Hypertension Medications Flashcards
general diuretics MOA
- inc urinary output
- dec circulating vol
- dec arterial resistance
- lower BP to decrease cardiac output*
diuretics extra info
- can enhance effects of other hypertensives
- least expensive
- typically first line therapy for many
hydroclorothiazide class
thiazide diuretic
hydroclorothiazide moa
inhibits absorption of Na/K/Cl in distal convoluted tubules
- increases water loss which decreases cardiac output
relaxes arterioles
- dec peripheral resistance
hydroclorothiazide side effects
- electrolyte and metabolic disturbances
- hypokalemia
- orthostatic hypotension
- may worsen renal insufficiencies
- hyperuricemia
- can elevate levels of glucose, cholesterol, and triglycerides
furosemide class
loop diuretic
furosemide moa
inhibits kidneys ability to reabsorb Na in loop of Henle
- Na goes into urine and water follows
- dec fluid in bv so dec cardiac output
- IV or PO
furosemide side effects
- hypokalemia
- dehydration
- hypotension
- ototoxicity
furosemide nursing considerations
- monitor K levels
- monitor output levels bc should have high output
hypokalemia
low K (below 3.5)
- normal range: 3.5-5.0
- thiazide and loop diuretic common side effect
why is hypokalemia problematic
K is needed for proper contractions of heart, w/out enough K, there is a disruption to proper cardiac function
spironolactone class
potassium sparing diuretic
spironolactone moa
block action of aldosterone
- K retention, Na water excreted
spironolactone side effects
hyperkalemia which can cause endocrine effects like
- deepened voice, impotence irregular menstrual cycles, gynecomastia, hirsutism
spironolactone nursing info
- only given PO
- usually given in combo with other HTN meds/diuretics to get more results and lower risk of hypokalemia
- small dieresis and hypotensive
sympatholytics general info
SNS blockers
- SNS usually vasoconstrictors so when blocked vasoconstriction is lessened
- dec peripheral vascular resistance
beta blockers medications
- metoprolol (selective)
- propranolol (non selective)
- carvedilol (alpha and beta blockers)
beta blocker types
- beta 1 receptors; found in the heart called cardioselective beta receptors
- beta 2 receptors: found in the lungs
beta blocker moa
- inc nitric oxide –> vasodilation response
- block stimulation of beta 1 receptors –> decreases HR and contractility
side effects of beta blockers
- fatigue/lethargy
-bradycardia - hypotension
- can mask hypoglycemia
beta blockers nursing considerations
- wean when discontinuing
- possibility of rebound HTN
- do not use non selective blockers for pt with chronic lung problems like asthma
- recognize risk for hypotension/bradycardia
beta blockers general info
- PO/IV
- end in -olol
- primarily treats HTN but also prescribed for cardiovascular disease
beta blocker is short for
- beta adrenergic blocker
centrally acting sympatholytic are aka
alpha-2 adrenergic agonist
centrally acting sympatholytic drug
clonidine
clonidine moa
dec sympathetic outflow –> decreases stimulation of adrenergic receptors
- blocks both alpha and beta receptors which decreases bp
clonidine side effects
- drowsiness
- rebound HTN
- may worsen pre existing liver disease
clonidine nursing indications
- HTN
- PO or transdermal patch
- do not abruptly discontinue –> rebound HTN
doxazosin class
selective alpha-1 blockers
doxazosin moa
selective alpha-1 blockade
- venous and arterial dilation
doxazosin side effects
hypotension and dizziness
doxazosin nursing info
- not first line treatment
- tamsulosin (flomax) is also an alpha 1 block out but only used to treat BPH (benign prostate hypertrophy)
captopril and lisinopril class
ace inhibitors
captopril and lisinopril moa
blocks angiotensin converting enzyme
- inhibits production of angiotensin-2 (powerful vasoconstrictor)
- inhibits aldosterone secretion –> less water retention
captopril and lisinopril side effects
- first does hypotension
- dry, persistent, cough
- dizziness
- rash
- serious: angioedema
captopril and lisinopril nursing consideration
- not appropriate for pregnant women
- use caution if pt has renal insufficiency
- captopril can cause neutropenia
- risk of hyperkalemia
- often given in conjunction with thiazide diuretics
captopril and lisinopril other nursing info
- slows progression of LV hypertrophy
- ends in -pril
- drug of choice for DM so has some renal protective effects
- safe first line therapy for hypertension and heart failure
losartan class
angiotensin receptor blocker (arb)
losartan moa
blocks action of angiotensin 2 AFTER it is formed
- causes vasodilation
- inc Na and water excretion
losartan side effects
generally well tolerated
- some have risk of angioedema
losartan nursing considerations
- do not use if pregnant
- use contraceptive if using
- use caution if renal problems
- only give PO
- ends in -sartan
losartan indications
- HTN
- heart failure
- stroke progression
aliskiren class
renin inhibitor
aliskiren moa
direct inhibitor of renin which
- induces vasodilation, dec blood vol, decreases SNS, and inhibitors of cardiac/vascular hypertrophy
aliskiren side effects
relatively well tolerated
- GI discomfort
- when given ACEi, watch for hyperkalemia especially if DM
aliskiren nursing considerations
- takes several weeks for full effect
- do not take if pregnant
- give PO
calcium channel blocker drugs
nifedipine
nicardipine
verapamil
diltiazem
ca channel moa
block ca access to cells causes
- dec contractility
- dec conductivity of heart
–> which decreases demand of o2
ca channel side effects
- hypotension, orthostatic hypotension
- bradycardia
- may precipitate AV block
- headache
- abdominal discomfort
- peripheral edema
ca channel indications
HTN and chest pain (angina pectoris)
- dilt and verapamil: heart rhythm disorders
- nicardipine: refractive hypotension
ca channel nursing considerations
- best for elderly or blacks
- diuretics can be give for peripheral edema
- PO or IV
hydralazine class
vasodilator
hydralazine moa
work directly on arterial and venous smooth muscle and cause relaxation
hydralazine side effects
-hypotension
-dizziness
-headache
- tachycardia
- edema
- dyspnea
- GI upset
hydralazine nursing considerations
- treatment for HTN
- PO usually w other hypertensive agents
- IV in emergency or PO not tolerated
