Antihypertensive Drugs Flashcards
Name the four SECOND line (alternate) treatments.
Alpha1-adrenergic antagonists, Alpha2-adrenergic agonists, Direct acting vasodilators, Peripheral adrenergic antagonist.
Name the five FIRST LINE antihypertensive drug classes.
Diuretics, Angiotensin converting enzyme (ACE) inhibitors, Angiotensin II receptor blockers (ARBs), Calcium channel blockers, Beta-adrenergic antagonists
What type of medication treatment should be started first ?
Thiazide Diuretic
The job of this drug class is to reduce blood volume lowering pressure
Diuretics
What are the general adverse s/e of diuretics ?
Dehydration, hyponatremia, hypokalemia (less with potassium sparing diuretics), nocturia (if taken too late in the day)
Name the three types of diuretics.
Thiazide, potassium sparing and high ceiling loop diuretics
**Enhances effect of lasix
Blocks reabsorption of sodium and chloride in the distal convoluted tubule causing water to be retained –> increasing flow of urine
A/E- hyperglycemia, dizziness, stomach upset, orthostatic hypotension, hyponatremia, HYPOKALEMIA, blurred vision
Hydrocholorthiazide (Hydrodiuril)
-Thiazide (most common diuretic for HTN)
**Increase urine production, but spare K
Blocks the action of aldosterone in the distal nephron
A/E- hyperkalemia
Drug interactions-
Triamterene and Spironolactone
-Potassium sparing
**Usually not used for HTN, but for patients w/ low GFR. Diuresis in 5 mins with IV
Blocks reabsorption of sodium and chloride in the ascending Loop of Henle preventing reabsorption of water and producing profound diuresis
A/E- severe hyponatremia, HYPOKALEMIA, hypocloremia, dehydration and ototoxicity
Furosemide and Bumetanide
-Loop diuretics
What are the nursing responsibilities for giving a Loop Diuretic ?
Obtain weight, baseline VS and electrolytes, patient teaching
Administer Lasix w/ food, administer IV injections slowly over 1-2 mins
What are the nursing responsibilities when giving potassium sparing diuretics ?
Obtain baseline electrolytes
Effects are seen in 1-2 days
What are the nursing responsibilities when giving Thiazide and related Diuretic?
Obtain baseline weight, VS, and electrolytes (K, Na, Glucose), know the patient’s GFR
**Arteriole selective drug
Blocks calcium channels in the vascular smooth muscle only
Indirect effects- increase Hr and force of contraction when used w/ fast actne formula
Nifedipine (Procardia), Amlodipine
-Calcium channel blocker
**Non- selective drugs. Affect myocardial contraction and HR
Blocks calcium channels in the heart and blood vessels
Verapamil, Diltazem (Cardiazem)
–Calcium Channel blockers
What are the adverse effects of calcium channel blockers ?
Reflex tachycardia, peripheral edema, dizziness, 2nd and 3rd degree heart block, exacerbation of some dysrhythmias and heart failure.
What are the nursing responsibilities when administering calcium channel blockers ?
Obtain baseline ECG and watch PO and IV dosages
Can exacerbate effects of digoxin
✋ Use cautiously in patients w/ AV block
The job of this drug class is the 1) reduce HR and contractility —> lowers myocardial oxygen demand, 2) reduces dysrhythmias, 3) protects against MI, **4) exacerbate asthma (first generation)
Beta blockers
How many beta blocking agents are there?
Three. First generation, second generation and third generation beta blocking agents
First generation (noncardioselective) Beta block agent that blocks B1 and B2
Propranolol (Inderal), Timolol (Blocadren)
Second generation (cardioselective) block only B1
Metoprolol (Lopressor), Atenolol (Tenormin)
Third generation (vasodilating)
Normodyne (Labetalol)
What are the other names that beta blockers what be referred to ?
Beta-adrenergic blocking agents, beta-adrenergic antagonists, or beta antagonists
Name the four MOA for the beta blocker Metoprolol (Lopressor).
