diuretic drugs and hypertension drugs

Question 1

Diltiazem( cardizem, dilacor, taztia) for HTN and angina

Answer 1

Therapeutic Class:
Drug for angina, hypertension, and
dysrhythmias

Pharmacologic Class:
Calcium channel blocker

Actions and Uses
inhibits the transport of calcium into
myocardial cells.relax both coronary and peripheral blood vessels, bringing more oxygen to the myocardium and reducing cardiac workload. When given PO,
indications for diltiazem include stable and variant angina as well as HTN. Diltiazem is available by the IV route for the treatment of
atrial dysrhythmias.

Risks/ alert:
* During I V administration, the patient must be continuously monitored, and cardioversion equipment must be available.
* The various extended-release forms have different dosages and are not interchangeable.
* Extended-release tablets and capsules should not be crushed or split.
* Pregnancy category C.

Pharmacokinetics:
onset- 30-60min ( IR); 2-3hrs (ER): 3 min (IV)
peak- 2-3 hrs (IR); 6-11hrs (ER)
duration- 6-8hrs (IR); 12hrs (ER)

AE:
vasodilation: headache, dizziness, and edema of the ankles and feet. Abrupt withdrawal may precipitate an acute anginal episode.

Contraindications:
AV heart block, sick sinus syndrome, severe hypotension, bleeding
aneurysm, or those undergoing intracranial surgery.

Interactions
Drug–Drug:
with other cardiovascular drugs, particularly digoxin or beta-adrenergic blockers, may cause partial or complete heart block, heart failure,
or dysrhythmias. Additive hypotension may occur if used with ethanol, beta blockers, or antihypertensives. Diltiazem and
dantrolene should never be used in combination because cardiovascular collapse may result.

Herbal/food:
ginseng= decrease effectiveness. Garlic, hawthorn and goldenseal= increase antihypertensive effect of diltiazem

Overdose:
calcium chloride

Question 2

Potassium sparing — spironolactone

Answer 2

Route:
PO 25-110mg/day ( max 50)

AE:
dysrhythmias from hyperkalemia, dehydration, hyponatremia, fatigue, headache

• Treat heart failure when systolic
  dysfunction is present (later stage HF)
• action is to retain sodium & water
• contradicted in prego women
• teach pt to avoid salt and potassium

Question 3

thiazide — hydrochlorothiazide

Answer 3

route:
PO 25-100mg/day ( max 50 )

AE:
hypokalemia, electrolyte depletion, dehydration, hypoTN, hypoNa+, coma

-decrease the reabsorption of sodium. blocks
reabsorption, more sodium is sent into urine, and water follows
– Monitor blood glucose and uric acid levels
– Possible need to increase potassium in diet or with supplements
– Monitor potassium and sodium for hypokalemia and hyponatremia
– Pregnancy Category B
– Monitor for hx of lupus, and those who take digoxin

Question 4

Loop diuretic —Furosemide

Answer 4

PO: 20-80 mg/day (max 600)

AE:
hypoNa+, tinnitus, dehydration, ototoxicity

turn off the sodium pumps in the
nephron tube in a different place from thiazide diuretics.
– Severe potassium loss – hypokalemia
– Calcium loss in urine
– Hypotension
– Hearing loss (these drugs are ototoxic)
– Glucose and uric acid levels
– Pregnancy category C

Question 5

CCB for HTN and angina

Answer 5

BV:
-AMLODIPINE (norvasc) PO: 5-10mg daily

AE: flushed skin, peripheral edema, constipation, sexual dysfunction

-NIFEDIPINE (adalat, procardia) PO 10-20mg tid

AE: hepatotoxicity, MI, HF, angioedema

CCB relaxes smooth muscle reducing cardiac workload

AE: hypoTN, bradycardia, HF

Question 6

Nifedipine (adalat, procardia)

Answer 6

Therapeutic Class:
Drug for hypertension and angina

Pharmacologic Class:
Calcium channel blocker

Actions and Uses
prescribed for HTN and angina. It is occasionally used to treat Raynaud’s phenomenon (off-label). Nifedipine acts by selectively blocking calcium channels in myocardial and vascular smooth muscle, including those in
the coronary arteries. This results in coronary artery dilation, less oxygen
utilization by the heart, an increase in cardiac output, and a fall in blood
pressure. It is available as immediate-release capsules and as extended-
release tablets (XL). The immediate release forms are not approved for HTN.

