![Page 1: Antihypertensive Pharmacologic Agents NUR133 Lecture #11 K Burger, MSEd, MSN, RN, CNE Referenced from: Lilley et al (2005) Pharmacology and the nursing](https://reader030.vdocuments.us/reader030/viewer/2022032517/56649caf5503460f949738f9/html5/thumbnails/1.jpg)
Antihypertensive Pharmacologic Agents
NUR133 Lecture #11
K Burger, MSEd, MSN, RN, CNEReferenced from:
Lilley et al (2005)
Pharmacology and the nursing process (4th ed). Elsevier
![Page 2: Antihypertensive Pharmacologic Agents NUR133 Lecture #11 K Burger, MSEd, MSN, RN, CNE Referenced from: Lilley et al (2005) Pharmacology and the nursing](https://reader030.vdocuments.us/reader030/viewer/2022032517/56649caf5503460f949738f9/html5/thumbnails/2.jpg)
Categories
Adrenergic agents-Alpha blockers-Beta blockers-Alpha/Beta blockers
Angiotensin-converting enzyme inhibitorsAngiotensin II receptor blockersCalcium channel blockersVasodilatorsDiuretics
![Page 3: Antihypertensive Pharmacologic Agents NUR133 Lecture #11 K Burger, MSEd, MSN, RN, CNE Referenced from: Lilley et al (2005) Pharmacology and the nursing](https://reader030.vdocuments.us/reader030/viewer/2022032517/56649caf5503460f949738f9/html5/thumbnails/3.jpg)
Adrenergic Agents
Alpha Blockers(peripherally acting)
Prazosin (Minipress) Blocks norepinephrine
at receptor sites Sympathetic Nervous
System not stimulated Blood vessel dilation
results in decreased BP
Alpha Blockers
(centrally acting)
Clonidine (Catapres) Reduces norepinephrine
production Sympathetic Nervous
System not stimulated Blood vessel dilation
results in decreased BP
![Page 4: Antihypertensive Pharmacologic Agents NUR133 Lecture #11 K Burger, MSEd, MSN, RN, CNE Referenced from: Lilley et al (2005) Pharmacology and the nursing](https://reader030.vdocuments.us/reader030/viewer/2022032517/56649caf5503460f949738f9/html5/thumbnails/4.jpg)
Adrenergic Agents
Beta Blockers
atenolol (Tenormin) metoprolol (Lopressor) propranolol (Inderal) Block SNS stimulation of heart; reduces SA node activity Reduces ventricular contraction rate Reduction in cardiac output results in lower BP Also used as: Antidysrhythmic, Antianginal
![Page 5: Antihypertensive Pharmacologic Agents NUR133 Lecture #11 K Burger, MSEd, MSN, RN, CNE Referenced from: Lilley et al (2005) Pharmacology and the nursing](https://reader030.vdocuments.us/reader030/viewer/2022032517/56649caf5503460f949738f9/html5/thumbnails/5.jpg)
Adrenergic Agents
Alpha / Beta Blocker Combination
Carvedilol ( Coreg )
Dual antihypertensive effect on both CO and SVR Alpha blocker promotes vasodilation; decreased SVR Beta blocker reduces heart rate; decreased CO Overall effect = decreased BP
![Page 6: Antihypertensive Pharmacologic Agents NUR133 Lecture #11 K Burger, MSEd, MSN, RN, CNE Referenced from: Lilley et al (2005) Pharmacology and the nursing](https://reader030.vdocuments.us/reader030/viewer/2022032517/56649caf5503460f949738f9/html5/thumbnails/6.jpg)
Adrenergic AgentsNursing Implications
Orthostatic hypotension common;take alphas @ bedtime Other side effects:
fatigue, dizziness, sedation, constipation Potentiates CNS depressants (Alcohol/Opiods) Abrupt withdrawal of central alpha blocker causes
rebound hypertension Less side effects with peripheral acting and/or
