Metoprolol and Hydralazine

Metoprolol (Beta-Blocker)

• Treats hypertension, angina, heart failure and prevents heart attacks
• Acts as Beta-1 adrenergic antagonist, which blocks beta receptors in the heart
• The blocking of beta receptors decreases heart rate and cardiac output
• This leads to a lowering of blood pressure
• Can cause bradycardia, hypotension, dizziness, fatigue, erectile dysfunction and heart failure exacerbation
• Is contraindicated with severe bradycardia, heart block (2nd/3rd degree) and asthma (non-selective beta blockers)
• Other antihypertensives (additive hypotension), calcium channel blockers (increased risk of bradycardia), and NSAIDs may reduce antihypertensive effect
• Monitor heart rate and blood pressure regularly
• Taper dose slowly to avoid withdrawal symptoms. Assess for signs of heart failure
• Take as prescribed, don't stop abruptly
• Report dizziness, fatigue, or difficulty breathing

Hydralazine (Vasodilator)

• Treats hypertension and heart failure.
• Acts as a direct vasodilator, relaxing smooth muscle in the blood vessels, lowering blood pressure
• Can cause reflex tachycardia, hypotension, dizziness, headache, palpitations and fluid retention
• Is contraindicated with coronary artery disease and mitral valve disease (can worsen ischemia)
• Other antihypertensives and NSAIDs may reduce effectiveness
• Monitor blood pressure, heart rate, and fluid retention
• Notify healthcare provider if experiencing swelling, dizziness, or increased heart rate

Doxazosin (Alpha-Blocker)

• Treats hypertension and benign prostatic hyperplasia (BPH)
• Acts as Alpha-1 adrenergic antagonist, dilates blood vessels, which decreases blood pressure
• Can cause orthostatic hypotension, dizziness, fatigue, headache and reflex tachycardia
• Is contraindicated with hypersensitivity, caution in those with a history of syncope
• Other antihypertensive medications (additive hypotension), phosphodiesterase inhibitors (e.g., sildenafil) can have interactions
• Monitor blood pressure, especially after the first dose (risk of first-dose hypotension)
• Take at bedtime to reduce the risk of orthostatic hypotension and to rise slowly from sitting/lying down

Heart Failure

• Heart failure is where the heart cannot pump blood effectively
• This leads to fluid buildup and insufficient oxygen delivery
• Limit salt intake, monitor weight (fluid retention), take medications as prescribed, and avoid alcohol

Lisinopril (ACE Inhibitor)

• Treats hypertension, heart failure, post-myocardial infarction
• Inhibits the angiotensin-converting enzyme (ACE)
• Prevents the conversion of angiotensin I to angiotensin II
• Leading to vasodilation, reduced blood pressure, and decreased workload on the heart
• Can cause hyperkalemia, hypotension, dizziness, cough, angioedema
• Is contraindicated in pregnancy (teratogenic), bilateral renal artery stenosis
• Potassium supplements, potassium-sparing diuretics (increased risk of hyperkalemia) and NSAIDs may reduce effectiveness with this drug
• Monitor kidney function (BUN, creatinine), electrolytes (especially potassium), and blood pressure.
• Report persistent cough, swelling, or signs of hyperkalemia (muscle weakness, irregular heartbeat)

Digoxin (Cardiac Glycoside)

• Treats heart failure and atrial fibrillation.
• Increases the force of myocardial contraction and decreases heart rate
• Inhibits the Na+/K+ ATPase pump.
• Can cause Digoxin toxicity (nausea, vomiting, arrhythmias, confusion, visual disturbances), bradycardia and hyperkalemia
• Is contraindicated if you hypersensitivity, ventricular fibrillation, caution in renal impairment
• Diuretics (increased risk of hypokalemia, increasing digoxin toxicity), certain antiarrhythmics and antacids can have interactions with digoxin
• Monitor serum digoxin levels within the therapeutic range of 0.5–2 ng/mL
• Hold if heart rate is <60 bpm, and electrolytes (especially potassium)