Antihypertensive Medications

Adverse Effects of Triamterene (Dyrenium)

• Hyperkalemia, nausea, vomiting, leg cramps, dizziness

Hypertension in Pregnancy

• Labetalol and methyldopa are the drugs of choice for treating pregnant women with mild preeclampsia

Hypertension in Diabetics

• ACEI, ARBs, and diuretics in low doses are the preferred antihypertensive drugs
• Beta blockers should be used with caution as they can suppress glycogenolysis and mask early signs of hypoglycemia

Hypertension in African Americans

• Diuretics are the first choice of drugs for treating hypertension in the African American population
• Monotherapy with beta blockers and ACEIs is less effective in African Americans compared to Caucasians
• ACEIs should be used in African American patients with type 1 diabetes and proteinuria, or with hypertensive nephrosclerosis

Combination Therapy for Hypertension

• ACEI plus a thiazide diuretic, an ACEI plus a CCB, or a beta blocker plus a thiazide are recommended combinations when blood pressure cannot be adequately controlled by a single drug

Contraindications in Pregnancy

• ACEIs, ARBs, and DRI's are counteracted in pregnancy
• Methyldopa and labetalol are recommended for pregnant women

Digoxin (Lanoxin)

• MOA: increases myocardial contractility, alters electrical activity of the heart
• Use: treats dysrhythmia (A-fib or flutter) or CHF
• Interactions: hypokalemia and increased risk of dysrhythmia
• Monitoring: digoxin levels, apical pulse, and assess for decreased S/S of CHF
• Teaching: how to monitor HR, hold if below 50, signs of toxicity (altered heart rate or rhythm, visual or gastrointestinal disturbances)
• Antidote: Digibind

Metoprolol (Lopressor)

• Selective B-Adrenergic Blocker (B1)
• Preferred for people with lung issues because it only affects the heart, not the lungs
• Treats: angina, HF, HTN, and MI

Medication Preferences

• ACEI (Lisinopril) or ARB (losartan) are preferred for diabetic patients with high blood pressure
• Metoprolol is preferred for African Americans
• Metformin is the first medication to choose when treating patients with diabetes

Nifedipine (CCB)

• Contraindications: IR dose is associated with increased mortality in MI and unstable angina
• Preferred over verapamil for patients with AV block, heart failure, bradycardia, or sick sinus syndrome
• Adverse effects: flushing, dizziness, peripheral edema, gingival hyperplasia, chronic eczematous rash
• Patient education and monitoring: monitor BP and angina record, teach patients to keep an angina record and monitor their blood pressure and AE

Hydralazine

• MOA: vasodilator, dilates arterioles and peripheral resistance, and arterial blood pressure falls
• Therapeutic goal: to reduce BP and reduce afterload in a short time in CHF
• Interactions and adverse effects: caution with use in other hypotensive drugs, postural hypotension, reflex tachy, myocardial contractility, NA and water retention, and lupus-like syndrome
• If tachycardia reflex is severe, prescribe beta blocker to counteract it