Risk/ alert:
Do not administer immediate-release formulations of nifedipine if an impending MI is suspected or within 2 weeks following a confirmed MI.
* Administer nifedipine capsules or tablets whole. If capsules or extended-release tablets are chewed, divided, or crushed, the entire dose will be delivered at once.
* Pregnancy category C.

pharmacokinetics:
onset- 30 min
peak- 6 hrs
duration- 24hrs

AE:
vasodialation— headache, dizzy, peripheral edema and flushing. Cam cause tachy. Drug should be discontinued gradually.

Contraindication:
hypersensitivity and to other CCBs

Interactions:
drug to drug- When given concurrently with other antihypertensives, additive effects on blood pressure will result. Concurrent use of nifedipine with a beta blocker
increases the risk of HF. Nifedipine may increase serum levels of digoxin, leading to bradycardia and digoxin toxicity.
Nifedipine can increase the effect of statins by affecting metabolism. Alcohol potentiates the vasodilating action of nifedipine and could lead to syncope caused by a severe drop in blood pressure.

Lab: increase alkaline phosphates, lactase dehydrogenase, Alt, creatine, and AST and CPK

herbal/ food: grapefruit juice and melatonin increases BP and HR

overdose: calcium infusions

Question 7

Nurse role on CCB

Answer 7

• monitor BP (orthostatic hypotension) , ECG (EKG)
• do not drink grape juice

Question 8

ACE inhibitors (-pril) for HTN and MI

Answer 8

ENALAPRIL
- PO
- angioedema, acute renal failure, fetal toxicity

MOA: reduces levels of angiotensin II reducing vasoconstriction.

response: vasodilation of BV = decreasing BP

SE: hypoTN, dry cough, hyperkalemia

AE: swelling, trouble swallowing, stomach pain, yellow eyes/skin, renal insufficiency

LISINOPRIL

same AE as enalapril

Question 9

ARBS (-artan) ( angiotensin II receptor bloker) for HTN

Answer 9

LOSARTAN & VALSARTAN
- AE: angioedema, acute renal failure, fetal toxicity

2nd choice of ACE inhibitors if pt is allergic ( ARBS are more tolerable)

Question 10

Role of nurse: ACE inhibitors

Answer 10

BEFORE—>
-Check baseline of VS, weights and I/Os
-are they taking other antihypertensive meds or diuretics = hypoTN

AFTER—>
- check K+, I/O, weight
- infections, angio edema

PT EDUCATION—>
- take drug at same time each day
- no alcohol
- no salt

Risk:
- pediatrics are more sensitive
- Peg. D

Question 11

Beta Adrenergic Blockers (BB)

Answer 11

(-olol)

• Intended use for pt with HF, HTN, and angina/MI
• Intended response: decrease HR and contractility

Question 12

Atenolol (Tenormin)

Answer 12

** first line drug for angina

Therapeutic Class:
Drug for angina, MI, and hypertension

Pharmacologic Class:
Beta-adrenergic blocker

Actions and Uses
Selectively blocks beta1-adrenergic receptors in the heart. Its effectiveness in treating angina is attributed to its ability to slow heart
rate and reduce contractility lowering myocardial oxygen demand. Go slow and low until reached therapeutic effect

Risk:
- assess pulse and BP before, during and after administration
-Preg. D

Pharmacokinetics:
onset- 1hr
peak- 2-4hrs
duration- 12-24hrs

AE:
fatigue, weakness, bradycardia, and
hypotension.

BLACK BOX WARNING: Abrupt discontinuation should be avoided in patients with ischemic heart disease; doses should be gradually
reduced over a 1- to 2-week period. If angina worsens during the withdrawal period, the drug should be reinstituted.

Contraindications:
Because atenolol slows heart rate, it should not be
used in patients with severe bradycardia, atrioventricular (AV) heart block, cardiogenic shock, or decompensated HF. Due to its vasodilation
effects, it is contraindicated in patients with severe hypotension.

Interactions —>
Drug–Drug:
Concurrent use with CCBs may result in excessive cardiac suppression. Use with digoxin may slow AV conduction, leading to heart block. Concurrent use of atenolol with other antihypertensives may result
in additive hypotension. Anticholinergics may cause decreased absorption (GI) tract.

Lab Tests:
increase uric acid, lipids, potassium, creatinine, and antinuclear antibody

Treatment of Overdose: severe hypotension and bradycardia. Atropine or isoproterenol = reverse bradycardia. Atenolol can be removed from the
systemic circulation by hemodialysis.

