydrochlorothiazide

• decreases serum sodium levels and blood volume

• Prevents kidneys from reabsorbing sodium and chloride

• Increases excretion of sodium, chloride, and water in urine

how is hydrochlorothiazide taken?

PO

adverse effects of hydrochlorothiazide

• Dizziness, lightheadedness

• Low blood pressure (especially when standing)

• Nausea, vomiting, loss of appetite

• Dry mouth, muscle cramps, frequent urination

contraindications of hydrochlorothiazide

allergy to sulfonamides

cautions with taking hydrochlorothiazide

• Gout: increased uric acid levels

• Diabetes: altered BG

• Hyperparathyroidism: decreased Ca excretion
  
  

indications of calcium beta blockers: diltiazem

•  treatment of essential hypertension in the extended-release form

actions of diltiazem

•  relaxes smooth muscle contraction, causing vasodilation and decreased myocardial contractility

how is diltiazem taken?

po, extended release

adverse effects of dilitzaem

• Dizziness, light-headedness

• Headache

• Swelling in the legs (peripheral edema)

• Slow heart rate (bradycardia)

• Irregular heartbeat (AV block)

• Flushing, nausea

contraindications of dilitzamen

 heart block or bradycardia, renal/hepatic dysfunction

what is a commonly given calcium channel blocker?

• Nifedipine

indications of ACE inhibitor: catopril

• treats hypertension, heart failure, diabetic nephropathy, and left ventricular dysfunction after a myocardial infarction (MI)

actions of ace inhibitor: catopril

• blocks the conversion of angiotensin I → angiotensin II

how is catopril taken

PO

major adverse effects of catopril

• Renal dysfunction

• Cough

• Angioedema (rapid swelling of the deeper layer of the skin)

• Neutropenia (low levels of WBCs)

• Not used in pregnancy!

nurse teachings regarding catopril

• Avoid salt substitutes containing potassium (to avoid hyperkalemia)

• Report any swelling, hoarseness, difficulty breathing, fever, or sore throat

whats another ace inhibitor that is commonly given?

lisinopril

indications of ARBS: losartan

• treats hypertension and diabetic nephropathy 

actions of arbs: losartan

• blocks the effects of angiotensin II on blood vessels

contraindications of losartan

pregnancy and lactation

caution with losartan

•  hepatic or renal dysfunction

action of Direct renin inhibitors: Aliskiren

•  directly inhibits renin, which results in decreased formation of angiotensin II (vasoconstrictor)

contraindications with aliskiren

• pregnancy, concomitant use of ACEIs or ARBs, severe renal impairment

adverse effects of aliskiren

angioedema, will decrease aldosterone levels, so monitor for hyperkalemia

drug interactions with alliskiren

• ACEIs, ARBs, K+ supplements, and NSAIDs (renal dysfunction)

Actions of Cardioselective (β₁): atenolol OR Non-cardioselective (β₁ and β₂): propranolol

•  blocks SNS stimulation of beta receptors (decrease in HR, decrease in myocardial contractility, slowing of AV node conduction time, and vasodilation)

what does Cardioselective (β₁): atenolol OR Non-cardioselective (β₁ and β₂): propranolol treat?

•  treats hypertension and cardiac conditions

adverse effects of Cardioselective (β₁): atenolol OR Non-cardioselective (β₁ and β₂): propranolol

• bradycardia, dizziness, HF, impotence, bronchospasm, decreased exercise tolerance, gastric pain, or flatulence

warning for Cardioselective (β₁): atenolol OR Non-cardioselective (β₁ and β₂): propranolol

• stopping suddenly can cause life-threatening arrhythmias, hypertension, or myocardial ischemia!

contraindications for Cardioselective (β₁): atenolol OR Non-cardioselective (β₁ and β₂): propranolol

• severe bradycardia, AV heart block, shock, uncompensated HF, nonselective type in COPD/asthma

• Always assess for signs of decreased CO, HF, bronchoconstriction, and hypoglycemia in diabetes

indications of Beta and alpha: labetalol

hypertension alone or in combination

actions of beta and alpha: labetalol

• blocks alpha- and beta-receptors in the SNS

how is labetalol given

IM or PO

contraindications of labetalol

• Bradycardia or heart block

• Shock or HF

cautions with labetalol

•  bronchospasm, asthma

drug interactions with labetalol

calcium channel blockers

nursing considerations with labetol

•  may cause orthostatic hypotension

action of Alpha₂ agonists: clonidine

•  stimulates alpha2 receptors, which leads to decreased sympathetic outflow; inhibits tachycardia and vasoconstriction

how is Alpha₂ agonists: clonidine given

PO or transdermal patch

special nursing considerations with clonidine

• Can cause sedation (caution using other sedation meds)

• Monitor for orthostatic hypotension, especially in older adults

• Should not be abruptly discontinued (withdrawal)

indication of Vasodilator: nitroprusside

•  severe hypertension or uncontrolled BP during anesthesia or acute heart failure

action of nitropruisside

potent dilation of arteries

how is nitroporuisside given

IV

caution with nitroporuisside

•  PAD (peripheral artery disease), CAD (coronary artery disease), HF (heart failure), or tachycardia

nursing considerations with nitroporuisside

• Med has a brownish tint and is sensitive to light (cover bag)

• Assess for signs of cyanide toxicity (bright red venous blood, metabolic acidosis, air hunger, confusion, death)

• Start oral antihypertensives quickly to decrease the time needed on this med

commonly given form of nitroporuisside?

Hydralazine