hypertension drugs Flashcards
diuretics
increase urine output by inhibiting sodium and water reabsorption by the kidney.
diuretics examples
thiazide and thiazide-like diuretics
loop diuretics
potassium-sparing diuretics
diuretic implications
- Give with food to prevent gastrointestinal upset.
- Monitor intake and output (I&O) and weight to determine fluid loss.
- Check for edema improvement in patients with heart failure and reduced blood pressure (BP) in hypertension.
- Electrolyte imbalances may occur quickly.
- Teach:
- Take during waking hours to prevent excessive urination during sleeping hours.
Thiazide and Thiazide-Like Diuretics
Increase urine output by promoting sodium, chloride, and water excretion; cause loss of potassium, sodium, and magnesium; calcium saved; no immediate effect; most effective in normal kidney function.
Thiazide and Thiazide-Like Diuretics examples
Thiazide:
- hydrochlorothiazide (HydroDIURIL)
- chlorothiazide (Diuril)
Thiazide-like:
- chlorthalidone (Hygroton)
- indapamide (Lozol)
- metolazone (Zaroxolyn)
Thiazide and Thiazide-Like Diuretics implications
- Hypercalcemia could be hazardous to the patient on digoxin.
- Monitor potassium level for hypokalemia.
- Blood glucose may increase in diabetics.
- Teach:
- Wear sunscreen and protective clothing to prevent photosensitivity.
loop diuretics
Act on ascending loop of Henle in the kidney to cause sodium and water loss; also causes loss of potassium, magnesium, and calcium.
loop diuretics examples
- bumetanide (Bumex)
- furosemide (Lasix)
- torsemide (Demadex)
loop diuretics implications
- Contraindicated if allergic to sulfonamides.
- Monitor potassium level for hypokalemia.
- Teach:
- Take with food or milk to prevent gastrointestinal upset.
- Use sunscreen to prevent photosensitivity.
Potassium-sparing Diuretics
Mild diuretic; can be used as combination therapy; promote sodium and water excretion and potassium retention by the kidney.
Potassium-sparing Diuretics examples
- amiloride (Midamor)
- spironolactone (Aldactone)
Potassium-sparing Diuretics implications
- Check potassium level for hyperkalemia before administration.
- Check BP before administration.
Sympatholytics (Beta Blockers)
Decrease sympathetic nervous system response, resulting in decreased BP, heart rate, contractility, cardiac output, and renin activity.
Sympatholytics (Beta Blockers) examples
- atenolol (Tenormin)
- metoprolol (Lopressor)
- metoprolol extended-release (Toprol XL)
- nadolol (Corgard)
- propranolol (Inderal)
- propranolol long-acting (Inderal LA)
Sympatholytics (Beta Blockers) implications
- Check heart rate and BP before administration as causes bradycardia and orthostatic hypotension.
- Check daily I&O and weight.
- Monitor for bronchospasm.
- Teach:
- Rise slowly.
- Do not stop the drug abruptly to avoid rebound hypertension, angina, or arrhythmias.
Alpha-1 Blockers
Block effects of the sympathetic nervous system on blood vessels’ smooth muscle, resulting in vasodilation and decreased BP.
Alpha-1 Blockers examples
- prazosin (Minipress)
- terazosin (Hytrin)
Alpha-1 Blockers implications
- Check heart rate and BP before administration; causes hypotension and tachycardia.
- Teach:
- Rise slowly.
Combined Alpha and Beta Blockers
Block alpha-adrenergic receptors, causing vasodilation and reduced BP; decrease sympathetic nervous system response, resulting in decreased heart rate and contractility.
Combined Alpha and Beta Blockers examples
- carvedilol (Coreg)
- labetalol (Normodyne)
Combined Alpha and Beta Blockers implications
- Check heart rate and BP before administration as causes bradycardia and hypotension.
- Check daily I&O and weight.