1) Decreases HR, contractility though the AV node and CO
2) Supress flex tachycardia caused by vasodilators
3) Reduces renin –> reduces Angiotensinogen II vasoconstriction
4) Decreases PVR w/ long term use
What conditions would Metoprolol (Lopressor) be used for?
HF, HTN, stable angina, MI
In what conditions, would Metoprolol (Lopressor) NOT be used for ?
Severe hypotension, severe bradycardia, advanced AV heart block, cardiogenic shock, demcompensted HF, stroke, major depression, **severe renal disease
What are the nursing responsibilities when administering Metoprolol (Lopressor) ?
Assess BP and HR before administration, Assess pulmonary status, monitor apical pulse and VS throughout dosage adjustment, monitor for adverse effects, D/C slowly
What patient/family teaching will you teach a patient taking Metoprolol (Lopressor)?
Do not drive until effects are known, make position changes slowly, do not breast feed, monitor for blood glucose frequently if patient is diabetic.
Name the three beta adrenergic antagonists.
1) Propanolol (Inderal)
2) Timolol (Blocardren
3) Nadolol (Corgard)
What is the function of the alpha1-adrenergic antagonists?
Relax arterial and venous smooth muscle
Name the adverse side effects of taking alpha1-adrenergic antagonists ?
Orthostatic hypotension, first dose hypotension, weakness, dizziness, dry mouth, headache, nausea, and vomiting
Name the alpha1-adrenergic antagonists drug?
Prazosin
What is the function of the Alpha2 Agonist ?
Activate central alpha2 receptors and reduce sympathetic nerve impulses
Name the adverse effects when taking alpha2 agonists.
Sedation, dizziness, orthostatic hypotension
What are the two alpha2 agonists drugs ?
Methyldopa and Clonidine
Converted to “false” neurotransmitter in brain stem; causes shortage of “real” neurotransmitter and inhibition of sympathetic nervous system; creates less peripheral resistance and BP declines
Methyldopa (Alomet)
- Alpha2 agonists
In what health condition would you give Methyldopa (Aldomet) ?
HTN that has not responded adequately to safer antihypertensives
In what health conditions would you NOT give Methyldopa (Alomet) ?
Serious liver disease, blood dyscrasia, **renal impairment
What are the five drug interactions when taking Methyldopa (Aldomet) ?
1) additive hypotension w/ other antihypertensives and ethanol
2) increase risk of lithium toxicity
3) reduced antihypertensive actions with phenothiazine, TCAs, and NSAIDS
4) iron salts interfere w/ drug absorption
5) psychosis may develop if used w/ levodopa
Name the adverse effects when taking Methyldopa (Aldomet) .
Drowsiness, depression, headache, sedation, bizzare dreams, decreased libido/impotence, peripheral edema, hepatotoxity, **Positive Coombs test
What are the nursing responsibilities when administering Methyldopa (Aldomet) ?
Obtain a completed physical assessment and health history; check BP/ pulse q 30 mins when IV infusing; minimize daytime sedation; assess for adverse effects, monitor fluid/ electrolyte balance, I&O and weight
What should you teach your patient/family members about taking Methyldopa (Aldomet) ?
1) shake suspension well before measuring dose
2) do not take with any other drugs or herbal supplements
3) make position changes slowly
4) do not stop taking medication
5) do not breastfeed
Name the angiotensin converting enzyme (ACE) inhibitor drugs.
Enalapril (Vasotec); Lisnopril (Prinvil, Zestril); Captopril (Capoten)
This drug class is responsible for 1) vasodilation by reducing Angiotensin II, 2) increases effectiveness of diuretics, 3) protects kidneys
Angiotensin converting enzyme (ACE) inhibitors
What are the adverse effect when taking ACE inhibitors ?
PERSISTANT COUGH, postural hypotension, angioedema (fatal ->treat with epinephrine subQ
What are the drug interactions when taking ACE inhibitors ?
What are the nursing responsibilities when administering ACE inhibitors?
Check K levels
Only Enalapril is administered IV –> watch for dose
Dosage for all ACE’s should be adjusted for renal patients–> especially renal artery stenosis
