HTN Drugs Flashcards
Diuretics
Indications
hypertension, HF
Diuretics
Mechanism of action
reduce blood volume
lower BP
Diuretics
Adverse affects
Hyponatremia (low sodium in blood)
Hypokalemia (low potassium)
Hyperkalemia (high potassium)
Nocturia (urination at night)
Diuretics
Assessment
○ Obtain complete health hx
○ Obtain baseline VS and weight
○ Assess for pulmonary and peripheral edema (Auscultate lungs)
○ Obtain blood and urine samples
Diuretics
Planning
○ Pt to exhibit reduction in systolic and diastolic BP while maintaining normal electrolyte levels
○ Provide drug education regarding drug action, precautions, and possible adverse effects
○ Pt to report dizziness, headaches, hypotension
Diuretics
Interventions
monitor for…
- signs of hyperglycemia
- liver and kidney function
- signs of hypersensitivity to drug
- alcohol and caffeine use (hypotensive effect of thiazides)
- hearing and vision (loop diuretics are ototoxic)
Calcium Channel Blockers
Indications
Used for HTN, variant/vasospastic angina, Raynaud’s phenomenon and hypertrophic cardiomyopathy
heart and BV
Calcium Channel Blockers
3 categories
Arteriole selective drugs (nifedipine)
Cardioselective drugs (diltiazen)
Non-selective drugs (Verapamil)
Arteriole selective drugs
CCB
relax arterial smooth muscle
indicated for hypertension, angina, Raynaud’s
Cardioselective drugs
CCB
decreases HR and force of contraction
indicated for hypertension, angina dysrhythmias
Non-selective drugs
CCB
affect arterial smooth muscle and heart
indicated for hypertension, angina, certain dysrhythmias
Calcium Channel Blockers
Adverse effects
● Dizziness, flushing, hypotension ● Reflex tachycardia (w/ nifedipine) ● Peripheral edema ● Dysrhythmias ● Exacerbation of heart failure
Nifedipine (Adalat)
Therapeutic effects/uses:
CCB
○ Hypertension
○ Chronic stable or variant angina
Nifedipine (Adalat)
Mechanisms of action
○ Selectively blocks calcium channels in vascular smooth muscle, causing vasodilation which reduces resistance and BP
Nifedipine (Adalat)
Adverse effects
○ Hypotension
○ Dizziness
○ Headache
○ Peripheral edema
Nifedipine (Adalat)
Serious adverse effects
○ Hepatotoxicity ○ Paradoxical angina (inadequate delivery of O2 to myocardium) ○ Severe hypotension ○ Exacerbation of heart failure ○ Confusion
Nifedipine (Adalat)
Assessment
○ Obtain baseline ECG
○ Assess for pulmonary and peripheral edema
○ Assess neurological status and LOC
Nifedipine (Adalat)
Planning
○ Pt to exhibit reduced systolic and diastolic BP
○ Provide education
Nifedipine (Adalat)
Interventions
- Vs, ECG, S/S orthostatic hypotension
ACE inhibitors
Indications
HTN, HF
ACE inhibitors
Mechanism of action
Reduce production of angiotensin II
- Promotes vasodilation, reducing peripheral resistance and BP
- Reduces secretion of ADH and aldosterone, increasing urine output, decreasing blood volume and decreasing blood pressure
- Enhances effects of diuretics
ACE inhibitors
Adverse effects
○ Persistent cough (bradykinin builds up to cause irritation due to vasodilation)
○ Postural hypotension
○ Hyperkalemia
○ Angioedema
ACE inhibitors
Assessment
obtain blood and urine samples for lab testing
ACE inhibitors
Planning
Pt to maintain normal electrolyte levels throughout duration of therapy (K+ is at risk)
ACE inhibitors
○ When giving first dose, monitor pt for “first-dose phenomenon” syncope
○ Observe for angioedema at start of therapy
○ Monitor for blood dyscrasias
○ Monitor:
- S/S infection or bruising
- Liver and kidney function
- K+ levels
Angiotensin II receptor blockers
indications
HTN and HF
ARBs
Mechanism of action
- block receptors for angiotensin II in arteriolar smooth muscle and in the adrenal gland
- causes BP to fall
- arteriolar dilation and increases sodium excretion by the kidneys
(different from ACE inhibitors because it blocks the action of angiotensin II after it is formed)
ARBs
Adverse effects
○ Orthostatic hypotension, hypotension
○ First-dose phenomenon
○ Dizziness, headaches
○ Hyperkalemia
Beta 1 adrenergic antagonists (beta blockers):
Indications
Hypertension, dysrhythmias, angina
Beta Blockers
Mechanism of action
- Block beta1 receptors decreased CO
- Can be non-specific as well and block beta2 and/or alpha1 receptors
- Block sympathetic response to low blood glucose
Cardio selective beta blockers
- decreases HR and affect myocardial conduction and contractility (decreases oxygen demand)
Nonspecific beta blockers
- decreases HR and affect myocardial conduction and contractility (decreases oxygen demand)
AND
- act on respiratory system and BV, producing vasoconstriction and bronchoconstriction
Beta blockers
Adverse affects
○ Bradycardia, dysthymias
○ Hypotension
○ Bronchospasm
○ Hypoglycemia b/c it blocks body’s normal response to adjust to blood sugar, inhibits release of glucose, blocks release of insulin
Beta Blockers
Assessment/Planning
○ Obtain baseline CO and urinary output
○ Assess for presence of respiratory disease (as beta blockers can affect beta 2 receptors)
Beta Blockers
Interventions
monitor
- VS, pulse, dysrhythmias
- Signs of pulmonary edema
- Adverse effects including orthostatic hypotension, fatigue, weakness, drowsiness
- Signs of hypoglycemia
- Fluid intake and output, body weight
Alpha 1 adrenergic antagonists
Indications
HTN
Alpha 1 adrenergic antagonists
Mechanism of action
Block alpha1 receptors -> vasodilation
Alpha 1 adrenergic antagonists
Adverse effects
- orthostatic hypotension
- Tachycardia, palpitations
- Dizziness, headaches, flushing
- Nausea, vomiting
Direct-acting Vasodilators
Indications
HTN
Direct-acting vasodilators
Mechanism of action
Relax arterial smooth muscle directly causing vasodilation
Direct-acting vasodilators
Adverse effects
- Hypotension
- Reflex tachycardia
- Dizziness, headache, flushing
Prototype drug Hydralazine (Apresoline)
Therapeutic effects/uses
- Moderate to severe hypertension
- Hypertensive emergencies
- Acute heart failure
Prototype drug Hydralazine (Apresoline)
Mechanism of action
Causes peripheral vasodilation of arterioles, reducing peripheral resistance and pressure
Prototype drug Hydralazine (Apresoline)
Serious adverse effects
- Lupus-like syndrome
- Blood dyscrasias
Prototype drug Hydralazine (Apresoline)
Assessment/Planning
- Obtain baseline ECG
- Auscultate heart and chest sounds
- Assess LOC and neuro status
- Obtain blood and urine sample
Prototype drug Hydralazine (Apresoline)
Interventions
- Monitoring BP
- Monitoring dizziness, LOC
- Monitor any signs of angina
- Evaluate for lifestyle changes that may occur
HTN emergency
- Life-threatening conditions present when diastolic pressure over 120 mmHg
- Fast-acting direct vasodilators such as Nitroprusside sodium are used
- Mechanism of action: donates nitric oxide, a direct vasodilator
- Adverse effects: hypotension, flushing, dizziness, headache
