Antihypertensives Drug Table PDF

ANTIHYPERTENSIVES Drug Name and Class Mechanism of Action Adverse Effects Nursing Implications DIURETICS prototype: hydrochlorothiazide - Inhibits Na/Cl channel in distal - orthostatic hypotension - advan...

ANTIHYPERTENSIVES Drug Name and Class Mechanism of Action Adverse Effects Nursing Implications DIURETICS prototype: hydrochlorothiazide - Inhibits Na/Cl channel in distal - orthostatic hypotension - advantages convoluted tubule - dizziness - inexpensive - Increases renal excretion of Na and Cl - hypokalemia - reduce morbidity and mortality - Increases urine output - hyponatremia - few side effects - Decreases blood volume - hypercalcemia - useful for pts w/ predisposition of - MOA unknown but causes - hyperuricemia kidney stones and osteopenia vasodilation - hyperglycemia - take in morning/during day - monitor I/O, weight, labs - educate: change positions slowly, encourage K+ rich foods - avoid in patients w/ sulfa allergy or gout Drug Name and Class Mechanism of Action Adverse Effects Nursing Implications ANGIOTENSIN CONVERTING ENZYME (ACE) INHIBITORS ‘coughing prils’ prototype: captopril - Blocks enzyme that converts - cough - monitor labs and electrolytes angiotensin I to angiotensin II - angioedema - consult HCP if cough becomes - Inhibits the breakdown of bradykinin - pregnancy c/i bothersome = prolongs vasodilating effects - taste change - avoid salt substitutes w/ K+ or K+ - used for HTN, DM, prevent/reverse - orthostatic hypotension, fatigue, rash rich foods heart remodeling w/ HF, post MI - proteinuria - BBW - don’t get pregnant! women of - renal insufficiency c/i childbearing age should be on birth - inc potassium control - lowers BP/leukopenia - don’t take w/ ARBs Drug Name and Class Mechanism of Action Adverse Effects Nursing Implications ANGIOTENSIN II RECEPTOR BLOCKERS (ARBs) ‘sartan sisters’ prototype: losartan - blocks angiotensin II at various - advantages: no cough, angioedema - don’t take w/ an ACE inhibitor receptor sites rare - prevents effects of vasoconstriction - BBW - pregnancy and aldosterone secretion - uses: HTN, DM, HF, post MI Drug Name and Class Mechanism of Action Adverse Effects Nursing Implications CALCIUM CHANNEL BLOCKERS ‘dipine’ dihydropyridines (amlodipine) - Inhibits the influx of calcium ions in - CYP3A4 metabolism - educate pt on possible food/drug the smooth muscles of the blood - edema (peripheral or pulmonary) interactions vessels - flushing - CYP3A4 inducers: St. John’s wort - Relaxation and dilation of arteries - reflex tachycardia (dec effectiveness) - used for HTN in african americans, - CYP3A4 inhibitors: grapefruit angina, and conditions w/ *more effect on vasodilation juice (inc plasma concentration) vasoconstriction/vasospasms *less effect on heart function - educate pt on how to relieve edema → compression socks, encourage walking, elevate extremity non-dihydropyridines - Inhibits the influx of calcium ions in - CYP3A4 metabolism - caution use w/ bradycardia, HF, verapamil, diltiazem cardiac muscles and pacemaker cells - bradycardia beta-blockers - Decrease conduction = decrease HR - rare - arrhythmias, heart block, HF - Decrease contractility - used for HTN, angina, *less effect on vasodilation tachyarrhythmias *more effect on heart function Drug Name and Class Mechanism of Action Adverse Effects Nursing Implications BETA ADRENERGIC BLOCKERS ‘olol twins’ prototype: propranolol - not initial therapy unless specifically - BBW - abrupt d/c caused exacerbation - monitor HR and rhythm indicated of angina, dysrhythmias, and MIs w/ - monitor weight, I/O, edema, lung - types: selective (metoprolol, atenolol, pts who had CAD sounds esmolol) and non-selective - bradycardia and heart blocks - don’t stop abruptly (propranolol, timolol) - exacerbates HF - don’t use non-selective BB w/ asthma  - blocks epinephrine and - taper off or COPD norepinephrine at beta-adrenergic - asthma and COPD use w/ caution - masks s/s of hypoglycemia - no receptors → dec HR and contraction - blood glucose masking tremors or tachycardia - used for HTN, stable angina, - lowers BP - educate DM pts to check BG regularly tachyarrhythmias, stable HF - orthostatic hypotension - dangle and go slowly from sitting to - circulation may be impaired standing - s/s of overdose → bradycardia, heart - caution use for those w/ PVD block, hypotension, mental status - can cause ED change Drug Name and Class Mechanism of Action Adverse Effects Nursing Implications DIRECT ACTING VASODILATOR prototype: sodium nitroprusside - Directly relaxes smooth muscle in - nausea - Given IV and requires continuous BP blood vessels = dilation and decreased - agitation monitoring peripheral vascular resistance - muscle twitching - Rapid onset and short duration of - Effective in managing a hypertensive action emergency - Converts to thiocyanate in liver: can have cyanide toxicity (coma, dilated pupils, pink color) - Monitor lab: thiocyanate levels - Antidote: amyl nitrate inhalation