Question 13

Role of Nurse: BB

Answer 13

BEFORE:
BP, daily weights, glucose levels, respiratory

AFTER:
HR, BP, SOB?

PT TEACHING:
pulse and BP
s/s
avoid orthostatic hypoTN

Risk:
- Preg C or D
- mental confusion

Question 14

Alpa 1 Adrenergic Antagonists ( blockers)

Answer 14

( -zosin)

• not the first line drugs for HTN
• usually combined with diuretics and beta blocker

Question 15

Doxazosin (cardura)

Answer 15

Therapeutic Class:
Drug for hypertension and benign prostatic
hyperplasia

Pharmacologic Class:
Alpha1-adrenergic blocker

Actions and Uses:
selective for blocking alpha1 receptors in vascular smooth muscle, it has few adverse effects on other autonomic organs and is
preferred over nonselective beta blockers. It dilates arteries and veins and is capable of causing a rapid fall in blood pressure. Doxazosin and several other alpha1-adrenergic blockers also relax smooth muscle
around the prostate gland. Patients who have benign prostatic hyperplasia
(BPH) sometimes receive this drug to relieve symptoms of dysuria. The extended release form of doxazosin is
approved to treat BPH but not HTN

Risks/alert:
-monitor closely for HypoTN and syncope 2-6hrs following first doses
- Preg. B

Pharmacokinetics:
onset- 4-8hrs BP or 2 wks BPH
peak- 2-3hrs
duration- 24hrs

AE:
dyspnea, asthenia, HypoTN, orthostatic hypoTN and somnolence.

Contraindications:
pts with prior hypersensitivity to alpha 1- blockers

interactions–>
drug-drug: with phosphodiesterase-5 inhibitors (sildenafil) = lowering BP and symptomatic hypoTN. NSAIDs decreases antihypertensive action of doxazosin

overdose: you’ll know if they have HypoTn and it will be treated with a vasopressor and/or IV infusion of fluids

Question 16

Alpha 2- Adrenergic Agonists

Answer 16

• dilates arteries= lowering BP and hearts workload
• only prescribed when its very difficult to control hypoTN

The safest one is:
-METHYLDOPA on those who are pregnant and breastfeeding
*clonidine hasn’t been researched in pregnancy and breastfeeding

Question 17

Rule of a nurse: adrenergic antagonists

Answer 17

• baseline of VS
• ECG
• watch for heart block and rebound HypoTN
• if diabetic check glucose level
  RISK—–> B and C

Question 18

Direct vasodilators

Answer 18

NITROPRUSSIDE IV
- used for hypertensive emergencies during L&D

Question 19

Hydralazine

Answer 19

Therapeutic Class:
Drug for hypertension and heart failure

Pharmacologic Class:
Direct-acting vasodilator

Actions and Uses:
first oral antihypertensive drugs
marketed. Its a direct vasodilation
of arterial smooth muscle NOT veins.
Tolerance to the drug develops and a dosage increase may be necessary. Drugs in other antihypertensive classes have largely
replaced hydralazine due to safety concerns. The parenteral formulations of hydralazine are for the treatment of hypertensive
emergency.
Hydralazine with isosorbide dinitrate are combined to treat HF in AF pts

Risks/alerts:
-rebound if abruptly stop
- Preg C

Pharmacokinetics:
onset- 20-30min PO; 10-30 min IM ; 5-20min IV
peak- 1-2hrs PO and IM; 30-45min IV
duration- 3-8hrs PO; 1-4hrs IV

AE:
tachychardia, palpitations, flushing. Sodium and fluid retention

Contraindications:
contraindicated in patients with angina or rheumatic mitral valve heart disease. Patients with lupus should not receive hydralazine, because the drug can worsen symptoms.

interactions—->
Drug–Drug:
hydralazine with other antihypertensives= hypotension. NSAIDs may decrease the antihypertensive action of
hydralazine.

Lab Tests:
May produce a false-positive Coombs’ test.

Herbal/Food: Hawthorn should be avoided =
hypotensive

Treatment of Overdose:
hypotension–> treated with a vasopressor and/or an IDrug–Drug: Administering hydralazine with other antihypertensives may
cause severe hypotension. This includes all drug classes used as
antihypertensives. N S A I Ds may decrease the antihypertensive action of
hydralazine.
Lab Tests: May produce a false-positive Coombs’ test.
Herbal/Food: Hawthorn should be avoided because it may cause additive
hypotensive effects.
Treatment of Overdose: The most likely sign of overdosage is
hypotension, which may be treated with a vasopressor and/or IV infusion of fluids.