combination adrenergics Monitor HR =>60 for beta blockers
![Page 7: Antihypertensive Pharmacologic Agents NUR133 Lecture #11 K Burger, MSEd, MSN, RN, CNE Referenced from: Lilley et al (2005) Pharmacology and the nursing](https://reader030.vdocuments.us/reader030/viewer/2022032517/56649caf5503460f949738f9/html5/thumbnails/7.jpg)
Angiotensin-Converting Enzyme InhibitorsACE Inhibitors
Inhibit the conversion of Angiotensin I to Angiotensin II resulting in:Vasodilation,decreased SVR, decreased BP Decreased aldosterone,diuresis,decreased SVR&BP
May be combined with a thiazide diuretic or calcium channel blocker
Safe and effective; often used as first line Rx Used also for: CHF, post MI to stop LVH progress Renal protective effects in patients with diabetes
![Page 8: Antihypertensive Pharmacologic Agents NUR133 Lecture #11 K Burger, MSEd, MSN, RN, CNE Referenced from: Lilley et al (2005) Pharmacology and the nursing](https://reader030.vdocuments.us/reader030/viewer/2022032517/56649caf5503460f949738f9/html5/thumbnails/8.jpg)
ACE Inhibitors
captopril (Capoten)Short half-life, must be dosed more frequently than others
enalapril (Vasotec)The only ACE inhibitor available in oral and parenteral forms
Newer agents, long half-lives, once-a-day dosing
![Page 9: Antihypertensive Pharmacologic Agents NUR133 Lecture #11 K Burger, MSEd, MSN, RN, CNE Referenced from: Lilley et al (2005) Pharmacology and the nursing](https://reader030.vdocuments.us/reader030/viewer/2022032517/56649caf5503460f949738f9/html5/thumbnails/9.jpg)
ACE InhibitorsNursing Implications
Dry, nonproductive cough common
Other side effects: fatigue,dizziness,headache, mood changes
First-dose hypotensive effect may occur
Additive effects when given with diuretics or other antihypertensives
Antagonistic effects when given with NSAIDs
If given with K supplement may cause hyperK
![Page 10: Antihypertensive Pharmacologic Agents NUR133 Lecture #11 K Burger, MSEd, MSN, RN, CNE Referenced from: Lilley et al (2005) Pharmacology and the nursing](https://reader030.vdocuments.us/reader030/viewer/2022032517/56649caf5503460f949738f9/html5/thumbnails/10.jpg)
Angiotensin II Receptor BlockersARBs
Losartan ( Cozaar ) Valsartan ( Diovan ) Block the binding of Angiotensin II to AT1
receptors on vessels & adrenal gland thereby:- promoting vasodilation / lower aldosterone- decreased SVR and decreased BP
Newer class and well-tolerated
![Page 11: Antihypertensive Pharmacologic Agents NUR133 Lecture #11 K Burger, MSEd, MSN, RN, CNE Referenced from: Lilley et al (2005) Pharmacology and the nursing](https://reader030.vdocuments.us/reader030/viewer/2022032517/56649caf5503460f949738f9/html5/thumbnails/11.jpg)
ARBNursing Implications
Common side effects:Upper respiratory infectionHeadache
Less likely to cause hyperkalemia (unlike ACE) Can be used in pts who cannot tolerate ACE Rx Do not cause coughing Used cautiously in geriatric pts and impaired
renal function
![Page 12: Antihypertensive Pharmacologic Agents NUR133 Lecture #11 K Burger, MSEd, MSN, RN, CNE Referenced from: Lilley et al (2005) Pharmacology and the nursing](https://reader030.vdocuments.us/reader030/viewer/2022032517/56649caf5503460f949738f9/html5/thumbnails/12.jpg)
Calcium Channel BlockersCCBs
