Antihypertensive Drugs Flashcards
Captopril
Functional Classification
Antihypertensive
Captopril
Mechanism of Action
Selectively suppresses renin-angiotensin-aldosterone system; inhibits ACE; prevents conversion of angiotensin I to angiotensin II
Captopril
Uses
Hypertension, CHF, left ventricular dysfunction after MI, diabetic nephropathy
Captopril
Contraindications
Breastfeeding, children, hypersensitivity, heart block, potassium-sparing diuretics, bilateral renal artery stenosis, angioedema, Pregnancy (D)
Captopril
Side Effects
CNS: fever, chills
CV: Hypotension, postural hypotension, Tachycardia, angina
GI: loss of taste, increased LFT’s
GU: impotence, dysuria, nocturia, proteinuria, NEPHROTIC SYNDROME, ACUTE REVERSIBLE RENAL FAILURE, polyuria, oliguria, urinary frequency
HEMA: NEUTROPENIA, AGRANULOCYTOSIS, PANCYTOPENIA, THROMBOCYTOPENIA, anemia
INTEG: rash, pruritus
MISC: ANGIOEDEMA, hyperkalemia
RESP: BRONCHOSPASM, Dyspnea, Cough
Captopril
Nursing Considerations
ASSESS:
- BLOOD DYSCRASIAS: blood studies: decreased platelets; WBC with differential at baseline and periodically q3mo; if neutrophils <1000/mm3, discontinue treatment (recommended with collagen-vascular or renal disease)
- HYPERTENSION: BP, pulse rates at baseline, frequently
- Renal studies: protein, BUN, creatinine; watch for raised levels, may indicate nephrotic syndrome; increased LFTs, uric acid; glucose may be increased
- Allergic reaction: rash, fever, pruritus, urticaria; discontinue product if antihistamines fail to help
- CHF: edema, dyspnea, wet crackles, increased BP, weight gain
Captopril
Overdose Treatment
0.9% NaCl IV/INF; hemodialysis
Clonidine
Functional Classification
Antihypertensive
Clonidine
Chemical Classification
Central alpha-adrenergic agonist
Clonidine
Mechanism of Action
Inhibits sympathetic vasomotor center in CNS, which reduces impulses in sympathetic nervous system; blood pressure, pulse rate, cardiac output decrease, prevents pain signal transmission in CNS by alpha-adrenergic receptor stimulation of the spinal cord
Clonidine
Uses
Mild to moderate hypertension, used alone or in combination; severe pain in cancer patients (epidural)
Clonidine
Contraindications
Hypersensitivity; (epidural) bleeding disorders, anticoagulants
Clonidine
Side Effects
CNS: Drowsiness, Sedation, Headache, Fatigue, nightmares, insomnia, mental changes, anxiety, depression, hallucinations, delirium
CV: Orthostatic Hypotension, Palpitations, CHF, ECG abnormalities, sinus tachycardia
EENT: taste change, parotid pain
ENDO: hyperglycemia
GI: Nausea, Vomiting, Malaise, constipation, Dry Mouth
GU: impotence, dysuria, nocturia, gynecomastia
INTEG: Rash, alopecia, facial pallor, pruritus, hives, edema, burning papules, excoriation (transdermal patches)
MISC: withdrawal symptoms
MS: muscle, joint pain; leg cramps
Clonidine
Nursing Considerations
ASSESS:
- HYPERTENSION: BP, pulse; report significant changes
- OPIATE WITHDRAWAL (UNLABELED): fever, diarrhea, nausea, vomiting, cramps, insomnia, shivering, dilated pupils
- CANCER PAIN: location, intensity, character, alleviating, aggravating factors at baseline and frequently
- Edema in feet, legs daily; monitor I&O; check for falling output
- ALLERGIC REACTION: rash, fever, pruritus, urticaria; product should be discontinued if antihistamines fail to help
- CHF: edema, dyspnea, wet crackle, BP
- Renal symptoms: polyuria
Clonidine
Overdose Treatment
Supportive treatment, administer tolazoline, atropine, DOPamine prn
Hydralazine
Functional Classification
Antihypertensive, direct-acting peripheral vasodilator
Hydralazine
Chemical Classification