- Monitor edema, neck vein distention, and lung sounds.
- Teach:
- Rise slowly.
- Do not stop the drug abruptly to avoid rebound hypertension, angina, or arrhythmias.
Central-Acting Alpha2 Agonists
Block effects of sympathetic nervous system centrally.
Central-Acting Alpha2 Agonists examples
- clonidine (Catapres)
- guanfacine hydrochloride (Tenex)
Central-Acting Alpha2 Agonists implications
- Check for decreased BP and edema.
- Teach:
- Rise slowly.
- Do not stop the drug abruptly to avoid rebound hypertension, angina, or arrhythmias. Suggest gum or hard candy for dry mouth.
Angiotensin-Converting Enzyme (ACE) Inhibitors
Block production of angiotensin II, a potent vasoconstrictor, reduces peripheral arterial resistance and BP.
Angiotensin-Converting Enzyme (ACE) Inhibitors examples
- benazepril hydrochloride (Lotensin)
- captopril (Capoten)
- enalapril maleate (Vasotec)
- fosinopril (Monopril)
- lisinopril (Prinivil, Zestril)
- moexipril (Univasc)
- perindopril (Aceon)
- quinapril (Accupril)
- ramipril (Altace)
- trandolapril (Mavik)
Angiotensin-Converting Enzyme (ACE) Inhibitors implications
- Monitor patient for edema with heart failure, decreased BP with hypertension, and new-onset cough.
- Teach:
- Rise slowly.
- Report new-onset cough.
- Use sunscreen to prevent photosensitivity.
- Understand angioedema can occur anytime during therapy.
- Do not stop the drug abruptly to avoid rebound hypertension, angina, or arrhythmias.
Angiotensin II Receptor Blocker (ARB)
Blocks angiotensin II receptors, causing vasodilation and reduction in BP.
Angiotensin II Receptor Blocker (ARB) examples
- candesartan (Atacand)
- eprosartan (Teveten)
- irbesartan (Avapro)
- losartan (Cozaar)
- olmesartan (Benicar)
- telmisartan (Micardis)
- valsartan (Diovan)
Angiotensin II Receptor Blocker (ARB) implications
- Monitor patient for edema with heart failure and decreased BP with hypertension.
- Teach:
- Report new-onset cough.
- Use sunscreen to prevent photosensitivity.
Aldosterone Receptor Antagonist
Blocks binding of aldosterone at receptor site reduces sodium reabsorption and then BP.
Aldosterone Receptor Antagonist examples
eplerenone (Inspra)
Aldosterone Receptor Antagonist implications
Monitor potassium for hyperkalemia before and during therapy.
Calcium Channel Blocker (CCB)
It prevents the movement of extracellular calcium into the cell, causing vasodilation.
Calcium Channel Blocker (CCB) examples
- amlodipine (Norvasc)
- diltiazem (Cardizem)
- felodipine (Plendil)
- isradipine (DynaCirc)
- nicardipine hydrochloride (Cardene, Cardene SR)
- nifedipine (Procardia)
- nisoldipine (Solar)
- verapamil (Calan SR, Isoptin SR)
Calcium Channel Blocker (CCB) implications
- Check BP (for hypotension), heart rate (for bradycardia), arrhythmias, and angina.
- It might increase blood levels of digoxin.
Direct Vasodilators
Relax smooth muscles of blood vessels, causing vasodilation and decreased BP.
Direct Vasodilators examples
- hydralazine (Apresoline)
- minoxidil (Loniten)
Direct Vasodilators implications
- Monitor BP for hypotension/hypertension and increased heart rate.
- Treat headache with acetaminophen.
- Often given with diuretic to reduce edema resulting from water and sodium retention.
Combination Agents examples
- losartan (Cozaar) + hydrochlorothiazide (HydroDIURIL) = Hyzaar
- telmisartan (Micardis) + hydrochlorothiazide (HydroDIURIL) = Micardis HCT