Diltiazem (Cardizem) Verapamil ( Calan ) Nifedipine ( Procardia ) Cause smooth muscle relaxation by blocking the
binding of calcium to its receptors, preventing muscle contraction
This causes decreased peripheral smooth muscle tone, decreased SVR and BP
Slows cardiac conduction; decreases HR&CO&BP Also used as : antidysrythmic, antianginal
![Page 13: Antihypertensive Pharmacologic Agents NUR133 Lecture #11 K Burger, MSEd, MSN, RN, CNE Referenced from: Lilley et al (2005) Pharmacology and the nursing](https://reader030.vdocuments.us/reader030/viewer/2022032517/56649caf5503460f949738f9/html5/thumbnails/13.jpg)
Calcium Channel BlockersNursing Implications
Considered safe with limited side-effects
First line drug choice
More effective in geriatric and African-American patients
Possible side effects:hypotension, dysrythmias, constipation, nausea,rash,peripheral edema, dermatitis
![Page 14: Antihypertensive Pharmacologic Agents NUR133 Lecture #11 K Burger, MSEd, MSN, RN, CNE Referenced from: Lilley et al (2005) Pharmacology and the nursing](https://reader030.vdocuments.us/reader030/viewer/2022032517/56649caf5503460f949738f9/html5/thumbnails/14.jpg)
Vasodilators
hydralazine HCl (Apresoline) sodium nitroprusside (Nipride, Nitropress)
Directly relaxes arteriolar smooth muscle
vasodilation; decreased SVR; decreased BP May be used in combination with other agents Sodium nitroprusside is reserved for the
management of hypertensive emergencies
![Page 15: Antihypertensive Pharmacologic Agents NUR133 Lecture #11 K Burger, MSEd, MSN, RN, CNE Referenced from: Lilley et al (2005) Pharmacology and the nursing](https://reader030.vdocuments.us/reader030/viewer/2022032517/56649caf5503460f949738f9/html5/thumbnails/15.jpg)
VasodilatorsNursing Implications
Hydralazine Side Effects: dizziness, headache, anxiety, tachycardia
Sodium Nitroprusside Side Effects: bradycardia, hypotensionControlled administration/IV infusion pump
![Page 16: Antihypertensive Pharmacologic Agents NUR133 Lecture #11 K Burger, MSEd, MSN, RN, CNE Referenced from: Lilley et al (2005) Pharmacology and the nursing](https://reader030.vdocuments.us/reader030/viewer/2022032517/56649caf5503460f949738f9/html5/thumbnails/16.jpg)
Antihypertensive Agents General Nursing Implications
Educate patients about the importance of not missing a dose, taking the medications exactly as prescribed, never doubling up on doses, and not stopping abruptly
Patients should not take any OTC drugs without first checking with MD
PO meds should be taken with meals
Educate patient on concurrent lifestyle modifications:Diet, Exercise, Stress Reduction
Instruct patients on how to monitor their own BP
![Page 17: Antihypertensive Pharmacologic Agents NUR133 Lecture #11 K Burger, MSEd, MSN, RN, CNE Referenced from: Lilley et al (2005) Pharmacology and the nursing](https://reader030.vdocuments.us/reader030/viewer/2022032517/56649caf5503460f949738f9/html5/thumbnails/17.jpg)
Antihypertensive AgentsNursing Implications
Instruct patients that these drugs should not be stopped abruptly, as this may cause a rebound hypertensive crisis, and perhaps lead to CVA.
Oral forms should be given with meals so that absorption is more gradual and effective.
Administer IV forms with extreme caution and use an IV pump.