Phthalazine
Hydralazine
Mechanism of Action
Vasodilates arteriolar smooth muscle by direct relaxation; reduction in blood pressure with reflex increases in heart rate, stroke volume, cardiac output
Hydralazine
Uses
Essential hypertension; severe essential hypertension
Hydralazine
Contraindications
Hypersensitivity to hydralazine’s, mitral valvular rheumatic heart disease, CAD
Hydralazine
Side Effects
CNS: Headache, Tremors, Dizziness, Anxiety, peripheral neuritis, depression, fever, chills
CV: Palpitations, Reflex Tachycardia, Angina, SHOCK, rebound hypertension, orthostatic hypotension
GI: Nausea, Vomiting, Anorexia, Diarrhea, constipation, paralytic ileus
GU: urinary retention, glomerulonephritis, hematuria
HEMA: LEUKOPENIA, AGRANULOCYTOSIS, anemia, THROMBOCYTOPENIA
INTEG: rash, pruritus, urticaria
MISC: nasal congestion, muscle cramps, Lupuslike Symptoms, flushing, edema, dyspnea
Hydralazine
Nursing Considerations
ASSESS:
- Cardiac status: BP q5min x 2hr, the q 1hr x 2hr, then q4hr; pulse, jugular venous distention q4hr
- Electrolytes, blood studies: K, Na, Cl, CO2, CBC, serum glucose, LE prep, ANA titer before, during treatment; assess for fever, joint pain, rash, sore throat (lupuslike symptoms); notify prescriber
- Weight daily, I&O
- Edema in feet, legs daily, skin turgor, dryness of mucous membranes for hydration status
- Crackles, dyspnea, orthopnea
- IV site for extravasation, rate
- Mental status: affect, mood, behavior, anxiety; check for personality changes
Hydralazine
Overdose Treatment
Administer vasopressors, volume expanders for shock; if PO, lavage or give activated charcoal, digitalization
Losartan (Cozaar)
Functional Classification
Antihypertensive
Losartan (Cozaar)
Chemical Classification
Angiotensin II receptor (type AT1) antagonist
Losartan (Cozaar)
Mechanism of Action
Blocks the vasoconstrictor and aldosterone-secreting effects of angiotensin II; selectively blocks the binding of angiotensin II to the AT1 receptor found in tissues
Losartan (Cozaar)
Uses
Hypertension, alone or in combination; nephropathy in type 2 diabetes; proteinuria; stroke prophylaxis for hypertensive patients with left ventricular hypertrophy
Losartan (Cozaar)
Contraindications
Hypersensitivity
Losartan (Cozaar)
Side Effects
CNS: Dizziness, Insomnia, anxiety, confusion, abnormal dreams, migraine, tremor, vertigo, headache, malaise, depression
CV: angina pectoris, 2nd-degree AV block, CEREBROVASCULAR ACCIDENT, hypotension, MI. Dysrhythmias
EENT: blurred vision, burning eyes, conjunctivitis
GI: Diarrhea, Dyspepsia, anorexia, constipation, dry mouth, flatulence, gastritis, vomiting
GU: impotence, nocturia, urinary frequency, UTI, RENAL FAILURE
HEMA: anemia, THROMBOCYTOPENIA
INTEG: alopecia, dermatitis, dry skin, flushing, photosensitivity, rash, pruritus, sweating, ANGIOEDEMA
META: gout
MS: cramps, myalgia, pain, stiffness
RESP: Cough, Upper Respiratory Infection, congestion, dyspnea, bronchitis
Losartan (Cozaar)
Nursing Considerations
ASSESS:
- BP with position changes, pulse before and periodically during treatment; note rate, rhythm, quality
- Baselines of renal, hepatic studies before therapy begins and periodically thereafter
- Skin turgor, dryness of mucous membranes for hydration status
- Angioedema: facial swelling, dyspnea, wheezing; may occur rapidly; tongue swelling (rare)
- CHF: jugular venous distention; edema in feet/legs, weight daily
- BLOOD DYSCRASIAS: thrombocytopenia, anemia (rare)
- Pregnancy before starting treatment: pregnancy (D) 2nd/3rd trimester
Captopril
Chemical Classification
Angiotensin-Converting Enzyme (ACE) inhibitor
