AH1 - Meds for HTN

Diuretics
- • Potassium-sparing: spironolactone
  • Loop: furosemide; bumetanide
  • Thiazide: hydrochlorothiazide; chlorothiazide
- Diuretic nursing implications:
  - Assess for weakness, dizziness, or a new onset of confusion because these drugs can cause hypovolemia and dehydration.
    Teach older adults to rise slowly because the medication can cause orthostatic hypotension associated with diuresis.
    For potassium-sparing agents:
    • Teach the patient to decrease intake of foods that are high in potassium and to undergo follow-up laboratory tests for electrolyte levels because these agents cause retention of K+ in the body.
    • Teach the patient to report weakness and irregular pulse to the primary health care provider because these symptoms may indicate hyperkalemia.
    For loop and thiazide agents:
    • Teach the patient to eat foods high in K+ and to undergo follow-up laboratory tests to monitor electrolyte levels because these agents cause K+ and Mg2+ excretion.
    • Use with caution in patients with diabetes because glucose control can be affected.
    • Use with caution in patients with gout because uric acid retention can occur.

Beta blocker
- examples:
  - • Atenolol
    • Metoprolol
- Beta blocker nursing implications:
  - Assess heart rate (HR) and blood pressure (BP) before administration because beta blockers cause a decrease in HR and cardiac output and suppress renin activity.
    • Do not administer if HR is <50–60 beats/min.
    • Hold for systolic <90–100 mm Hg and contact the health care provider.
    • Monitor for orthostatic hypotension because this is a common adverse effect that can contribute to falls and confusion, especially in older adults.
    Use with caution in patients with diabetes because glucose production may be affected.
    Teach the patient that these agents can cause fatigue, depression, and sexual dysfunction. These adverse effects should be reported to the primary health care provider.

Ca channel blockers
- examples
  - • Verapamil
    • Amlodipine
    • Diltiazem
- nursing implications for CCBs
  - Monitor pulse and BP before taking each day because the drug slows SA and AV conduction, which decreases HR and vasodilation and causes decreased BP.
    Teach patients to avoid grapefruit juice and grapefruit while taking calcium channel blockers because grapefruit and its juice can enhance the action of the drug, causing organ dysfunction or death.

Angiotensin converting enzyme (ACE) inhibitors
- examples:
  - • Lisinopril
    • Enalapril
    • Captopril
- nursing implications for ACE inhibitors
  - Report persistent, dry cough to the primary health care provider because this is a common and annoying side effect; another type of antihypertensive medication may be necessary.
    Monitor BP carefully, especially orthostatic pressures, because these agents result in vasodilation and decreased BP.
    • Do not give the drug without checking with the health care provider if systolic BP is below 100.
    •Assess for hyperkalemia because ACE inhibitors reduce the excretion of potassium.

Angiotensin 2 receptor blockers (ARB)
- examples
  - • Valsartan
    • Losartan
- nursing implications for ARBs
  - Teach patients to avoid foods high in potassium because ARBs can cause hyperkalemia, especially when combined with other hypertensive agents.
    Monitor BP carefully, especially orthostatic pressures, because these agents result in vasodilation and decreased BP.
    Do not give the drug without checking with the health care provider if systolic BP is below 100.