![Page 18: Antihypertensive Pharmacologic Agents NUR133 Lecture #11 K Burger, MSEd, MSN, RN, CNE Referenced from: Lilley et al (2005) Pharmacology and the nursing](https://reader030.vdocuments.us/reader030/viewer/2022032517/56649caf5503460f949738f9/html5/thumbnails/18.jpg)
Antihypertensive Agents General Nursing Implications
Instruct patients to change positions slowly
Hot showers, tubs, weather, exercise, alcohol, prolonged sitting/standing may cause hypotension, dizziness, fainting
Patients should report: SOB, dyspnea, peripheral and/or angioedema, excessive weight gain, chest pain, palpitations
Men may experience impotence as expected SE
![Page 19: Antihypertensive Pharmacologic Agents NUR133 Lecture #11 K Burger, MSEd, MSN, RN, CNE Referenced from: Lilley et al (2005) Pharmacology and the nursing](https://reader030.vdocuments.us/reader030/viewer/2022032517/56649caf5503460f949738f9/html5/thumbnails/19.jpg)
Diuretics
Main classifications:Thiazide and thiazide-likeLoopPotassium-sparing
Others: Osmotic Carbonic Anhydrase Inhibitors
![Page 20: Antihypertensive Pharmacologic Agents NUR133 Lecture #11 K Burger, MSEd, MSN, RN, CNE Referenced from: Lilley et al (2005) Pharmacology and the nursing](https://reader030.vdocuments.us/reader030/viewer/2022032517/56649caf5503460f949738f9/html5/thumbnails/20.jpg)
Thiazide Diuretics
Hydrochlorothiazide ( HydroDIURIL )Inhibits Na reabsorption at distal tubule
resulting in diuresis; decreased SVR & BPAlso acts to relax arterioles;decrease SVRFirst line medication regimen for HTNSafe for most patients; inexpensiveOften used in combination w/ other drugs
![Page 21: Antihypertensive Pharmacologic Agents NUR133 Lecture #11 K Burger, MSEd, MSN, RN, CNE Referenced from: Lilley et al (2005) Pharmacology and the nursing](https://reader030.vdocuments.us/reader030/viewer/2022032517/56649caf5503460f949738f9/html5/thumbnails/21.jpg)
Loop Diuretics
Furosemide (Lasix)Blocks Cl and Na reabsorption at Loop of
Henle resulting in diuresis; decreased SVR and decreased BP
Stimulate prostaglandins; vasodilation ofrenal, lung, system vessels
Rapid onset and most potent diureticCan be given once dailyEffective even in renal impaired patients
![Page 22: Antihypertensive Pharmacologic Agents NUR133 Lecture #11 K Burger, MSEd, MSN, RN, CNE Referenced from: Lilley et al (2005) Pharmacology and the nursing](https://reader030.vdocuments.us/reader030/viewer/2022032517/56649caf5503460f949738f9/html5/thumbnails/22.jpg)
Thiazide and Loop DiureticsNursing Implications
Monitor K levels closely for hypokalemiaTeach patient to eat high K foodsCross allergies may exist to sulfonamidesConcurrent digoxin Rx may lead to digoxin
toxicityNSAIDS may decrease diuretic effectConcurrent antiglycemic Rx may lead to
hyperglycemia
![Page 23: Antihypertensive Pharmacologic Agents NUR133 Lecture #11 K Burger, MSEd, MSN, RN, CNE Referenced from: Lilley et al (2005) Pharmacology and the nursing](https://reader030.vdocuments.us/reader030/viewer/2022032517/56649caf5503460f949738f9/html5/thumbnails/23.jpg)
Potassium-sparing Diuretics
Spironlactone ( Aldactone )Works in the collecting ductBinds and blocks aldactone receptors
resulting in blocked Na water reabsorption;decreased SVR and BP
Considered a weak diureticOften used in conjunction with more potent
K depleting diuretics
![Page 24: Antihypertensive Pharmacologic Agents NUR133 Lecture #11 K Burger, MSEd, MSN, RN, CNE Referenced from: Lilley et al (2005) Pharmacology and the nursing](https://reader030.vdocuments.us/reader030/viewer/2022032517/56649caf5503460f949738f9/html5/thumbnails/24.jpg)
Potassium-sparing DiureticNursing Implications
Monitor K levels closely for hyperkalemiaEspecially with renal impairment, use of potassium supplements, or ACE drugs
May cause gynecomastia, amenorrhea, and post-menopausal bleeding
Other side effects: dizziness, ha, cramps, nausea,diarrhea.
![Page 25: Antihypertensive Pharmacologic Agents NUR133 Lecture #11 K Burger, MSEd, MSN, RN, CNE Referenced from: Lilley et al (2005) Pharmacology and the nursing](https://reader030.vdocuments.us/reader030/viewer/2022032517/56649caf5503460f949738f9/html5/thumbnails/25.jpg)
DiureticsGeneral Nursing Implications
Instruct patient to take early in the day to avoid sleep disturbances
Geriatric patients more sensitive to fluid balance changes; caution for postural hypotension
Monitor weights, potassium levels as well as Na and Cl
Instruct patients to notify MD if ill with vomiting and/or diarrhea