Antihypertensive Drugs Flashcards
Captopril
Chemical Classification
Angiotensin-Converting Enzyme (ACE) inhibitor
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
